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Low Stomach Acid: An Epidemic Hidden in Plain Sight


07-29-2015, 12:44 AM #1
umphreak
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Low Stomach Acid: An Epidemic Hidden in Plain Sight
an original article by Umphreak


Did you know that in the vast majority of cases, painful acid reflux and peptic ulcers are caused not by too much stomach acid, but by too little? This may seem hard to believe for those who have been told by their doctor that the burning they experience after meals is the result of overproduction of stomach acid. Acid suppressant drugs, which include proton pump inhibitors (such as Prilosec) and H2 receptor antagonists (such as Tagamet and Zantac), are among the most prescribed drugs in the world. In some countries these medications are available over-the-counter. Additionally, over-the-counter antacids including Tums, Rolaids, and Alka-Seltzer are widely used. Studies have estimated that as many as 40 percent of Americans experience heartburn at least once a month! 

While excess acid can indeed cause burning sensations in the GI tract, it is very rare for the body to produce too much acid, and the same symptoms can result from too little acid. Insufficient stomach acid, on the other hand, is surprisingly common especially in older people, as acid production often decreases with age.

In addition to heartburn and ulcers, a wide variety of symptoms and conditions are associated with low production of stomach acid, including but not limited to:

  • constipation and/or diarrhea
  • gas and/or belching
  • bloating, sense of excess fullness, and/or sleepiness after meals
  • nausea from eating fatty foods
  • candida overgrowth and other gut flora imbalances, including parasites
  • fatigue
  • food allergies and sensitivities
  • frequent infections
  • nutrient deficiencies, especially B12, folate, iron, calcium, and zinc
  • general malnutrition and poor nutrient absorption
  • weak or brittle fingernails
  • liver toxicity
  • depression and anxiety

Proper Digestion: A Brief Overview


In order to understand how low stomach acid can cause all of these symptoms, we need to first understand how the digestive system is supposed to work. When we eat a meal, the stomach produces gastric juice made up of hydrochloric acid and the enzyme pepsinogen. When it contacts the acid, pepsinogen is converted into its active form, pepsin. Together the acid and pepsin begin the digestion of proteins in the stomach. The normal resting pH of the stomach is between 1 and 3, which is very acidic. A thick layer of mucus protects the stomach lining from this highly acidic environment. Again, it is normal and desirable for the stomach to be extremely acidic, and in fact the stomach is perfectly designed for such acidity. Other tissues of the body, including the lining of the esophagus and small intestine, are unprotected from even the smallest amount of acid.

In the stomach, food is churned and mixed with the gastric juice. Once the stomach acid and pepsin have done their work, the food will be partially broken down into a thick liquidy substance called chyme (pronounced like “time” with a “k”) which has the consistency of split pea soup. Next, the pyloric valve that connects the lower stomach with the small intestine will begin to open, letting a little of the chyme through at a time.

As the chyme enters the first part of the small intestine, the duodenum, the intestine is triggered by the acidity of the chyme to release the hormones secretin and cholecystokinin (pronounced “coal-uh-cyst-o-KINE-in”). Secretin tells the pancreas to release digestive enzymes that finish breaking down proteins, fats, and carbohydrates into smaller units that can be absorbed through the intestinal wall. It also causes the pancreas to release bicarbonate, which neutralizes the acidity of the chyme. The normal pH of the intestines is 7 (neutral), so the bicarbonate is necessary to prevent the acid from eating away at the intestinal wall. Cholecystokinin tells the gallbladder to release its bile, which emulsifies fats and allows for their absorption. Once this chain of events has taken place, at least 90% of nutrient absorption will take place in the small intestine, with the remainder absorbed in the colon.


When Things Go Wrong


That’s how digestion is supposed to happen under ideal circumstances. But what happens if there is not enough stomach acid? First and foremost, protein digestion is dramatically impaired. In order to absorb protein, it must first be broken down into individual amino acids. Without adequate stomach acid, this simply doesn’t happen to the extent that it should. Deficiencies in protein can produce effects as varied as neurotransmitter imbalance in the brain, endocrine dysfunction, edema, muscle wasting, fatigue, frequent infections, and slow wound healing. Second, a number of vitamins and minerals are dependent on a certain level of acidity for absorption. These include iron, calcium, zinc, B12, B6, and folate. Deficiencies of these nutrients can have far-reaching ill effects on health, including anemia, homocysteine buildup, poor bone health, immune dysfunction, and even birth defects and permanent nerve damage.

