Hi Guys
It may be an obvious answer to some but what does low stomach acid mean? Low in quantity/volume or low in acid content ie not 1 or 2 PH?
I had always visualised volume but then I had a sudden thought. .. perhaps it relates to acidity rating?
TIA as always
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I am not sure.
Gastric juice contains HCl as well as sodium and potassium and other things i've forgotten .
If we are talking about autoimmune destruction of GPC cells I would say quantity/volume of HCl. But then if the rest of the gastric juice volume remains constant, then the overall concentration of HCl will be lower, resulting in a higher pH (less acidic) as well.
But I am not 100% sure , i recently read about it but cannot remember how the rest of the gastric juice is produced. If that too goes down proportionally, then pH would remain the same.
I hope someone else can answer this.
Great question!! 😄👏
Well I’m trying to think it through ( Difficult for me!) For P.A. patients Their parietal cells are destroyed in varying degrees by the Intrinsic Factor Antibodies . so producing less stomach acid So less stomach acid is mixed in to the stomach contents , which means the contents are of LOW concentration . Does this make sense?
Also as we all age, we have parietal cells which are not functioning at full capacity .So low volume of acid results in low acidity of stomach contents . This results in the oesophageal sphincter not recognising the low acidity and failing to close completely . Result ? “ Heartburn” caused by leakage of low concentration of acid in the stomach contents and prescription of PPIs which we know completely annihilate stomach acid .
I have no medical knowledge , so please ignore all this if you think it sounds preposterous ! I humbly apologise if this sounds nonsensical !
Low acidity means exactly that - a low measure of acidity.
Ironically, the scale used to measure acidity (pH) starts at 1 and goes up to 7 which means neither acid nor alkaline (base) and then goes on up to 14 for something that is highly alkaline such as drain clean
So low stomach acidity means the pH of the liquid in your stomach is 4or more on the pH scale
I've always thought just less acidic .PH change
Caused by some medications.
Simply age
Or composition .
My first thought was Low On Whisky 😄
Hi Wwwdot, low stomach acid means just that, low quantity. PH if your stomach is not meaning a direct measurement of your acid by itself but rather the environment in your stomach which includes other gastric juices and enzymes oh yes plus ingested food. With low quantity your Parietal Cells are not pumping enough quantity or volume to reach for your stomach environment to reach a PH of ideally 2. Your stomach, after a fast, before you've eaten, PH starts at around 6 or 7 or neutral. Before you ingest that first bite your Parietal Cells (PCs) will already have started pumping just at the thought of that first bite and smell. So normally right then before that first bite the contents of your stomach will be highly acidic (low quantity yet lower PH) as it's just acid and some enzymes, no food yet. Once you start eating the acid will become diluted as your stomach starts to mix the food with acid and enzymes. This mushy mass is called chime. So your acid gets diluted for a bit until your PCs catch up by pumping more acid (quantity) they will keep pumping until the chime reaches a PH of around 2 to 3. That is ideal. Once this level of high acidity is reached the Proton Pumps in the PCs will turn off and stop pumping acid, With advances state of autoimmune PA/AMAG enough of your PCs will have been destroyed that the "quantity" of acid is insufficient for your stomach to reach a PH of 2 or 3. So being able to reach a PH if only 4 or 5 is considered low stomach acid or hypochlorhydria and only being able to reach a PH of 6 or 7 is considered no stomach acid or achlorhydria.
So, yes PH is driven by acid quantity. The more acid the lower PH. Remember if the small quantity of acid were measured by itself (i.e. pure) it would measure highly acidic maybe around a PH of one. But again it's proper quantity that's required for your chime to reach a PH of 2 or 3.
As usual I've rambled again! 😊
Hope this makes sense and is helpful. Let me know if you've questions. Rexz
Hi Rexz
Glad I haven’t yet eaten!
Thank you this is making sense now so that’s why Lansoprazole is called a Propton Pump Inhibitor! Sounds less dangerous and more friendly than a gut biome killer!
I am trying to take Betaine and Pepsin before I eat to see if that will help me eat more often.
Your explanation may explain why I don’t get hungry when I smell food or feel hungry - when I forget to eat as I do t feel hungry, I just go lightheaded and feel ill so I quickly eat or drink something then I am ok again.
Thank you again for taking the time to reply
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I would suggest questioning your GP on the Lansoprazole prescription. I was prescribed Omeprazole originally. Both are Proton Pumps Inhibitors (PPIs). Mine was prescribed due to gastritis and acid reflux. When I was first prescribed it I asked to have my stomach acid PH checked. My doc refused, said it wouldn't change how they treated me. So I went to another doc and hospital and had my Gastric PH checked during an endoscopy and they confirmed it was a PH of 6. That is when I started taking Betaine HCI and digestive enzymes just before each meal. Solved much of my digestive issues and acid reflux. Acid reflux is most likely caused by low acid rather than too much acid. I know it's counter intuitive but that's the case.
