FEATURE ARTICLE

Indigestion, , 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 is to utilize Thegaseousness term "" 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 is using deglycyrrhizinated dominant treatment of indigestion is the Journal of 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 medications including antacids. burning discomfort that radiates upwards All antacids are relatively safe when The '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 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 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 , 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 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- 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 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). , 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 by secreting even more much more beneficial than calcium include: nausea, , 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 ), 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 calcium bound The natural approach to In order for calcium carbonate to other Krebs cycle intermediates are indigestion and other insoluble calcium salts to be widely available. Although some antacids are in assimilated they must first be solubilized Magnesium compounds: Magne- essence natural products and have an and ionized by stomach acid. This sium salts such as magnesium oxide, appropriate use in treating occasional requirement is where the problem hydroxide, and carbonate often appear indigestion, in most chronic cases a more arises with calcium carbonate for many in aluminum-containing products. critical look at the problem of indigestion individuals. In studies with post- Phillips Milk of Magnesia is the only is needed. In the patient with chronic menopausal women, it has been shown major brand that features only indigestion, rather than focusing on that about 40')/0 are severely deficient magnesium; it is a suspension of blocking the digestive process with

12 American Journal of Natural Medicine January/February 1997 * Vol. 4, No. 1 antacids, the natural approach to common cause of indigestion is a lack Diseases Associated with indigestion focuses on aiding digestion. of gastric acid secretion. Hypochlorhydria Low Gastric Acidity Digestion occurs as a result of both refers to deficient gastric acid secretion physical and chemical processes. The while achlorhydria refers to a complete • Addison's disease physical changes of food are brought absence of gastric acid secretion. • Asthma about by grinding, crushing, and mixing Many symptoms and signs suggest • Celiac disease of the food mass (chyme) with digestive impaired gastric acid secretion, and a • Dermatitis herpetiformis juices during propulsion through the number of specific diseases have been • mellitus digestive tract. Chewing food thoroughly found to be associated with insuffi- • Eczema is the first aspect of good digestion. It cient gastric acid output.13-24 These • is not only the mechanical effect, but are listed in the charts on this page. • Graves disease also important is the mixing of the food Several studies have shown that • Chronic autoimmune disorders with the saliva. Saliva contains the the ability to secrete gastric acid • enzyme salivary amylase (ptyalin) which decreases with age.25-27 Some studies • Chronic hives breaks down starch molecules into found low stomach acidity in over half • Lupus erythematosis smaller sugars. of those over age 60. The best method • Myasthenia gravis It is the role of the esophagus to of diagnosing lack of gastric acid is a • Osteoporosis transport food and liquids from the special procedure known as the • Pernicious mouth to the stomach. The stomach Heidelberg gastric analysis.28 This • Psoriasis primarily functions in the digestion of technique utilizes an electronic capsule • Rheumatoid arthritis proteins and ionization of minerals. attached to a string. The capsule is • Rosacea The stomach secretes hydrochloric swallowed and then kept in the stomach • Sjogren's syndrome acid, various hormones, and enzymes. with the aid of the string. The capsule • Thyrotoxicosis measures the pH of the stomach and • Hyper- and Hydrochloric acid (HCI) sends a radio message to a receiver • Vitiligo Although much is said about hyper- which then records the pH level. Dr. acidity conditions, probably a more Jonathan Wright believes the response to a bicarbonate challenge during or capsule. (One at the next meal, two Heidelberg gastric analysis is the true at the meal after that, then three at Common Signs and Symptoms test of the functional ability of the the next meal.) of Low Gastric Acidity stomach to secrete acid.29 After the 2. Continue to increase the dose until test, the capsule is pulled up from the you reach seven tablets or when • Bloating, belching, burning, and stomach by the string attached to it. you feel a warmth in your stomach, flatulence immediately after meals Since not everyone can have detailed whichever occurs first. A feeling of • A sense of fullness after eating gastric acid analysis to determine the warmth in the stomach means that • Indigestion, diarrhea or consti- need for gastric acid supplementation, you have taken too many tablets for pation a practical method of determination that meal, and you need to take one • Multiple food allergies is often used. If an individual is experi- less tablet for that meal size. It is a • Nausea after taking supplements encing any signs and symptoms of good idea to try the larger dose again • Itching around the gastric acid insufficiency as listed or has at another meal to make sure that it • Weak, peeling and cracked finger- any of the diseases listed, the method was the HCI that caused the warmth nails outlined below can be employed. and not something else. • Dilated blood vessels in the cheeks 3. After you have found that the largest and nose Protocol for hydrochloric acid dose that you can take at your large • Acne supplements meals without feeling any warmth, • Iron deficiency 1. Begin by taking one tablet or capsule maintain that dose at all meals of • Chronic intestinal parasites or containing 10 grains (600 mg) of similar size. You will need to take less abnormal flora hydrochloric acid at your next large at smaller meals. • Undigested food in stool meal. If this does not aggravate your 4. When taking a number of tablets or • Chronic candida infections symptoms, at every meal after that capsules it is best to take them • Upper digestive tract gassiness of the same size take one more tablet throughout the meal.

