Leaky gut syndrome
This article is not intended to diagnose or treat any diseases.
Due diligence is a necessary part of the healing process. If you believe you are worth the effort, then seek the knowledge you need to reveal the truth.
In the world of functional medicine and nutrition we use a large array of herbs, vitamins, minerals, amino acids and other biological substances to restore function and support healing. Most of the supplements we use are fairly safe. Even when the diagnosis is incorrect or if a side effect occurs, most reactions will resolve quickly with no permanent harm. However, there is a handful of supplements that can cause, at best, a setback and, on occasion, significant side effects. Betaine hydrochloride (HCl) is one of them. When used appropriately and under the correct diagnosis, Betaine HCl can have seemingly magical effects on conditions like acne, eczema, asthma, idiopathic malnutrition, GERD and other digestive issues. However, a visit to most mainstream medical websites will advise you, “Do not take Betaine HCL”. This is with good reason. Betaine HCL can exacerbate several underlying health conditions and, in rare instances, can cause life-threatening health issues.
Betaine HCL is used to treat a condition called hypochlorhydria (insufficiently strong stomach acid). Although it hasn’t been subject to rigorous clinical trials, here is the simplified hypothesis; when acid is the stomach is not strong enough (pH between 1.5 and 3.5) animal protein cannot be effectively digested into amino acids and smaller protein fragments. As a result, the stomach somehow detects this problem and continues to produce weak acid. The weak acid fills up past the stomach and into the esophagus. Unlike the iron-clad lining of the stomach, the esophagus is easily damaged by acid. The thinking is that Betaine HCl works by restoring the correct pH (increasing the acidity) of stomach acid. When the correct dosage achieved, the excess production of weak acid stops and normal digestion of protein and minerals resumes. If the correct dose is not achieved, supplementing with Betaine HCl has little value. Practitioners, here is a link to a method that was originally presented by Jonathan Wright M.D. on how to figure out the correct dose of Betaine HCl. As the author describes, most cases require no more than 2500mg for reestablishing adequate acid levels. I have seen a few cases where the replacement dose was over 6000mg per meal.
Accurate Diagnosis is Crucial
There are many downstream health issues that can arise from inadequate digestion of protein. These include IBS, excessive flatulence, leaky gut syndrome, asthma, acne, allergies, eczema, acid reflux, idiopathic malnutrition, premature osteoporosis etc. There are scientifically sound explanations for each of these that we will discuss another time. However, any of these conditions can be caused by other factors and, none of them is a defining symptom of low stomach acid (hypochlorhydria).
Most importantly, acid reflux, often diagnosed as GERD, is NOT a pathognomonic symptom of hypochlorhydria. The exact same symptoms can be caused by overgrowth of bacteria and in small intestine, excess production of acid, stagnation of the motor migrating complex and, more commonly, by excess histamine. This is why decades of research produced two classes of drugs to treat GERD. These are the proton pump inhibitors (PPI’s) and H2 blockers (Histamine receptor blockers). It can be implied that the effectiveness of these two categories of drugs in treating symptoms can shed some clarity on the root of the problem. In more complex cases, hypochlorhydria and excess histamine will occur simultaneously.
The Big Cautions With Betaine HCl
Esophageal Damage and Strictures
Pills of Betaine HCl can get lodged in areas where the esophagus has narrowed from scar tissue or has shrunk from old age. This usually causes a strong, sharp pain. If the pill remains for more than a couple of minutes, it can literally burn the area. If this happens, the irritation can last several days and it is best to discontinue the course of Betaine HCl therapy until it is completely healed. To prevent damage to the esophagus in cases like these, it is crucial to flush the area until the pill is small enough to move on. This can be done by sipping a weak solution of baking soda in warm water (1/4 tsp per 12 oz of water) OR by diluting a full dose of a liquid antacid in warm water. DO NOT use baking soda if the patient has high blood pressure. This scenario is more common in elderly patients and it is better to break up the Betaine HCl capsules before swallowing them. As a general rule, if this happens, don’t hesitate to seek medical attention.