Third, without the proper acidity, secretin and cholecystokinin will not be released, and there will be a lack of enzymes and bile to finish digestion, along with an absence of bicarbonate. The lack of bile can lead to feelings of nausea, headaches, and even vomiting as fats go undigested and become rancid. The gallbladder is a rhythmical organ, designed to empty several times per day. The liver will continue to make bile whether the gallbladder empties or not, and the bile has the ability to thicken and become concentrated in the gallbladder. This is an important survival mechanism, but if it happens enough times, the bile becomes sludgy and can eventually form gallstones. The lack of bicarbonate to neutralize the acid is also a serious problem. You see, while the acidity may not be high enough to properly break down proteins or trigger the release of bicarbonate, it will still generally be high enough to damage the delicate lining of the small intestine. Over time, this can cause or exacerbate duodenal ulcers.

Fourth, the body realizes what will happen if the chyme is allowed to move into the small intestine, and so the stomach will try to hold onto the chyme for as long as possible. If the meal contained carbohydrates, they will begin to ferment in the warm environment of the stomach, producing gas. This can lead to a bloated feeling after meals, as well as belching. Under normal circumstances, the sphincter that connects the bottom of the esophagus to the stomach will open only when food is swallowed, to allow it to pass into the stomach. The rest of the time, it will remain firmly closed to protect the esophagus. Acid reflux can only occur when the esophageal sphincter opens at inappropriate times, allowing acid to splash into the esophagus as the stomach churns the chyme. A buildup of gas in the stomach can put pressure on the sphincter and cause it to open at the wrong time. Just as with the small intestine, the esophagus is not designed for even small amounts of acid. In this way, insufficient stomach acid can result in acid reflux and heartburn.

And fifth, over time, low stomach acid can lead to severe imbalances in the normal gut flora that populates our GI tract. In the small intestine and colon, the incorrect pH creates an inhospitable environment for the beneficial gut flora, while favoring the growth of pathogenic bacteria, yeast, and fungi. One of the many roles of beneficial gut flora is the production of certain B vitamins, especially those that are difficult to obtain enough of from diet alone. When these organisms are crowded out by pathogenic flora, deficiencies in these vitamins are practically inevitable. These pathogens feed on the food particles that we failed to digest because of low stomach acid. They also secrete toxins which irritate the lining of the small intestine, and can eventually flatten the villi, dramatically decreasing the surface area available for nutrient absorption. If this gut flora imbalance (also called dysbiosis) continues for long enough, the intestinal lining can actually develop holes, a scenario known as leaky gut. Normally the lining will only allow very small particles through for absorption, but with leaky gut, undigested food particles can leak through into the bloodstream. If the food particles contain proteins, the immune system will attack and form antibodies to them, believing them to be foreign invaders. This is the beginning of a food allergy. 

Even the stomach, normally acidic enough to kill practically everything that passes through, can fall prey to H. pylori bacterial infections and other bacterial overgrowth. H. Pylori is one of the few organisms that has a built-in mechanism for surviving the acidity of the stomach. It is normally confined to certain areas of the stomach, but in the case of low stomach acid, it can infect the cells that secrete hydrochloric acid and cause them to atrophy, exacerbating the problem. H. pylori has been implicated as a strong contributor to gastric ulcers and gastric cancer, and infection of the stomach can further weaken the esophageal sphincter, increasing the likelihood of acid reflux. Furthermore, stomach acidity serves as an essential barrier to disease-causing viruses, bacteria, and parasites that we ingest in our food and water. When this barrier is weakened, these pathogens can pass into our intestines and make us sick, taxing our immune system.

As you can see, low stomach acid is not something to take lightly! This condition can set the stage for serious health problems down the road. Dr. Jonathon Wright, who operates the Tacoma Clinic, is one of the few doctors that are aware of the severity of this situation, and he actually tests his patients for their levels of stomach acid if they present with related symptoms. Dr. Wright states that over 90% of people that come to his clinic with heartburn are found to have below normal production of stomach acid! Many people with low stomach acid do not even experience heartburn, so it’s clear that a large percentage of the general population suffers from this condition.


Acid Suppressing Drugs: A Recipe for Disaster


So the real question is, if this is such a common problem with such serious consequences, why don’t more people know about it? The answer is that when people with acid-related symptoms go to the doctor, they are generally told that their stomach produces too much acid, and they are prescribed drugs that suppress acid production! Few people question this assumption, because it seems to explain the burning they are experiencing.

