If you struggle with heartburn or acid reflux, you just pop some pills for that, right? Turns out regular use of drugs to treat heartburn, acid reflux, and ulcers can lead to an earlier death. These disorders are some of the easier to manage using functional medicine protocols, so it’s unnecessary to risk shortening your lifespan through chronic disease when you can enjoy improved health instead.
A recent study found that chronic use of proton pump inhibitors (PPIs) is linked to an increased risk of death from cardiovascular disease, kidney disease, and upper gastrointestinal cancer. The degree of risk increases with duration of use, even if you take low doses. Other studies have linked PPIs to dementia, bone fractures, and pneumonia.
Common brands of PPIs include Prevacid, Prilosec, Nexium and Protonix.
The study looked through the medical records of more than 200,000 people over 10 years. They found those who took PPIs had an almost 20 percent increased rate of death over people who took other types of acid-suppressing drugs (unfortunately, they did not compare death rates to people who took no acid-suppressing drugs). This applied to both prescription and over-the-counter PPIs.
What’s even more alarming is that researchers found more than half the people taking PP!s had no medical need for the drugs and PPI-related deaths were more common in this group.
Why you should address the root cause of your acid reflux or heartburn instead of taking acid-suppressing drugs
It’s assumed overly high stomach acid causes heartburn and acid reflux, but in most cases it’s due to low stomach acid. Stomach acid is vital to the health of the body in its role of digesting foods, in particular meats. When stomach acid is too low your stomach is unable to properly digest foods. Your small intestine does not want to accept improperly undigested food — this will damage its lining and contribute to intestinal permeability, or leaky gut. The low pH of the stomach acid prevents the valve to the small intestine from opening and, as a result, the contents of the stomach shoot back up into the esophagus.
Although the food is not acidic enough to gain entry into the small intestine in a timely manner, it is too acidic for the delicate tissue of the esophagus, which it burns as it shoots back up toward your throat. The extra time the food spends in your stomach also causes it to putrefy, causing that acid stomach sensation, or the feeling of having a brick in your stomach. Some people quit eating meat not because they want to be vegetarians, but because eating meat makes them feel sick.
Low stomach acid contributes to digestive issues throughout the rest of the digestive tract. As undigested food travels into the intestines, it causes inflammation and damages the lining of the intestines. This leads to intestinal permeability, or leaky gut, a condition in which the lining of the small intestine becomes inflamed and leaky. Leaky gut allows undigested foods into the bloodstream, yet prevents micronutrients from passing through because of the inflammation. Undigested foods in the bloodstream trigger inflammation throughout the body.
Stomach acid serves another useful purpose in that it kills bacteria, fungi, and other pathogens that may be in your food, preventing them from getting into the digestive tract and the bloodstream. When stomach acid is low, you lose this additional layer of protection.
Sufficient stomach acid also prevents food sensitivities. Undigested food particles trigger the gut’s immune system to become over burdened and over reactive. This causes the immune system to start reacting to more of the foods you eat, creating immune reactions that become food sensitivities. This is called losing oral tolerance, and it can be a primary cause of food sensitivities and other health issues.
Symptoms of low stomach acid
Stomach ulcers (low stomach acid raises the risk of an pylori infection, which causes stomach ulcers)
Belching after meals
Hiccups after eating
Undigested food in stools
What to do for low stomach acid
You can help support your stomach acid by taking betaine hydrochloric acid (HCl) capsules. Take HCL after you begin eating a meal with meat or protein. How much do you take? Keep increasing your dose until you feel warmth in your stomach, then cut back down to the previous dose. You may need quite a bit in the beginning but then find you need to gradually lower your dose over time.
If you feel intense gastric burning with even one capsule, it means you may have ulcers and an H. pylori infection that can be treated with nutritional compounds.
Although the produce section at the grocery store may look vast, it only represents a fraction of edible, nutritious, and tasty plant foods. It’s estimated there are more than 20,000 species of edible plants, and that we only eat about 20 to 50 of them. As a result, this may be playing a significant role in the rapidly declining health of westerners. Our gut bacteria, or gut microbiome, is a foundation to our health, and healthy gut bacteria depend on a diverse and ample array of vegetables.
