According to Michael D. Gershon, MD, approximately 20% of Americans
least miserably affected, by functional bowel disease.
However, only ten percent of those afflicted discuss their disorder
with a doctor.1 People are often too embarrassed to
mention their bad breath, gas, bloating and fullness after meals,
diarrhea, or constipation.1,2 Many are unaware that
these symptoms are frequently caused by too little stomach acid.
on, they can easily be corrected with the help of a physician skilled
in natural medicine.3 Left untreated, or worse still
treated with acid stoppers, they can eventually cause irreparable
The stomach is essentially where digestion begins; it is also the
gateway to the intestine's immune system.1,2 Sufficient
stomach acid destroys harmful microbes and simultaneously provides
and stimuli required for the secretion of bile that sterilizes
the small intestine.1 Without an adequate production
of stomach acid, we
cannot maintain the necessary pH levels for optimal enzymatic activity
throughout the entire body, nor can we maintain a healthy bacterial
balance.5 Harmful bacteria, fungi, and parasites accumulate,
worsening the aforementioned digestive problems. These intractable
poison and damage the gastrointestinal tract, causing intestinal
permeability (leaky gut), which can lead to deep-seated autoimmune
throughout the entire body, nutritional deficiencies and oxidative
stress increase, causing maintenance, immune, and repair systems
to fail.5 By the time a person realizes that their diarrhea
or heartburn is not simply due to what they eat, it can take a
great deal of time
and effort to eliminate the layers of infection and toxicity, heal
the gastrointestinal tract, and develop good digestion.6,7
What can we do to prevent low stomach acid? How can people who
have battled to regain a healthy digestion keep it and never lose
A healthy digestion
depends on our innate ability to metabolize large amounts of oxygen.1,8
We cannot make stomach acid without the process of oxidative phosphorylation
in the oversized mitochondria in the stomach's parietal cells.9 Because
it goes against all chemical and electrical gradients, this process requires
substantial quantities of oxygen and calories to generate sufficient adenosine
triphosphate (ATP), our energy currency, to get the work done.1 However,
because of pollution and the destruction of trees, overall oxygen is steadily
Oxygen in the air in developed areas has decreased by at least 40% in the
last century.10 At the same time, our need for oxygen (to fight
infection, to reduce inflammation, to detoxify harmful chemicals, and to
make adrenal hormones)
has escalated. By improving the way one metabolizes oxygen, each of us
can have a much healthier digestion – indeed, a much healthier life.
Bear in mind that oxygen, like food, is a double-edged sword; it can cause
free radical damage.10,11 This is especially true when there
is insufficient antioxidant protection, which occurs with low gastric activity.5,12
I am particularly interested in this subject because I have been diagnosed
with a genetic inflammatory disease, variegate porphyria, that reduces
ability to metabolize oxygen.13 The subject is vast, so I will
limit the rest of this article to an aspect of oxygen metabolism that is
Have you realized to what extent our efficient use of oxygen depends on
the compound carnitine and on fatty acids and cholesterol? The following
recently became evident during my latest struggle with variegate, which
can make it difficult (and, for lengthy periods, impossible) to digest
1. Oxygen is useless when our cells cannot receive it to create energy.15
The flow of oxygen into cells is controlled by the correct balance
and availability, not only of eicosanoids formed from cell membrane
fatty acids, but also of adrenal hormones synthesized from cholesterol.16
These important regulators of the in-flow of oxygen also require oxygen
