169 | Miracle Molecules: Stomach Acid and Bile (Part 1)

Ever wondered how something as simple as stomach acid could be a miracle molecule in your digestive health? Join us on the Inflammation Nation Podcast as we unravel the complexities of gut health and the miraculous roles of hydrochloric acid and bile. After sharing a personal story about our recent RV breakdown in Virginia and treasured family moments in Canada, we shift focus to debunking the myth that supplements can solve all health problems. We emphasize why a balanced diet and healthy lifestyle are irreplaceable foundations for well-being.

Discover the brain-gut connection and how your brain orchestrates key digestive functions such as motility, blood flow, and secretion of essential digestive components. Learn about the step-by-step process by which stomach acid and bile break down proteins and fats, turning digestion into a finely-tuned symphony. This episode takes you through the intricacies of how your digestive system works and why addressing core health mechanisms is far more effective than relying on trendy health solutions.

In our final discussion, we uncover the critical role of stomach acid and bile in our immune defenses as we age, and how decreased production of these vital substances can make us more susceptible to infections and conditions like SIBO. We also touch on the impact of medications like proton pump inhibitors on stomach acid production. Remember, the information shared is for educational purposes and is not a substitute for professional medical advice. Tune in to equip yourself with the knowledge and tools you need to tackle inflammation and achieve optimal health.

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Transcript

Speaker 1 0:02

Hey everyone, welcome to the Inflammation Nation podcast. I'm your host, Dr Steve Noseberg.

Speaker 2 0:08

One of the greatest obstacles to crafting health and wellness is identifying and controlling inflammation. It's at the core of all complex and chronic diseases and it's the driving mechanism that underlies the most common symptoms that people like you struggle to overcome. Join us as we explore cutting edge science and research to give you the information and tools you need to create the quality of life you want and deserve. And now here is the host of Inflammation Nation, dr Stephen Nosworthy.

Speaker 1 0:36

Hey guys, welcome back to the podcast Once again. I've been off the podcast airwaves for I guess it's been about a month or so now, so let me just quickly fill you in on what happened. You may know that we spend most summers in Canada with my dad, my sister and our extended family. I'm originally Canadian, spent more than half my life in the States I'm actually a dual citizen at this point, but anyways, we were coming up for our annual trip and life in the States I'm actually a dual citizen at this point, but anyways, we were coming up for our annual trip and visit for the summer, towing our RV, and we were in the mountains of Virginia and we had this catastrophic engine failure in the truck that I used to pull the RV and we got stranded in this quaint small town right on the border of Virginia, north Carolina. And in fact the North Carolina town was the model for the town Mayberry, if you're old enough to remember the Andy Griffith show, that was placed in a theoretical town in North Carolina called Mayberry Actually not a real town, but it was modeled after this particular town and so we ended up having to spend four days literally stuck in this small town in the mountains, which you know doesn't sound too bad, does it? But nevertheless it just kind of took me out of my normal routine. And then, as soon as we got here to Canada for the summer, my daughter, my son-in-law and four of my grandchildren came up to visit from Texas and we had 10 days of just fantastic family fun. Nevertheless, again, it took me out of my routine.

Speaker 1 2:12

So here we are and we're back, and so we're still talking about miracle molecules, and I hope that you've enjoyed this series. It's one of those things where, gosh, I could probably keep doing this for years, just simply because there are so many unique and special things that happen inside your body, compounds that we either make or things that we might take, say, from a supplemental standpoint, but nevertheless, there's probably an inexhaustible supply of things that we could talk about in the context of things that we consider to be miracle molecules. And so the next two might be the last. I just have to put a little thought into whether or not I want to keep going on with this or move on to some other topics, but today we're going to be talking about actually two things. We're going to be talking about stomach acid, or hydrochloric acid, and bile. I know it doesn't sound all that appetizing or maybe scintillating, but it's one thing.

Speaker 1 3:12

It's very interesting to note that what is bandied about on the internet as cutting edge ways to enhance your health and longevity are either old school things that get rebranded as if they're something new or they get presented as if they're the only thing that you need to do or need to take. For example, in the last year we've seen specific probiotics touted as the answer to prediabetes, for example, and I can guarantee that a lot of people with prediabetes are taking this specific probiotic, hoping that they don't have to change their diet or move their bodies. Likewise, almost every year or so, there's a new supplement that is supposed to enhance longevity by improving mitochondrial function. But if you don't remove the thing that is impairing your mitochondria to begin with, you can take boatloads of these supplements and it's really not going to make that much of a difference. This is probably a good time just to remind you that the word supplement as in nutritional supplement, it means something that completes or enhances something else when added to it. That's what a supplement is. So if all you do is take nutritional supplements but you're not adding that to an optimized diet and lifestyle, then you're missing the point, and you've probably heard me say before and I know I've certainly said this in the functional medicine seminars that I've taught over the last 15 years or so is that diet and lifestyle like you can't out-supplement a bad diet, you can't out-supplement a bad lifestyle. Those have to be your first and foremost strategies when it comes to reclaiming your health and getting back to the person that you used to be or to become the person that you want to be in the future. So supplements are just that there's something that's added to other things that are more fundamental, so to speak.

