Digestive Insufficiencies Flashcards
1
Q
Hypochlorhydria
A
Low stomach acid production characterised by a fasting gastric pH above 3.0 (1.5–3.0 is considered normal).
2
Q
Hypochlorhydria: Signs and Symptoms
A
- Gas and bloating (often <30 minutes after eating), heartburn, sensation of fullness after meals, foul smelling stools, diarrhoea, nausea after taking supplements, food allergies, brittle nails.
- Nutrient deficiencies (malabsorption) e.g., iron, zinc, folate and B12.
3
Q
Implications of hypochlorhydria
A
- Reduced mineral absorption (e.g., calcium ↓ bone density, iron →anaemia) and poor protein digestion = small intestinal protein putrefaction.
‒ Protein putrefaction creates polyamines which are implicated in colorectal cancer. - Higher pH means reduced protection from bacterial infection, facilitating H. pylori survival in the stomach and allowing bacteria to proliferate in the small intestine (SIBO).
- Reduced gastric activity results in poor pancreatic juice and bile flow, as well as less intrinsic factor, reducing B12 absorption.
4
Q
Natural approach to hypochlorhydria
A
- Chew thoroughly, avoid overeating and drinking with meals.
- Apple cider vinegar (1 2 tsp) diluted in a little water before meals.
- Zinc and B6 rich foods.
- Bitter foods and herbs stimulate digestive secretions (incl. HCl):
‒ Bitter greens e.g., rocket, chicory, dandelion leaf, watercress.
‒ Herbs : Gentian , dandelion, goldenseal, barberry bark stimulate the Vagus nerve (although energetically cold ).
‒ Alternative herbs Fennel seed, cardamon, citrus peel, ginger (these are energetically ‘warming so good if excess cold / aggravated Agni / Spleen Qi deficiency).
5
Q
Supplementing with Betaine HCl
A
- Begin by taking 1 capsule containing
350-750 mg Betaine HCl with a
protein containing meal (>500 kcal+). - If no discomfort (tingling / burning), increase mealtime dose by 1 capsule every 2 days (max. 3 g) until dose results in tingling or warm sensation then reduce dose by 1 capsule.
- Use this dose at subsequent meals.
6
Q
Exocrine pancreatic insufficiency (EPI)
A
A deficiency of exocrine pancreatic enzymes needed to maintain normal digestion resulting in nutrient (especially fat) malabsorption.
7
Q
Exocrine pancreatic insufficiency (EPI): Signs and Symptoms
A
- Bloating / belching / flatulence 1–2 hours after eating.
- Steatorrhoea (excessive fat in faeces; i.e., greasy or floating stools).
- Drowsiness after meals.
- Food intolerances.
- Low zinc, B12 and folate absorption.
- Symptoms of IBS, candidiasis or SIBO.
8
Q
Causes of pancreatic insufficiency
A
- Chronic stress —↓ Vagus nerve activity.
- Hypochlorhydria—↓ CCK stimulation.
- Chronic diseases: cystic fibrosis, chronic pancreatitis, obstructive pancreatic tumours, GI surgery (resection), diabetes mellitus.
- Damaged small intestinal wall (e.g., coeliac, IBD) —↓CCK production and ↓ pancreatic stimulation.
- Xenobiotics (pesticides, herbicides, phthalates, BPA) can inactivate pancreatic enzymes.
- Microbial interactions: SIBO (although it could be a cause or effect) can deconjugate pancreatic enzymes; dysbiosis.
9
Q
Naturopathic approach to pancreatic insufficiency
A
- Don’t overeat, chew adequately, avoid snacking between meals.
- Correct stomach acid levels.
- Stimulate the Vagus nerve to activate the parasympathetic nervous system:
‒ Deep (diaphragmatic) breathing before meals.
‒ Gargle, hum or sing.
‒ Laughter and social enrichment.
‒ Using bitters such as gentian, artichoke and dandelion. - Pancreatic enzyme replacement (see next
10
Q
Pancreatic Enzyme Replacement Therapy (PERT)
A
- Animal-derived (pork pancreatin) has been the standard of care in conventional medicine providing amylase, lipase and protease.
- Plant-based and microbe-derived enzymes appear to offer advantages, e.g., better acid stability, broader range of enzymes, more variants and wider pH range.
11
Q
Bile insufficiency
A
A condition whereby bile synthesis and / or bile flow (note —bile should be quite ‘thin’) is compromised affecting one’s ability to digest, absorb and utilise fatty acids from the diet.
12
Q
Bile insufficiency: Signs and Symptoms
A
- Steatorrhoea:Constipation or diarrhoea.
- Intolerance to fatty foods / nausea when eaten.
- Bloating, excess flatulence and cramping.
13
Q
Stool test indicators of bile insufficiency
A
- Low / absent bile acids (accompanied by key signs / symptoms —as zero can be normal if very efficient at resorbing bile salts).
- High faecal fats (steatocrit) —indicates fat malabsorption.
14
Q
Common causes of bile insufficiency
A
- Low dietary fat intake.
- Impaired liver function and obstructed bile ducts.
- Obesity (shown to have ↓ postprandial bile acid response).
- Oestrogen dominance (↑ liver production of cholesterol which thickens bile and alsoslows the excretion of oestrogen —a viscous cycle!).
*Other GI conditions e.g., cholecystectomy (gall bladder removal), coeliac disease, Crohn’s disease, chronic pancreatitis, SIBO.
*Low HCl (reducing CCK and hence bile release).
15
Q
Implications of long-term bile insufficiency
A
- Deficiency of fat-soluble nutrients:
– Vitamins A, D, E, K; essential fatty acids, phytonutrients (e.g., beta-carotene). - Hormone imbalances (i.e., associated with poor oestrogen clearance).
- Hypercholesterolaemia.
- Compromised liver detoxification.
- SIBO and dysbiosis (bile has antimicrobial effects, detoxifies bacterial endotoxins and stimulates peristalsis).
- Gallstones or inflammation of the liver or pancreas.