Very few doctors bother to test their patients’ actual acid production before prescribing acid-blocking drugs. These drugs simply add insult to injury when it comes to the cascade of dysfunction that results from low stomach acid. The patients are happy at first, because the drugs take away their pain, and they feel they have been cured. But the reality is that the root cause of the problem has not been addressed. Without the acid, the burning sensations no longer occur, giving patients a false sense of security. Meanwhile, their nutrient deficiencies, digestive dysfunction, and gut flora imbalances continue unchecked, leading to even worse problems down the road. These patients will generally have to take the drugs for many years or even for life, because if they stop, their painful symptoms will return. Acid suppressants have been linked to increased risk of bone fractures, pneumonia, Clostridium difficile infection, and abnormally low levels of magnesium in the blood.

It’s difficult for me to fathom these doctors can forget everything they learned in medical school about how the digestive system is supposed to work, and prescribe these drugs without even bothering to test the actual acid levels of their patients. In addition to worsening the effects of low stomach acid we’ve already outlined, acid-blocking drugs represent an extra burden to the liver, which must metabolize them. Some of the nutrient deficiencies caused by low stomach acid can prevent the liver from doing its detoxification duties properly, leading to liver toxicity in the long run.

Even those who manage their heartburn or ulcer symptoms with over-the-counter antacids are setting themselves up for future health problems. As we’ve already seen, neutralizing the acid provides temporary relief from the burning but actually makes the root cause of the problem worse. Many antacids contain aluminum, which has been implicated in Alzheimer’s disease and breast cancer. Regular use of calcium carbonate antacids can cause milk-alkali syndrome, which leads to kidney failure if left untreated. In addition, most commercial antacids contain questionable additives. If you are experiencing painful acid reflux and need relief from the burning, a solution of baking soda in water is a much better and more affordable option for neutralizing acid.
It is important to note that in very rare cases, sensations of burning in the upper abdomen can be due to excessive stomach acid. This condition is called Zollinger-Ellison syndrome, and it’s caused by malignant tumors in the pancreas, duodenum, or lymph nodes surrounding the pancreas. If this syndrome is present, the use of a proton pump inhibitor (such as Prilosec) is indicated. In the vast majority of cases, however, burning is caused by insufficient stomach acid.


Causes of Low Stomach Acid


At this point, some of you may be wondering what causes low stomach acid in the first place. Deficiencies of B1, B6, and zinc, which are needed for acid production, definitely play a huge role. All three of these nutrients are commonly deficient in Americans, and can be depleted by chronic stress or by the consumption of refined carbohydrates. Many people are surprised to find that they present with sub-clinical deficiencies of B-vitamins in spite of taking large doses in their multivitamins. This is because the B-vitamins found in nearly all supplements are the synthetic forms, and high doses must be used to get any effect. Even then, many people find that their symptoms don’t respond to the synthetic forms. Natural forms of vitamins are more effective at much lower doses, although they tend to be more expensive. 

Vegetarian diets are a risk factor for zinc deficiency unless they are extremely well-planned. This is because zinc and copper must be maintained in a certain ratio (8:1 in favor of zinc) in the body, and plant foods are invariably low in zinc and high in copper. The only exception is pumpkin seeds. The zinc found in plant foods also has much lower bio-availability than zinc from animal foods. The best food sources of zinc include shellfish (especially oysters), red meat, dark meat turkey and chicken, cheese, yogurt, and eggs.

Chronic low-level dehydration is another major factor, as water is required for the production of hydrochloric acid. Those who follow a low-salt diet (a terrible idea for the vast majority of people) are also depriving themselves of sodium and chloride, both needed to produce hydrochloric acid. It is difficult, if not impossible, to obtain adequate chloride from other foods in the diet. And atrophic gastritis, a condition in which the stomach cells that produce acid become inflamed and atrophy, will definitely decrease the body’s ability to produce enough acid.


Solutions for Better Digestion



So, what is one to do if they find themselves with symptoms of insufficient stomach acid? Digestion is a north to south process in the body, and that’s the best way to address digestive issues, as a seemingly minor problem upstream can cause serious issues downstream. Digestion begins in the brain when we smell our food. Optimal digestion requires a state of relative relaxation. Stress, anger, frustration, or distraction put the body into a state of fight-or-flight, in which the body directs energy away from activities like digestion and reproduction. For this reason, it’s important for those with digestive problems to cultivate a sense of gratitude and relaxation before eating a meal, and to avoid eating when upset or distracted by other activities (like driving a car or watching television). It’s also imperative to chew your food well and resist wolfing it down quickly.

