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Indigestion, Antacids, Achlorhydria and H. Pylori. by Michael T

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Indigestion, Antacids, Achlorhydria and H. Pylori. by Michael T FEATURE ARTICLE Indigestion, antacids, achlorhydria and H. pylori. by Michael T. Murray, N.D. digestive aids include hydrochloric Perhaps the most effective treatment of used to describe a feeling of acid and pancreatic enzyme prepara- chronic reflux esophagitis is to utilize Thegaseousness term "indigestion" or fullness is in often the tions. This article will take a critical look gravity. The standard recommendation abdomen. It can also be used to describe at the use of these agents and contrast is to simply place four-inch blocks "heartburn." Indigestion can be attributed their use with natural digestive aids. The under the bedposts at the head of the to a great many causes, including not topic of H. pylori will also be addressed. bed. This elevation of the head is very only increased secretion of acid but also effective in many cases. decreased secretion of acid and other General considerations Another recommendation to heal digestive factors and enzymes. The A 1983 article in the American the esophagus is using deglycyrrhizinated dominant treatment of indigestion is the Journal of Gastroenterology asked the licorice (DGL). Although DGL is primarily use of over-the-counter preparations. question "Why do apparently healthy used for treating peptic ulcers, I have These preparations include antacids people use antacids?"1 The answer: used it clinically in cases of heartburn which work by binding free acid, and reflux esophagitis, the medical term with success. DGL is further discussed drugs like Tagamet, Zantac, and Pepcid for heartburn. Reflux esophagitis is below. which inhibit the release of antacids by most often caused by the flow of gastric blocking histamine (H2) receptors juices up the esophagus leading to a Common antacid medications including antacids. burning discomfort that radiates upwards All antacids are relatively safe when The stomach's optimal pH range is and is made worse by lying down. used on an occasional basis for heartburn 1.5 to 2.5 with hydrochloric acid being Reflux esophagitis is most often caused or indigestion. Taken regularly, however, the primary stomach acid. The use of by overeating (remember that old Alka- they can lead to malabsorption of antacids and H2-receptor antagonists Seltzer theme: I can't believe I ate the nutrients, bowel irregularities, kidney will typically raise the pH above 3.5. whole thing?). Other common causes stones, and other side effects. There are This increase effectively inhibits the include obesity, cigarette smoking, several approved types of antacids. action of pepsin, an enzyme involved chocolate, fried foods, carbonated Each of these types are discussed below. in protein digestion that can be irritating beverages (soft drinks), alcohol, and Aluminum containing compounds: to the stomach. Although raising the pH coffee. These factors either increase Aluminum containing antacids include can reduce symptoms, it must be pointed the pressure within the stomach, thereby Maalox, Rolaids, Digel, Mylanta, Riopan, out that hydrochloric acid and pepsin causing the gastric contents to flow Wingel, Amphogel and AlernaGel. are important factors in protein digestion. upwards, or they decrease the tone of Although these antacids are potent and If their secretion is insufficient or the sphincter between the stomach effective in neutralizing acid, there are inhibited, proper protein digestion and and the esophagus that normally prevents some significant long-term safety mineral disassociation will not occur. gastric reflux into the esophagus. The concerns. There is ever-growing evidence In addition, the change in pH can first step in treating reflux esophagitis to indicate that aluminum may play a adversely affect gut microbial flora is prevention. In most cases this step role in impairing mental function as well including the promotion of an overgrowth simply involves eliminating or reducing as in diseases of the nervous system of Helicobacter (H.) pylori. Therefore, the causative factor. including Alzheimer's disease, dialysis it is important to use antacids wisely and For occasional heartburn, antacids dementia, Parkinson's disease, and sparingly. may well be appropriate. However, Lou Gehrig's disease (amyotrophic In addition, many nutrition-orien- they should not be abused. If heartburn lateral sclerosis).2-4 Although manufac- tated physicians believe that it is not too is a chronic problem it may be a sign turers and the FDA tell us that the much acid, but rather a lack of acid, that of a hiatal hernia, the out-pouching of aluminum in antacids is not absorbed, is the problem. Typically, in addressing the stomach above the diaphragm. this appears to be fraudulent