Anyone with confirmed autoimmune PA/AMAG especially an advanced stage needs every last proton pump to be pumping away as much acid as it can! Not to be inhibited with a PPI.
The result of PPI combined with PA is detrimental to your whole digestive system.
Anyway, I'm not a doc. But highly recommend having this conversation with your doc/GP.
Btw PPIs are the most over prescribed medication.
If you need references for your doc let me know and I'll certainly dig them out
Hope this helps some. Rexz
100% agree with you Rex.
Years ago one of my GIs prescribed PPIs, and I took them, not knowing better. I went back after a few weeks complaining that my digestion had gotten worse and had basically crawled to a total stop, and that the reflux was worse. He looked at me confused and said he'd never heard of that. I stopped them and educated myself. Last time I was there I asked about pH testing and atrophic gastritis and he just looked at me blank. Went on to prescribe PPIs after the endoscopy. 🤯 He also did not do the biopsies correctly - put everything from the antrum, corpus, and the other one I always forget (fundus)? all in the same pot, and didn't take the right # of samples. Gah! This is at a teaching hospital! I could pull my hair out. Thankfully I have another GI I have seen before and consult with remotely.
Yes, for those with PA/AMAG they rarely do the endoscopy/gastroscopy screening and biopsies correctly. The reason that probably 98-99% of gastritis is caused by H-pylori bacterial infection which is primarily limited to the antrum (lowers stomach) and the lower half of gastric body. Where's AMAG (PA is but a symptom of advanced state of AMAG) starts in the gastric Fundus, the very top of the stomach and upper body. The AMAG will eventually migrate downward due to much higher levels of Gastrin. So the biopsy protocols the Sydney protocol and the European standard MAPPS II focus on the H-pylori caused gastritis. Those with PA need to let their Doc/GI specialist know that they are a ZEBRA in the midst of a herd of horses! Pound your hooves and make them listen. My next substack installment describes this in much more detail with very specific instructions to give to doc/GP or whomever is performing your endoscopy/gastroscopy. It's incredibly important they get it right. They are just not trained on anything related to AMAG.Rex Rex
Looking forward to it! I really should print off one of the AMAG papers/protocols and take it with me to the next endoscopy. I am getting them every 2-3 years now and the next one is due the summer of 2024.
Do you know if there's any link between AMAG and colon polyps?
In my missile business we always do a launch readiness review to go over all the procedures and readiness for a launch...it just makes sense since some of these launches cost $100M US plus. I remember the first time I called my GI doctor to schedule a "prelaunch' visit they scoffed. Said you already have an appointment scheduled post endoscopy. I stood firm, I told them I was a ZEBRA and I wanted a pre-endoscopy visit! We did that and I went over the entire procedure, what imaging was being used, the biopsy protocol, the places to biopsy, instructions to place each biopsies tissue in its own container ( more expensive but very important), to label them separately and instructions to the pathologist on how to classify them. I have both EGD with different imaging plus endoscopic ultrasound done. Anyway, after the first time I think my doc appreciates it. He's learned a lot but I still demand this pre visit each time, because it's been 6 months since my last endoscopy and I know he thinks I've turned back into a horse!
For those not familiar with the horse and zebra thing. It's from the medical school saying relating to symptoms..."If you hear hoofbeats look for horses not zebras". This is because horses are far more common than zebras and statistically you should be a horse. Do not let them make you become a statistic. Loudly tell them you're a zebra! Heck we may even be unicorns for all I know. 😂
Rex
dreamstime.com/logo-showcas... AI generated "Logo Design For Pernicious Anemia Oncology Unit With Zebra Nerite" and this one's even nicer dreamstime.com/logo-showcas...
Haha, it's like looking in the mirror!Thank you for sending those.
😂😂 they're royalty free.. I think per forum guidelines you are now obliged to put one of these images in a substack post, at some point 😆🤣
Just checked my last report. They didn't even biopsy the fundus 🤣🤦♀️ Can they visually see changes or is it possible that it's only noticable on biopsy? Sorry for all the questions, I really need to read up on AMAG!
Yeah that was my issue to begin with. That's the zebra in you. They are focusing on lower part of stomach for biopsies. The changes are microscopic to start hence the biopsies. But with different imaging they can see some changes. If a change becomes raised or a growth (polyp) they can see that for sure. That's why it is so incredibly important to have this gastric mapping done correctly because that's what determines your risk of progression to cancer. Even with all that there is a 15 to 20 percent chance each endoscopy that they visually miss something. Depends on the imaging used and the skill of the performing doctor. Rex
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