by Jeffrey Dach MD
Mary is a 62 year old accountant who arrived in my office with a chief complaint of hair loss. Mary was dressed smartly, wearing a grey suit. Not only that, but her skin tone was also a peculiar grey color matching the color of her suit.
Upper Left Image: Lady Jane Grey, engraving Date 1620, by Willem van de Passe, courtesy of Wikimedia Commons
Mary arrived in my office with a large bag of vitamins for her hair, which included biotin, and Chinese herbs (shin bet). She had been to dermatologists and hair loss doctors who gave her creams and shampoos. Nothing seems to be helping. Mary sat down and told me her story.
Mary had been doing fine until about two years ago when she had experienced a stressful family event when her mom passed away. Shortly after that she noticed her hair thinning and falling out. She also noticed leg cramps at night which wake her up. She has gas and bloating after meals, and finds that many foods don’t agree with her.
Mary’s nails were soft and peeling, and there were patches of absent or thinning hair on her scalp. Mary’s tongue was red and beefy (Hunter’s Glossitis from low B12). We gave Mary a lab sheet and sent her to the lab for blood work. The lab panel showed low B12, low Iron, Low Ferritin, low magnesium, low selenium and borderline anemia, and Mary’s serum gastrin was elevated, a finding diagnostic for hypochlorhydia (low stomach acid). This explained Mary’s hair loss and other symptoms.
Mary’s story reminded me of “the Grey Man”, a patient seen by Jonathan Wright MD who had peculiar grey skin tone and severe fatigue from years of acid blocker drug use.
This “Grey Man” story can be found in the book: “Why Stomach Acid Is Good for You: Natural Relief from Heartburn, Indigestion, Reflux and GERD”by Jonathan Wright, MD and Lane Lenard, PhD (Amazon Listing). We keep a few of these books in the office for patients to borrow and read.
Mary wasn’t taking any acid blocking drugs. Instead, Mary had gastric atrophy causing the low acid production, a common condition in which the acid producing cells of the stomach lining gradually disappear, leaving behind a stomach unable to produce much gastric acid.
Why We Need Stomach Acid
You might then ask:
“Well, So What ?, We don’t need gastric acid anyway because millions of people are on gastric acid blocking drugs handed out freely by the medical profession”.
Unfortunately this is wrong. The body does need gastric acid. Without gastric acid we are unable to digest and absorb proteins, vitamins and minerals. The minerals are iron, calcium, magnesium, selenium and zinc. Without gastric acid we are unable to absorb vitamins like B12, thiamine and folate. Without gastric acid we are unable to digest and absorb amino acids for protein production. This leads to inability to form collagen, hair loss and muscle loss. Gastric acid plays a huge role in sterilizing our food and protecting us from infection. Low gastric acid allows for candida overgrowth, and gut dysbiosis as well as chronic GI parasites. Low gastric acid leads to large undigested food particles entering the circulation through the “leaky gut” and causing an immune response which may lead to multiple food allergies, and autoimmune diseases.
Symptoms of Low Gastric Acid
1) Belching, bloating, burning, or “acid reflux” after eating, immediately after meals.
2) a sense of fullness after eating.
3) Indigestion and constipation because food is not being digested properly
4) Skin conditions such as Acne, Rosacea, Urticaria, Eczema
Dilated blood vessels in the cheeks and nose (in non-alcoholics), this is called “Rosacea Acne
5) Vertical ridging on the nails because of inability to absorb nutrients from food, Weak, peeling, and cracked fingernails.
6) Leg and foot cramps from mineral deficiencies because you are not absorbing minerals.
7) Chronic injuries due poor amino acid status and inability to restore tissue, muscle atrophy and wasting.
8) Multiple Food allergies, which may be associate d with asthma.
9) Gallstones. You may have already had a cholecystectomy.
10) Poor cognitive function and the onset of dementia.
11) Low bone mineral density and osteoporosis.
12) Itching around the rectum from parasites.