Speaker 1 5:08

Now, this might not be true when you take a nutritional product that is designed to, say, fix a nutrient deficiency. For example, I often prescribe vitamin D to someone whose vitamin D levels are either frankly deficient or they're suboptimal. Maybe it's vitamin A, but maybe it's glutathione, maybe it's iron, just depends on the case. But I guess technically I'm still supplementing their dietary content or perhaps accounting for some type of gut malabsorption issue that prevents them from getting all the nutrients in their food. In that case, the vitamin prescription, if you will, that I give them is supplementing my recommendation. That will help to fix their gut. But hopefully you get my point, like I don't want you to expect nutritional supplementation to fix your problems when you're ignoring the core mechanisms that are creating your complaints. Right, supplements are just that the things we do in addition to the things that are more fundamental.

Speaker 1 6:03

Now, since I just mentioned the gut, that's a good segue into this next installment of Miracle Molecules, and today, again, I'm going to double up and talk about two things that each function on their own, but they also work together, and these are hydrochloric acid, or stomach acid, and bile or I might refer to them as bile salts and bile, or I might refer to them as bile salts. Now let's dive in by talking briefly about the GI system as a whole first, and then we'll focus in on both of these miracle molecules. We'll probably take two episodes to do this. So one of the things that I teach to new doctors in our functional medicine seminars is that you have to approach the gut from top to bottom, or sometimes we might say north to south, meaning that we start with the concept that the brain, which is topmost, or further north, if you will, the brain, exerts significance and perhaps even primary control over how the gut functions and when the communication between the brain and the gut is off, then things below that, things that are further south, so to speak, tend to go wrong.

Speaker 1 7:13

In general, the three things that have the greatest control over how your gut functions are the brain, the thyroid and the local gut environment itself, meaning what is happening inside the gut. But the brain is still primary, and I can say that confidently because we have studies that show when the connection from the brain to the gut is severed by cutting the vagus nerve I'm sure you've heard about that the gut still works. It just works with much less capacity or it's much less efficient. So the brain is absolutely critical to gut health. So, very quickly, your brain controls four major functions of your gut. It controls gut motility, which literally refers to moving food from the mouth to the anus, moving food from the mouth to the anus. It controls blood flow, which helps keep the lining of the gut healthy and, say, prevents or helps to repair leaky gut. It also controls acid enzyme and bile secretion, which are best known for their roles in digesting protein, fats and carbohydrates. And then, finally, the brain controls the muscular valves that keep the different compartments of your gut separate from each other, so that food moves only in one direction. It moves from north to south, top to bottom, and these valves basically act as one-way shutoff valves so that bacteria in the colon don't migrate up into the small intestine, where they're not supposed to be. That's a very quick and dirty overview of how the brain-gut axis is organized, but for today I want to focus on the part of the system where we find stomach acid and bile, and I just noted that these are best known for the rules in digestion.

Speaker 1 9:04

So let's break that down first. No pun intended, all right. Hydrochloric acid it's used to break down dietary proteins, but it doesn't do that directly. In fact, the most potent digester of proteins is something called pepsin, which is activated by hydrochloric acid. So here's how this works when we eat food that contains proteins, the brain sends a signal down to the gut to release pepsin in an inactive form. You see this feature of human function all over the place. That we have things in their inactive form, they have to be converted to the active form to actually do something. That we have things in their inactive form, they have to be converted to the active form to actually do something.

Speaker 1 9:47

So the brain sends signals down to the gut to release pepsin in the inactive form when we consume protein. But at the same time it also releases the neurotransmitter acetylcholine and hydrochloric acid into the gut from specialized cells in the gut lining. Now we usually think of acetylcholine as, hey, that's a neurotransmitter. That means the brain. Well, if you've never heard this before, the neurological system called the enteric nervous system in your gut is referred to quite often as the second brain. In fact, we have so much neurological tissue in the gut that it rivals other parts of the brain in terms of the density of the neurons that we have in the gut, that it rivals other parts of the brain in terms of the density of the neurons that we have in the gut that help to control gut function. So, nevertheless, the brain.

