The 5 “R” Approach
The second “R” refers to Replace. This “R”, for me, demonstrates the idea of optimizing or improving the function of the gut the best. The objective is to Replace, using supplements or foods, the acidity of the stomach, pancreatic enzymes and bile salts. These are all necessary for optimal digestive function.
Replace hydrochloric acid (HCl) and pepsin
Digestion is the process of breaking a bite of food down into the nutrients we absorb: protein, carbohydrate and fat molecules. The process of digestion begins in the mouth with chewing and an enzyme in our saliva called amylase. This enzyme starts the process of breaking down carbohydrates. Swallowing then sends the food down the esophagus to the stomach.
The stomach is supposed to be a very acidic environment filled with hydrochloric acid and pepsin, which breaks down proteins that are made up of long chains of individual amino acids. These individual amino acids are what we want to absorb as a nutrient so they need to be broken apart in the stomach and upper intestine in preparation for absorption by the villi in the lower intestine.
The level of acidity of any environment is determined by the pH and the stomach needs to be very acidic to break down proteins properly (pH=1.5-3.0). It is the acidic environment in the stomach that unravels proteins and allows pepsin to be produced to cut the bonds between the individual amino acids. The stomach typically has the cells to produce the acid as well as a thick mucus layer to protect its walls from the acid. But, if this is not functioning properly many problems can develop.
This acidic environment is also necessary to open the valve at the lower end of the stomach to allow the digested bolus of food to move from the stomach into the intestine. If the stomach is NOT acidic enough then this valve will not open and the bolus of food will NOT proceed down the digestive tract, and instead will sit in the stomach and build pressure and eventually regurgitate backward up the esophagus causing heartburn. The esophagus is not meant to have acid in it. It is not suited for an acid environment like the stomach and it does not produce bicarbonate like the small intestine to neutralize the acidic pH of the digested bolus of food from the stomach. So, from a functional perspective of the digestive tract, it is more functional to increase the acidity of the stomach in those with a normal stomach lining (no ulcers) and get the food breaking down properly as well as moving forward out of the stomach and onward into the small intestine for further digestion and eventual absorption.
Another normal function of stomach acid is to kill bacteria in our food. If we do not produce enough acid in our stomach to kill the bad bacteria and we do not breakdown proteins properly it is not a leap to understand how this dysfunction would cause problems for people with allergies and with leaky gut. Undigested food and bad bacteria will populate the lower intestines and colon and cause a great deal of problems.
The answer is to improve digestion is first of all being sure to chew food thoroughly before swallowing and optimize stomach acid. Things that can be taken to optimize stomach acid are apple cider vinegar and/or lemon juice diluted in a small glass of water or dilute juice prior to meals. Supplements of betaine HCL and pepsin enzyme can be taken with meals to help increase stomach acid and improve stomach digestive function in those without ulcers or severe heartburn. Those with ulcers or severe heartburn should work with a functional medicine practitioner to improve the situation with food and diet and other measures prior to adding HCL supplements and can do some testing with the practitioner to safely progress toward improved function. If a person has been taking antacid medications for a number of years, they should NOT stop those medications cold turkey without first changing their diet and working with a functional medicine practitioner because it will typically not be successful until other changes occur first.
Replace Pancreatic Enzymes
Next along the digestive process is the pancreas, which produces pancreatic enzymes and secretes them into the upper small intestine. The pancreas produces a collection of enzymes that can break down fats, carbohydrates and proteins: lipase, amylase and protease. Many people with gut problems and dysbiosis are not breaking down the foods they eat effectively and need to replace or supplement with pancreatic enzymes with meals. Remember, if you are not breaking the foods you eat down completely into individual molecules of fat, protein and carbohydrate, then a foreign substance is travelling into your lower small intestine and trying to be absorbed. If you have leaky gut and attempt to absorb this foreign substance, then your immune system will react against it and cause an immune reaction with inflammation.
Replace Bile Salts
Finally, the gallbladder is another gastrointestinal organ with an important role in digestion. The bile salts produced by the gallbladder and secreted into the intestine are meant to help breakdown fats, remove cholesterol and help remove toxins. They also help with the motility or movement of digested substances through the GI tract. Bile salts can be taken as a supplement such as ox bile; but, certain foods can increase the production of bile salts. Dandelion greens, chicory, artichoke and daikon radishes are all examples of choleretic foods that can increase the production of bile salts.
So, it is extremely important in gut health to optimally digest or breakdown the foods we eat. If our digestive tract and the organs that support it are not functioning optimally, then there are supplements and foods that one can take to Replace the different enzymes and other chemicals necessary to optimize digestion. Just remember that Replace is only one of five “R’s” in the Functional Medicine approach to optimal gut health. Next week I will discuss the third “R” which stands for Re-inoculate.