Continuing Mike's thread on bile acid malabsorption

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Continuing Mike's thread on bile acid malabsorption

Post by Polly »

Hi!

I am starting a new thread since it is so popular (and long).

The last posts were about Caltrate (calcium carbonate) helping the D and calcium citrate not being as effective against the D. This has been documented.

This discussion brings us back again to the whole issue of acidic vs. alkaline foods. I think that the more alkaline the diet, the better for the MC/food sensitivities. I'm not totally sure why??? I seem to remember that the bad bacteria thrive in a more acidic environment. Also, many with MC seem to suffer from excess stomach acid or reflux.......and indeed, inflammation all the way down the GI tract. Thus, the carbonate, which is more alkaline than the citrate, would help to neutralize this acid and prevent it from going down into the colon where the bad bacteria could feed on it.

We do know that keeping the body alkaline enables it to retain more calcium. A study was done that showed that taking potassium carbonate led to less excretion of calcium by the body. Thus, the REAL benefit to the Caltrate not be its calcium.....but rather the fact that it helps to alkalize the body so that less calcium is excreted and is therefore retained.

This is why dairy is NOT a good source of calcium, despite what the dairy industry would have us believe. Dairy (and especially cheese) are highly acidic foods which cause the kidney to excrete lots of calcium. Thus, our modern diet high in dairy (and grains, which are also acidic) necessitates supplementation with huge amounts of calcium in order to make up for all that is lost through the kidneys.

This makes sense intuitively, too, doesn't it? Paleo people ate no dairy or grains (and of course, had no calcium supplementation) but yet had far stronger bones, grew much taller, and had far better teeth than the people who came later and began farming and eating grains and dairy. This has been well-documented by the scientists by examination of bones, skulls, etc., of paleo people.

Marsha got me up on my soapbox again today by sending me a thought-provoking PM - telling me how much better she does when eating 2 alkaline items - the calcium carbonate (Caltrate) and egg whites. This could definitely be one of the missing pieces in the whole MC picture, IMHO. Thanks, Marsha.

Love,

Polly
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Post by kate_ce1995 »

Also, many with MC seem to suffer from excess stomach acid or reflux.......and indeed, inflammation all the way down the GI tract. Thus, the carbonate, which is more alkaline than the citrate, would help to neutralize this acid and prevent it from going down into the colon where the bad bacteria could feed on it
Okay, maybe you can help me here (so I don't have to research and read the whole long thread which I don't seem to have time or energy to do these days). I have been having horrible reflux/acidic stomach recently. Now part of this in probably (or is this an old wives tale too) due to stress. But I saw a nutritionist/chiropractor Monday who said people with food allergies often have reduced stomach acid production and are therefore not digesting as well causing some of these problems. He mentioned that we will further discuss this this coming Monday when we meet, but he will likely recommend "bitters" which supposedly get the digestive juices going.

This seems a bit paradoxical to me. I think I must be missing something.

As for the paleo diet, I have been slow reading the book, but am intrigued. I have upped my protien intake (I think), and now need to add more veggies to my diet (I do okay on fruit I think). My staple veggies have been paleo no-nos...corn, peas, green beans. Lunch all week has bene homemade chicken soup to which I just add salt, pepper to taste, carrots, celery and parsley. Although I read a recipie last night that adds garlic, so I might try that next time.

Katy
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Post by Polly »

Hi Katy,

I know......it's so confusing. First of all, there is no question that stress can increase stomach acid production.

And there are some people who suffer from not enough stomach acid. I think Cristi was one, if I remember correctly, but then she did not do well when she took an acid supplement to correct the problem. (Cristi, please correct me if I am wrong). Acid production tends to decrease with age, but you are still young.

And you need to be careful about treating EXCESS acid, because proton-pump inhibitors (like Prilosec) have been associated wth MC causation.

Here is a quick and dirty test you might do at home to see what feels better. When your stomach is acting up, you can either take some (alkaline) Tums (I don't think they contain gluten but check to be sure) or a tsp. or more if needed of (acid) apple cider vinegar. See which one helps the problem. Do this at different times, of course, and it may help you see if you have too much acid or not enough. Just a thought.

Love,

Polly
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Post by kate_ce1995 »

Well, I can tell you tums solves the problems. At least the ones I've had recently. I am so confused.

Does excessive stomach acid create problems with digestion? Is this a balance thing? Didn't I read somewhere that eating too much alkiline food actually increases its production? Or am I wrong about that.