Many people inadvertently dilute their stomach acid and enzymes by drinking too many liquids with meals. One study showed that one glass of water increased stomach pH by more than 4 within one minute! As a general rule, avoid drinking more than half a cup of water within 30 minutes before or 2 hours after eating a meal. It’s a good idea to add a little lemon or lime juice or raw apple cider vinegar to your water to make it more acidic. Some people find that a tablespoon or two of raw apple cider vinegar in a small amount of water before meals improves their digestion a lot. Another option is Swedish bitters or other bitter herbs before meals, as the bitter taste stimulates acid and bile production.

Foods that normalize acid production include homemade bone broth, fermented vegetables, and unrefined sea salt. Bone broth contains the amino acid glycine, which has been shown to increase acid production. Traditionally fermented vegetables, especially kimchi and sauerkraut, contain probiotics which combat pathogenic overgrowth (including H. pylori overgrowth, which can cause atrophy of the acid-producing cells). Kimchi in particular has been shown to significantly inhibit H. pylori. Probiotics also manufacture certain vitamins for us, providing a safeguard against deficiencies. Sea salt contains chloride, which is an essential building block for stomach acid.  The best indicator of how much salt you need is your appetite for it; salt your food until it tastes good but not overly salty.  It’s also wise to consume a nutrient-dense diet and to avoid processed foods in general.

If the above measures have been tried without success, it’s likely that supplemental hydrochloric acid is indicated. For those with persistent digestive difficulties, acid supplements can make a world of difference in the way they feel after meals. To find the correct dose, either the patient’s own acid levels can be tested or a dosing protocol can be followed. Both of these methods should only be used with the guidance of a health professional that is familiar with stomach acid supplementation. In some cases, as with gastritis, it may be necessary to heal the lining of the stomach before supplemental acid can be tolerated. At the same time, it’s essential to correct nutrient deficiencies that have been caused by years of insufficient acid or other factors. Depending on the person, issues like gallbladder problems, dysbiosis, and leaky gut may need to be addressed as well before digestion can return to normal.

People with low stomach acid often ask if they will have to take hydrochloric acid supplements forever. There is no easy answer to that question, as it depends entirely on the person. Some people may be able to jump-start their body’s own acid production by supplementing for several months with hydrochloric acid and correcting deficiencies. Others may never completely recover their own acid production and may need to supplement hydrochloric acid for life if they want to have normal digestion. The vast majority of people will at least be able to reduce their dose over time.

For those who experience acid reflux, adopting a low-carbohydrate diet may be extremely helpful in controlling their symptoms. One study examining 5 patients whose reflux had not responded to any of the conventional treatments found that their symptoms were completely eliminated within a week of adopting a very low-carb diet (less than 20 grams per day). These improvements were sustained even after they liberalized their carb intakes to 70 grams per day. Cutting carb intake (especially refined carbs) lowers intra-abdominal pressure that can affect the lower esophageal sphincter, causing it to open at inappropriate times and allowing acid to splash into the esophagus.


Conclusion


Insufficient stomach acid is a serious and common problem in the United States, and if left unchecked it can lead to severe health consequences in the future. Every cell in your entire body depends on proper digestion and absorption for the nutrients it needs to function. With low stomach acid, even the most perfect diet or most high-quality supplements will not make much of a difference, because the nutrients they contain will not be absorbed. It is far easier to address low stomach acid in its earlier stages than it is to correct the dysbiosis, food allergies, acid reflux, ulcers, and gastritis that can result from it. 

I envision a world in which we respect the amazing design of our digestive systems and realize that suppressing it is not the answer. In this kind of a world, we would address the causes of dysfunction rather than simply suppressing the symptoms. The goal would be perfectly functioning digestion, not just the elimination of pain. By becoming knowledgeable about and taking responsibility for our own health, we can move in the direction of a saner system of healthcare.
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07-30-2015, 02:30 PM #2
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I think my dad has this problem, since reading your post I told him to start adding a little sea salt to his food - he had stopped eating it almost completely for years, after finding out he has high blood pressure.
Anyway glad you're back, your posts are always so helpful  Heart

Always go too far, because that's where you'll find the truth. (Albert Camus)
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07-30-2015, 05:02 PM #3
umphreak
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(07-30-2015, 02:30 PM)Blodfleur Wrote:  I think my dad has this problem, since reading your post I told him to start adding a little sea salt to his food - he had stopped eating it almost completely for years, after finding out he has high blood pressure.
Anyway glad you're back, your posts are always so helpful  Heart

Thanks for the kind words.  Did you happen to see the article I posted from Scientific American a week or so ago, called "It's Time to End the War on Salt"?  That might be helpful if he needs a bit more convincing that eating natural salt is unlikely to affect his blood pressure.  At any rate, even for those individuals who are "sensitive" to salt in that way, a better solution than avoiding salt is to eat more potassium, which has a balancing effect on sodium in the body.  Most fresh, unprocessed foods are good sources, especially vegetables, fruits, beans, dairy, fish, and meats.  Potatoes have been somewhat demonized as an "unhealthy" vegetable, but they are actually one of the best sources of potassium out there, when eaten with the skin and baked, boiled, or pan-fried rather than deep-fried.  I consider potatoes to be a very healthy food.

