Posted by Larry Hoover on August 17, 2004, at 9:25:55
In reply to Re: Urticaria and incomplete protein digestion » Larry Hoover, posted by KaraS on August 17, 2004, at 0:38:57
> > > Larry,
> > > Also maybe I should take more enzymes than just bromelain (protease and papain?) to see if they can help with protein digestion? Should I also take enzymes that digest starch and fat? (I don't know if they would effect protein usage at all in the long run.)
> >
> > Proteolytic enzymes have to survive the effects of stomach acid to be effective in aiding digestion. Protease only works at low pH. If your stomach acid is weak (called hypochlorhydria) or absent (achlorhydria), your own body's protease does nothing. By taking a mixture of proteolytic enzymes, you cover functionality at the different acid regimes which may be present in the stomach.
> >
> > As an aside, GERD is often related to hypochlorhydria. The stomach is slow in producing the acid it needs, and it comes late, after much of the food is already passing into the duodenum. The excess acid is easily burped up into the esophagus.
>
>
> My mother has had a terrible time with indigestion over the years. She lived on Maalox and Mylanta ever since I can remember, until the current medications came out. She's an extremely nervous person - I don't know whether that is really relevant but at least it used to be considered the cause of her indigestion problems. In the last couple of years she was diagnosed with GERD and she's really having a terrible time with it. She can't keep a lot of food down. The doctors have told her that she's not a candidate for surgery. They do something they call stretching her stomach periodically but it doesn't do much good. I'd be grateful for anything you could tell me to advise her.I'll tell you my story, and maybe it will be a model for her self-care.
Like your mother, I used to live on Maalox (or so it seemed). I had a bottle in the car, a bottle in my tool kit, a bottle in the living room, the bedroom....
I was told I had ulcers, and I went on the bland diet, and took those old-time ulcer pills, and I still had reflux and I still had indigestion and I still drank Maalox.
That went on for many years. Later, doctors added the diagnosis of Irritable Bowel Syndrome, and GERD. I could never figure out which "trigger" foods I was supposed to avoid, so I just went on, treating it all symptomatically. (As a long-time trucker, you don't eat what you want to anyway. You eat what you can find any place where you can park a big rig.)
Along came the new class of acid inhibiters. I was put on Losec (also known as Prilosec). Finally, something that significantly helped. It didn't fix things altogether, but it reduced adverse events to around 20% of what I used to deal with. I still needed all those symptomatic adjustments, just much less often.
Along the way, after about four years on this drug, I took part in the clinical trial for Nexium (drugs were free, for eight months). As part of the screening, there was an endoscopy (showing significant stomach inflammation), a breath-test for Helicobacter pylori (I was never able to get that result, despite numerous attempts.... :-/ ), and routine monitoring. I was able to break the blind, as I knew I was in one of the two treatment arms (different doses of active ingredient). Part of the trial was designed to show if PRN dosing was effective, and I could feel the effects of the drug, without any doubt. (Anyway, you'll see major depression as a possible, but rare, side effect of Nexium. That was me. You had to remain otherwise drug-free during the trial.) The whole point of the exercise was to get a new patent for the same drug. Nexium is the s-enantiomer of Prilosec, which is no longer under patent. (Same deal with Celexa/Lexapro.)
Geez, I can go on, can't I? Get to the point, Lar. Get to the point.
Around about this time, I noticed that certain of my symptoms seemed to correlate with B-12 deficiency. As I was on a PPI drug (proton-pump inhibitor, i.e. acid blocking), that made sense. You need good levels of stomach acid to get B-12 out of your food. Your body stores (up to) a few year's supply in the liver, but that won't last forever, and....it looked like mine was running out.