Ancient humans harvested wild fruits, nuts, and seeds that varied with the seasons. They also dug up underground roots and stems. Studies of the Hadza people, in Tanzania, one of the last remaining hunter-gatherer populations left on the planet, gives us additional insight into the human microbiome and health.
The Hadza have one of the most diverse gut microbiomes on the planet; Americans have the worst. The Hadza gut microbiome diversity is about 40 percent higher than that of the average person in the United States.
Americans consume an average of 15 grams of fiber a day, most of it coming from grains. The American Heart Association recommends eating 25 to 35 grams a day. Some microbiome authors suggest even higher amounts — at least 40 grams of fiber a day.
In contrast, the Hadza consume about 100 to 150 grams of fiber a day, with the average Hadza person eating almost 600 species of plants that vary with the seasons. They suffer almost none of the same diseases that have come to characterize the average American — obesity, diabetes, autoimmune diseases, and cancer.
If you would like help understanding Integrating ancient fiber to modern diet, you can schedule a FREE 15-MINUTE CONSULTATION with Dr. Celaya.
Studies show fiber also lowers heart disease risk by binding with “bad” cholesterol to remove from your body. A high-fiber diet also lowers high blood pressure and thus the risk of stroke.
They type of fiber you eat matters too. What gut bacteria need for optimal function are “prebiotic” fibers mixed in with a diverse array of produce.
Prebiotic fibers best feed the healthy bacteria in our guts, thus improving overall health. Good sources of prebiotics include all vegetables but especially:
Not only do prebiotic fibers help with bowel regularity, they also change the composition of the gut microbiome in a favorable direction. They help strengthen intestinal walls, improve absorption of important nutrients, produce hormones that control appetite, reduce anxiety, and help protect you against chronic disease.
If you’re not used to eating high amounts of plant foods loaded with fiber, don’t double or triple your intake overnight. Your gut may rebel with constipation, diarrhea, pain, bloating, and gas. It takes your digestive system and gut microbiome some time to adapt and be able to adequately digest large amounts of fiber. Gradually increase the amount of fiber you eat by 1 to 2 grams a day over several weeks to give your system time to adjust.
Also, you may have noticed legumes, or beans, are especially high in fiber. It’s tempting to make those a staple in your diet as a result, and if they don’t disturb your health then go for it. However, many people cannot tolerate the lectins in legumes — they trigger inflammation or autoimmune flare-ups. For people with SIBO, small intestinal bacterial overgrowth, they also cause intense digestive issues and inflammatory responses.
Also, some people need to avoid nightshade vegetables because they trigger inflammation, particularly in relation to arthritis. These include eggplant, potatoes (but not sweet potatoes or yams), peppers, tomatoes, tomatillos, hot pepper products (cayenne, Tabasco, etc.), and pepper-based spices. Simply removing nightshades from the diet has brought relief from joint pain for many, especially those with rheumatoid arthritis.
Lastly, some people have gut or immune disorders that make a high-fiber diet inappropriate until they resolve those. Ask me for more information if eating fiber makes you miserable.
What does a high fiber paleo diet look like?
Most people with chronic inflammatory and autoimmune disorders fare best on a paleo diet that eliminates grains and legumes. As grains and legumes are sources of high fiber, what does a high-fiber paleo diet look like?
The recommended produce consumption is seven to 10 servings a day. That may sound like a lot, but one serving is a half-cup of chopped produce, or a cup of leafy greens. Because sugary foods can be inflammatory, aim for veggies and fruits that are low in sugar and unlikely to destabilize your blood sugar.
Therefore, shoot for at least three to four servings of produce per meal – that’s 1.5 to 2 cups of chopped veggies or 3 cups of leafy greens. Or break that up into five meals if you eat more frequently to stabilize low blood sugar.
Ask my office for more ways to support your gut microbiome.
If you feel like you have a harder time staying slim than your grandparents did at your age, you are right. We are about 10 percent heavier than people in the 80s, even when we eat the same foods and exercise just as much. This may be due to changes in lifestyle and environmental factors that impact our BMI, or body mass index.