Exacerbation of Gastritis
Gastritis is inflammation of the stomach lining. It has many causes but ultimately occurs because the cells lining the stomach cannot replace themselves quickly enough to maintain the integrity of the tissue. When this happens, any small amount of acid can quickly damage the lining. This is a potentially dangerous situation as ulcers can form. Possible causes include excessive alcohol consumption, use of corticosteroids and NSAIDS, stress, excess acid production, nutritional deficiencies, excess levels of histamine and infection.
Combine a stomach that is severely irritated by excess histamine and add Betaine HCl and you have yourself a new condition that can take several weeks to fully heal.
Symptoms of gastritis can easily go unnoticed. This is especially true for people who are busy, overwhelmed and/or highly driven. I meet people all the time in my practice who have had low to mid-grade symptoms of gastritis for years without giving it a single consideration that something could be wrong. This can also happen because some people have an altered perception of pain in their digestive tract. Nerve blocks and cauterizations as well as medications, like antidepressants, narcotics and opioids, can reduce pain sensations. Practitioners! Confirm your diagnosis before prescribing Betaine HCl and proceed cautiously with the dose. DO NOT assume that patients will notice side effects immediately.
A True Story of a Gastritis Nightmare
More than a decade ago, I had a nutrition consultation with a gentleman who had clear signs of gastritis. Although he didn’t think so, his lifestyle was extremely stressful. He was founder and CEO of a very successful chain of stores. He worked long hours and traveled frequently. Drinking too much alcohol was one way he compensated for the stress. His symptoms manifested as a dull ache (fairly mild) above his naval that was worse on an empty stomach, with water, with spicy food and about 20 minutes after eating (food usually absorbs acid for a few minutes before the stomach makes more). He denied any sign of dark, tarry pieces in his stool (a sign of bleeding in the digestive system). At the time of our meeting, he was preparing to leave for a big game hunting trip in east Africa. I insisted that he consult a physician before departing. His first week in the African bush he developed anemia as a result of a bleeding ulcer. It took several days for him to reach a facility with adequate medical care. He ended up having to have surgery and, more unfortunately, a blood transfusion that left him with a lifelong disease.
Healing gut disorders is often one of the most complicated, daunting and challenging aspect of all health issues. There are multiple systems that all have to work in harmony and one tiny defect can affect everything downstream. If you are lucky, sometimes a simple probiotic, glutamine or digestive enzyme will fix the issue. However more often than not, simply diagnosing the root cause is buried underneath a pile of confusing symptoms. Because many gut disorders heal much faster with the assistance of glutamine it is important to understand the side effects that it can cause and what they mean.
When you read about glutamine on the various online resources (some being more accurate than others) it sounds like a miracle for treating anything from leaky gut to Crohn’s disease. Generally speaking, glutamine is absolutely lovely for two specific problems.
- Supplying energy for the cells of the small intestine. The cells of the small intestine use glutamine instead of glucose as an energy source.
- Supporting fast healing of almost any damaged tissue of the digestive lining.
These make glutamine a keystone remedy for repairing conditions like burning mouth syndrome, gastritis, stomach and duodenal ulcers, leaky gut syndrome of both the small and large intestine, damage from chemotherapy, food poisoning and irritants like gluten. However, if you haven’t identified the cause of the damage, then taking glutamine is like trying to patch a crack in a dam that is expanding everyday. Although it can produce noticeable improvement, glutamine deficiency is rarely the core cause of digestive problems. Interestingly, unexpected side effects to glutamine can help guide you to the root of the problem. Here are the main ones I’ve seen in my practice.
#1 Increased bloating with glutamine:
There are only two possible things that can cause increased bloating with glutamine. First, and more common, is constipation or undigested food that is stagnant in the digestive system. Many patients may not even be aware that they are constipated. A simple way to find out is to do the beet test. Simply eat some red beets and see how long it takes for them to come out. Believe me, the blood-red color is unmistakable. Anything over 24 hours is quite suspicious.