Omega-3's are also helpful for high blood pressure, especially fatty fish, fermented cod liver oil or flax seed oil.  Emphasizing foods high in magnesium like dark leafy greens and beans (to get magnesium from beans they must be soaked overnight in dechlorinated warm water, then rinsed well before cooking) is good too.  Full-fat dairy products, especially butter and ghee, are a great source of vitamin K2, which reduces arterial calcification (along with all other soft-tissue calcification) that often leads to high blood pressure.  Gouda cheese is an especially good source because the culture used to make it produces vitamin K2.  Other foods that are great for high blood pressure include beets, hibiscus tea, and green and oolong tea.
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07-30-2015, 05:27 PM #4
khadeejah
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Excuse me for jumping in your reply ---- thank you for the tip about soaking the beans - We eat a lot of chick peas and fava beans. I only use dry beans but didn't think about the chlorinated water. Is it true that chlorine evaporates from a pot of tap water if you let it sit overnight? Any other bean types you recommend or don't recommend? Thanks again Umphreak and blodfleur.
This post was last modified: 07-30-2015, 05:32 PM by khadeejah.



07-31-2015, 12:15 AM #5
umphreak
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(07-30-2015, 05:27 PM)khadeejah Wrote:  Excuse me for jumping in your reply   ----   thank you for the tip about soaking the beans -  We eat a lot of chick peas and fava beans. I only use dry beans but didn't think about the chlorinated water.  Is it true that chlorine evaporates from a pot of tap water if you let it sit overnight?  Any other bean types you recommend or don't recommend?  Thanks again Umphreak and blodfleur.

Hi khadeejah, I'm actually going to be traveling for about a week and a half, so I'll have to wait to give you a full reply when I'm back.  The short answer is that from what I've read, it is supposed to be true that chlorine will evaporate from water left sitting open, but I've heard 24 hours.  Thanks for the really good questions!

08-03-2015, 05:58 PM #6
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(07-30-2015, 05:02 PM)umphreak Wrote:  
(07-30-2015, 02:30 PM)Blodfleur Wrote:  I think my dad has this problem, since reading your post I told him to start adding a little sea salt to his food - he had stopped eating it almost completely for years, after finding out he has high blood pressure.
Anyway glad you're back, your posts are always so helpful  Heart

Thanks for the kind words.  Did you happen to see the article I posted from Scientific American a week or so ago, called "It's Time to End the War on Salt"?  That might be helpful if he needs a bit more convincing that eating natural salt is unlikely to affect his blood pressure.  At any rate, even for those individuals who are "sensitive" to salt in that way, a better solution than avoiding salt is to eat more potassium, which has a balancing effect on sodium in the body.  Most fresh, unprocessed foods are good sources, especially vegetables, fruits, beans, dairy, fish, and meats.  Potatoes have been somewhat demonized as an "unhealthy" vegetable, but they are actually one of the best sources of potassium out there, when eaten with the skin and baked, boiled, or pan-fried rather than deep-fried.  I consider potatoes to be a very healthy food.

Omega-3's are also helpful for high blood pressure, especially fatty fish, fermented cod liver oil or flax seed oil.  Emphasizing foods high in magnesium like dark leafy greens and beans (to get magnesium from beans they must be soaked overnight in dechlorinated warm water, then rinsed well before cooking) is good too.  Full-fat dairy products, especially butter and ghee, are a great source of vitamin K2, which reduces arterial calcification (along with all other soft-tissue calcification) that often leads to high blood pressure.  Gouda cheese is an especially good source because the culture used to make it produces vitamin K2.  Other foods that are great for high blood pressure include beets, hibiscus tea, and green and oolong tea.
Where can I find that article?
well my dad loves potatoes so that's good, they really are demonised though :/ and everyone keeps going on about alkaline diets and alkalizing our stomachs - I think I might need to a little because I eat a lot of sugar and not much veg Blush
Anyway actually I wanted to ask your advice on something -  my brother is quite ill now with holes in his kidneys that are causing protein to leak out and he's swollen everywhere - they've got him on steroids to try and close the holes but they don't seem to be working. I was thinking maybe theres something nutritional that could help? Also they said he has too much calcium in his blood so I remembered your past posts about k2 and I told him to eat more cream and liver - I don't think he ever really eats or likes those types of food Undecided 
I'm glad to add gouda to my list of k2 foods now - maybe he'll eat that - I only knew of cream, liver and egg shells... and peas I think
Anyway I really appreciate all the info you give us on here, in many cases it could literally be lifesaving, so thanks.

