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.
- Finish the meal and observe what happens.
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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.
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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:
- Stomach pain
- Leaky Gut
- 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:
- Brain-related issues: depression, anxiety, mood fluctuations, brain fog, migraines
- Achy joints, arthritis, rheumatoid arthritis
- Skin problems like eczema, acne, and psoriasis
- 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.
People with eating disorders such as anorexia simply do not experience hunger and satiety in the same way people who have a healthy relationship with food do. New research suggests that the composition of gut bacteria, or the gut microbiome, may play a role in the behavioral aspects of anorexia and eating disorders. For instance, previous research shows a connection between mood disorders such as depression and poor gut microbiome diversity. Less than half of people with eating disorders fully recover, showing that conventional treatments are failing untold numbers of people, the vast majority of them women.
The study showed that patients with anorexia had lower diversity of gut bacteria than healthy individuals. They also found that the less diverse the gut microbiome was the more depression and anxiety patients suffered. The researchers also found that as a patient with anorexia began eating again their gut bacteria diversity was partially restored, which in itself aided in recovery.
Alterations in the gut microbiome can affect how a person’s body functions, how they think, feel, and behave, and how they interact with others.
The gut microbiome is critical not only to regulating mood and behavior, it also plays a vital role in regulating metabolic function, appetite control, and weight.
A better understanding of the role of the gut microbiome in anorexia can help researchers forge new directions in treatment around determining target weight goals, how fast the anorexic patient should gain weight, and what type of diet the anorexic patient should follow to best support the brain’s role in eating disorder behaviors.
The researchers are now investigating whether targeted probiotics could ease the renourishment and refeeding phase of anorexia recovery — many patients struggle with gastric and abdominal distress when reintroducing foods. Customized probiotic therapy could also support the mental and emotional aspects of recovery from an eating disorder.
Gut bacteria targeted in eating disorders
Past research has also shown a link between the gut microbiome and eating disorders, which affect an estimated 5 to 10 percent of the population. A 2015 study from France showed gut bacteria plays a role in eating disorders.
The study looked at mice who had an inflammatory reaction to a protein made by gut bacteria. In essence, the mice responded to these bacteria as if it were an allergy or sensitivity. This immune response caused eating disorders in the mice.
The gut bacteria that triggered this reaction is very similar in structure to a hormone called alpha-Melanocyte-stimulating hormone (a-MSH). a-MSH is a satiety hormone that tells you when to feel full. When the immune system attacks the gut bacteria similar to a-MSH, it also attacks the a-MSH due to their structural similarity. This immune reaction can then dysregulate signals around feeding, energy usage, and anxiety.
If you would like help understanding Gut Health, you can schedule a FREE 15-MINUTE CONSULTATION with Dr. Celaya.
When the immune system mistakenly attacks the body
This study is evidence of a “cross-reactive” immune reaction, in which the immune system confuses something in the body with something infectious and attacks both. This is a very common mechanism in autoimmune reactions, such as with Hashimoto’s hypothyroidism, type 1 diabetes, or multiple sclerosis.
The research suggests that some eating disorders may have an immune reaction driving the psychological disorder.
Tips on addressing eating disorders nutritionally
Although eating disorders are highly complicated and require intensive, sometimes multi-faceted therapeutic approaches, it’s still important to be mindful of nutritional strategies to support the brain and the gut microbiome:
Eliminate processed carbs and sugars as they trigger addictive tendencies metabolically.
Keep blood sugar stable to curbing cravings, food obsession, and relentless hunger. You may need to eat small, frequent meals that include protein initially.
Base your diet on plenty of vegetables and a wide, ever changing diversity of vegetables. This will increase the diversity of your gut microbiome, which promotes psychological health and stability.
Supporting your brain chemicals, or neurotransmitters. Neurotransmitters affect your mood, thoughts about yourself, behavior, energy levels, and other aspects of how you feel and function. For instance, you may need serotonin or dopamine support. Serotonin is the neurotransmitter that allows us to feel joy and stave off depression. Dopamine, on the other hand, is necessary to feel self-worth, motivation, and to not experience constant cravings. Both serotonin and dopamine have been shown to play a role in eating disorders. If you have been starving yourself, binging and purging, undereating, or affecting your diet in other ways due to an eating disorder, there is a strong possibility you may be deficient in either one or both of these important neurotransmitters.
Ask my office for more advice on how to support a healthier approach to balanced approach to recovering from eating disorders.
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Numerous studies show a strong link between gluten intolerance and Hashimoto’s disease, an autoimmune disease that attacks the thyroid gland, causing hypothyroidism. This is because gluten has a molecular structure that closely resembles thyroid tissue — gluten sensitivity triggers an attack on the thyroid gland. Gluten (technically, the correct term is gliadin), is the protein found in wheat and wheat-like grains, such as spelt, kamut, rye, barley, triticale, and oats.
One of the immune system’s primary jobs is to protect the body from foreign invaders. Sometimes it may recognize a common food as a dangerous invader. When you eat that food throughout each day this can keep your immune system engaged in constant battle, making it hyper zealous, overly sensitive, and thus prone towards food sensitivities and autoimmunity.
Some people also have celiac disease, disease in which gluten triggers an autoimmune attack against the gut, the skin, or neurological tissue. Gluten sensitivity is more common than celiac disease, however, both show up in higher numbers in people with Hashimoto’s hypothyroidism.
If you would like help understanding Gluten Intolerance, you can schedule a FREE 15-MINUTE CONSULTATION with Dr. Celaya.
If you have been diagnosed with hypothyroidism you should first test for Hashimoto’s by screening for TPO and TGB antibodies — the majority of hypothyroidism cases are caused by Hashimoto’s.
You should also screen for gluten intolerance or celiac disease given how common these conditions are in patients with Hashimoto’s. Likewise, people who discover they are gluten intolerant or have celiac disease should screen for Hashimoto’s.
It’s important to give up gluten completely if you have Hashimoto’s and gluten intolerance. Cheats and little bites are not ok as they trigger an immune response that ultimately destroys thyroid tissue. Also, it’s important to avoid foods that have been contaminated by gluten. Be careful when in a kitchen where gluten is used, with restaurant food, or with questionable packaged foods.
Cyrex Labs offers testing to identify gluten intolerance. However, sometimes the immune system can be so depleted that it produces too few antibodies to produce a positive test, even though you react to gluten. You can screen for this with a total immunoglobulin test.
However, given the evidence establishing a link between gluten intolerance and Hashimoto’s disease, you may be surprised how much better you feel by simply removing gluten from your diet as a start.
Many people have to remove other foods as well, such as dairy, eggs, or other grains. Following the autoimmune paleo diet for about a month and then reintroducing restricted foods one at a time every 72 hours can help you determine which foods trigger an inflammatory reaction in you.
Many people are able to put their hypothyroid symptoms into remission simply by following a diet that eliminates gluten and other trigger foods. Although autoimmune diseases such as Hashimoto’s can be successfully managed through diet and lifestyle strategies, it’s important to understand they can’t be cured. It’s just a matter of taming the immune system.
Ask my office for ways to manage your autoimmune Hashimoto’s hypothyroid condition.
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