Glutamine can sometimes improve normal churning movements in the gut known as peristalsis. If the patient is constipated the churning movement can move undigested food that is in the stool or trapped behind it into new areas where bacteria are waiting for their next meal. The bacteria produce various gasses as a byproduct of digesting these foods.
The second cause is glutamine-eating bacteria. The first time I saw this was in a patient with a severe case of SIBO. None of my other colleagues had ever seen it before and it took me quite a while to figure out what it was. It turns out that there are some bacteria that are happy to use glutamine as a food source. In this patient’s case she had glutamine-eating bacteria in her small intestine where no bacteria should have been growing. They would produce extreme bloating within 30 minutes of taking glutamine.
#2 Glutamate-type effect:
Some bacteria convert harmless glutamine into glutamate. Glutamate is most commonly known in monosodium glutamate (MSG). It has excitatory effects on the nervous system and is a known “excitotoxin”.
Common side effects include dialation of pupils, feeling wound up or anxious, headaches or aggravation of migraines, a tight sensation in the diaphragm and, if severe, heart palpitations. In this case it is important to identify and diminish the populations of the offending bacteria before continuing the use of glutamine.
*It took me 15 years to understand why some patients had this reaction to glutamine. Dr. Katherine Pollard’s talk at the 2015 American Association for the Advancement of Science finally revealed the missing piece.
#3 Allergies or other immune reactions to glutamine:
Any immune reactions to glutamine are ALWAYS due to either to added ingredients or to residues from the source of the glutamine (usually an animal source). It is not possible to have an immune reaction (allergy or otherwise) to glutamine by itself. The immune system is not capable of recognizing individual amino acids as a threat. Pure glutamine does not clump or cake and will homogenize quickly in liquids. If the glutamine you are using does not have these properties then it probably contains fillers.
Aside from classic histamine-type allergies that produce itching, swelling and nausea, it is possible to have other types of immune reactions to a substance that have nothing to do with an actual allergy. This is very common in leaky gut syndrome where various types of immune cells are recruited to deal with different substances that have breached past the intestinal lining. For example, neutrophils normally attack bacteria. However they are known to react to some food proteins that mimic antigens (proteins) on the surface of bacteria. Lectins from beans are a common example. An immune reaction after taking glutamine can manifest as an allergy or an exacerbation of the existing symptoms. For example, if acne, joint aches or interstitial cystitis has developed from leaky gut syndrome (this is not the only cause of these conditions), there will be a very obvious flare within 4 hours of taking the glutamine. In this case consider trying an alternative brand or a pharmaceutical-grade, synthetic glutamine that has no residues. Although there are hundreds of supplement manufacturers, most obtain their ingredients from a handful of bulk suppliers. Therefore, even an alternate brand can produce the exact same effect if they get their glutamine from the same bulk supplier. There is one way to avoid getting the same bulk glutamine from a different brand. Contact the company from whom you obtained the glutamine. Nicely explain that you have had a reaction to it. Ask them what the source is of the glutamine (so you can identify the offending residue) and the name of their bulk supplier. Once you have this information, you can contact other supplement companies and identify ones that don’t use the same bulk supplier or source. If you want to help others, feel free to post your discoveries here.
I was first introduced to the concept of Sympathetic Overdrive while attending a lecture about the etiology of autoimmune disease presented by Gary and Rain Klepper D.C. Over ten years later, any skepticism I had regarding the importance of this concept has fully dissolved. There is an array of chronic diseases, including many autoimmune and skin disorders, which are ultimately and intimately related to gut health. Overlooking this single issue can render an otherwise sound treatment protocol slow or ineffective. For successful treatment of gut-related conditions it is imperative that the presence and severity of sympathetic overdrive be assessed and addressed.