Vol. 4, No. 1 * January/February 1997 American Journal of Natural Medicine 13 5. As your stomach begins to regain the Another 19th century French H. pylori induced intestinal damage are ability to produce the amount of scientist, Claude Bernard, also made maintaining a low pH and insuring HCI needed to properly digest your major contributions to medical under- adequate antioxidant defense mecha- food, you will notice the warm standing. Only Bernard had a different nisms.33-35 Low levels of and feeling again and will have to cut view of health and disease. Bernard E and other antioxidant factors in the down the dose level, believed that the state of a person's gastric juice not only appear to lead internal environment or "milieu interieur" to the progression of H. pylori What causes hypochlorhydria was more important in determining colonization, but since the mechanism Like , disease than the organism or pathogen by which H. pylori damages the achlorhydria and hypochlorhydria itself. In other words, Bernard believed stomach and intestinal mucosa is via have been linked to the overgrowth of that the internal "terrain" or host suscep- oxidative damage, it also contributes the bacteria Helicobacter pylori. It has tibility to infection was more important to the ulcer-causing potential of H. been shown that 900/,) to 100% of than the germ. Physicians, he believed, pylori.36 Furthermore, antioxidant patients with duodenal ulcers, 70('/o should focus more of their attention on status and gastric acid output appears with gastric ulcers, and about 50% of making this internal terrain a very to be the answer to the question as to people over the age of 50 test positive inhospitable place for disease to flourish. why everyone infected with H. pyloni for H. pylori.30 Low gastric output is Bernard's theory led to some rather does not get peptic ulcer disease or thought to predispose to H. pylori interesting studies. In fact, a firm gastric cancer. colonization and H. pylori colonization advocate of the germ theory would As for how to eradicate the organism increases gastric pH, thereby setting up find some of these studies to be as well as stimulate increased host a positive feedback scenario and absolutely crazy. One of the most inter- defense factors, I recommend degly- increasing the likelihood for the esting studies was conducted by a cyrrhizinated licorice (DGL). DGL has colonization of the stomach and Russian scientist named Elie Metchnikoff, shown good results in healing both with other organisms.31 the discoverer of the white blood cell. duodenal ulcers and gastric ulcers. Interestingly, there has been only scant He and his research associates consumed Rather than inhibit the release of acid, research into the effects of antacids cultures containing millions of cholera DGL stimulates the normal defense and H2 -receptor antagonists on bacteria. Yet none of them developed mechanisms that prevent ulcer formation. promoting H. pylori overgrowth.32 cholera. The reason: Their immune Specifically, DGL improves both the If H. pylori leads to systems were not compromised. quality and quantity of the protective achlorhydria, the next obvious question Metchnikoff believed, like Bernard, substances which line the intestinal is what are the factors that lead to H. that the correct way to deal with infec- tract; increases the lifespan of the pylori gastritis? Consistent with history, tious disease was to focus on enhancing intestinal cell; and improves blood conventional medicine is obsessed the body's own defenses. supply to the intestinal lining.37,38 with the infective agent rather than During the last part of their lives, Numerous clinical studies over the host defense factors. This obsession Pasteur and Bernard engaged in scien- years have found DGL to be an effective really began with Louis Pasteur, the 19th tific discussions on the virtues of the germ anti-ulcer compound. In several head century physician and researcher who theory and Bernard's perspective on the to head comparison studies, DGL has discovered the antibiotic effects of internal terrain. On his deathbed, been shown to be more effective than penicillin. Pasteur played a major role Pasteur said: "Bernard was right. The either Tagamet, Zantac, or antacids in in the development of the germ theory. pathogen is nothing. The terrain is both short term treatment and mainte- This theory holds that different diseases everything." nance therapy of peptic