Diseases Associated with Low Gastric Acid
Asthma – see the Jonathan Wright Book for a discussion of proper treatment of asthma in children with B12 injections, B6 Magnesium, avoiding food allergens and addressing low gastric acid.
Celiac disease – Wheat gluten sensitivity – Enterolabs, Cyrex labs, antigliadin antibody
Chronic autoimmune disorders-entire list of autoimmune diseases
Cognitive Dysfunction and Dementia from B12 deficiency
Dermatitis herpetiformis (herpes)-typical for wheat gluten sensitivity
Depression- Leaky Gut with LPS (see articles by Michael Maes)
Diabetes – Autoimmune type one
Gall bladder disease – associated with hypochlorhydia
Graves disease-Autoimmune-Elevated TSH receptor ab-Yersinia molecular Mimciry with TSH receptor
Iron deficiency-Low Iron and Low ferritin
Hyper and hypothyroidism- Autoimmune-Hashimotos Thyroiditis
Lupus erythematosus -autoimmune
Neuropathy and NeuroPsychiatric Disorder from B12 deficiency
Osteoporosis-from Calcium Malabsorption
Pernicious anemia – Parietal Cell Antibodies-B12 deficiency-gastric atrophy
Sjögren’s syndrome – Autoimmune
Thyrotoxicosis-three types: Graves, Hashitoxicosis, and Txic Nodular Goiter
Chronic intestinal parasites or abnormal flora -GI-Fx shows parasite DNA
Undigested food in stool-Demonstrated on GI-FX test
Chronic candida infections-from gut dysbiosis
Upper digestive tract gassiness-from dysbiosis
Testing for Low Stomach Acidity -Diagnosis of Low Gastric Acid
The Heidelberg Capsule
Jonathon Wright MD uses the Heidelberg capsule at the Tahoma Clinic to measure gastric acid. The patient swallows a small disposable oral capsule containing a pH meter and radio-telemetry device. This is the most accurate and direct way to measure gastric acid. Dr. Wright has done this on literally thousands of patients, laying the ground work for his book on “Why You Need Gastric Acid.”
Indirect Lab Tests Useful in Detecting Low Gastric Acid
Indirect lab tests may be useful. Serum gastrin is elevated in patients with low gastric acid. Serum amino acids, B12, Iron, Ferritin and Hbg/Hct may be low from malabsorption. Serum Triglycerides may be low indicating fat malabsorption. Stool testing (GI-Fx) may show dysbiosis with overgrowth of candida, parasites or incomplete digestion with Fat and Protein malabsorption.
Treatment of Low Gastric Acid- Without Drugs
Treatment of low gastric acid is done with natural supplements and without drugs, explaining why mainstream medicine is blind to this diagnosis and treatment.
Mainstream medicine docs will never measure gastric acid. Instead, mainstream docs merely assume the problem is excess stomach acid, and then prescribe acid blocking drugs like the proton pump inhibitors, Prilosec, Nexium, Tagamet, etc. As you know by now, acid blocking drugs are not the answer to a low gastric acid condition , and will merely make the patient worse.
Betain HCL with Pepsin, Digestive Enzymes, Probiotics
Acid replacement is readily available from the health food store as Betain HCL with Pepsin. The Betaine HCL capsules are taken with meals according to a Schedule Sheet which we review and hand out at the office. The sheet can be found Here:
Self-testing and treatment for low HCl / Hypochlorhydria:
1. Begin by taking one capsule of Betaine HCl/Pepsin with a large meal containing fat and protein. A normal response in a healthy person would be discomfort—basically a heartburn feeling. If you do not feel a burning sensation, at the next meal, start taking two capsules with each large meal.
2. If there are no adverse “heartburn feelings” or other discomfort after two days, then increase the number of capsules with each meal to three capsules.
3. Continue increasing the number of capsules every 2 days, using up to eight capsules with each meal if necessary. These dosages may seem large, but a normally functioning stomach manufactures considerably more. You’ll know you’ve taken too much if you experience tingling, heartburn, diarrhea, or any type of discomfort including a feeling of unease, digestive discomfort, neck ache, backache, headache, or any new odd symptom. If you experience tingling, burning, or any symptom that is uncomfortable, you can neutralize the acid with 1 tsp baking soda in water or milk.