for their production.17
2. Heme is a protein which binds an oxygen molecule at its iron center;
it is absolutely essential for all of life's processes, including
the transport of oxygen to the tissues in the red blood cells' (RBCs)
hemoglobin.18 For example, heme is required for the intracellular creation
of energy, for the production of eicosanoids, adrenal hormones, and
bile. Heme is needed also for the production of carnitine, which transports
fatty acids into the cells' mitochondria, thereby increasing
energy production.19 (The oxidation of fatty acids provides significantly
more energy per carbon atom than does that of carbohydrates.20) A deficiency
of either of the amino acids lysine or methionine, or of vitamins C,
B6, niacin, or heme iron, causes a carnitine deficiency.16
3. The final enzymatic step in the biosynthesis of heme is stimulated
by fatty acids that
depend on carnitine.21,22 For an enzyme to function, it often needs to be "well
specific fatty acids.22 Research shows that palmitic acid and oleic acid (a
saturated and a monounsaturated fatty acid) stimulate the activity of the mitochondrial
ferrochelatase in the production of heme, but that linoleic acid (an omega-6
polyunsaturated fatty acid) inhibits ferrochelatase.22,23
Fat is so vital for the functioning of our bodies that excess carbohydrates
and even excess protein ends up as fat.22 When newly made, fat is saturated
fat, most of which is palmitic acid.24 If sufficient palmitic acid
is available, it can be elongated by further enzymatic activity to
form unsaturated fatty acids such as oleic acid.22 The biosynthesis
of fatty acids and cholesterol declines when sufficient quantities
are assimilated from our diets.22 People who don't consume (or
digest) enough fats and oils often have all of the saturated and unsaturated
fat and cholesterol that they need, but they are probably
deficient in essential polyunsaturated omega-6 and omega-3 fatty acids,
linoleic and alpha-linolenic acid, that regulate the RBCs' transport
of oxygen (but cannot be synthesized).11,16,22 Scientists recommend
that we ingest 30% of our dietary calories as fat. At least two to
three percent of these calories must be in the form of omega-6 fatty
acids, and at least one percent to 1.5% in the form of omega-3 fatty
acids.22 The structure and health of all cells depend on the saturated
and unsaturated fatty acids and cholesterol in their membranes.22,25
Cholesterol (which is an alcohol, not a fat) is a very important component
of cellular membranes.22 For example, 25% of a healthy RBC's
membrane lipid is cholesterol, and it gives RBCs their resilient discoid
shape.25 Unlike fats and oils, cholesterol does not need to be digested
or broken down into smaller particles, nor does cholesterol provide
us with energy. It is, however, essential for use as a tissue repairer,
as an antioxidant, in the skin as a substrate for provitamin D3, and
as a precursor for bile acids and many important hormones. We cannot
ingest enough cholesterol to supply our daily needs.22 The liver and
other organs and cells actively synthesize cholesterol from acetylCoA,
which is also a central intermediate for synthesizing fatty acids.26
The "anti-stress vitamin" pantothenic acid is vital to
the structure of acetylCoA and also to that of heme and the neurotransmitter,
acetylcholine.22,27 For people under stress, or those with high insulin
levels (whose cholesterol level is usually high), and for vegans (because
cholesterol is found in the lean tissue of animals), the biosynthesis
of cholesterol is much more active.22
However, for numerous reasons, people with low stomach acid can have difficulty
not only digesting fat, but also properly metabolizing and synthesizing cholesterol
and fatty acids.
With low stomach acid, many deficiencies develop and the necessary substrates – cofactors
and enzymes for fatty acid and cholesterol metabolism – become deficient.