ulcers.39-42 are caused by different infectious Unfortunately, Pasteur's legacy is The active components of DGL organisms. Much of Pasteur's life was the obsession with the pathogen and are believed to be special flavonoid deriv- dedicated to finding substances which modern medicine has largely forgotten atives. These compounds have demon- would kill the infecting organisms, the importance of the "terrain." So, strated impressive protection against Pasteur and others since him who what are the factors that predispose to chemically-induced ulcer formation pioneered effective treatments of infec- H. pylori overgrowth? Well, because in animal studies. A common question tious diseases have given us a great deal research focuses on eradicating the related to DGL is "Does DGL have for which we all should be thankful, organism there is little information on any effect on Heliobacter pylori?" The However, there is more to the equation protective factors against infectivity. of the virility of the organism. Proposed protective factors against Continued on page 16 14 American Journal of Natural Medicine January/February 1997 * Vol. 4, No. 1 Continued from page 14 responsible for keeping the small USP pancreatic enzyme product would intestine free from parasites (including be 500 to 1,000 mg three times a day answer appears to be yes. In a recent bacteria, yeast, protozoa, and intestinal study, several flavonoids were shown immediately before meals when used worms).45 A lack of proteases or other as a digestive aid and 10 to 20 minutes to inhibit H. pylori in a clear-cut digestive secretions greatly increases an concentration-dependent manner.43 before meals or on an empty stomach individual's risk of having an intestinal when anti-inflammatory effects are In addition, unlike antibiotics, the infection, including an overgrowth of desired. flavonoids were also shown to augment the yeast Candida albicans. Enzyme products are often enteric- natural defense factors which prevent Nutrition-oriented physicians use ulcer formation. The activity of flavone, coated, that is they are often coated to both physical symptoms and laboratory prevent digestion in the stomach, so that the most potent flavonoid in the study, tests to assess pancreatic function. was shown to be similar to that of the enzymes will be liberated in the small Common symptoms of pancreatic insuf- bismuth subcitrate. intestine. However, non-enteric-coated ficiency include abdominal bloating and enzyme preparations actually outperform In order to be effective in healing discomfort, gas, indigestion, and the peptic ulcers, it appears that DGL must enteric-coated products if they are passing of undigested food in the stool. given prior to a meal (for digestive mix with saliva. DGL may promote For laboratory diagnosis, most nutrition- the release of salivary compounds purposes) or on an empty stomach oriented physicians use the compre- (for anti-inflammatory effects). which stimulate the growth and regen- hensive stool and digestive analysis. This eration of stomach and intestinal cells. comprehensive analysis will usually Final comments DGL in capsule form has not been shown to be effective. reveal the level of pancreatic enzymes Proper digestion is a requirement being dumped into the intestines from The standard dosage for DGL is two for optimum health, and incomplete or the pancreas by determining the level disordered digestion can be a major to four 380 mg chewable tablets of excess fat in the stool, excess nitrogen between or 20 minutes before meals. contributor to the development of in the stool, and the presence of any Taking DGL after meals is associated many diseases. The problem is not other partially or completely undigested with poor results.44 DGL should be only that ingestion of foods and nutri- food elements. In addition, the complete tional substances are of little benefit when continued for eight to 16 weeks, stool and digestive analysis will also breakdown and assimilation are inade- depending on the response. reveal the health of the bacteria flora quate, but also that incompletely which often reflects the degree of digested food molecules can be inappro- Pancreatic enzymes as pancreatic function. digestive aids priately absorbed into the body. This The treatment of pancreatic insuf- problem can lead to various diseases Each day the pancreas secretes ficiency involves preparations from and the development of food allergies. about 1.5 quarts