4. When you reach a state of tingling, burning, or any other type of discomfort, cut back by one capsule per meal. If the discomfort continues, discontinue the HCl and consult with your healthcare professional.
5. Once you have established a dose (either 8 capsules or less, if warmth or heaviness occurs), continue this dose.
6. With smaller meals, you may require less Betaine HCl so you may reduce the amount of capsules taken.
7. Individuals with very moderate HCl deficiency generally show rapid improvement in symptoms and have early signs of intolerance to the acid. This typically indicates a return to normal acid secretion.
8. Individuals with low HCl/pepsin typically do not experience such quick improvement, so to maximize the absorption and benefits of the nutrients you take, it is important to be consistent.
Treatment with Apple Cider Vinegar
A milder form of treatment is with the acid, apple cider vinegar, one tablespoon taken before each meal. Use the raw/unpasteurized Apple Cider Vinegar. The apple cider vinegar commonly found in supermarkets is usually pasteurized.
Braggs or something similar at the health food store is a good bet. Besides being unpasteurized, it may be unfiltered with floating particulate matter, called the mother which causes the vinegar to ferment, and isn’t harmful.
How to take your Apple Cider Vinegar
Start with a small amount, a teaspoon or half a teaspoon in a glass of water and drink. After a few days, gradually increase to one or two tablespoons before each meal. If you continue more than two weeks,, drink through a straw to avoid fental exposure to the acid.
Link to Basic Supplement for Hair Skin and Nails:
Articles with related interest
Jeffrey Dach MD
Links and References
PDF FILE Testing for Low Stomach Acidity
Self-testing and treatment for low HCl/hypochlorhydria
Testing for Low Stomach Acidity
3) drnatashaturner.com/wp-content/uploads/2010/08/Clear-MedicineHCL-challenge.pdf TAKE THE HCL CHALLENGE This simple test can help you determine whether you have the appropriate level of hydrochloric acid in your stomach for optimal digestion Maximize Your Progress with Hydrochloric Acid
Hydrochloric Acid by Kelly – Gregory S. video of jonathan wright
99% of the Time it is Low Stomach Acidity (Hypochlorhydria) Which Causes Heartburn and Acid Reflux – Antacids Make The Problem Worse! Source
How To Test For Hypochlorhydria At Home
There are a variety of simple at-home tests available that can help patients self-diagnose Hypochlorhydria, as well as advanced diagnostic procedures that are performed by a licensed medical practitioner.
Here are the two most commonly-used home tests for low stomach acid:
The “Lemon Test”
One of the simplest ways to test for low stomach acid in the comfort of your own home is known as the “lemon test.” When you are suffering from stomach discomfort, simply place a teaspoon of lemon juice in 2-4 ounces of water and drink the mixture. If there is not enough acid in your stomach, the addition of the acid-filled lemon juice mixture will provide you with relief from your symptoms. In people with too much stomach acid, drinking acidic beverages like lemon water will make digestive discomfort worse.
Testing For Hypochlorhydria Using Betaine Hydrochloride (Betaine HCL)
According to Dr. Natasha Turner, a Toronto, Canada-based Naturopathic Doctor, best-selling author and regular guest of the Dr. Oz Show, the following is a simple test that can be used at home to test for low stomach acid”
Note: People who have ulcers should NOT attempt this test: Prepare for the test by purchasing Betaine Hydrochloride, also known as BH, HCL or Betaine HCL capsules. Look for BH which has been produced by a reputable supplement company and be sure not to confuse BH with Betaine Anhydrous, a product used to treat some rare genetic disorders.
Betaine Hydrochloride (BH) is an over-the-counter supplement that contains hydrochloric acid; it is sold in most pharmacies, health stores and online supplement retailers.