Recent research by York University’s Faculty of Health shows it’s harder to maintain the same weight at a certain age than it was for someone 20 or 30 years ago. Even if you eat exactly the same macros (protein, fat, and carbs) and do the same amount and type of exercise, you are likely to be heavier than they were at your age.
In fact, with all factors accounted for, the predicted BMI has risen 2.3 points between 1988 and 2006.
According to study author Jennifer Kuk, “Our study results suggest that if you are 40 years old now, you’d have to eat even less and exercise more than if you were a 40-year-old in 1971, to prevent gaining weight. However, it also indicates there may be other specific changes contributing to the rise in obesity beyond just diet and exercise.”
Specific factors contribute to our increased BMI
Historically we tend to look only to dietary and exercise habits when we consider our weight or BMI (body mass index).
However, weight management is much more complex than watching what you eat and how much you work out. Our BMI is affected by many factors such as:
Gut bacteria populations
Nighttime light exposure
While the study’s authors admit we need more research to determine exactly how these factors play into the changed BMI picture, they suggest three main players:
Increased environmental toxins. Compared to 30 years ago, we are exposed to a higher level of environmental toxins such as pesticides, air pollution, heavy metals, flame retardants, plastics used for food storage, and more. These toxins put a heavy burden on the endocrine system, altering the hormonal processes that affect metabolism and weight management.
Increased use of prescription drugs. Since the 1970s our use of prescription drugs has risen dramatically. Many antidepressant drugs are linked with weight gain and are the most prescribed drugs in the US for people between 18 and 44.
Our gut microbiome has changed. The gut microbiome, or the community of good and bad bacteria that naturally inhabit the digestive tract, have changed dramatically since the 80’s.
Americans eat differently than they used to. The products we eat are more filled with antibiotics, pesticides, and other toxins; we eat more artificial sweeteners; and we eat more junk food. All of these factors may negatively affect our gut bacteria populations.
A hot topic of research, the gut microbiome is linked to more and more aspects of health and disease. We now know that some gut bacteria are linked with weight gain and obesity. In fact, doctors are even using fecal implantation — insertion of gut bacteria from a healthy slim patient into the gut of an unhealthy obese patient — to reduce chronic obesity.
If you would like help understanding about keeping your weight balanced, you can schedule a FREE 15-MINUTE CONSULTATION with Dr. Celaya.
Support your microbiome with SCFA
In functional medicine we consider the gut microbiome to be a foundation of health. An imbalanced gut microbiome can prevent you from healing from many health disorders, so it makes sense to do everything you can to support yours.
One important factor is oral tolerance, or the body’s ability to properly recognize food proteins. When we lose oral tolerance, the immune system mistakenly thinks more and more foods are pathogens, and we begin to have more food sensitivities, increased hormonal issues, increased autoimmunity, and imbalanced metabolism and weigh gain.
You can support oral tolerance by fixing leaky gut, supporting liver function, taming histamine reactions, reducing stress, and balancing blood sugar. But one of the best ways to support it is by providing your body with plenty of short-chain fatty acids (SCFA).
SCFA are powerful gut signaling compounds found in fruits and vegetables that affect not only the gut but also the brain and other parts of the body.
Your gut bacteria not only make SCFA, they also need them as fuel to produce more SCFA. The more you eat them, the more your good gut bacteria can outweigh the bad.
Three main SCFAs include:
SCFA bind to cell receptors that control your hunger and appetite, turn off insulin resistance, and burn body fat more efficiently.
When you are low on SCFA you will:
Have a larger appetite
Be prone to insulin resistance (think pre-diabetes)
Store body fat better than you burn it
When gut diversity is ruined, SCFA can’t signal properly and you end up with what we call an “obese microbiome.”
How to support SCFA
To support healthy levels of SCFA, adopt the following habits:
Eat abundant and varied produce. Eat plenty of diverse vegetables so your gut bacteria stay adept at recognizing many different food proteins. Aim for 7 to 9 servings a day. One serving consists of a half cup of chopped vegetable or one cup of shredded greens. Go easy on high-sugar fruits to keep your blood sugar stable.