of pancreatic juice in fresh hog pancreas. The United States the . Enzymes secreted Although antacids and H2-receptor Pharmacopoeia (USP) has set strict antagonists may lead to relief of include lipases which digest fat, proteases definition for level of activity. A 1X symptoms attributed to indigestion, which digest proteins, and amylases pancreatic enzyme (pancreatin) product they actually interfere with the digestive which digest starch molecules. While has in each milligram not less than starch and fat digestion can be carried process and disrupt gut microbial 25 USP units of amylase activity, not ecology. A better approach may be to out satisfactorily without the help of less than 2.0 USP units of lipase activity, pancreatic enzymes, the proteases are enhance digestion with the help of and not less than 25 USP units for digestive aids like hydrochloric acid, critical to proper protein digestion. protease activity. Pancreatin of higher Incomplete digestion of proteins creates pancreatin, and enzyme preparations. potency is given a whole number References a number of problems for the body multiple indicating its strength. For I. Graham DY, Smith .11., and Patterson DJ: Why do including the development of allergies example, a full-strength undiluted apparently healthy people use antacid tablets? Am J and formation of toxic substances pancreatic extract that is ten times Gastroenterol 78:257-60, 1983. 2. Bolla K1, Briefel G, Spector D, et al.. Neurocognitive produced during putrefaction. stronger than the USP standard would effects of aluminum. Arch Neurol 49:1021-6, 1992. Putrefaction refers to the breakdown of be referred to as lox Use. Full-strength 3. Flaten TP: Geographical associations between protein material by bacteria. aluminum and drinking water and death rates with products are preferred to lower potency dementia (including Alzheimer's disease), Parkinson's As well as being necessary for pancreatin products because lower disease and amyotrophic sclerosis in Norway. Environ protein digestion, the proteases serve potency products are often diluted Geochem Health 12:152-7, 1990. several other important functions. For 4. Per! DP, Gajdusek DC, Garruto RM, et al.: with salt, lactose, or galactose to Intraneuronal aluminum accumulation in amyotrophic example, the proteases, as well as lateral sclerosis and Parkinsonism-dementia of Guam. achieve desired strength (e.g., 4X or 1X). Science 217:1053-5, 1982. other digestive secretions, are largely The dosage recommendation for a 10X 5. Weberg R and Berstad A: Gastrointestinal

16 American Journal of Natural Medicine January/February 1997 * Vol. 4, No. 1 absorption of aluminum from single doses of aluminum roidism. Acta Med Scand 186:529-33, 1969. 21, 1995. containing antacids in man. Eur J Clin Invest 16:428- 23. Howitz I and Schwartz NI: Vitiligo, Achlorhydria, 32, 1986. 35. Phu!! PS, et al.: Vitamin E concentrations in the and pernicious Anemia. Lancet i:1331-4, 1971. human stomach and duodenum - correclation with 6. Weberg R, Berstad A, Aaseth J and Ealch JA: 24. Howden CV and Hunt RH: Relationship between Helicobacter pylori infection. Gut 39:31-5, 1996. Mineral-metabolic side effects of low-dose antacids. Scand gastric secretion and infection. Gut 28:96-107, 1987. Gastroenterol 20:741-6, 1985. 36. Baik SC, et al.: Increased oxidative DNA damage 25. Rafsky HA and Weingarcen M: A study of the gastric 7. Taylor GA, Ferrier IN, McLoughlin IJ, et al.: in Helicobacter pylori-infected human gastric mucosa. secretory response in the aged. Gastroent May:348-52, Cancer Res 56:1279-82, 1996. Gastrointestinal absorption of aluminum in Alzheimer's 1946. 37. van Marie J, et al.: Deglycyntizinized liquorice disease: Response to aluminum citrate. Age Ageing 21:81- 26. Davies D and James TG: An investigation into the 90, 1992. (DGL) and the renewal of rat stomach epithelium. Eur gastric secretion of a hundred normal persons over the I Pharmacol 72:219-25, 1981. 8. Grossman M, KirsnerJ and Gillespie I: Basal and age of sixty. Brit J Med i:1-14, 1930. 38. Johnson B and McIssac R. Effect of some anti- histalog-stimulated gastric secretion in control subjects 27 Baron JH: Studies of basal and peak acid output ulcer agents on mucosal blood flow. Br J Pharmacol 1:308, and in patients with peptic ulcer or gastric cancer. with an augmented histamine meal. Gut 3:136-44, 1981. Gastroenterology 45:15-26, 1963. 1963. 39. Kassir ZA: Endoscopic controlled trial of four drug 9. Recker R: Calcium absorption and achlorhydria. 