Understanding Sympathetic Overdrive
There are two major parts of the nervous system. The parasympathetic, which is activated when we relax, is known as the “rest and digest” part of our nervous system. It stimulates blood flow to the digestive system, brain, extremities and sexual organs. The other part, the sympathetic nervous system, is responsible for the “fight or flight” response. It is activated when our body perceives stress. It reduces blood flow to the extremities, brain and digestive organs in preparation for a perceived survival situation. As we go through our daily lives, our external circumstances and our thoughts stimulate a constant dance between these two aspects of the nervous system. When a person is constantly stressed, their nervous system can be tilted into the state of sympathetic overdrive. The stress can be brought on by various factors including constant worry, skipping meals, not getting adequate rest, not allowing adequate time to carry out tasks and difficult life situations. People who work long hours that involve concentration and active thinking are prone to sympathetic overdrive. This condition is rampant in corporate executives and hedge fund managers. It can also be triggered by situations that remind our subconscious of stressful or scary events from our past.
When a person experiences enough stress to stimulate the sympathetic nervous system, they often experience cold hands and feet. Less noticeable but more serious is the reduced blood flow to the digestive tissues. If this only happens occasionally, the system usually has the resilience to recover. However, if the body is in a state of sympathetic overdrive, tissues of the digestive system constantly experience a state of reduced blood flow and oxygen exchange. Elevated levels of cortisol, the stress hormone, can lead to further damage to these tissues.
The effects of reduced blood flow from sympathetic overdrive interferes with the proper functioning of digestive organs, alters the balance of microbes residing within the gut, reduces the proper functioning of the immune system and interferes with proper filtering of nutrients that are absorbed. Many of the beneficial bacteria and fungi growing in our gut only thrive in an oxygen environment. These bacteria are known as aerobes. As the oxygen supply diminishes with circulation, bacteria that thrive in the absence of oxygen, anaerobes, begin to replace the withering populations of aerobic bacteria. Clostridium Difficile (aka C. Diff), a common infection in hospitals, is a classic anaerobic bacterium. Aside from C. Diff., there are likely hundreds of species of anaerobic bacteria that can or do reside in the human gut. So far, it is estimated that we’ve only been able to culture and identify between 1-5% of these organisms. However, we know they exist because we can test for one of their main waste products, beta-glucuronidase. This little waste product can reap havoc on the body’s detoxification systems and will be discussed in another article.
One would expect significant digestive disturbances in this situation. However, some people never experience any digestive symptoms. In the past 15 years I have seen hundreds of patients who tested positive for overgrowth of C. Diff, numerous pathogens or the presence of beta glucuronidase with no digestive symptoms. On the other hand, most of these patients had other significant chronic diseases including eczema, psoriasis, tyramine intolerance, rheumatoid arthritis, Hashimoto’s thyroiditis and fibromyalgia. I want to be absolutely clear that this scenario is only one piece of the puzzle in healing these diseases.
There are very few possibilities to explain how pathogenic bacteria can thrive in the digestive tract without initiating a proper immune response. The most logical explanation is the disruption of proper immune functioning from gut-associated lymphoid tissue (GALT). I suspect that this system either becomes defective or overloaded. As a result, the constant stream of antigens override this system and they are passed along to other parts of immune system in the mucosa associated lymphoid tissue (MALT). As a result, inflammatory conditions, like eczema and joint stiffness, arise in other parts of the body. This too is a very large subject that I will discuss in another article or in my book.
Assessing the Presence and Severity of Sympathetic Overdrive
There are several key signs that suggest a patient is experiencing Sympathetic Overdrive. Many of these were originally observed in the Traditional Chinese Medicine literature under the concepts of Liver Qi Stagnation, Liver overacting on Spleen and/or Stomach. Obviously, there are variations but here are some basic guidelines.