Prior to eating your largest meal of the day which includes a portion of protein, take one capsule or tablet of BH. Shortly afterwards, you should feel a warm, slightly burning sensation throughout your stomach. This indicates that the BH has activated the existing acid in your stomach, letting you know that your naturally-occurring levels of stomach acid are sufficient. (Burning, stomach pain, acid stomach, nauseousness/queasiness, constipation, loose stool, burning stool or rectum, acid reflux can all be symptoms of taking too much HCL.)
Patients who feel no effects whatsoever after taking a single dose of BH should repeat the above process the following day prior to their largest meal, however, the dose should now be increased to two tablets or capsules of BH.
Once again, pay attention to any warming or burning sensations in the stomach or digestive tract. If you feel a warm sensation in your stomach after taking two BH tablets, repeat the procedure the next day before your main meal, reducing the dose back down to one tablet or capsule.
Dr. Turner advises that patients continue this course of treatment (taking one tablet of BH prior to the largest meal each day) until a feeling of warmth or burning occurs after taking the supplement. This warming sensation indicates that there is enough acid in the stomach to support healthy functions without the need for supplementation with BH. She advises that patients should then begin taking a digestive enzyme product prior to each meal to help maintain a healthy digestive system.
What It Means If You Feel Nothing After Taking Two Pills of Betaine Hydrochloride
Dr. Turner advises that people who have relatively sufficient levels of naturally-occurring stomach acid will feel a warm, mildly burning sensation in their stomach after taking one or two doses of BH. However, people who suffer from low stomach acid will require larger doses of BH to activate their stomach acid, a definitive sign of low stomach acidity. If you follow the above BH/meal protocol and do not feel these sensations, take one additional pill of BH prior to your largest meal each day until you do feel a warm, burning sensation in your abdomen, up to a maximum of 10 BH pills per day.
According to Dr. Turner, the amount of BH supplementation it takes to elicit a symptomatic response (warmth and burning in the digestive tract) is relative to the severity of the patients’ Hypochlorhydria – the lower the levels of naturally-occurring stomach acid are, the greater the dose of BH needs to be to activate the heartburn symptoms. Simply put, if you test yourself for low stomach acid by taking one, then two, tablets of BH prior to eating a meal and you do not feel any sort of warming or burning sensation in your stomach or digestive tract, you can be relatively certain that you are suffering from Hypochlorhydria (low stomach acid). Dr. Turner further discusses that effectively treating low stomach acidity requires strict adherence to a regiment of BH supplementation for an extended period of time: Correcting a hydrochloric acid deficiency may take a few weeks or even months
www.ndhealthfacts.org/wiki/Hypochlorhydria_%28Low_Stomach_Acid%29 Hypochlorhydria (Low Stomach Acid)
www.nutritional-healing.com.au/content/articles-content.php?heading=Stomach%20acid%20deficiency%20%28Hypochlorhydria%29 Stomach acid deficiency (Hypochlorhydria)
People with low stomach acid usually have a number of the following symptoms/signs. Stomach aching/pain/discomfort or bloating after meals Feel unwell/fatigued right after meals Food or water ‘sits in stomach’ High fat foods cause nausea/stomach upset Undigested food in stool Reflux &/or heartburn Poor appetite or feel overly full easily Multiple food sensitivities Trouble digesting red meat Constipation Low iron levels Frequent nausea Nausea/reflux after supplements (e.g. fish oil) Burping after meals
Management of Low Stomach Acid April 25, 2011
Dr. Paul Jaconello, Medical Doctor
The Adverse Effects of Hypochlorhydria
a. amino acid deficiencies due to poor digestion and assimilation of protein. Low grade amino acid deficiencies can be associated with muscle wasting, immuno-deficiency, nervous system dysfunction and reduce liver detoxification.
b. multiple mineral deficiencies particularly of calcium, iron, magnesium and possibly selenium, chromium, manganese, copper and other trace minerals. Deficiencies of these minerals can further cause ill health and increased risk to degenerative diseases.
c. vitamin B12 deficiency. This is particularly seen in achlorhydric patients where there is no production of intrinsic factor. This is a chemical compound produced by the stomach which tags onto vitamin B12 released from protein in the stomach and carries it down the intestine to allow B12 to be absorbed in the lower part of the small intestine.