28. Mojaverian P, et al.: Estimation of gastric residence New England Journal of Medicine 313:70-3, 1985. regimens in the treatment of chronic duodenal ulceration. time of the Heidelberg capsule in humans. Gastroenterology Irish Med J 78:153-6, 1985. 'a Nicar MJ and Pak CYC: Calcium bioavailability 89:392-7, 1985. from calcium carbonate and calcium citrate. Journal of 40. Morgan AG, et al.: Maintenance therapy: A two 29. Wright J: A proposal for standardized challenge year comparison between Caved-S and cimetidine Clinical Endocrinolgy and Metabolism 61:391-3, 1985. testing of gastric acid secretory capacity using the treatment in the prevention of symptomatic gastric Editorial: Citrate for calcium nephrolithiasis. Heidelberg capsule radiotelemetry system. J John Lancet i:955, 1986. ulcer. Gut 26:599-602, 1985. Bastyr Col Nat Med 1:2:3-11, 1979. 12. Cushner HM, Copley JB and Foulks CJ: Calcium 41. Morgan Ag, et al.: Comparison between cimetidine 30. Berstad K and Berstad A: Helicobacter pylori and Caved-S in the treatment of gastric ulceration, and citrate, a new phosphate-binding and alkalinizing agent infection in peptic ulcer disease. Scand J Gasroenterol subsequent maintenance therapy. Gut 23:545-51, 1982. for patients with renal failure. Curr Ther Res 40:998- 28:561-7, 1993. '004, 1986. 42. Glick L: Deglyerrhizinated liquorice in peptic 31. Sarker SA and Gyr K: Non-immunological ulcer. Lancet 0:817, 1982. 13. Barrie SA: Heidelberg pH capsule gastric analysis. defence mechanisms of the gut. Gut 33:987-93, 1992. 43. Bell W, Birkholz and Sewing KF: Effects of In: Pizzomo JE and Murray MT: A Textbook of Natural 32. Stockbruegger RW, et al.: Intragastric nitrites, Medicine. JBC Publications, Seattle, WA 1985. flavonoids on acid secretion, gastric mucosa] nitrosamines, and bacterial overgrowth during cimetidine prostaglandin production and helicobacter pylori growth. 14. Bray GW: The hypochlorhydria of asthma in therapy. Gut 23:1048-54, 1982. childhood. Br Med. J i:181-97, 1930. Arzneim Forsch 45:697-700, 1995. 33. Shibata T, et al.: High acid output may protect the 15. Rabinowitch IM: Achlorhydria and its clinical signif- 44. Feldman 1-1 and Gilat T: A trial of deglycyrrhiz- gastric mucosa from injury caused by Helicobacter inated liquorice in the treatment of duodenal ulcer. icance in diabetes mellitus. Am J Dig Dis 18:322-33, 1949. pylori in duodenal ulcer patients. J Gastroenterol Gut 12:499-51, 1971. Hepatol 11:674-80, 1996. 16. Carper WM, Butler TJ, Kilby JO and Gibson 45. Rubinstein E, et al.: Antibacterial activity of the 34. Rokkas T, et al.: Helicobacter pylori infection and pancreatic fluid. Gastroenterol 88:927-32, 1985. MJ: , gastric secretion and flatulent dyspepsia. gastric juice vitamin C levels. Digestive Dis Sci 40:615- Lancet i:413-5, 1967. 17. Rawls WB and Ancona VC: Chronic urticaria associated with hypochlorhydria or achlorhydria. Rev Michael T. Murray, N.D. is a leading researcher and author in the Gastroent Oct:267-71, 1950. field of natural medicine. He is co-author of A Textbook of Natural 18. Gianella RA, Broitman SA and Zarricheck N: Medicine, the definitive textbook on naturopathic medicine for Influence of gastric acidity on bacterial and parasitic enteric physicians, and sole author of several books, including Natural infections. Ann lot Med 78:271-6, 1973. 19. De Witte Ti, Geerdink PJ and Lamers CB: Alternatives to Over-the-Counter and Prescription Drugs, The Hypochlorhydria and hypergastrinaemia in rheumatoid Healing Power of Herbs, Natural Alternatives to Prozac, and his arthritis. Ann Rheum Dis 38:14-17, 1979. newest, The Encyclopedia of Nutritional Supplements. Dr. Murray Ryle JA and Barber HW. Gastric analysis in acne serves on several editorial boards and advisory panels. As well as rosacea. Lancet ii: I 1 95-6, 1920. maintaining a private medical practice, Dr. Murray is an accom- 21. Ayres S: Gastric secretion in psoriasis, eczema and plished educator and lecturer. In addition to his many books, he dermatitis herpetiformis. Arch Derm Jul:854-9, 1929. 22. Dotevall G and Walan A: Gastric secretion of acid has written thousands of articles, appeared on hundreds of radio and TV programs, and lectured to over 100,000 people nationwide. and intrinsic factor in patients with hyper and hypothy-

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Vol. 4, No. 1 * January/February 1997 American Journal of Natural Medicine 17