Last week we started by taking look at how diet can influence blood pressure.  This week, we continue by discussing Heartburn.  First of all, stomach acid is extremely important to our overall health.  It is responsible for keeping the stomach free of bacteria and in the digestion of food.  It is a major player in our immune function.  When we suppress it through the use of antacids, we begin to suffer from a variety of problems. 

Digestion

We digest starches and sugars in our mouth and in our small intestines, not in our stomach.  The main enzyme responsible for breakdown of the carbohydrates we eat is called Amylase, released in our saliva and into our small intestine from the pancreas.  When we swallow food, the acid in our stomach neutralizes the amylase in our saliva and carbohydrate digestion stops until it enters the small intestine.  When we eat starches, we really want them to get in and out of the stomach as quickly as possible.

Protein on the other hand is primarily digested in the stomach and the small intestine and requires a high acid content in the stomach to get things going.  Fat digestion begins in the stomach through the combination of a digestive enzyme for fat that is released into saliva called Lingual (tongue) lipase.  This lipase is highly effective in the acid environment of the stomach so that it can begin the process of breaking down the fat.  Once the food is released into the small intestine, fat digestion really speeds up.

Fat, and to some degree protein, can slow down the release of food from the stomach to the small intestine.  This is because both of them require more exposure to stomach’s acid environment in order to be properly digested.  When you take acid lowering medications, you extend this even longer.  You also delay stomach emptying when you don’t chew your food thoroughly because it arrives at the stomach in much larger chunks and with inadequate amounts of the amylase and lipase mixed in.  And just to make things more interesting, being stressed out also reduces digestion and absorption!

So, if you’re like the typical American eating a sugar-based meal (sandwich with sugar-based condiments, potatoes, and a sugar-drink) while stressed out, not chewing your food well and consuming an appetizer of Tums or Prilosec, here’s what happens… 

The sugars in the meal aren’t given adequate exposure to Amylase while you chew because you aren’t chewing well.  So the starches arrive in the stomach largely intact.  The fats likewise are marginally exposed to Lipase so that when they arrive in the stomach, they don’t have enough of the enzyme to begin breaking down the fatty acids.  And protein arrives in the stomach in large chunks which will take a very long time to break down.

Because the proteins are in large chunks and the fats are slow to break down without Lingual Lipase, your stomach is going to be very slow to empty.  Now, since you also blunted the stomach’s ability to make acid by taking your Prilosec or you neutralized the acid by taking Tums, you have further extended the stay of your food. 

 An Immune System Detour

The part of digestion that rarely gets any press is its immune role.  Food is not the only thing that you eat!  On the food, the utensils, and living in your mouth and on your skin are billions of bacterial, fungal, and viral organisms.  They are made of proteins, fats and carbs just like we are.  When we chew thoroughly we are also making sure that all the hitchhikers are getting bathed in those enzymes.  When this happens correctly, the bad guys are digested along with our food and we can then absorb their proteins, fats, and carbs to make ourselves out of.

 Back to our regularly scheduled discussion

When you have reduced the stomach acid, chewed poorly, and eaten a lot of sugar you have a situation where the critters are also able to live longer in the stomach.  Since the stomach isn’t emptying as fast, you have the food you intended to eat sitting around in a moist, warm, oxygen-deprived, acidic environment with bacteria that live on sugar and prefer to be anaerobic (without oxygen).  The sugars begin to ferment and give off gas which increases the pressure within the stomach.  This puts pressure on the esophageal sphincter (the “door” into the stomach) causing it to open, releasing some acidic contents and burning the esophagus.

The longer you stay on acid-lowering medications, the more bacteria will be able to survive within your stomach.  The more bacteria survive, the more they will digest the sugars and starches sitting around in your stomach and contribute to the gas.  So, over time you find that the treatment requires more and more dosing and eventually doesn’t work anymore.

Eventually, a low production of stomach acid also begins to effect nutrient absorption, beginning with the poor digestion of protein and fat and leading to micronutrients such as vitamin B-12, iron and calcium.

When you combine the high levels of sugar and starch most of us are eating with the use of antacids, it becomes nearly impossible to escape poor digestion, gas, bloating and heartburn.  As you can see, lowering the production of stomach acid is not actually addressing the cause of the problem and leads to not only an entire new set of problems but also furthers the problem it is supposed to be helping!

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