Chapter 58 Maldigestion
Proper digestion, absorption, and elimination are necessary to gain the nutritional benefits from foods. Any disruption of these processes causes substantial, and usually progressive, health problems throughout the body. This chapter provides some overview of digestive dysfunction and ways to improve digestion. For specific digestive tract disorders (e.g., irritable bowel syndrome, peptic ulcers, inflammatory bowel disease, celiac disease), see Section 6. For information on the various laboratory procedures for evaluation of digestive function (e.g., comprehensive digestive stool analysis, intestinal permeability assessment, small intestinal bacterial overgrowth breath test), see Section 2.
The term indigestion is often used by patients to describe a feeling of gaseousness or fullness in the abdomen. It can also be used to describe “heartburn.” In a survey of over 20,000 adults in the United States, the overall prevalence of at least 1 upper gastrointestinal symptom was reported in 45% of those surveyed (based on the preceding 3-month period); symptoms included heartburn, early satiety, loss of appetite, and postprandial fullness (bloating).1 These symptoms of indigestion can be attributed to a great many causes, including not only increased secretion of acid but also decreased secretion of acid and other digestive factors and enzymes.
Indigestion is commonly treated with antacids or acid-blocking drugs, either chosen by patients over-the-counter or prescribed by medical practitioners. The use of these agents will typically raise the gastric pH above 3.5, effectively inhibiting the action of pepsin, the enzyme involved in protein digestion that can be irritating to the stomach. Although raising the pH can reduce symptoms, it also substantially impairs protein digestion and mineral disassociation. In addition, the change in pH can adversely affect gut microbial flora, including the promotion of an overgrowth of Helicobacter pylori. Finally, most nutrition-oriented physicians believe that lack of acid, not excess, is the true culprit in most patients with indigestion.
According to surveys, most people use antacids to relieve symptoms of reflux esophagitis.2 However, reflux esophagitis is most often caused by overeating, not excessive acid production. Other common causes are as follows:
Chronic heartburn may also be a sign of a hiatal hernia. However, although 50% of people older than 50 years have hiatal hernias, only 5% of patients with hiatal hernias actually experience reflux esophagitis. Perhaps the most effective treatment of chronic reflux esophagitis and symptomatic hiatal hernias is to utilize gravity. The standard recommendation is to simply place 4-inch blocks under the bedposts at the head of the patient’s bed. This elevation of the head is very effective in many cases. Another recommendation to heal the esophagus is the use of deglycyrrhizinated licorice.
In the patient with chronic indigestion, rather than focus on blocking the digestive process with antacids, the natural approach focuses on aiding digestion. Although much is said about hyperacidity conditions, a more common cause of indigestion is a lack of gastric acid secretion. Many symptoms and signs suggest impaired gastric acid secretion, and a number of specific diseases have been associated with insufficient gastric acid output.3–13 They are listed in Boxes 58-1 and 58-2.