Well and truly debunked

The following is an article by Dr. Ralph Giarnella MD, I stumbled across this article in the T-Nation forums and thought people would be interested to give it a read. Poliquin is one of many people in the fitness industry afforded a public podium to spread their “expert” opinion.

Its always good to see rational discourse deliver an academic fist fucking to the bullshitters of this world.

Here is the Article in full.

A Rebuttal to Charles Poliquin’s Article on Stomach Acid.

Dr. Ralph Giarnella MD practices Gastroenterology in Southington, Connecticut.

T-Nation: Besides zinc and magnesium, what other deficiencies do those of us seeking muscle and performance need to worry about?

Poliquin wrote: The most common one, which actually causes zinc and magnesium deficiency, is hydrochloric acid (HCl) deficiency. Back when I was an undergrad many moons ago, they used to tell us that you lose about 1% stomach acid per year after the age of 40. Well, that’s not true anymore because our high stress levels these days decrease HCl.

We did a study at our Chicago facility where we gave 160 clients an HCL test. Only two people passed it with a medium score; 158 had a horrendous score.

Giarnella MD: What kind of test did he perform? Hydrochloric acid is only present in the stomach when stimulated by the ingestion of meals (gastric phase) or in anticipation of eating (cephalic phase of stimulation).

Did they put a nasogastric tube into the clients stomach, stimulate them in such a way that the stomach would secrete acid and then suction the contents of the stomach to measure the amount of acidity present? When I was a Gastrenterology Fellow in training, we would measure gastric acid secretion by doing such a test. We used intravenous calcium infusion to stimulate the stomach to produce acid. We would then suction the entire contents of the stomach by way of a nasogastric tube and measure both the amount of fluid produced as well as the acidity. The last time I did that test was in 1976 one year before Tegamet was introduced.

Poliquin wrote: If there’s insufficient hydrochloric acid, proteins will pass into the intestine and putrefy instead of being digested.

Giarnella MD: This statement is blatantly false. The vast majority of protein digestion takes place in the small intestine by way of enzymes secreted by the pancreas and these enzymes require an alkaline solution to function.
If the statement made by Poliquin were true the best diet pill in the world would be Nexium because it totally shuts down the stomach’s ability to produce acid.

Poliquin wrote: Carbohydrates will also be left to ferment without adequate digestive enzymes from the pancreas.

Giarnella MD: Another false statement. Carbohydrates are primarily digested by enzymes contained in the brush border of the intestines. These enzymes not only do not need HCL but they work best in an alkaline solution.

Poliquin wrote: Fat digestion is also dependent on the acid’s influence on the pancreas to secrete lipase and the gall bladder to secrete bile.

Giarnella MD: Another false statement. Neither lipase nor bile are stimulated by the presence of acid. The only substance produced by the pancreas that is stimulated by acid is Bicarbonate. Lipase and bile are stimulated by the presence of fat in the duodenum by way of a cholecystikinin.

If we were to believe Poliquin’s statement that protein, carbs and fat cannot be digested without acid then the ideal weight loss pill should be Nexium. Nexium shuts down the stomachs ability to produce acid, therefore taking Nexium you should be able eat all the food that you want without fear of gaining weight, after all it will all end up in your colon and eventually down the toilet.

Poliquin wrote: Poor digestion of these macronutrients means poor absorption of our basic energy sources. Over the last four years, I’ve been amazed how a correction in HCL deficiency has led to not only dramatic improvements in physique and strength, but also improvements in a variety of health parameters. Interestingly enough, in strength-trained individuals those improvements are often associated with gains of 15 to 18 pounds of lean body mass within two months!

Why? They are now absorbing proteins and minerals.

Giarnella MD: I would be interested in testing how much HCL acid is really in the capsules Poliquin is giving his athletes. HCL is one of the most caustic acids. Only Sulfuric (battery) acid and Flouric acid are more caustic. Just a small amount of undiluted HCL in the esophagus can cause significant ulceration.

Poliquin wrote: Here are a few of the symptoms of low stomach acid:

belching or gas within one hour of a meal
bloating shortly after eating
bad breath
loss of taste for meat
nausea after taking supplements
brittle fingernails
undigested food in stool
foul-smelling stools
stomach pain
desire to skip meals
estrogen buildup
acne rosacea

Giarnella MD: All false and unfounded statements.

Poliquin wrote: In the US, many experts estimate the deficiency to be in the range of 40 to 50%. Some gastroenterologists are now advancing that it is today�?�¢??s most under-diagnosed ailment.

Giarnella MD: I would like to know who these gastroenterologists are. I have attended national Gastrointestinal conventions, I read GI journals every day and I have never heard anyone state that HCL deficiency is a major problem. Amongst the most sought after and prescribed medications in the world are the Proton Pump inhibitors and H2 blockers better known as Nexium, Tegament and Zanctac. If HCL deficiency were a problem there would be no need for any of these medications

Poliquin wrote: There are a variety of medical tests you can get,

Giarnella MD: I would like to know what these tests are.

Poliquin wrote: but here’s a simple test you can do at home (but I suggest you talk to a physician qualified in nutritional medicine before you try it). It requires a bottle of Betaine HCl, at 200 mg potency per capsule.

Giarnella MD: Betaine HCL is a methyl group donor that functions in the normal metabolic cycle of methionine and reduces homocystinuria in patients with inborn errors of methionine metabolism.



BetaineHCL is used in the management of homocystinuria, including forms of the disorder caused by cystathionine synthase (CBS) deficiency, 5,10-methylenetetrahydrofolate reductase (MTHFR) deficiency, or cobalamin cofactor metabolism (cbl) defect, and has been designated an orphan drug by the US Food and Drug Administration (FDA) for the management of this condition. Although betaine can correct biochemical abnormalities (e.g., reduce elevated plasma homocysteine concentrations) in these patients, the drug does not correct the underlying basic genetic disorder.