Speaker 1 10:33

Once you consume protein, the brain releases pepsin in the inactive form. At the same time, it releases acetylcholine and hydrochloric acid. And so the acetylcholine and hydrochloric acid, together with a few other minor players, take this pepsin and convert it from the inactive to the active form, and the pepsin is actually what does the work in breaking the protein bonds that keep together the amino acids that make up the proteins. In essence, the hydrochloric acid changes the pH of the stomach lowers the pH, meaning it's more acidic, which is the primary signal that activates pepsin, which then breaks down your dietary proteins into single amino acids that can be absorbed by the cells of your small intestine, because your gut lining cannot absorb whole proteins, it can't even absorb peptide or protein fragments. We have to break it down into individual single amino acids to be able to do that. So, in essence, the hydrochloric acid changes the pH of the stomach, which is the primary signal that activates pepsin, which then breaks down your proteins into single amino acids that can be absorbed by the small intestinal cells. So again, the basic process is that, while pepsin does the work of protein digestion, it needs hydrochloric acid to activate it first, and this is perhaps one of the reasons why hydrochloric acid to activate it first. And this is perhaps one of the reasons why hydrochloric acid is something that's very commonly prescribed in the world of nutritional medicine, because of what it does changes the pH and then activates a whole bunch of other things. So that's a very quick overview of hydrochloric acid.

Speaker 1 12:10

Now let's talk about bile, of hydrochloric acid. Now let's talk about bile. Bile, in its digestive role, is used to emulsify dietary fats so that we can break those down even further using pancreatic enzymes called lipases Emulsification just if you don't know what that is. It's the chemical process of breaking large fat droplets into smaller ones that are then easier to process. So again, it's kind of a stepwise system.

Speaker 1 12:42

Now bile is formed in the liver and it's concentrated in the gallbladder where it sits waiting to be released, and the signal that causes the gallbladder to contract and to release its stored bile is the fat content of the food passing from the stomach to the upper part of the small intestine, just like protein, triggers the release of hydrochloric acid and pepsin to digest proteins. The more fat that's in your food, the more bile gets released, and vice versa the less fat you have, the less bile you need released, and vice versa, the less fat you have, the less bile you need. So whether we talk about protein or fat digestion, hydrochloric acid or bile, the general process is the same. The presence of certain types of macronutrients in the food that you eat triggers the production of specific chemicals and molecules that are used to break the macronutrients down protein, fat and carbs into their smaller or smallest components so that we can absorb them and that absorption happens in the small intestine. It doesn't happen in the stomach, it doesn't happen in the colon. But these core functions are not what make hydrochloric acid and bile miracle molecules. Hydrochloric acid and bile miracle molecules, that comes from their roles in immunity and your microbiome. There are others, but we're just going to focus on those. So let's talk about immunity.

Speaker 1 14:04

When we look at how we fight off infections, or perhaps how we get infected, there are only a few ways that things that want to infect us can get inside us to do that. So things like viruses, bacteria, parasites they only get into us in one of three ways. They can cross our skin barrier, like if you have a cut in your skin, that can get infected. We can breathe them in. Like you know, you go to your cousin's house and he or she has a cold or the flu and you breathe that in and then you get sick yourself. Or we can swallow them, and that's where we're going to focus here. Right, honestly, there's not a single bite of food that you swallow that doesn't have something in it that wants to infect you.

Speaker 1 14:51

No matter where you source your food and how you're prepared, it can still infect you, and this is why hydrochloric acid is placed up front in the digestion process. It appears earlier in this top to bottom or north to south progression, not only because we need to break down large protein molecules into smaller ones and then eventually amino acids, but because hydrochloric acid it's an acid, which means it's a powerful sterilizing agent, and in this sense hydrochloric acid is a unique part of your immune system, more specifically a branch of the immune system called the innate immune system. Now, when I use the term innate immune system, I'm usually referring to immune cells, things like macrophages or neutrophils or perhaps natural killer cells. But the very first exposure to your immune system that any potential pathogen that you swallow encounters is stomach acid, and this is followed very closely by the antimicrobial capacity of bile. Once your food leaves your stomach and reaches the top of your small intestine, and in fact before any infections get spotted and attacked by your gut-based immune cells, they have already taken like a one-two punch from stomach acid and bile.