Always go too far, because that's where you'll find the truth. (Albert Camus)

08-03-2015, 07:07 PM #7
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Potatoes are great, even better when cooled because of resistant starch http://wellnessmama.com/17005/resistant-...superfood/


I boil potatoes and make a potato salad after they have cooled with shallots, rocket, dill, onion, salt, pepper olive oil and a little bit of apple cider vinegar.
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08-10-2015, 07:14 AM #8
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(08-03-2015, 07:07 PM)Talijana Wrote:  Potatoes are great, even better when cooled because of resistant starch http://wellnessmama.com/17005/resistant-...superfood/


I boil potatoes and make a potato salad after they have cooled with shallots, rocket, dill, onion, salt, pepper olive oil and a little bit of apple cider vinegar.
Sounds yum, I'm gonna try that Smile

Always go too far, because that's where you'll find the truth. (Albert Camus)

08-14-2015, 12:22 PM #9
umphreak
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(07-30-2015, 05:27 PM)khadeejah Wrote:  Excuse me for jumping in your reply   ----   thank you for the tip about soaking the beans -  We eat a lot of chick peas and fava beans. I only use dry beans but didn't think about the chlorinated water.  Is it true that chlorine evaporates from a pot of tap water if you let it sit overnight?  Any other bean types you recommend or don't recommend?  Thanks again Umphreak and blodfleur.

Ok, I'm back.  So about the water question...chlorine should evaporate if the water sits open for 24 hours, but the tricky thing is that some places now have water that is disinfected with chloramines instead of chlorine.  Chloramines will not evaporate, so be sure to check which disinfectant your water company uses.  If your water has chloramines then the best thing to do is to get reverse osmosis water.  Reverse osmosis water is also good for drinking because it is very pure and is the only way I know of to remove fluoride, but it is devoid of minerals so it's best to add trace mineral drops.  I like the brand ConcenTrace, which is high in magnesium.  Modern diets are really low in magnesium and it's been depleted from most soils, so drops like these are a good idea for everyone.  You can add them to food and other beverages as well.

As far as beans go, chickpeas and favas are great.  Black beans and adzuki beans are a bit higher in magnesium, so you might want to include those occasionally as well.  The only beans I really don't recommend in most forms are soybeans.  They were traditionally fermented in various ways before consumption.  Soybeans are much higher than other beans in anti-nutrients, and they are more resistant to breaking down.  I recommend avoiding all forms of soy other than naturally fermented soy sauce, miso, tempeh, and natto.  Tofu, soy milk, edamame, and anything with soy protein added are practically indigestible.  They also contain large amounts of phytoestrogens which can be detrimental to health.

Besides soaking in warm water for long periods of time, sprouting is another good way to reduce phytic acid in beans.  But the beans need to be sprouted for a long time for this to work - 5 days is best.  And always cook bean sprouts before eating them.

08-14-2015, 07:17 PM #10
umphreak
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(08-03-2015, 05:58 PM)Blodfleur Wrote:  Where can I find that article?
well my dad loves potatoes so that's good, they really are demonised though :/ and everyone keeps going on about alkaline diets and alkalizing our stomachs - I think I might need to a little because I eat a lot of sugar and not much veg Blush
Anyway actually I wanted to ask your advice on something -  my brother is quite ill now with holes in his kidneys that are causing protein to leak out and he's swollen everywhere - they've got him on steroids to try and close the holes but they don't seem to be working. I was thinking maybe theres something nutritional that could help? Also they said he has too much calcium in his blood so I remembered your past posts about k2 and I told him to eat more cream and liver - I don't think he ever really eats or likes those types of food Undecided 
I'm glad to add gouda to my list of k2 foods now - maybe he'll eat that - I only knew of cream, liver and egg shells... and peas I think
Anyway I really appreciate all the info you give us on here, in many cases it could literally be lifesaving, so thanks.