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Post by tex »

Hi All,

I don't have much time to make this post, before I have to get back to work, but I'd like to throw in my 2 cents worth. First of all, unless the stomach contents are very acid, (a pH preferably in the range of 2 or 3), digestion will not be properly initiated, and if it is not properly initiated, it will not be properly completed, farther down the G. I. tract, resulting in problems with reflux, gases, etc. Most undesirable bacteria will be killed in the stomach if the pH is low enough, eliminating many, many problems, farther down the line, with the risk of potential bacterial overgrowth. There are exceptions, (such as E. coli), which are tolerant of acid environments, but they are also tolerant of other environments, so raising the pH of your stomach will not help to lower an E. coli risk, it will only diminish the effectiveness of your digestive process.

Granted, a neutral pH is desirable in the chime, (the partially digested food coming out of the stomach, and entering the small intestine), but that neutralization process is assigned to the pancreas, not the stomach. The stomach must have a low pH to maintain proper operation, and the pH is adjusted to neutral, or near neutral, by the pancreas, which releases bicarbonate into the chime, after it leaves the stomach.

The bottom line is, if the pH is too low in the intestines, it's not because of excess stomach acid - it's because of improper operation of the pancreas. I will grant you though, as Polly says, certain foods will continue to influence the pH in the intestines, as digestion progresses. In my opinion, (and this is just my opinion), raising the pH of the stomach is not likely to relieve that problem, since the pancreas will simply inject less bicarbonate into the chime, if the pH is higher when it leaves the stomach.

IOW, food selection is important to the regulation of pH values, farther down the digestive tract, but in the stomach, it doesn't matter what you eat, it will only be digested properly if the pH level is very low. That's how the digestive system was designed, and that is how it should operate.

And, FWIW, Katy, I agree with your nutritionist/chiropractor - most reflux problems are caused by insufficient gastric acid, not too much. Most doctors seem to miss that point completely.

Love,
Tex
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Post by mle_ii »

I have to agree with Tex here. What??? :???: :lol:

Anyway, I think that in the short term the antiacids or reducing stomach acid by any means help, but in the long term are not a good thing. By making the stomach more alkaline you are going to have malabsorption issues with food, vitamins, and minerals, increased incidences of bad bacteria, bacterial overgrowth, cancer. In other words it's not a good thing.

So how indeed is something that reduces acidity seem to be helping relieve symptoms. Well the same way that other medicines seem to do the same, by covering up symptoms of a disease. But not by fixing the disease.

So what might be increasing the acidity of your intestines and colon that's bad? Like Tex said, one particular problem is with the pancreas. But it doesn't end there. What else can increase the acidity of the intestines but not the stomach. Well, here's a few:
Sugar Malabsorption - bacteria consume this and then produce acid
Food Malabsorption - similar to the last item, and decreasing stomach acid doesn't help
Bile Acid Malabsorption - again bacteria, they convert to some pretty toxic things, especially bad bacteria
Bad Bacteria - the list is probably pretty long, but some bacteria produce different toxins that can increase acidity of the stomach
Not enough Good Bacteria - some help to regulate the acidity
Virus - some can change the acid/alkaline content of the gut
Gut Motility - how fast food moves through. Too fast and the acid doesn't have time to be neutalized, too slow and bacteria move up the GI and produce more acid
Foods/drinks - probably not affected much by the actual alkaline or acid content of foods, the GI can handle that, but like Tex said there are foods that we injest that will effect this. Heck Gluten/Wheat is one of them.
Vitamin Levels or intake - the stuff that neutralizes bile acid is made up of certain chemicals, don't have them then we don't produce things correctly. Also refering to the chemical messangers that tell your stomach to produce less or more acid, bile to increase/decrease, alkalinity to increase/decrease and motility to increase decrease.

I'm sure there's more but I'm stopping for now.

You can see with a few of them that we can get into a vicious cycle. One of those vicious cycles could be kicked off by too many antiacids when you don't need them.

Thanks,
Mike

PS. I saw a paleo comment with regards to calcium. Well, perhaps we didn't need as much calcium due to a few factors, exercise (increases bone density), fewer chemicals (some decrease bone density), more sun (there I go again with Vitamin D), and different foods (some higher in calcium) to pick off some randomly. Heck food is a big issue, take a look at animals, they eat everything they can of an animal, including small bones. Whereas we dend to pick them out more. Bones are pretty high in calcium... duh. :)
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Post by cludwig »

Hi Katy,

I was treated for years with proton pump inhibitors for "acid reflux". In reality my symptoms were not that of acid reflux...burning stomach acid coming up the esophogus sp? and into the mouth, but was a burning stomach. Tex nailed what had been happening to me in that with adrenal fatigue my stomach was not producing the protective mucous it needed to protect itself against the stomach acid. I started taking slippery elm before eating and have been having great results....a very happy stomach.