For example, an adequate production of hydrochloric acid is necessary for the
secretion and activation of the proteolytic (protein-digesting) enzyme pepsin.1,28
Pepsinogen (the inactive form of pepsin) is synthesized in pyramid-shaped chief
cells at the base of the same glands in the fundus and corpus regions of the
stomach that also house the parietal cells that produce hydrochloric acid.1
Pepsin needs an extremely acid working environment; the optimal pH for pepsin
is 1.0 to 2.0.28 A healthy stomach produces enough hydrochloric acid to dissolve
a meal; the acid coats and permeates the food, taking the stomach's enzymes,
such as pepsin, with it.1,29
Normally, we absorb 90% of the sodium and potassium in our diet.30 Because
nature abhors a vacuum, especially a charge separation, positively charged
sodium and potassium ions take the place of hydrogen and chloride ions when
they are secreted, and then they combine to form hydrochloric acid in the stomach's
lumen.1,31 By doing so, these ions constitute what is known as the "alkaline
tide" in the bloodstream during meals.31 When the stomach's acidic "chyme" empties
into the duodenum, it stimulates the secretion of neutralizing sodium/potassium
alkali from cells that line the tunnels in the pancreas from Brunner's
glands in the duodenal wall, and also an alkaline bile from the gall bladder,
providing for further necessary digestive activity.1
All these steps, required for an adequate digestion, become defective with
low stomach acid.11 The small intestine, being deficient in alkali,
is too acid, inhibiting the activity of pancreatic enzymes such as lipase,
a pH of 6.0 to 8.0.28 The common bile duct cannot empty properly
because the pylorus (or small intestine's opening) is in spasm.32 In
a stagnant gall bladder that is deficient in choline, iron, and vitamin C,
gall stones form.5,33
There are also deficiencies of the essential cofactors, chromium, copper, and
manganese-reducing protective HDL cholesterol levels.16,34 Low HDL
causes far more heart disease
in the United States than does high cholesterol.35 The absorption of these
(and other) trace minerals is facilitated by chelating amino acids and by a
number of proteins, including a transporter protein called divalent metal transporter
1 (DMTI).36,37 Because amino acids and endogenous proteins, such as DMT1,
are missing in the gastrointestinal tracts of people with low stomach acid,
mineral deficiencies develop. The production of all endogenous proteins (including
lipase) depends on the minerals, co-enzymcs, and amino acids that sufficient
stomach acid provides.38 When there is a higher concentration of ionic copper
in the intestine than in the bloodstream, it diffuses through narrow cellular
junctions in the intestinal wall.39 However, even this passive form of absorption
fails in an inflamed intestinal tract that is often found with long-term low-gastric
Without sufficient stomach acid, food stagnates, ferments, and encourages the
growth of intractable bacterial infections.2 Constant use of antibiotics interferes
with the production of biotin that is manufactured by intestinal bacteria.40
Biotin is the coenzyme of the first committed enzymatic step in the manufacture
of fatty acids.24 People with stomach disease or with the inflammatory diseases
that accompany poor digestion have been noted to have "poor biotin status.40
All the B complex vitamins are vital for the metabolism of fatty acids and
cholesterol, and they all become deficient with low stomach acid because, for
the above reasons, zinc is missing and is required for their absorption.41
Biotin, pantothenic acid (B5), niacin (B3), and riboflavin (B2) are especially
needed for the synthesis of fatty acids and cholesterol.24,42
The liver becomes overburdened and congested with the deficiencies and toxic
byproducts of digestive disease and with the accompanying infections.41 Toxins
accumulate when the oxygen level is low, because the enzymes and oxygen required
to neutralize and remove them are missing.19 The liver stores environmental
toxins that it
cannot break down in its lower lobe. This is the same place where fatty acids
and fat-soluble vitamins A, D, E, and K are stored for the production of cholesterol
and hormones.2 Most of the cholesterol we make is synthesized by the liver.22
Enzymes that metabolize toxic chemicals are also required to synthesize hormones
and bile acids.44 In my case, after many years with low stomach acid, I had
no appetite for meat, had an allergy to eggs, and had a total serum cholesterol
level that hovered around 100, resulting in a low cortisol level and rampant
When I cannot digest fat and I fail to take carnitine, I can become very weak
and tired.14,l6 My cells arc probably deficient in energy or ATP and are lacking
the essential, unsaturated fatty acids that help to keep cell membranes fluid.