Speaker 1 16:15

Now this raises a few questions and potential issues that I'll do my best to answer probably not sequentially, no particular order as we go through the rest of this episode and the next one. What happens if stomach acid and bile production is reduced for some reason. What happens to stomach acid and bile production as we age? What happens to stomach acid and bile production as a result of very common metabolic issues, say Hashimoto's disease or just hypothyroidism in general? And what happens to stomach acid when you use very commonly used medications that are classified as proton pump inhibitors, things like Zantac or Pepsid AC or whatever flavor pill of the day they're using to suppress acid reflux? And what happens to bile production when you have things like fatty liver or gallstones, which might be associated with hormonal imbalances or common metabolic disorders like insulin resistance or prediabetes? And again, we'll try to answer these in no particular order, but these are, as a clinician, these are questions that I would have if someone comes into me and I think, as part of the constellation of problems they're facing.

Speaker 1 19:28

Maybe hydrochloric acid and bile insufficiency is part of that. It's one thing to give someone a supplement that has hydrochloric acid in it, or even bile salts, for example. It's another to identify why they got there, because, remember, supplements are adding to things that are more fundamental and the more fundamental thing is answering the question well, how did this happen? And let's see if we can fix that. So, again in no particular order, let's talk about hydrochloric acid and the aging process.

Speaker 1 20:01

Like, we know that our hydrochloric acid status changes as we age, and starting around the age 65, low stomach acid is very common. It's way more common after 65 than it is prior to. That it doesn't mean you can't have low stomach acid if you're, say, 42. And low stomach acid can lead to a myriad of consequences, not only things like poor protein digestion or even poor amino acid status, which can lead to a loss of muscle mass and frailty, right, since these amino acids are the building blocks of your skeletal muscle. And all of that, of course, would be made worse with an inactive lifestyle, particularly if you're not engaged in some kind of resistance training to build your muscles. But the loss of hydrochloric acid status as we age opens us up to more infections from the foods that we eat. And this is one reason why we tend to see certain types of gut dysfunctions like SIBO, or small intestinal bacterial overgrowth, in the elderly population than we do in the younger. And again, it doesn't mean you can't get SIBO if you're in your 20s, 30s or 40s. You certainly can. But we see certain things in the elderly population because as we get older, things go wrong.

Speaker 1 21:21

Now you might recall that SIBO again small intestinal bacterial overgrowth is where we have bacteria that are too high up in the small intestine, where they feed off the fermentable sugar, starches and fibers that are found in certain fruits and vegetables. And all fruits and vegetables have these fermentable compounds, there's just different types and they're found in higher concentrations in certain fruits and vegetables. Now, in reality there are two primary ways to get SIBO. One is bottom-up and the other is top-down. In the bottom-up model, bacteria from the large intestine and colon migrate up into the small intestine because the brain-gut axis fails to control the ileocecal valve we talked about that in the introduction. To control the ileocecal valve we talked about that in the introduction so that the bacteria in the lower intestine can move in a retrograde fashion up into the small intestine and in other words, we lose the separation and compartmentalization that normally keeps bacteria in the large intestine and the colon. That's a bottoms-up model of how someone acquires SIBO.

Speaker 1 22:30

But the top-down model of SIBO is where we eat food with some organism in it like bacteria, and there's actually something called SIFO, which is a fungal overgrowth, but let's just stick to bacteria. So with this top-down model of SIBO we eat something that has some bacteria in it and we can't sterilize it because we don't have good stomach acid, and so these bacteria take up residence in the upper small intestine, where they're really not supposed to be. And that happens again because we can't sterilize the food we're eating, because we're not making enough stomach acid right, so the bacterial load that we swallow doesn't get neutralized or sterilized and then it can infect the small intestine as we age and we tend to lose hydrochloric acid because of atrophy of the hydrochloric acid-producing cells. Remember I said, hydrochloric acid is made by certain cells in the gut. These are called parietal cells, and when we can't sterilize our food, we get infections in the stomach or high in the small intestine and that can manifest as SIBO, which classically presents as gas or bloating and distention, particularly when you eat certain sugars, fibers and starches. And this is also a very common cause of IBS. I mean, the last statistic I saw was that about 80, well, it depends on the study anywhere from 40, let's say upwards of 80% of people who have IBS have it because they have SIBO. And then the question is well, why do you have SIBO and what can we do to try to change that? And the answer is quite a lot.

Speaker 1 24:08

Now, one of the common organisms for infections in the stomach itself or at the very top of the small intestine is an organism of bacteria called H pylori, and H pylori is perhaps the most common cause of gastritis and gastric ulcers. And in fact H pylori is considered to be the most common cause of gastritis and gastric ulcers. And in fact H pylori is considered to be the most common infection in the world, since at any given time, roughly half the world's population has H pylori present in their stomachs. But here's the kicker 80 to 85% of the time these infections are asymptomatic, which means that you don't even know you have it. And over time the H pylori shuts down stomach acid production by impairing these parietal cells that make hydrochloric acid. And the research suggests that everyone with these silent H pylori infections will eventually develop gastritis and a high percentage have increased risk for stomach cancer because of the long-term low-grade inflammation that H pylori induces.