- Cold hands and feet – This symptom can arises when the stress response is fairly pronounced. Of course, it can be caused by other conditions that affect circulation. However, as a general rule, if the patient is experiencing both cold hands and feet, it is usually a symptom of sympathetic overdrive.
- Constipation or sluggish bowel movements without dry stools – the reduction of circulation to the digestive system slows churning in the intestinal tract and can lead to mild constipation or sluggish movement. It is possible to have constipation with dry stools along with this condition but it will not be caused by it.
- Overgrowth of anaerobic bacteria or elevated beta-glucuronidase on a stool and digestive analysis.
- Any symptom that is generally worse with stress is often related to sympathetic overdrive.
Treating Sympathetic Overdrive
There are multiple ways of treating this problem. However, tools that the patient can use several times per day will accelerate progress. The most powerful remedy for this situation is a variation of abdominal breathing that originated from the ancient practice of Qi Gong. This exercise, acts as a pump to restore circulation to the digestive tissues and directly stimulate the parasympathetic nervous system.
Instructions: Stand with your feet shoulder width apart and your knees slightly bent. Place your hands on the lower abdomen below the naval bringing your attention to this area. Inhaling deeply, extend your abdomen out as if it is a balloon filling with air. Exhale and squeeze the lower abdomen in imagining that you are trying to touch your naval to your spine. The repetitions can be done fairly quickly averaging about 1 every 3-4 seconds or slowly for a deeper meditative effect. You can also do this exercise while driving or lying down. Repeat 5-10 times several times per day or whenever symptoms appear. For amazing abdominal muscles repeat 100-200x per day.
You can find other meditative and breathing exercises in my previous post “Finding Inspiration Through Respiration”
Abdominal heat packs – simply applying heat to the abdominal area can stimulate circulation to these tissues and stimulate the parasympathetic nervous system.
Acupuncture is powerfully effective for “resetting” the nervous system and reducing stress. It has been demonstrated to treat the most extreme version of sympathetic overdrive, which we call post-traumatic stress disorder or PTSD. It is so effective that a few years ago, the U.S Department of Defense funded The Air Force Acupuncture Center. This is a clinic dedicated to treating military personnel who suffer from PTSD. It is used as a practice and training facility for physicians and medical professionals for “battlefield acupuncture”.
Herbs and Homeopathic Remedies that Really Work
Please note that all of these recommendations should be administered under the guidance of a qualified health care provider.
Rescue Remedy – This is available in all health food stores and online. Its intended use was originally for stress and traumatic experiences. I have found it to be incredibly helpful for treatment of gut disorders that involve sympathetic overdrive. Just follow the instuctions.
Psy-Stabil by Pekana – This is another remedy that falls under the practice of homotoxicology, which is slightly different from homeopathy. Its effects are similar to Rescue Remedy but may be a bit stronger. It is also very helpful for relieving anxiety.
Rhodiola – This herb is literally miraculous for restoring circulation to the digestive system and also balancing the nervous system. It is also helpful for treating addiction and some causes of depression. Be careful! It has some interactions with medications. Practitioners, be sure to take the time to inform yourself before prescribing it.
Lactobacillus Rhamanosus – This beneficial bacterium is one of the few that generates hydrogen peroxide. It is very helpful for reintroducing oxygen to the digestive tract and reducing overgrowth of C. Diff and other obligate anaerobes.
Other tips for preventing stimulation of the sympathetic nervous system:
- Don’t skip meals! Every time your body has to accommodate a drop in blood sugar, it stimulates the production of cortisol and initiates a stress response
- Take time everyday to do nothing
- Give yourself the gift of extra time to complete tasks. Cramming more and more tasks into your day increases stress and reduces creativity and the possibility of spontaneity.
- Pay attention to the situations and people in your life who make you feel stressed. Reflect on why they trigger these feelings in you and decide if there are ways of managing your exposure to them.
- Spend time in Nature. This is proven to reduce stress levels.
“Healing is a matter of time, but it is sometimes also a matter of opportunity.” – Hippocrates