Here's the article I mentioned: http://www.scientificamerican.com/articl...r-on-salt/

Interesting questions.  The issue of nephrotic syndrome certainly has no simple answers, and it is definitely outside of my areas of expertise.  However, I am always interested in learning more about how diet and nutrition can affect medical conditions in beneficial ways, so I'd love to share the research that I've done on this topic.  Does your brother have any other medical conditions like diabetes that could be contributing to his kidney problems?  Also, I'm assuming your brother is an adult, so correct me if I'm wrong.

Now, before I say any more, it hopefully goes without saying that I am not a medical doctor and no comment of mine should be construed by anyone as medical advice.  Rather, what I do is provide advice for nutritional support for individuals who may or may not have medical conditions.  I think I'll add a disclaimer to my article just in case.

Basically, my research into nephrotic syndrome indicates that it is beneficial to moderately restrict protein intake to around 10% of calories.  I found one study of 9 patients that were fed a (relatively) high protein diet (1.6 g/kg body weight), followed by a (relatively) low protein diet (.8 g/kg body weight).  The results were that serum albumin actually increased slightly on the low protein diet (albumin loss being one of the causes of edema or swelling in nephrotic patients, so increased albumin is a good thing!).  Urinary albumin loss was decreased in all patients (some dramatically, others only slightly).  Urinary protein loss was also decreased in all patients, again some very dramatically (in one patient by nearly 75%!), others more modestly.  These findings would indicate that restricting protein modestly (10% of calories is really not super low, but is definitely on the lower end of the spectrum) could be beneficial for nephrotic syndrome.  

Another study I read used a much lower protein diet (.3 g/kg body weight) plus a supplement of essential amino acids.  All patients in the study who had initial glomerular filtration rates (GFRs) of less or equal to 30 mL/min had modest reductions in protein excretion and modest increases in serum albumin, but all eventually went on to need dialysis.  However, for the 5 patients who had initial GFRs between 32 and 69 mL/min, more dramatic reductions in protein loss and increases in serum albumin were reported.  4 out of 5 of them essentially went into remission or near remission and were even able to return to normal or near normal diets after a period of time on the very low protein diet plus essential amino acid supplements.  These are very encouraging findings for those whose initial GFRs are not too low!  I would not recommend making such dramatic dietary changes without informing one's doctor and constantly monitoring all related parameters.  In fact, even a more modest decrease in dietary protein would definitely warrant vigilance in monitoring its effects on proteinuria and serum albumin.  That said, these studies sound encouraging.

Now, the funny (or disturbing, depending on how you look at it!) thing about general dietary recommendations for nephrotic syndrome are that they invariably recommend avoiding saturated fat and cholesterol and eating a low-fat diet in general.  They recommend choosing low-fat dairy products and lean meats.  These foods are not only unhealthy in general, but for the nephrotic patient they are far too high in protein!  Eating foods with the natural fat they come with is absolutely crucial for anyone who is attempting to restrict protein.  When you remove the fat you are left with essentially purified protein and a refined food, which is no bueno, in my opinion.  I would recommend that if your brother would like to try restricting protein moderately, he emphasize eggs, whole dairy products, and shellfish, especially oysters.  Oysters are extremely high in zinc, which tends to be deficient in nephrotic patients.  Just one or two servings of 6 medium oysters per week would be sufficient.  Red meat is also a good source of zinc, but in order to limit protein it would be necessary to limit servings to about 3 oz.  B vitamins also tend to be deficient, so whole yogurt, lacto-fermented vegetables, nutritional yeast, liver, and shellfish are good sources of these.  Common sense would dictate that including gelatin rich bone broth in the diet regularly would be highly beneficial, partly because it acts as a protein-sparer, allowing one to get by on less protein.  This is because of the specific amino acids it contains.  It is also just highly beneficial for health in general.

Gelatin rich broth is simple to make: place bone-in skin-on chicken drumsticks in a pot with enough purified water to cover them.  Bring to a boil, skim any scum that might rise to the surface and discard, then reduce to a very slow simmer and allow to simmer, covered, until all of the gelatinous connective tissue surrounding the joints has dissolved (usually about 12-24 hours).  A crock pot can be very good for this if it can be set to go at a slow simmer.  Once the connective tissue is dissolved, simply strain the broth through a fine mesh sieve, allow to cool, and use within 3 days or freeze for later.  You can use it to make soups, stews, delicious gravies and reduction sauces, add it to practically any sauce including store-bought sauces and boil it down to the desired consistency, or even drink it as a warm beverage with a pinch of thyme and sea salt.