Speaker 1 25:11

And for the longest time, scientists thought that the stomach was completely sterile because of its acid content. That is until they discovered H pylori. I think it was early 80s, I'm going to say 1982. And then for decades H pylori was thought to be the only bacteria that could colonize the stomach, because it controls the acid production. It shuts it down. That is until better techniques discovered that a strain of streptococcal species could also infect the stomach, and I'm sure more will be discovered in the future.

Speaker 1 25:47

Now, one particular form of strep that can infect the stomach is something called strep mutans, which is a major contributor to cavities in your teeth, and so we have studies that show that strep from your mouth can seep into your stomach and then create biofilm and I know I've talked about biofilm before to your stomach and then create biofilm and I know I've talked about biofilm before which, it turns out, creates the perfect habitat for H pylori to grow, and this is why people with poor dental hygiene have higher rates of H pylori in their stomach. Now, as I said, h pylori shuts down stomach acid, which allows H pylori, strep and other organisms to get past that first line of immune defense, which is not an immune cell, but it's a highly acidic stomach. Now, low stomach acid can also happen with hypothyroidism or Hashimoto's disease. When thyroid hormones are low, we can't make sufficient amounts of another protein called gastrin, which is part of the production process of hydrochloric acid. Right, remember, hydrochloric acid changes the pH of the stomach, which then activates pepsin. But in order to make hydrochloric acid we need this thing called gastrin, which tends to be low in people with Hashimoto's.

Medical Disclaimer and Functional Medicine

Speaker 1 27:07

Gastrin does several things in the gut, one of which is activating this thing called the proton pump, and I'll refer you back to proton pump inhibitor medications like Zantac and Pepsod that shut down acid. This is how it does it by shutting down the proton pump, gastrin activates the proton pump, which sends both hydrogen and chloride ions hydrochloric acid, hydrogen and chloride ions into the gut, where they combine to make stomach acid or again hydrochloric acid. And this is one of several reasons why people with Hashimoto's tend to have GI complaints. There's not many people I've worked with and I've worked with hundreds, if not more, of people with Hashimoto's over the last 15 years. I'm sure it's in the very high hundreds, if not in the thousands, and very few of them have normal gut function. Right, gastrin does several things in the gut, one of which is activating the proton pump, which then sends hydrogen chloride ions into the gut. They make the hydrochloric acid and, again very common with Hashimoto's they tend to have GI complaints, which range from protein maldigestion to low gut motility, to SIBO infections, to leaky gut, and the list could continue.

Speaker 1 28:27

Finally, and I've mentioned these proton pump inhibitors like Pepsin, ac, zantac and so on, these are used to control acid reflux and they can certainly do that right, they reduce the acid symptomatology. But there are some downsides. The first is that the lower stomach acid means less sterilization and an increased potential for H pylori, strep and other gut infections, and that's not cool. But perhaps the worst potential long-term outcome of proton pump inhibitor use is that in some people it causes gastrin levels to get too high because the body is now you're using a medication to shut down the proton pump and the innate intelligence of the body is saying well, I need more acid. So it keeps trying to make more, so it makes more gastrin, and this is a risk factor for neoplasia or uncontrolled tissue growth. Call it cancer. And this is why people who have low stomach acid from any cause whether it's H pylori infections, low thyroid or proton pump inhibitor use have a greater risk for stomach cancer than those who have adequate hydrochloric acid status. All right, I'm going to leave it there for now. Next time we're going to talk about the role of bile, also as part of the innate immune system, but also we'll talk about its role in detoxification, and we'll come back to both hydrochloric acid and bile and their roles in the microbiome. We're going to do that next time right here on the Inflammation Nation podcast.

Speaker 1 30:03

This podcast is for general informational and educational purposes only only, and does not constitute the practice of medicine in any form or capacity. No doctor-patient relationship is formed. The use of the information in this podcast or any materials associated with or linked to the podcast is at the listener's own risk. The content of this podcast is not intended to be a substitute for professional and personalized medical advice, diagnosis or treatment, and listeners should not disregard or delay obtaining proper medical advice when a health condition exists and warrants that. And finally, functional medicine is not intended or designed to treat disease, but rather is a natural approach to support restoring health and wellness. The use of diet and lifestyle modifications and nutritional supplementation is supportive for adjunctive care.