Is Gastroesophageal Reflux a Disease or Disorder?
NUTRITION
Howard Loomis
A disease is a pathological process that can be identified with objective evidence. It may be seen on an MRI or X-ray, heard through a stethoscope, identified with an EKG, or perhaps be suspected by palpating a breast lump or enlarged prostate gland. A disorder is a normal physiological process that is going too fast or too slow, or is otherwise out of time with another normal body process.
One of the most common problems seen in chiropractic offices today is poor digestion. The patient is usually taking OTC or prescription medications for the problem. In fact, medically, all digestive complaints are treated by stopping the production of stomach acid without determining the cause of heartburn, gas, or bloating. There simply are no blood tests to determine whether the problem originates in the stomach, duodenum, biliary system, pancreas, or jejunum.
Unfortunately, the problem is so common that it is simply overlooked as a component of any other dysfunction the patient is experiencing. It may be a good idea to look at the immediate consequences of these medications on the digestive organs and long-term effects on the rest of the body. For example, how many of your patients present with symptoms of protein deficiency, such as edema, cold hands and feet, and muscle cramps at rest?
If a patient is using a stomach acid blocker of any kind, has only symptoms of indigestion and heartburn, and does not have a diagnosis of digestive pathology, do you have an alternative that would restore normal digestive function? Yes!
Let’s begin by stating that stomach acid does not digest food, and it certainly cannot digest enzymes just because they contain protein. In fact, stomach acid activates a protein-digesting enzyme (pepsinogen) and maintains the pH of stomach contents between 3.0 to 5.0 so the activated form (pepsin) can begin the digestion of protein.
Normalizing Digestion without OTC or Prescription Drugs
Supplemental food enzymes taken with meals can assist the body with normal digestion and therefore relieve the fear of side effects with long-term use. After chewing and swallowing salivary enzymes, supplemental food enzymes begin digestion and continue it until stomach acid production is initiated by the stretching of the stomach. On average, it takes young healthy adults 45 minutes for stomach acid to form and begin activating pepsinogen.
‘ ^ Let's begin by stating that stomach acid does not digest food, and it certainly cannot digest enzymes just because they contain protein. J J
A considerable amount of predigestion can take place in that time. For example, at least 35 to 45% of starch can be digested just by file action of salivary enzymes. More than 70 years ago, a series of experiments found that an average of 59 to 76% of ingested carbohydrates is digested within 15 to 30 minutes after a meal.1 More recent references place the range between 3 5 to 45%.2
Unfortunately, the amount of time necessary to make stomach acid increases with age. Studies have proven that older adults often suffer from inadequate stomach acid levels, so predigestion with plant enzymes becomes even more necessary as we age.
There is a common misconception that stomach acid digests food enzymes because they contain protein. The truth is nothing can digest or even denature an enzyme. The basic science taught in all physiology classes tells us stomach acid does not perform digestion at all. In fact, stomach acid only serves to activate the protein-digesting enzyme pepsinogen
into pepsin, beginning the £ £ process of protein digestion.
Regardless, plant or food enzymes are not destroyed by the highly acidic environment of the stomach. They simply
become dormant until reaching the higher pH levels in the small intestine (above 3.0), where they again become active and continue the digestive process. Once their digestive function in the gastrointestinal tract is completed, a large number of enzymes are absorbed through the gut wall into the bloodstream.
OTC and Prescription Drugs for Digestive Symptoms
The reality is that many of your patients are taking medication for GERD. So, how exactly do these medications work?
Antacids
Antacids, including baking soda, neutralize the acid in the stomach after it is produced. Despite the development of potent medications for the treatment of GERD, antacids remain a mainstay for symptomatic relief.
Histamine Antagonists (H2 blockers)
Although antacids can neutralize acid, they do so for only a short period of time. The first medication developed for more effective and convenient treatment of acid-related diseases, including GERD, was a histamine antagonist (Tagamet).