To make it more cost effective it's a good idea to remove the drumsticks with a slotted spoon after they have simmered for about 2 or 3 hours, pull off the meat, and throw everything else back into the pot to simmer for the remaining time.  The cooked meat can be frozen in meal-sized portions.  It's great for enchiladas, soups, stews, Indian dishes, taco filling, you name it!  It is so easy to make simple soups when you have the broth and cooked meat on hand: simply add lots of chopped vegetables, root vegetables, grains, or beans, some thyme or oregano, and sea salt salt to taste.  On the other hand, if the added step of pulling the meat off the bones would discourage your brother (or whoever is cooking for him) from making the broth, you can also just use chicken wings and leave them in there until the broth is done.

As for your comment about his calcium being too high, extra vitamin K2 certainly would not hurt and would probably help.  And it would be good for his health in general.  The best source of K2 that would appeal to the average person these days is hard cheese.  Like I mentioned, gouda in particular is very high, but all hard cheeses are very good sources.  It's a good idea to eat some hard cheese every day for this reason.  Soft cheese are also good sources, followed by egg yolks (especially from hens raised outdoors), goose leg, cheese curds, butter, and chicken liver.  So cheeses and egg yolks are probably his best bets.

I would also like to address your comment about alkalizing diets, because this is one of the most common misconceptions about diet in general that tends to circulate around alternative circles.  First off, the stomach should always be acidic, not alkaline.  An alkaline stomach (or even a less acidic stomach) means zero digestion is taking place.  The alkaline diet myth stems from the fact that the blood needs to be maintained in a slightly alkaline state at all times.  In fact, this is so important that the body maintains the blood pH in a very narrow range at all times.  If it goes outside of this range, you basically die!  Anyone who claims that the foods you eat or don't eat can affect the pH of your blood (also known as systemic pH) has zero idea what they are talking about.  If you want to learn more about this topic, Chris Kresser wrote a couple of great articles dismantling the acid-alkaline theory here: http://chriskresser.com/the-ph-myth-part-1/ and here: http://chriskresser.com/the-acid-alkaline-myth-part-2/

Weston A. Price himself once wrote an article about the acid-alkaline myth, because it was just beginning to become a popular theory in his day.  He was able to show that of the healthy populations he studied consuming their traditional diets, the majority of them had diets that were net "acid-forming".  And yet they enjoyed robust health, great bone structure, and freedom from dental deformities, dental decay, and the diseases of modern civilization.

The point is, don't beat yourself up if your diet is not as "alkaline" as some people claim it should be.  That said, it's always a good idea to reduce excess sugar in the diet, and to eat more vegetables.  To reduce sugar, you can start by making your own desserts using unrefined sweeteners like coconut palm sugar, Sucanat, grade B maple syrup, and raw honey.  That alone will mitigate many of the problems with excess sugar consumption.  When you do eat refined sugar, foods that contain some fat are better than those that are basically pure sugar.  So a chocolate bar is better than hard candy, and ice cream is better than a soda.  The fat will fill you up faster so you eat less sugar overall, and will also keep you full for much longer and prevent a huge drop in blood sugar later that could cause you to crave more sugar.  If you drink a lot of sugary beverages, try switching to kombucha - the G.T. Dave's brand is especially good because it is very low in sugar but still tastes pretty sweet.  Kombucha is high in B-vitamins that can help with sugar cravings.  Fruit juice diluted 50% with water is also a good substitute.  If you do those three things for awhile and then gradually cut back on the amount of sweets you eat in general, you'll be doing pretty good.

Eating more vegetables is a lot easier when you eat them with plenty of yummy fat!  Simply cooking them in butter or putting melted butter on steamed veggies will make them a lot more appetizing.  Don't forget the salt.  One of my favorite meals to make is whole roasted chicken with a bone broth reduction sauce (super easy, you just deglaze the drippings from the roasting pan with a splash of dry vermouth, add to some bone broth in a pot with a pinch of thyme and/or tarragon, and boil rapidly until reduced by about half, then add salt to taste) over roasted potatoes and sauteed kale.  In fact, a reduction sauce like I just described would be absolutely fantastic over just about any vegetable.  It's like a gravy without the flour.  And you can add a multitude of different ingredients - cream, tomato sauce, herbs, spices, you name it!  The important element is reduced gelatin rich bone broth.  Coconut milk based curries are super easy to make and taste great with a lot of veggies.  I also love veggies in soups and stews, where you don't really even taste them.

Hope that helps!