Nausea, stomach upset, or diarrhea may occur

Approx. Price: $185 per 180Grams (source Medscape Drug search)

Poliquin wrote: Here’s how it’s performed:

Step 1: Have a high-protein solid meal (no shakes). Let’s say for illustration purposes a 12-ounce steak and vegetables.

Step 2: Eat half the protein, roughly 6 ounces of the steak.

Step 3: Swallow a 200mg capsule of HCl.

Step 4: Eat the other half of the steak and the vegetables.

Step 5: Wait 15 minutes.

Step 6: If your stomach acid is normal, you’ll feel like you just drank a hot cup of tea or feel a burn. If you feel nothing, you need HCl as a supplement.

So what do you do next? At every meal repeat steps 1 to 6, upping the dose one capsule per meal until you feel the burning sensation. So if it takes five meals to get a burning sensation, you need on average four capsules per meal. If you get to seven capsules and you have no burning, stop the test you’re achloridic, meaning you have almost no stomach acid!

At our Phoenix center alone we’ve been doing over 250 tests a year for the last four years, and in that time I’ve never seen one person not need at least one capsule; the average person tested could feel it after five capsules. You’re getting better when you start feeling a burn at your initial determined dosage. For example, if you found that five capsules was your initial need, you may find that three days later it starts to burn, so then you’d cut back to four capsules with a typical high-protein solid meal, and so on.

Giarnella MD: If the capsules noted in the above citation in fact do contain Hydrochloric acid then this is a very dangerous and possibly life threatening practice.

I have had patients who developed severe esophageal ulcerations caused by pills which remained in the esophagus too long. Just two weeks ago one of my patients had to be hospitalized and transfused several units of blood because he often would take his medications without drinking fluids. The pills in question did not contain Hydrochloric acid.

On another note, normal acidity of the stomach does not cause a burning sensation. I would be very concerned if anything you eat or drink causes a burning sensation. If there is in fact some HCL in those pills the patients may be developing gastritis (small erosions or ulcerations of the gastric mucosa).

I would love to perform and Esophogastro Duodenoscopy on these clients after they have ingested 5-6 HCL pills and felt a burn. Pass the Maalox please.

Poliquin wrote: Most people achieve normal levels within eight weeks even when they start at seven capsules, but some individuals take as much as 18 months. I have two clients who need two caps a day permanently. Why? Because neither one will ever escape their stress levels (one of them is a real estate mogul and the other is a highly accomplished author). Make sure that your HCL product also contains the probiotic pepsin and the digestive enzymes papain and pancreatin, as they have a synergistic effect with HCL therapy.

Giarnella MD: How would taking HCL pills restore the stomach ability to produce acid in 8 weeks or even 18 months?

Furthermore there is no evidence that stress causes achlorhydria. On the contrary under certain circumstances, which I will not elaborate here, extreme stress can cause stress ulcerations. Patients in the Intensive Care Units are often given acid suppressant drugs to prevent these stress ulcers.

Unless you suffer from chronic pancreatitis or small bowel disease such as Chron�?�¢??s disease there is not need for digestive enzymes. Just another useless supplement.

Poliquin wrote: In addition to the above HCL protocols, here are a few other suggestions to normalize your stomach acid levels. First, avoid carbonated drinks.

Second, avoid all-you-can-eat buffets, as they’re America’s leading source of food-borne pathogens. Finally, there are numerous herbs that can contribute to raising HCL, such as gentian, peppermint, and ginger, but
be aware that very few controlled studies exist on this topic.

I believe this is so important that my clients aren’t given a supplement program until they get an HCL test. Remember, not only are you what you eat, you are what you assimilate!

Giarnella MD: Gastric acid and Pepsin are not critical to the digestion or absorption of foods.

Poliquin wrote: One of the folks I’m training is a 77 year old male, a vegetarian for most of his adult life. His energy has been in a terrible fix for some months now, along with waking nightly with back and hip pain – so bad he was hooked on pain killers for a short spell.

Giarnella MD: This poor old man probably suffers from severe osteoporosis or severe degenerative joint disease neither of which is associated with the presence or absence of acid in the stomach.

Poliquin wrote: Vegetarian diets are notorious for leading to anemia due to loss of production of stomach acid resulting in inability to metabolize folic acid to B-12 and mineral absorption. This man has found relief with B-12 injections resulting in loss of pain and uninterrupted night sleep.

Giarnella MD: This last one is another false statement based on his obvious lack of knowledge of nutrition and physiology of the GI tract.

The stomach produces a substance called Intrinsic factor. Intrinsic factor is not related to acid production. Intrinsic factor is needed for the proper absorption of B12

However there is a condition often seen in the elderly called atrophic gastritis which causes a decrease in all the substances produced by the stomach including Intrinsic factor.

Just as we lose our hair and our skin wrinkles as we age so to the cells of the intestine gradually atrophy. It is called the aging factor. Like it or not there is a programmed slow cell death in all cells. No one lives forever.

Back to the atrophic gastritis. In this condition there is a concomitant decrease in production of all substances usually produced by these cells. Intrinsic factor, as I stated previously is not dependent on acid for its function, but it is necessary to facilitate the absorption of B12 in the distal part of the intestine called the ileum.

There is a saying that always rings true: A little bit of knowledge is a dangerous thing – Captain Queeg, The Caine Mutiny (1954).

I was a little puzzled by that saying when I first heard it as a youngster but after reflection I realized the truthfulness of the saying.

Some people who learn a little about a subject think they know all there is to know and make bad judgments based on their limited knowledge.

I prefer the following: The more I learn, the more I realize how little I really know – author unknown.