So, I delved into the literature, studying the hormonal regulation of digestion. What turns on the acid-pumps? What signals the release of digestive enzymes? That sort of thing. I was so fascinated, I forgot to save any of the links, as I stayed up until dawn (whoa! I've been at this all night?!?), looking at leptin and grehlin (sp?) and pepsin and serotonin (yes, there is a link to serotonin....it's responsible for the ability to close the sphincter at the top of the stomach, to prevent heartburn) and such like.
Lo and behold, I discovered the makings of a vicious circle. In simple terms, the treatments for GERD "lock in" the deficiencies that cause GERD. I concluded that GERD isn't "too much acid", it's "poorly timed acid". The signalling for acid release is lagging too far behind the food, and the acid lands on top of the food (due to gravity) rather than getting mixed with the food, as it is swallowed. The intense acid concentration on top of the food degrades the surface of that mass, releasing gases which cause you to burp, and the burps are very acid. Ouch!
So....finally to the point. Yes, there is a point. Nutritional treatment of GERD.
This worked for me. No promises for anyone else.
At the point I did this research, if I was so much as two hours late with a Prilosec dose, I paid a price. But, I started taking these supps, and three days later, I didn't need Prilosec any more. It was that dramatic. I recently mailed a 6 or 8 month supply of Prilosec to somebody, because I don't need it any more (I waited a couple of years to be sure....I am a Scot at heart).
The point, Lar, the point. Doh!
I was already taking a B-complex, and zinc and selenium and magnesium. All factor in, so you do need those. The key ingredients that I added were bromelain (1,000 mg a half hour after each meal), trimethylglycine (1,000 mg, twice daily....doesn't matter about the food bit), and B-12 (1,000 mcg once daily, not sure if it matters about food or not). (These are acute treatment amounts. Maintenance doses, once symptoms remit, as required.)
Now, because my body was probably already replete with the first group (zinc et al), my rapid response may not be seen in your mother's case. Much of her symptomatology is, in my sometimes humble opinion, due to malnutrition. She may need a while to even get used to basic supplementation. The longer it's gone on, the harder it is to bring your body back from the edge. Nonetheless, after feeling completely and totally tethered to the drug Prilosec (I thought it was for life, like if I needed insulin), I broke that tether completely.
Your body may vary.
You may recall I mentioned Helicobacter pylori. If your mother has not been tested for that infection, she ought to be. The test is not very expensive ($80?), is non-invasive, and may indicate a treatable condition (antibiotic therapy) that can exacerbate indigestion/reflux.
> > Standard medical practise for GERD is to suppress stomach acid production in general, which only ensures that you will have iatrogenic hypochlorhydria, and thus decreased protein digestion and reduced availability of vitamin B12 (which is essential in acid production in the first place).
> >
> > > I hate to ask you this but I was looking at the page on iHerb.com and I'm totally overwhelmed by all of the choices. Do any of the choices here stand out to you as a good selection(s)? I have no sense here or what is needed and what is overkill.
> > >
> > > http://www.iherb.com/digestion.html
> > >
> > > Thanks,
> > > Kara
> >
> > What I do not know is how likely it is that enzymes which normally function in the alkaline environment of the intestines (entera) can get past the high-acid stomach environment. Enzymes are proteins too, and are not treated specially by the stomach. It's all food to the stomach. Ideally, you'd take enteric-coated (not acid soluble, dissolves once reaching the entera, i.e. intestines) starch and fat enzymes, but uncoated proteolytic ones.
> >
> > That said, I'd go with this product:
> > http://www.iherb.com/superenzymes.html
> >
> > Lar
>
>
> Lar,
>
> That was very sweet of you to select the brand for me.I also selected it for *me*, Kara. Thanks.
> I felt bad after I sent that post - thinking that I was imposing and shouldn't have asked you for that.
Why? I don't mind in the slightest. I am honoured, truth be told.
> Anyway, please know that i really appreciate it.
>
> KaraI knew that. You're welcome.
Lar
poster:Larry Hoover
thread:364999
URL: http://www.dr-bob.org/babble/alter/20040815/msgs/378598.html