infor- indigestion, naturopathic physicians However, it is interesting to note that mation as absorption studies prove use measures to enhance rather than only 5% of patients with hiatal hernias otherwise even when low-dose therapy inhibit digestion. Commonly used actually experience reflux esophagitis. is used.5-7 Absorption of aluminum is Vol. 4, No. 1 * January/February 1997 American Journal of Natural Medicine 11 greatly enhanced if the meal contains in stomach acid.8 Patients with insuf- magnesium hydroxide in water. In any citrus fruit, orange juice, soda, or ficient stomach acid output can only addition to acting as a mild antacid, other sources of citric acid. The bottom absorb about 4% of an oral dose of magnesium hydroxide also exerts a line is there is no reason to use the calcium as calcium carbonate, while laxative effect. It is a safe and effective aluminum-containing antacids at this a person with normal stomach acid product for people with normal kidney time as the potential risk far outweighs can typically absorb about 22%.9 function, though diarrhea is a definite the short-term benefit. Patients with low stomach acid secretion risk. Sodium bicarbonate: Sodium bicar- need a form of calcium already in a H2-receptor antagonists: These bonate is baking soda. Alka-Seltzer is soluble and ionized state, like calcium drugs work to block the action of simply ordinary baking soda in an bound to Krebs cycle intermediates histamine on the secretion of stomach effervescent form. Although sodium (e.g., citrate, malate, succinate, and acid. Histamine normally acts on the bicarbonate can be useful in short- fumarate) or lactate and aspartate. acid secreting cells of the stomach in term therapy, it is not indicated for About 45% of the calcium is absorbed a manner which results in the secretion chronic or prolonged therapy due to the from calcium citrate in patients with of stomach acid. By blocking this risk of sodium overload. In addition, reduced stomach acid compared to effect of histamine, stomach acid because the bicarbonate ion is rapidly 4% absorption for calcium carbonate. output is greatly reduced. Examples of absorbed, long-term administration It has also been demonstrated that H2-receptor antagonists include can cause systemic alkalosis (excessive calcium is more bioavailable from cimitidine (Tagamet), ranitidine (Zantac), pH throughout the body). This can calcium citrate than from calcium famotidine (Pepcid), and nizatidine lead to the formation of kidney stones, carbonate in normal subjects as well.10 (Axid). nausea, vomiting, headache, and mental The strong alkaline nature of confusion. Recently the makers of these drugs carbonate combined with the calcium were able to successfully encourage the Calcium carbonate and calcium that is absorbed greatly increases the FDA to make them available over-the- citrate: An example of a calcium risk of kidney stones, especially if milk counter. As a result, I believe we may carbonate containing antacid is Turns. products are a regular part of the diet. see more problems with digestive Although fast-acting and potent, calcium In contrast, the chemical nature of disturbances and other side effects carbonate can produce what is known citrate is to actually prevent kidney caused by these drugs. Since H2- as acid rebound three or four hours after stones from developing.11 This along receptor antagonists block a vital bodily use. This means that the body will try with its superior absorption clearly function involved in digestion, digestive to overcompensate the neutralization demonstrates that calcium citrate is disturbances are quite common and can of gastric acid by secreting even more much more beneficial than calcium include: nausea, constipation, and acid. This is not viewed as being clini- carbonate as a calcium supplement. In diarrhea. Nutrient deficiencies can cally significant in the treatment of addition, calcium citrate may be the best appear as a result of impaired digestion. indigestion, but it may play a role in antacid as well. Calcium citrate is Other possible side effects include: delaying ulcer healing. showing impressive results as an antacid bacterial overgrowth (including Many physicians have been recom- (phosphate binder) in patients with overgrowth of Helicobacter pylori), mending Turns as a calcium supplement. kidney disease.12 It is much better liver damage, allergic reactions, In fact, calcium carbonate is the most tolerated than aluminum-containing headaches, breast enlargement in men, widely used form of calcium supplement. antacids. Although I am not aware of hair loss, osteoporosis, dizziness, While calcium carbonate is an effective any calcium citrate preparations being depression, insomnia, and impotence. antacid, there are better forms of marketed as antacids, preparations of calcium for supplementation. calcium citrate or other
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