With regards to reflux, I was told that the sphincter in the esophogus only closes tightly when stomach acid is high enough....therefore preventing the acid from leaving the stomach and leaking into the esophogus. When stomach acid is too low, the sphincter doesn't close all the way and you feel the acid in your throat. So when we feel that burning in our throat we assume there is too much acid when the opposite is usually the case.


Love,
Cristi

ps Prilosec is a major contributor to why I got MC....so please avoid that.
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Post by Polly »

Hi again!

I think it would be good to try to clarify this acid-base balance thing a little more. Yes, it is true that in most cases the stomach acid will be neutralized by the pancreatic bicarbonate. However, Mike has provided an excellent list of situations where this may not occur. I think in those with MC there are probably 2 main reasons why acid chyme might exist in the GI tract past the stomach- increased gut motility (that old incredible rumbling!) which does not allow enough time for the the pancreatic juices to work, and the effects from bad bacteria. Those 2 are hallmarks of MC.

What eating alkaline food does, however, is to decrease the acidity of the BLOOD, not necessarily the gut contents. Whenever the pancreas adds a bicarb molecule to neutralize the acidic stomach contents, it also adds a hydrogen ion to the bloodstream. Thus, the more acid the stomach contents, the more bircarb needed, and the more acid the blood becomes - which as noted earlier is then buffered by CALCIUM in the body. Calcium is pulled out of the bones to buffer the extra acid in the blood and is therefore excreted by the kidney in greater amounts than if it had been able to stay in the bone. It follows that the more alkaline the food, the less acidic the stomach contents would be and the less bicarb needed by the pancreas.

This said, it is important to have adequate stomach acid in order to begin digestion all of those troublesome (to us) proteins. But it is also possible to have excess stomach acid due to stress, for example. In that case, neutralization should help - especially short-term. If the problem is too little stomach acid, then that can be treated appropriately, too A test can be done to see which problem it is. Cristi, you had it, right?

Love,

Polly
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Post by cludwig »

Hi Polly,

I did have it ..but I am questioning its reliability. They had me come in the morning on an empty stomach...swallow the capsule that measures the acid...then had me drink baking soda water...then timed how long it took my stomach to return to a certain level of acidity. They told me mine took too long and therefore needed to supplement with acid pills. This may be true and it was just that I don't have the proper protective lining in my stomach...but those pills lit up my stomach in a very painful way.

What makes me wonder about the results is that to get your stomach acid flowing begins with chewing and smelling food and the whole eating process. This test was done on a completely empty stomach. Maybe they account for that..I am just not sure.

Love,
Cristi
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Post by artteacher »

I can't write much at the moment, but I had a couple thoughts. From what I've read, it's much more common to have low stomach acid than excess acid, and both conditions give similar symptoms: burping, gas, burning, acid reflux, etc. I also read today that only a small percentage of people with acid reflux actually have it because of excess acid production. Less than 20% comes to mind, but don't quote me. CDiff has been blamed recently on the over-prescribing of antacids because low stomach acid encourages bacterial growth.

But I hope we keep talking this out, because reading these comments really helps me understand how these things work.

Thanks, Marsha
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Post by Carol Arnett »

Most of this is way over my head, but I will add that Prilosec and Previcid , I believe, were the beginning of my MC. I now take Protonix and Caltrate. I was in remission for for 26 months and have recently experienced MC symptoms. They haven`t been terribly bad, but I can`t figure out what the trigger was. I was given Prednisone (just 5 doses) for a sprained neck but that evil drug is used to TREAT MC, isn`t it?
I say evil drug because I had an allergic reaction to it. I had facial edema along with swelling of the throat to the point where I could barely speak for a week. Not sure all this is appropriate in this thread. Hugs, Carol
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Post by tex »

This is a very fascinating topic.

Okay, granted, MCers may have intestinal pH imbalances during reactions. To my way of thinking, though, trying to buffer the pH in the intestines, by lowering the pH in the stomach, is kind of like burning down the barn, to get rid of the rats. It will get rid of the rats, alright, but the overall result is a disaster.

First of all, if the pH in the stomach is too high, instead of preserving and initiating digestion of any food present, the warm environment will tend to cause the food to spoil, and ferment. This causes undesirable gases, which will try to escape, and, (as Cristi has already pointed out), the gas will be able to push the stomach contents back into the esophagus, because the acid level is too low to allow the sphincter to work correctly. When the chime is released into the small intestine, it may not actually be chime, but simply partially spoiled food, and this will only serve to cause a further increase in intestinal motility, if the gut perceives it as something that it needs to get rid of.