Supplement with SCFA. You may benefit from also supplementing with butyrate, the main SCFA. Start with one capsule a day and work your way up to two capsules twice a day.
Boost glutathione levels. Glutathione is the master antioxidant that helps dampen inflammation, a main factor in loss of microbiome diversity. Take absorbable glutathione such as s-acetyl glutathione (regular glutathione isn’t absorbed well), or its precursors such as n-acetyl cysteine.
There are many other helpful ways to support a healthy microbiome. Contact my office to determine your microbiome health and how to improve it, so you can maintain a healthy weight.
When we go to the doctor with symptoms of acid reflux, gas, bloating and heartburn, typically the diagnosis of high stomach acid is based purely on symptoms — not a lab test for stomach acid levels — resulting in a prescription for antacids, histamine type 2 receptor agonists (H2 blockers), Proton Pump Inhibitors (PPIs), or even surgery.
For many people, these drugs only worsen the problem.
Antacids reduce stomach acid temporarily, then more acid is automatically produced to bring the stomach back to its intended pH level. This only treats the temporary symptoms and does nothing to fix the actual problem.
H2 blockers block a substance in the body that encourages acid production in the stomach. They work more slowly than antacids and are intended to last for longer periods of time. On the down side, they stop production of pepsin, a digestive enzyme necessary for breaking down protein.
Proton pump inhibitors permanently block an enzyme that tells your stomach to produce acid.
All of these methods are linked to serious side effects and can even contribute to the root causes of continued chronic low stomach acid and other serious health conditions.
5 Ways to test stomach acid levels
Because hypochlorhydria isn’t well known to most patients, many never trace it back to their chronic health condition and they continue to suffer.
The good news is multiple options exist for testing stomach acid levels, which will help you create a clear game plan for remedying the situation at its foundation.
1. Gastric acid secretion test. Highly invasive and expensive, this test is typically done if a patient is diagnosed with a stomach ulcer. It can be helpful to track if anti-ulcer medication is working and to see if material from the intestines is coming back into the stomach.
2. The Heidelberg Stomach Acid Test. Considered the gold standard test for hypochlorhydria, a small capsule with a radio transmitter is ingested to measure the pH of the stomach as you drink a solution with baking soda (reduces acidity). The baking soda will naturally neutralize the HCL in the stomach. If the body does not return it to normal, it’s a sign of hypochlorhydria.
This test provides a graph showing your specific stomach response to the baking soda challenge, and can help determine if you have hypochlorhydria, hyperchlorhydria (high acid), or achlorhydria (complete lack of acid). At a cost of about $350, this test is not covered by most insurance plans.
3. CBC and CMP. These are common factors on a metabolic blood panel, typically covered by insurance. A skilled clinician can diagnose hypochlorhydria by taking into account these lab results in combination with your symptoms.
4. Betaine HCl challenge. An at-home test considered to be quite reliable, however false positives are possible, so it’s recommended to repeat the test three times. The betaine HCl costs about $20. If you have low stomach acid, you can then take it to help restore your HCl levels.
Buy Betaine HCl with pepsin.
Eat a high-protein meal containing at least 6 ounces of meat (veggies are allowed with this).
In the middle of the meal (not the beginning) take one betaine HCl pill.
1. You notice no symptoms. This is likely a sign of low stomach acid.
2. Indigestion. Burning, heat, or heaviness in your chest likely indicate adequate stomach acid levels.
It is recommended to repeat the betaine HCl challenge two or three times to confirm your results. Three positive tests are a good indication of low stomach acid.
False positives are possible if:
You consume too little protein. A low protein meal doesn’t require much acid, so the betaine HCl can cause too much increase in acid.
You took the capsule before the meal, which can cause indigestion.
You have esophageal sphincter dysfunction. A hiatal hernia or poor esophageal sphincter tone can cause increased indigestion symptoms. Rule this out with a medical exam if you suspect it.
5. Baking soda stomach acid test. While not as accurate as the above tests, this is a free at-home test you can use to get an indication of your stomach acid levels. The results can vary from person to person depending on interpretation of the results. Some use it as a baseline measure and to track changes over time.
First thing in the morning, before eating or drinking anything:
Mix ¼ tsp baking soda in 4 to 6 ounces of cold water.
