Indigestion: The Tip of the Iceberg

Indigestion is just that, indigestion-not digesting properly. It is the result of a breakdown in the intricate balance of stomach secretions, secretions in the small intestines, and a feedback loop of many different chemical messengers and physical functioning of glands and valves. It is “the tip of the iceberg”, they symptom you notice that is part of a much larger imbalance.

Stomach Acid
Hydrochloric Acid (HCl) is secreted by the parietal cells. It activates pepsinogens to convert pepsin and renders some minerals more absorbable. Stomach acid prevents bacterial overgrowth by creating an essentially sterile environment (low acid can lead to H pylori infection).

The lining of the stomach contains deep collections of cells organized into gastric glands. These gastric glands secrete various substances into the stomach. The openings of the gastric glands into the surface of the stomach are called gastric pits. Mucous cells in the gastric pits secrete mucus. In the deeper part of the gland, parietal cells secrete hydrochloric acid. G cells, which are present predominantly only in the antrum of the stomach, secrete gastrin. ECL cells secrete histamine, and chief cells secrete pepsinogen (an inactive form of the pepsin-digesting enzyme pepsin). Intrinsic factor, needed for the absorption of vitamin B12, is also secreted by the gastric mucosa (most likely the parietal cells).

Low Stomach Acid
When stomach lining gets inflamed, parietal cells die, and HCl secretion falls off (atrophic gastritis).

The decreased HCl impairs proper digestion of proteins. Proteins that reach the bowels undigested or partially digested due to hypochlorhydria or achlorhydria can trigger an inflammatory reaction there as well.

The Tip of the Iceberg
This is where the real impact of impaired digestion happens. The inflammation results in damage to the intestinal lining by punching holes in one of the body’s most important protective barriers, resulting in Intestinal Hyperpermeability, sometimes known as “leaky gut” syndrome.

Additionally, NSAIDS and antibiotics can lead directly to inflammation in the stomach and intestines.

Dysbiosis is the state of disordered microbial ecology that causes disease. It may exist in the oral cavity, gastrointestinal tract or vaginal cavity. In dysbiosis, organisms of low intrinsic virulence, including bacteria, yeasts and protozoa, induce disease by altering the nutrition or immune responses of the host. The major causes of intestinal dysbiosis are:

Increased intestinal pH (caused by low stomach acid production!!!)
Poor diet/nutritional status
Antibiotic/drug therapy
Decreased immune status
Decreased gut motility
Intestinal infection
Presence of xenobiotics
Researchers increasingly acknowledge that there is a link between digestive processes and disease. For example, in patients with altered bowel anatomy, chronic bacterial overgrowth can lead to the formation of circulating immune complexes and synovitis (joint inflammation). Changes in bowel permeability due to local gut inflammation may expose the host to immune system to microbial or food antigens and even bacterial translocation. In some cases, toxins derived from enteric organisms may play a direct role in the induction of arthritis.

Clinical Conditions Associated with Low Stomach Acid Production
Addison’s disease
Anemia/pernicious anemia
Celiac Disease
Carcinoma of the stomach
Chronic Autoimmune disorders
Dermatitis herpetiformis
Diabetic Neuropathies
Flatulent dyspepsia
Gallbladder disease
Gastric Polyps
Myasthenia Gravis

SIBO-Small Intestinal Bacterial Overgrowth
Sjorgren’s Disease
Ulcerative Colitis
Treatment – Heal the mucosa, increase acid levels, increase acid production, normalize enzyme production, normalize intestinal flora!