Anatomy & Physiology Lesson, Please - BAD

[DJ]

I'm trying different remedies to tone down my cough/GERD situation. For the past two days, I have had "mother" apple cider vinegar, 2 tablespoons in warm water, drinking 3/4 before I eat and the rest near the end of my meal. I'm coughing less, and when I cough it is less deep, less mucus, and less gagging. My BMs have been less formed recently and this morning, my BM was fully formed.

It's too soon to tell if this is really working but if it is, it would seem to indicate low stomach acid. There has been much conversation about bile acid diarrhea (BAD). If I understand BAD correctly, it's an excess of bile acid released into the small intestine. Now the question:

If a person has low stomach acid, does poorly digested food entering the small intestine cause a release of excess acid in the intestine? IOW, can low stomach acid cause BAD?

Thanks.
DJ

[tex]

IOW, can low stomach acid cause BAD?

Excellent question. I wish I knew the answer. It might, or it might not. But it doesn't really matter, because I can tell you at least 1 thing that low stomach acid will do that canl result in D. Low stomach acidity will cause poor digestion, resulting in delayed release of stomach contents (which can contribute to GERD), and when digestion in the stomach is compromised, this can lead to a cascade of digestion problems all along the line, resulting in bacterial fermentation of the partially-digested food in the intestines, producing gas, bloating, and D.

And I suppose it is possible that this could contribute to BAD, because if the digestion of fat is disrupted early on, then the whole fat digestion process could head south. Lipase from the pancreas is use to digest fat (to break it down into amino acids), but lipase can only work on the surface of a fat globule. Therefore it is necessary to break fat up into many tiny globules so that the lipase can easily access it to break it down. Emulsification of fat (to break it up into tiny globules) begins in the stomach, and so I suppose it is possible that this may not occur if stomach acid is insufficient, and if this should happen, then BAM could be the result. Once out of the stomach, bile is used (similar to a detergent) to complete the emulsification of fat to facilitate further digestion by lipase.

But actually, BAD is not typically caused by excess stomach acid. The usual cause is poor absorption of bile salts in the terminal ileum. Normally, about 90 % of unused bile is reabsorbed in the terminal ileum, and recycled to make cholesterol, which is then used to make bile, cutaneous 7-dehydrocholesterol (used to make vitamin D when exposed to sunlight), and other vital substrates. When the bile acids are not properly or adequately absorbed in the terminal ileum (for whatever reason), the result is BAD, because too much bile does not play nice with the colon.

Tex

[dfpowell]

Tex,

In the post above, I don't think you meant that fat breaks down into amino acids.
Since protein digestion starts in the stomach, if someone has low stomach acid would those people on high protein diets be at a higher risk for improper digestion.

[tex]

Donna,

Thanks, you're right. Obviously fats break down into single fatty acids (not amino acids).

if someone has low stomach acid would those people on high protein diets be at a higher risk for improper digestion.

Probably, because meat is generally more difficult to digest than carbs, for example. But the problem with MC is that as the inflammation continues, the small intestine becomes unable to supply adequate amounts of the enzymes needed in the small intestine to digest sugars (carbs). Lactase is the first enzyme to become deficient, and there is a hierarchy that's followed as the ability to produce other enzymes become compromised. As the small intestine heals, the production of those enzymes is restored, in reverse order.

If I recall correctly, protein digestion begins with pepsin produced in the stomach, and it's completed by protease from the pancreas, after the protease is activated in the small intestine. So there are a number of places where digestion can be derailed, for any type of food. However, with MC, after fats, carbs are the most likely class of foods to be maldigested.

And remember that meat is the only food that contains all of the essential amino acids. So along with adequate fatty acids (to prevent the condition known as rabbit starvation), when digestion is compromised, we can survive much better on meat, than on carbs. IOW, we can live on meat alone (fatty meat), but we cannot live very long on only carbs.

Tex

[DJ]

Hi Tex, I read this yesterday but I had to "digest" it....hahahah. Thank you!! I plan to stick with the vinegar for two weeks as a trial. I saw my practitioner and she agrees. Whatever the case, my gut feels more stable but I do think about the fact that I am pouring acid down my already traumatized esophagus.

Maybe after two weeks when I eliminate the vinegar, I will try cholestyramine. For the moment, I'll be grateful that my BMs are more stable again.

I'm feeling that I have a few good options to try now and in the near future.

As always, I appreciate your time and help.

[tex]

If you diluted the vinegar in water, it shouldn't damage your esophagus. "Good" apple cider vinegar has a pH of about 3.0 or slightly below. Gastric acid (in a normal stomach) is about half that, so it is quite acidic. But if you diluted the vinegar by half or more (and you probably diluted it much more than that), then it will actually be a relatively mild acid. You could check the diluted mix with pH strips to determine the final pH. Any pharmacy (or Walmart) should have pH strips available for sale.

And you're most welcome, of course.

Tex

[DJ]

I used a hydroponic pH tester on an 8 oz cup of water with 20 ml of vinegar. the lowest pH on the product scale (measured by color of the liquid) is 4. The color reflected that the rating pH should be far below 4. I'm new with pH testing.
Anyway, I plan on keeping it short term. If it seems promising, I will go to an ENT for a scope and decide it I'm ok with longer term use. I am always worried about a cure that's worse than the problem. My mother is 94 and unlike her children, has taken medications only a few times in her life. She had a healthier life that her kids are experiencing. Hmmm, it seems there's a lesson here.