The fluidity of cell membranes is very important; it determines what can go
in and come out of each cell. For example, plasma membrane fluidity increases
cell receptor sensitivity to insulin.11 Sufficiently fluid membranes are also
necessary for the signaling of the immune system and to protect nerves from
damage.45 We need to assimilate polyunsaturated omega-3 and omega~6 fatty acids
each day, because we cannot synthesize them, They are vital for the production
and balance of the aforementioned oxygenating messengers, the eicosanoids,
and are needed for proper cell division, kidney function, and brain development.46
As one who has struggled with chronic infections, inflammation, and heart disease,
I have learned to respect the healing power that an improved ratio of essential
fatty acids provides.47 Simply by increasing the intake of omega-3
oils, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in
and by restricting omega-6 oils, such as soy and corn oil, our diets become
more like those of our ancestors.48 When humans were hunting, fishing,
and food gathering, they ate foods containing omega-6s and omega-3s in a ratio
of about 2.5:1.11,48 Researchers have found that an excess of omega-6 fats
from cereals, processed foods, especially from vegetable oils and spreads,
increases the risk of inflammatory diseases, such as asthma and eczema, and
also the possibility of neurological and degenerative diseases. Studies suggest
an improved ratio of fatty acids benefits patients with inflammatory bowel
disease, rheumatoid arthritis, as well as osteoarthritis, heart disease, diabetes,
stroke, and some cancers (breast, prostate, and colon).11,48,49,50 These conditions
have been repeatedly linked with a low oxygen level and with low stomach acid.3,10
All dietary fats provide energy; however, the essential omega-6 and omega-3
fatty acids are important oxygenating components of nerve cells and cell membranes,
and they need to be not only consumed but also assimilated daily.16,22
The long-chain, omega-3 polyunsaturated fatty acids EPA and DHA, found most
abundantly in fish oil and cod liver oil, and an omega-6 intermediate polyunsaturated
fatty acid, gamma-linolenic acid (GLA), found in borage and black currant oil,
are in the forms the body requires to produce anti-inflammatory prostaglandins
(which are eicosanoids).22 As you probably know, prostaglandins are potent,
hormone-like chemicals that act locally in the regulation, oxygenation, and
protection of most bodily tissues.46 Ideally, we should be able to produce
EPA and DHA from dietary alpha-linolenie acid, and GLA from linoleic acid.
However, there must be sufficient levels of amino acids, heme iron, saturated
fat, vitamin C, niacin (B3), pyroxidine (B6), zinc, and magnesium, as well
as a healthy pH (acid/alkaline balance) for these enzyme dependant conversions
to occur; therefore, they too are adversely affected by low stomach acid.5,16,17,22
Enzymes convert omega~6 fatty acids approximately four times more slowly than
they do omega-3 fatty acids, and both kinds of fatty acids compete for the
same enzymes.46,51 To minimize this problem and to reduce the synthesis
of pro-inflammatory compounds, such as cytokines IL-1 and tumor necrosis factor,
scientists have shown that there needs to be a sufficient consumption of fish
oil. In a 1998 study, KM Brown, et al. showed that there also needs to be an
adequate intake of vitamin E to protect cell membranes and dietary fats from
oxidation.51 For example, if you consume one-and-a-half tablespoons of cod
liver oil, you need to take 400 IU of vitamin F with it.52 The best form of
supplemental vitamin E is the natural d-alpha form that contains the mixed
tocopherols and the tocotrienols.53
What do you do when you cannot digest any of these essential nutrients and
you have an inflammatory disorder? Patients can request – from a physician
skilled in natural medicine – a Heidelberg capsule test (which shows
the stomach's exact pH) or a Comprehensive Digestive Stool Analysis (which
shows how well food is being digested) to find out whether they have hypochlorhydria
(low stomach acid) or achlorhydria (an inability to produce any stomach acid
at all). If they have either, they can, with their doctor's guidance,
readjust their stomach's acidity and the accompanying poor pH throughout
their intestine and tissues.3,8 By testing certain reflex points,
a good chiropractor could also help them to determine, and successfully treat,
acidity.54 In addition, consider being tested for heavy metal toxicity,
celiac disease, Helicobacter pylori, candida albicans, and parasites.5,55
During an extremely stressful 550-mile pilgrimage upstream to their spawning
ground in British Columbia, the sockeye salmon keep to the parts of the river
where the water current is strongest. This allows the water to push life-giving
oxygen over their gills.56 Like the salmon, we need to find ways to improve
our oxygen metabolism during what can be a stressful pilgrimage: recovering
from long term low stomach acid.57
In addition to the nutrients available in an easily assimilated or injectable
form, the following supplements may be helpful: Betaine HCl with pepsin acidifies
the stomach and is best taken under the supervision of a knowledgeable physician.