Drink the baking soda solution.
Time how long it takes for a burp to occur. Time it for up to 5 minutes
If you have not burped within five minutes, it may be a sign of insufficient stomach acid. Early and repeated burping may be due to too much stomach acid (do not to confuse this with small burps from swallowing air when drinking the solution). Any burping after 3 minutes is an indication of low stomach acid levels.
Low stomach acid can be associated with other health issues that have far-reaching consequences. If you suspect low stomach acid, ask our office about testing for the following:
B12 levels: Intrinsic factor is a glycoprotein in the stomach necessary for absorption of vitamin B12. When stomach acid is too low, intrinsic factor can’t do its job. This results in vitamin B12 deficiency, which is a serious health concern.
Homocysteine levels: Stomach acid is important for proper absorption of vitamin B12, a key factor in methylation that keeps inflammatory homocysteine at the right levels. When B12 is low, homocysteine elevates.
Supporting healthy stomach acid
Eat protein foods at the beginning of your meal to stimulate the digestive enzymes necessary for digesting protein.
Chew thoroughly. This is one of the most important parts of digestion. Food proteins need to be broken down to be properly digested.
Limit liquid intake during meals until at least 30 minutes after a meal to allow for proper stomach acid production, pathogen sterilization, and protein metabolism.
Stay hydrated between meals to support proper gut motility; this pushes the contents of the intestines out of the body instead of back into the stomach. This is very important for those who are prone to SIBO.
Betaine hydrochloride supplements help support healthy gut function and safely restore normal gastric acidity. (Do not confuse betaine HCl with anhydrous betaine, a methyl-donor nutrient taken to control homocysteine levels.)
Always take the betaine HCL either half-way through the meal or right at the end of the meal. Taking it before a meal may create a false experience of heartburn and can turn off stomach acid production for this meal. Caution: Do not take HCL if you are taking any NSAIDs such as ibuprofen, Tylenol, or aspirin.
HCl with pepsin. Add these to your diet when you consume protein. When you feel warmth in your stomach, that means you are taking enough. Then back it down a notch and monitor your response. Some people need one capsule, others need more as everyone is unique.
Pepsin. Typically used in conjunction with HCl, pepsin is considered very safe when administered to assist digestion.
Digestive enzymes help to break down food proteins. Make sure to get a high-quality blend.
Apple cider vinegar. One tablespoon in a bit of water right before a meal can help with digestion.
Fermented foods such as sauerkraut, kimchi, pickles, pickled ginger, and water kefir contain organic acids, enzymes and probiotics to assist with proper digestion. They are also anti-microbial and fight H. pylori, arch enemy of stomach acid production.
Taking the time to improve your stomach acid levels will make a huge difference in your symptoms and quality of life. Please contact my office for more help.
How can the 6 R’s help your digestion and autoimmunity?
Do you have autoimmunity and have tried everything to heal your gut? Maybe you’ve “gone Paleo,” made barrels of bone broth, stopped sugar and gluten and eaten lots of probiotic foods. You might have even taken tons of supplements, and it seems like it’s not working.
It turns out when it comes to healing the gut or recovering from chronic conditions, you have to do things in the right order to get well.
That is where the 4, 5, or 6 “R” Program comes in. This program first started as a 4 “R” program (Jeffrey Bland), then grew into a 5 “R” program, and now is a 6 “R” program.
The “R” Program is a systematic, comprehensive approach for restoring your gastrointestinal function. It can help people with:
Food allergies and intolerances (gluten, dairy)
SIBO, candida, and dysbiosis
Gut inflammation like Crohn’s disease or inflammatory bowel disorder
This program is not just for digestive issues though. It can also help chronic health conditions that seem unrelated to the digestive system, such as:
Lung issues like asthma, environmental allergies, bronchial problems
Sensitivity to odors and fragrances
Adrenal dysfunction, night sweats, hormonal imbalances
Compromised immune system, frequent infections
Autoimmune disorders like Hashimoto’s thyroiditis
The overall health of the gut depends on three things:
1 – Digestion (break down food)
2 – Absorption of nutrients
3 – Elimination of waste
The “R” Program also helps the following:
“Resets” your GI tract by normalizing digestion, absorption, and assimilation of your food. It reduces gas, stomach pain and bloating.