Secondly, the increased gut motility and/or bacterial overgrowth problems often associated with active MC, are not likely to be helped by increased levels of undigested food in the lumen, nor is it likely that they will be helped by higher pH levels. Most bacteria, for example, will be able to thrive, unless the pH is in the acidic range, and raising the pH offers no deterrence to them.

I'm not sure that it's possible to maintain normal blood chemistry during an active MC episode, since the leaky gut problem will very likely overwhelm many of the other relevant chemical processes, anyway. IOW, calcium is used to regulate the opening and closing of the "tight junctions", so it will have to be present in significant amounts in the bloodstream, anyway. The bottom line is, until an MC reaction is brought under control, much of the body chemistry is going to be abnormal. Consequently, there's not much point in trying to fine tune it, until the reaction is past.

Cristi, I agree with you about the gastric acid test. It may be calibrated with allowances for the way it is performed, but it most definitely does not emulate the normal stimulation of the upper digestive system, (even the saliva that is produced during the chewing process, has an affect on the proper stimulation of the stomach), and while it might even yield fairly reliable results with "normal" people, I think that it would be overly presumptive to assume that it is accurate for all patients, especially patients with other digestive system issues.

I don't believe that it's nice to try to fool mother nature, and trying to buffer gastric acid production, in order to solve upstream or downstream problems, is trying to fool mother nature.

Love,
Tex
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Post by kate_ce1995 »

So which way is one to go?

I felt pretty good on Wednesday, and then pretty good yesterday until 4:00. I am begining to suspect 2 things for this week. Actually 3.

1. Exhaustion. I can not get my energy back. But I am hoping to work a half day today, nap this afternoon and then Geoff is out hunting all weekend so I can sleep and putter all by myself. ME TIME.

2. Chicken Soup. I made chicken soup that tastes fine, but I didn't have any on Wednedsay and that's the day I felt the best. We used chicken that had been frozen, so I wonder if we froze it too close to its sell by date and it wasn't the best. Of course making soup boils the beejesus out of it, but still its a thought.

3. Gluten reaction. I have been really good with my choices on known/obvious products. But last Friday/Saturday I was at a conference/retreat for work and I'm wondering about my food choices. I didn't ask. What I ate seemed relatively safe (salad, pea soup, mussels, lamb chops w/caremalized onions, fruit, cream cheese (ever feel silly putting cream cheese on fruit so you can get protien...it was a continental breakfast), more salad and clam chowder). But I bet the clam chowder, and maybe seasoning on the lamb chops.

If it's stress I hope this weekend helps. If not, I see this nutritionist guy on Monday and hopefully he can point me in the right direction. It isn't fun, and what seems to happen to me is that I get the really uncomfortable anxiety type symptoms when I have a big old belch trying to get out.

Katy

Oh yeah, I am also a little worried about 2 other things. 1) some disease picked up during my blood transfusions a year and a half ago, and 2) bad bacteria, namely c-diff because Geoff's mom just got through that episode with it. I keep trying to tell myself either of these would make me much sicker than I am.
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Post by tex »

Hi Katy,

At your young age, exhaustion shouldn't be a major issue, though it might be contributing to the problem. Are you sure you're getting enough B-12?

Back when I first began getting sick regularly, I used to blame "bad chicken" for my problems, but I never could prove my suspicions.

It could be gluten, since one becomes more sensitive when cutting it out of the diet.

Normally, C. diff makes one very sick, (major diarrhea, and severe abdominal pain), and is often accompanied by blood in the stool.

That disease picked up from a transfusion might bear looking into. It probably wouldn't hurt to ask your doctor if a relapse/reinfection were possible.

I hope you find the problem soon. Are you sure you're not casein intolerant?

Tex
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Post by Polly »

Hi Katy,

I agree with all that Wayne has said. The B12 idea is interesting because it can be poorly absorbed because of a lack of stomach acid.

The clam chowder (I originally typed "calm" - now wouldn't a bowl of calm chowder be exactly what you need right now? LOL!) and seasonings are good bets for gluten. Wayne also has a point about casein - it is common to develop new intolerances as we go along, and with your history of fatigue and neck/shoulder pains it would fit. And it seems to be the second most common intolerance around here.

I would think you would be a whole lot sicker with C. diff. And have bloody stools. By all means ask your doc and/or get tested for anything you are worrying about picking up from the transfusion.

Have you thought about avoiding dairy for a few weeks to see what happens? I'm sure that thought is overwhelming to you at this point. You are exhausted, stressed, and have very little time for yourself, so I can imagine that the thought of trying to plan for and cook an even more restricted diet is daunting to say the least. Let us know if you'd like menu suggestions for GF/CF. But please try to put yourself first!!! Glad to hear you are having some ME time.

Love,

Polly
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