Never take anti-inflammatory medication at the same time as HCl.3 In
fact, anti-inflammatory medicines, such as aspirin, prevent the production
and significantly impair the healing process.58 Persistent use of
anti-inflammatory medicine (or a severe prostaglandin deficiency) has been
associated with gastrointestinal
bleeding, kidney and liver damage, heart problems, and aseptic necrosis.59,60
Because betaine HCl or hydrochloric acid can damage or destroy non-enteric-coated
combined enzymes and probiotic formulas, it is most helpful to take these supplements
with a glass of water about half an hour before meals.1,8 Ten or
more drops of herbal bitters can be diluted in a little water and sipped slowly
before meals.61 A combination of acetyl-l-carnitine (2 x 500 mg)
and (R)-lipoic acid (2 x 100 mg) increases energy; sublingual NADH (2 x 5 mg)
does the same.7,62
SAMe (800 mg to 1 ,600 mg a day) helps the liver to detoxify.16 When
the digestion has been corrected and nutrient levels have been restored, an
as the Vitamin Research Company's EnteraKlenz™ helps to detoxify
the gastrointestinal tract, reducing inflammation.7 Coconut oil
is highly effective against inflammation and is also rich in the antimicrobial
fatty acid, lauric
acid.22 MCT oil, which is man-made, is recommended for people with
lymphatic abnormalities, instead of other fats and oils, but is not for patients
3637 Serra Road
Malibu, CA 90265
Prostaglandin and Essential Fatty~Acid Sources
In order to reduce inflammation: a) restrict omega-6 fatty acids,
e.g., regular sunflower and safflower oils and animal products; b)
avoid trans-fatty acids in partially hydrogenated vegetable oils, e.g.,
corn, soy, cottonseed, and canola oil; and c) increase omega-3 fatty
acids, e.g., flaxseed, pumpkin seed, salmon, and sardines.
Prostaglandin Chart is coming. . .
Acknowledgment: I would like to thank North Atlantic Books for giving
permission to adapt page 132 of Healing with
Whole Foods by
Paul Pitchford, in order to provide the Prostaglandin Chart.
Also read Judy Kitchen's "An
Easy Way to Evaluate Digestion."
References (NOTE: Author's
been contacted to update links. 3/20/06)
1. Gershon, Michael. The Second
York, NY: Harper and Collins; 1999.
2. Lipski, Elizabeth. Digestive Wellness.
Connecticut: Keats Publishing; 1996, 2000.
3 Wright, Jonathan and Lane Lenard. Why Stomach Acid Is Good
New York: M, Evans and Company, Inc.; 2001.
4. Pizzorno, Joseph. Total Wellness.
California: Prima Publishing, 1996.
5. Kitchen, J. Hypochlorhydria: a review, part I. TLDP.
6. Private communication.
7. Personal experience.
8. Kitchen, J. Alkalinizing diet for anemia. TLDP.
9. lllingworth, John A. Bioenergetics: oxidative phosphorylation. School
of Biochemistry & Molecular Biology, University of Leeds, England.
Available at: www.bmb.leeds.ac.uk/Illingworth/oxphos.9/30/2003.
10. Ali, Majid. Oxygen and Aging.
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11. Rosedale, R. Insulin and its metabolic effects. Presented at Designs
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12. Kitchen, J. Shingles. TLDP.
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14. With variegate porphyria (an inherited disorder of heme metabolism)
the toxic accumulation of protoporphyrins in bile increases the incidence
of gall bladder disease.
Poh-Fitzpatriek, M. Variegate porphyria. Available at: http://www.emedicine.com/der/topic450.htm
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57. I recommend that you read the following very helpful reviews:
Alleger, I. Hands-on medicine produces miraculous cures. TLDP.
Klotter, J. Breath control for stress. TLDP.
58. Rudnick DA, Perlmutter DH, Muglia U, Prostaglandins arc required
for CREB activation and cellular proliferation during liver regeneration, Early
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61. Bone, Kerry. The story of bitters. Nutrition & Healing.
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