Populates your microbiome with the right bacteria. A healthy microbiome can produce vitamins like folic acid and others. It can also produce short chain fatty acids which feed your intestinal cells. It can regulate bowel movements (too fast or too slow is a problem), and influence your weight, nervous system, and even keep the bad bacteria at bay.
Heal’s leaky gut. This step can make a big difference in chronic related conditions like autoimmunity and immune issues and food allergies or intolerances, which can create inflammation.
Detoxifies your body from the inside out by reducing the toxins your gut flora produces from inadequately digested foods or the byproducts from bad bacteria.
Prevents diseases in the gut, like SIBO, IBS, inflammatory bowel disease and Crohn’s disease, not to mention autoimmunity.
Think of your gut as a garden. You must have a good starting point – healthy nourishment for the plants to grow.
You must have water.
Good fertilizer – you must eat the right foods to nourish your microbiome.
Weed and bug control – a healthy microbiome of the good guys helps control the bad.
Maintenance – sometimes we need to help the system with extra nourishment like Glutamine or bug eradication herbs. You even have to control your stress regularly which controls your hormones.
Harvesting – what goes in must come out in a timely manner. If it doesn’t, things can go bad – exercise, fresh juices, and fiber intake can help.
Your intestinal cells are always replenishing, and most conditions will see a benefit in 3 to 6 months. Autoimmunity like Crohn’s disease may take longer.
Here are the 6 R’s
1 – Remove – inflammatory foods. This can be done with the AIP, FODMAP, Paleo, or rotation diet. The goal is to reduce the burden of irritants and poorly digested foods in your GI tract and as a result of lower inflammation, dampen food allergies and intolerances.
2 – Replace – digestive support.
HCL – secreted by the stomach for protein digestion and to provide protection from various pathogens. It also helps stimulate other digestive processes.
Enzymes – proteases, cellulases, and lipases that break down fats, proteins, and carbohydrates.
Bile Salts – helps support bile which is normally secreted by the liver and stored in the gallbladder for use when digesting and utilizing fats.
If things don’t digest well, you won’t get your nutrients and then everything goes downhill from there. In addition, food that doesn’t digest can putrify in the gut and can cause inflammation.
3 – Repair – You need to add additional nutritional supplements to promote proper repair of the intestinal lining and hormones. Glutamine and glycine are important amino acids for repair of the gut wall. Glutamine serves as a source of fuel for the cells that line the intestines. Good support includes DLG, aloe, slippery elm, marshmallow root, and even ginger. B5, zinc, omega 3 fish oil, vitamin A, C, E, and D. Cabbage juice, collagen or bone broth can help as well. NAC or glutathione can be beneficial also.
4 – Remove infections – Test and treat for h pylori, parasites, fungus (candida), and other dysbiosis. So many other “R” plans, try to do this in the first step, which is very tough on the system. It makes a big difference to do it in this order when things are calmed down and your body can fight the infections effectively.
5 – Repopulate and Reinoculate – pre and probiotics. You need to take in the right foods for the probiotics to eat so they can thrive. They can include different fibers such as inulin, fructooligosaccharides or arabinogalactans. They can include berries, Jerusalem artichoke, flax seed, beans, lentils, chickpeas, and the cruciferous veggies.
Probiotics should be designed to support the proliferation of beneficial bacteria throughout the small and large intestines. They also need to have the right designed delivery mechanism so that the microbiome gets to where it needs to go, and avoids the stomach digestion. There is so much positive research on probiotics and the benefit to your health.
6 – Retain and Retest – You must maintain that healthy GI environment: diet, vitamins, minerals, protein, in addition to everything you learned earlier with the other R’s. Retesting is important to make sure you have achieved your goal. Occasional testing may be important to make sure you remain on the right track.
Have you ever wanted to know everything there is to know about your thyroid? This 7-part video series will cover thyroid lab testing, nutrition and infections that affect the thyroid, toxins, thyroid hormone conversion, lifestyle, and adrenal interplay.