Unfortunately, the amount of time necessary to make stomach acid increases with age.JJ
Histamine is important because it stimulates acid production. Released within the walls of the stomach, histamine stimulates the production of stomach acid by attaching to receptors on the stomach's acid-producing cells (parietal or oxyntic cells). Histamine antagonists work by blocking the receptor for histamine and thereby preventing stimulation of acid-producing cells.
H2 blockers are very good for relieving the symptoms of GERD, particularly heartburn. However, they are not very good for healing the inflammation (esophagitis) that may accompany GERD. In fact, they are used primarily for the treatment of heartburn not associated with inflammation, such as erosions or ulcers, strictures, or Barrett's esophagus.
Commonly used H2 blockers include Tagamet® (cimetidine), Zantac® (ranitidine), Axid® (nizatidine), and Pepcid® (famotidine).
Proton Pump Inhibitors
The second type of drug developed specifically for acidrelated diseases were proton pump inhibitors. PPIs block the secretion of acid by shutting off the exchange of sodium, potassium, and chloride ions during acid production. They are more effective for a longer period of time than H2 blockers.
PPIs are used when H2 blockers do not relieve symptoms adequately or when complications exist, such as erosions or ulcers, strictures, or Barrett's esophagus.
Five different PPIs are approved for the treatment of GERD, including Prilosec® (omeprazole), Prevacid® (lansoprazole), Aciphex® (rabeprazole), Protonix® (pantoprazole), and Nexium® (esomeprazole).
In addition to malabsorption of nutrients, other common side effects of PPIs include the following:
• Headaches
• Joint pain
• Rash or other skin issues
• Anxiety
• Dizziness
• Constipation
• Severe diarrhea
Since 2010, die US Food and Drag Administration (FDA) has released warnings that PPIs can contribute to the following conditions:
• Diarrhea associated with C. difficile infection
• Low magnesium levels
• Risk of fractures of the hip, wrist, and spine (hypocalcemia)
“In fact, stomach acid only serves to activate the protein-digesting enzyme pepsinogen into pepsin, beginning the process of protein digestion.
Protein Digestion: Essential for Health
Now that we know some side effects of these medications, we need to ask another question. What happens if you turn off stomach acid production or neutralize it after it is produced? We have already stated that stomach acid serves to activate the protein-digesting enzyme pepsinogen into pepsin, beginning the process of protein digestion. This means that protein digestion will be diminished. The implications of this for the body are vast. For example, following are some signs of protein deficiency that may begin to show up after long-term use of OTC and prescription medications for digestive disorders:
• Increased secretions in mouth/nose/eyes
• Water gain
• Swelling in hands and feet
• Cold hands and feet
• Muscle cramps at night
• Menstrual cramps
• Bleeding gums
• Patient does not tolerate exercise
As we have stated, medically, all digestive complaints are treated by stopping the production of stomach acid without determining the cause of heartburn, gas, or bloating. There is a better way.
Sources:
1. Bergeim, O. Intestinal Chemistry III. Salivary Digestion in the Human Stomach and Intestines. Archives of Internal Medicine (Chicago). 1926; 27(1): 110-117.
2. Guyton, A. C. (1991). Guyton textbook ofmedical physiology. Philadelphia, PA: Saunders Elsevier.
Dr. Loomis has an extensive background in enzymes and enzyme supplements. He is the founder and president of the Food Enzyme Institute. His extensive knowledge of physiology, biochemistry, and enzymology has made him a sought-after speaker and a prolific writer. The Food Enzyme Institute offers seminars to healthcare practitioners around the country. Dr. Loomis published ENZYMES: The Key to Health in 1999. He also co-authored andpublished The Enzyme Advantage: For Healthcare Providers and People Who Care About Their Health in 2015, and The Enzyme Ach’antage for Women in 2016, with respected medical journalist Arnold Mann. Contact info: 6421 Enterprise Lane, Madison, WI 53719 customer serviced)))bodenzymeinstitute.com, 800-662-2630.