When protein is poorly digested, partially digested fragments can gain access to the body and initiate an activation of the immune system causing conditions associated with food intolerance, e.g. arthritis, rhinitis, asthma, eczema, urticaria (hives) and colitis.
An increased lead of undigested protein fragments can get to the colon and feed a section of the flora there which overgrow, produce poisonous substances (like ammonia and various biogenic aminos) which are toxic to the body if allowed access to the general circulation. This is called putrefaction of the bowel.
Conditions Associated with Hypochlorhydria
These are numerous and include:
Patients with auto immune disease.
These diseases include
Type 1 diabetes,
multiple sclerosis and so on.
Clinical observation has elucidated that hypochlorhydria is present in 90% of lupus, 80% in rheumatoid arthritis and 60% in multiple sclerosis. Patients on gastric acid inhibitory drugs and antacids are often hypochlorhydric before they even started these drugs in about 90% of the cases!
Asthma, especially in childhood. The incidence is around 80%.
Osteoporosis. In 90% of patients, as those patients with hypochlorhydria cannot assimilate calcium and other minerals well which are vital for bone integrity.
Signs and Symptoms of Low Stomach Acid
Capillary dilatation in the cheeks. This gives a rosy red complexion. There is a very high correlation with gastric hypoacidity, especially in younger persons.
Fingernails that break easily. This is generally seen in women. Nails tend to be paper thin, crack, chip or layer back.
Hair loss in women. One also sees this in women who are pregnant, on oral contraceptive pills or estrogen replacement therapy and in folic acid deficient individuals.
Abdominal bloating, in the upper part with consumption if animal protein, especially beef, when food just “sits there like a rock” and doesn’t “digest” well.
Burping and belching.
A Disgusting Taste in Her Mouth David Edelberg, MD
World J Gastroenterol. 2009 November 7; 15(41): 5121–5128.
Pernicious anemia: New insights from a gastroenterological point of view Edith Lahner and Bruno Annibale Edith Lahner, Bruno Annibale, Department of Digestive and Liver Disease, University Sapienza, 2nd Medical School, Ospedale Sant’Andrea, Via di Grottarossa 1035, 00189 Roma, Italy
Hypochlorhydria – lack of stomach acid – can cause lots of problems
The Complete Practitioners Guide – Blood chemistry analysis ——————————————————————
3 Tests for Low Stomach Acid by Steven Wright
3 Common Signs of Low Stomach Acid by Steven Wright
Conventional vs. Natural Heartburn Remedies –
How to Test for Hypochlorhydria to Determine the Best Treatment Should I choose the conventional purple pill or natural heartburn remedies? Before you decide, learn why testing your stomach acid levels for hypochlorhydria can be beneficial.
Betaine HCl – One of the Best Natural Heartburn Remedies If you’re searching for chronic indigestion relief, look no further! Betaine HCl is among the top natural heartburn remedies. Learn exactly how to take this marvelous supplement.
The Unseen Epidemic: The Linked Syndromes of Achlorhydria and Atrophic Gastritis by Dr. Nigel Plummer
1) Belching, bloating, or “acid reflux” after eating
2) Indigestion and constipation because food is not being digested properly
3) Skin conditions such as acne
4) Vertical ridging on the nails because of inability to absorb nutrients from food
5) Leg and foot cramps because you are not absorbing minerals
6) Chronic injuries due poor amino acid status and inability to restore tissue
7) Food allergies and asthma
9) Poor cognitive function and the onset of dementia
10) Low bone mineral density and osteoporosis
www.selfgrowth.com/articles/Control_Autoimmune_Diseases_With_Stomach_Acid.html Control Autoimmune Diseases with Stomach Acid? By Marcus Laux, ND Marcus Laux, ND, is a licensed naturopathic physician who earned his doctorate at the National College of Naturopathic Medicine in Portland, Oregon.
Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie, Fl 33314
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