Fred M Bogan, DC
The standard medical treatment of heartburn and GERD (gastro-esophageal reflux disease) is a class of drugs that prevent acid production or release in the stomach, or at the very least will neutralize acid, such as an antacid like Tums, Rolaids, Mylanta, etc. This treatment is based on the premise that if there is excess acid in the stomach, then it must be true that the stomach is secreting too much acid, so therefore we must do something to prevent acid production or release in the stomach, or at least neutralize it after the fact.
I will admit that this seems very reasonable on the surface, but let’s look at how the stomach actually works and maybe we can see how that model might be somewhat, if not completely flawed.
When we eat food the chief cells of our stomach wall are designed to secrete a very strong solution of hydrochloric acid (pH of about 1.0 which is strong enough to burn a hole in an oak table). This secretion is under the control of the nervous system; that is the brain and, in this case the vagus nerve.
Under normal conditions the stomach will do just as described above and when the pH of the stomach reaches somewhere in the pH range of 2-3 (neutral pH is 7.0) the tiny receptor nerves in the stomach wall send a signal to the brain that the appropriate pH level has been achieved and the brain responds with a signal to the chief cells to stop acid production. Once this signal has been received by the chief cells they follow orders and stop production until such time as food is re-introduced at the next meal time. This is normal digestive function for the stomach.
Now, let’s consider what happens when a person is affected by a low acid reserve and has insufficient acid production during the mixing phase in the stomach. This mixing phase is usually no more than 20 minutes and has the expressed purpose of mixing hydrochloric acid and pepsin with the food before sending the food on down into the small intestine.
So, based on the above facts it is apparent that we have about a 20 minute window for reaching a critical pH level before the food is sent on down to the small intestine. If that person’s low acid reserves prevent the critical pH level then the pyloric valve opens and the food moves on regardless of the low acid level. Now, I ask you: “Did the receptor nerves ever send a signal to the brain that the critical level had been reached?” Definitely NOT. If not, then did the brain ever return a signal to the chief cells to stop acid production? Again, NO. So what is going to happen now?
What happens now is just what you are thinking…the chief cells are going to continue to pump acid in an effort to acidify the food that has already passed. Now we have what we chiropractors call “function out of time with need”. That means normal function, but at a time when normal function is not appropriate…therefore it becomes abnormal function, or dis-ease.
Now, depending on just how weak your acid juices are will determine how long it will be before you start to feel the effects of the acid on your stomach with no food to mix it with. If your acid is fairly strong you might feel acid upset within 15 or 20 minutes after eating. If your acid is very weak it might be the middle of the night before you feel the acid. Or, you will lie down and maybe your cardiac sphincter, the valve at the top of your stomach (between the esophagus and the stomach) may have a pin-hole leak, allowing a tiny amount of acid to leach up into the esophagus, resulting in a burning sensation in the esophagus (GERD). Naturally, this is always aggravated by reclining or lying down.
This low acidity has been shown to be a primary factor in the proliferation of H. pylori bacteria which are considered by many to be the cause of ulcers. That is because H. pylori cannot thrive in a highly acidic stomach. Now consider how your acid stoppers will improve the chances of H. pylori proliferation. (I do not consider H. pylori to be the cause of ulcers, but I do believe that they make ulcers much worse. H. pylori are nothing but opportunistic one-celled creatures that take advantage of any situation that is favorable to them—much like flies. Just because there are always flies in garbage does not mean that the flies cause the garbage. By the same token when the stomach or intestinal lining begin to break down due to nutritional deficiencies—low acid production being just one of them—H. pylori will move in, proliferate, and begin a feeding frenzy, just like flies on garbage.)
So, if all of this is true what do we do about it? We supplement with an acid supplement called Zypan. Zypan contains betaine hydrochloride (which becomes hydrochloric acid) and pepsin. Zypan quickly lowers the pH of the stomach during the first 20 minute mixing phase of digestion, thus allowing the pH receptors to signal the brain for shutdown of the acid system.
One of the most surprising things about this treatment is that, in time, the acid reserves of the patient are restored and Zypan is no longer needed, or needed only on occasion. Many of my patients now take Zypan instead of an acid stopper to stop acid indigestion or heartburn after the onset rather than an acid stopper. This was a surprise to me and I still don’t recommend it, but it often works.
If you suffer heartburn, acid indigestion or GERD I strongly encourage you to give this a try. There are a couple of situations where it is less effective:
1. in the case of severe ulcer where the acid burns the sensitive tissue. In this case you would just need to take an antacid to stop the burn. When the ulcer is healed you will re-institute Zypan therapy for as long as is needed.
2. in a case of hiatal hernia where any acid leaks into the esophagus, but here the Zypan is usually helpful anyway, for all of the reasons outlined above.