Heartburn and Autoimmunity (Part III)

I can’t count how many patients I’ve worked with over the years that have heartburn.  Most take some type of buffering agent to neutralize the acid such as Tums.  However, for the more severe cases, they will be prescribed a Proton Pump Inhibitor.  This is such a huge deal that I make my physiology students look this up and write an entire paper on how they work!  You do NOT want to inhibit the function of your cell membrane’s proton pump!  Most people can get on board that shutting down a system in the body may not be a good idea, but they don’t know the alternative options available.  That’s where understanding exactly why stomach acid is getting in the wrong place is imperative to fixing the problem for good.  That topic may be for another time, but for now, we are going to make the general statement that most cases of heartburn are actually cases of NOT ENOUGH stomach acid.  Therefore, taking meds to decrease the production even further drives us into a hole that is tough to get out of.  If you just trust me on that statement for the time being, we can look into why decreased stomach acid may play a role in the development of an autoimmune disease.

The stomach is the first stop in the tube after you swallow your food.  It has been designed to have a very acidic environment by the production of HCl.  The reason we need such an acidic pH (around 2), is because that acidity will start the breakdown of your food, kill many bacterial organisms that we do not want making it into the small intestines because they could make us ill, and is needed for vitamin and mineral absorption.  This acid is specifically important in the breakdown of proteins into their legos, amino acids.  (Remember how we need to first breakdown all of our food into it’s smallest components in order to absorb it.)  If this stomach acid plays so many crucial roles, you can imagine the domino of effects that may occur if there is not enough of it around.

When you aren’t producing enough stomach acid, the pancreas and liver aren’t getting the signal to release digestive enzymes and bile, which will mean your food will further lack breakdown.  If these stages of breakdown don’t occur, you can end up with nutritional deficiencies because you aren’t able to absorb things in such large forms.  I see this a lot with Crohn’s patients; men especially can be so skinny because they simply aren’t able to get nutrition absorbed! So, now we have undigested food in the small intestine, which creates the perfect environment for opportunistic bacteria and yeast to grow out of control.  If you have heard the term SIBO (Small intestinal bacterial overgrowth), you know how this can be troublesome for patients who are “eating perfectly” because that specific case requires  therapeutic protocols to actually fix it.  Until the overgrowth is addressed, you won’t digest anything appropriately no matter how perfect your diet.

Low stomach acid specifically impairs the digestive process and creates the perfect environment for bacterial imbalance in the gut.  Remember me talking about how you have 10 times the amount of bacteria in your gut then cells in your body?!  It’s crucial to have abundant good bacteria, and minimize opportunistic microorganisms.  Without balance, we have something called dysbiosis.  Dysbiosis is at the root of so many health conditions including autoimmune diseases because of the risk of infections, nutrient malabsorption, and the impaired integrity of the intestinal wall.  We don’t want an environment where the wall can be leaky, we have bad bacteria hanging around, and large protein structures on top of it.  If those things cross over the wall of enterocytes and  come in contact with the immune cells on the other side, we have just triggered an immune system response to our food.  All of this being a domino effect of NOT HAVING ADEQUATE STOMACH ACID!  That Nexium or Prilosec isn’t helping matters.

I want to throw out a couple things that can be common in patients.  One is H. Pylori.  This organism can overgrown in patients with low stomach acid and the infection NEEDS to be addressed before you can move forward.  The test I use cost about $100 and is worth every penny.  The other thing is that patients don’t often need stomach acid reducing meds, they need supplements that encourage the production of more!  When your body produces enough stomach acid, it’s the signal to the esophageal sphincter to close.  The reason you feel burning in the esophagus is typically because that “door” between the stomach and the esophagus hasn’t closed adequately.  Stomach acid in the esophagus doesn’t feel good and if left alone chronically, it can cause Barrett’s esophagus and cancer.  No good.

You can increase stomach acid by taking HCL/pepsin supplementation with meals, eat digestive bitters, drink a glass of water with lemon juice or apple cider vinegar in it 20 minutes before a meal, or indulge in a little kombucha.  I would also suggest a good probiotic to patients in this situation because you need to rebalance the microbiome.  I have links to ones I like in the “store” along the top bar.  It will send you to the products through Amazon. While these are great tips, I want to caution people from taking this upon themselves because if HCl is taken in conjunction with asprin, Advil, corticosteriods, etc, it can actually cause serious damage to the gut lining and cause ulcers.  Also, if a pathogen is present such as H. Pylori or SIBO, then more steps have to be taken to address that.  Moral of the story is that if you are taking meds to lower stomach acid, you most definitely have an underlying issue that is not being addressed.  You are simply masking the symptom of acid getting into the esophagus.  I would encourage you to ask why it would get there in the first place?  That is not normal.  Stomach acid was created for proper digestion and nutrient absorption, so any substances that would try to increase the pH to be more alkaline, is going to have a detrimental effect.

If you have an autoimmune disease that you are taking an immunosuppressant for, can you imagine the environment we are setting up for disaster if you have stomach acid issues that are allow bacteria to overgrow AND the meds you take are shutting down your immune system?!  Oh my.

I want your heart to be on fire, but just not due to low stomach acid.  Love you guys!

2 thoughts on “Heartburn and Autoimmunity (Part III)

Leave a Reply

Your email address will not be published. Required fields are marked *