Here’s another persistent patient story, a woman who endured years of symptoms and no definite answers. Then, six months ago, when her symptoms went into high gear, she knew she had to do something.
I first met Claudia, a bright, healthy looking woman, just a few weeks ago. She told me her longstanding digestive symptoms had started in her teens, manifesting as bloating, gas, and nausea after meals. Despite being written off as irritable bowel syndrome, she could detect no correlation to stress or food sensitivities. For Claudia, eating itself was never a pleasurable experience. In fact, once after a particularly stressful relationship when she became depressed and briefly stopped eating much at all, her digestive symptoms actually went away.
In her thirties, by avoiding junk foods she did a little better, but she was never “just fine.” Then, out of the blue, about six months ago, she began having a truly awful taste in her mouth, described as “bitter, sour, acid-y, disgusting!”
Again she played detective and tried to locate culprit foods, but she could find nothing consistent. By eating small meals, the vile taste would relent for a couple hours, but inevitably it would return. Claudia also mentioned she’d been having chronic vaginal yeast infections every four or five weeks, each severe enough to require treatment.
She took her problems to a gastroenterologist who suggested she take Nexium (to block acid production), but it had absolutely no effect. Then she underwent a gastroscopy, the doctor finding some redness in her esophagus consistent with gastroesophageal reflux disease (GERD, aka acid reflux or heartburn). He told her to double her Nexium. When Claudia tried it, her symptoms dramatically worsened. He suggested she keep taking the Nexium, but she chose not to and cancelled further appointments with him.
Next Claudia went to her colon therapist, my friend Alyce Sorokie at Partners in Wellness, who, after listening to her symptoms, suggested she try a particular supplement. Within a few days Claudia felt fine, the vile taste gone and her digestive misery also a memory. She felt better than she had in years. Not to disparage her gastroenterologist, but if he’d seen the supplement, he would have had his own “Aha!” moment and understood why his Nexium made everything worse. He also might have suggested some additional testing that would have been both uncomfortable and expensive, but wouldn’t have changed Claudia’s treatment one iota.
Claudia had made an appointment with me prior to receiving her supplement from Alyce, wanting an MD to explain just what was going on and why she needed this particular supplement. I explained that what she had was called hypochlorhydria, the medical term for when a person’s stomach isn’t producing enough acid to digest food. It’s actually far more common than people realize. The cause can be genetic or secondary to a separate condition, like hypothyroidism (low thyroid) or an autoimmune disorder that destroys the acid-producing cells in the stomach.
Most often, because people have varying amounts of stomach acid, hypochlorhydria just appears, sometimes starting early in life as mild chronic indigestion and then slowly worsening.
The condition is not all that easy to diagnose, and probably explains why hypochlorhydria is often overlooked as a possible cause of digestive symptoms. Strictly speaking, to diagnose it the doctor needs a rather expensive device called a Heidelberg machine that measures the acidity (pH) of the stomach. When I telephoned two gastroenterologists, neither owned one. Interestingly, when gastroenterologists are down there in your stomach with their gastroscopes, they’re endlessly looking for evidence of too much acid (“redness,” “ulcers”) and hunting for the ulcer-causing bacterium Helicobacter pylori (H. pylori), but they don’t check for insufficient acid.
Also, probably in response to the bloated advertising budgets of Big Pharma, gastroenterologists (and family practitioners and internists as well) routinely prescribe the acid-reducing drugs called proton pump inhibitors (PPIs)—including Nexium, Prevacid, AcipHex, and Dexilant–for just about every digestive symptom known.
As you might have guessed, because the job of PPIs is to reduce stomach acid, giving a PPI to someone with hypochlorhydria only makes matters worse, as it did when Claudia doubled her Nexium dose. In addition, deigning to recommend something as mundane as a nutritional supplement is beneath the dignity of most gastroenterologists, so patients with hypochlorhydria often go untreated for years.
Your impressive GI tract
To understand Claudia’s symptoms, picture your gastrointestinal (GI) tract as the long continuous tube it is, one end of which you wipe with a linen napkin, the other with Charmin. The GI system is really an external organ, a continuation of your skin (note how it turns inward at your lips). Gastroenterologists jokingly think of themselves as hard-working dermatologists.
When you take a bite of anything–from a Big Mac to that $500 meal over at Alinea–your teeth grind the food to a pulp that your mouth mixes with digestive enzyme-laden saliva, and after a few seconds it all plunges southward toward your stomach. Yes, there’s something undeniably ephemeral about fine dining. Once in your stomach, the whole mess is churned with pure hydrochloric acid and still more enzymes into a thick sludge called chyme (pronounced kim with a long i). Burger King chyme and Alinea chyme would be visibly indistinguishable from each other, but fortunately everything is far removed from your visual field and you can continue to enjoy your meal.
Your stomach then forces the chyme into the 22 feet of your small intestine for further digestion plus the absorption of all the nutrients you need to keep going in life. Once the nutrients have been extracted, the chyme is propelled into your large intestine, where excess fluid is extracted and…you know the rest.
With hypochlorhydria, the whole process grinds to a halt. Your chewed-up food is held in your stomach, feeling like dead weight, needing more acid to break it down and convert it to chyme. As Claudia described, the act of eating becomes distinctly unpleasurable. The vile taste she experienced comes from slowly putrefying food, sitting there. Vaginal Candida overgrowth is a common side effect of hypochlorhydria because inadequate acid throws off the balance of good and bad bacteria, allowing yeast to flourish. Not surprisingly, certain nutritional deficiencies also develop, notably vitamin B-12, which requires stomach acid to be absorbed.
A simple supplement restores Claudia to balance
The supplement Alyce handed Claudia was Betaine Hydrochloride (Betaine HCL). When taken about 30 minutes before a meal, it converts into enough stomach acid to digest food. Both Alyce and I often add digestive enzymes as well, and might also suggest beginning each meal with a teaspoon of bitter herbs to stimulate the body’s own acid and enzyme production.
One interesting sidelight of betaine is its use for people whose GERD has failed to respond to PPI acid blockers. While it’s extremely counterintuitive to add still more acid for a condition that seems to be caused by too much acid, when Alan Gaby, MD, author of Clinical Nutrition explains it, betaine makes sense. With hypochlorhydria, there is some acid present, but the stomach retains the chyme awaiting more. As the stomach keeps churning the food, even though the overall amount of acid is small the excessive churning causes some backflow of acid that’s experienced as reflux. Adding more acid (using betaine) signals your stomach to release the chyme into your intestine.
Thanks to a simple and inexpensive supplement, Claudia’s vile taste is now history. And her yeast infections too.
David Edelberg, MD