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Good Health and Bad Medicine:
 Carsickness And Seasickness

 Constipation - Part 1

 Constipation - Part 2

 Spastic Constipation

 Colitis

 Piles

 'gas' And Bloating

 Alkalizers And Acidosis

 Indigestion

 Diet - Part 1

 Read More Articles About: Good Health and Bad Medicine

Indigestion

( Originally Published 1940 )

IT IS clear, then, that in health, in all everyday ailments and even in most serious ailments there is never any danger of acidosis, and that "alkalizing" remedies to "alkalize" the blood and tissues or to keep them on the alkaline side are unnecessary. It is obvious, too, that the remedies will not pre-vent any of the symptoms for which they are advertised.

Often an alkalizing remedy advertised to keep you on the "alkaline side" is also advertised to "alkalize the stomach" or to "correct gastric acidity." Patent medicines are seldom modest in their claims, and alkalizing remedies are advertised as cures for "hyperacidity," "acid indigestion" and "gastric acidity," as well as for "acidosis." In patent medicine advertisements, the first three terms mean the same thing—simply indigestion. But because the public has been taught to regard the word "acid" as an ominous one evoking images of disease, corrosion and corruption, advertisers attach it to indigestion when selling so-called alkalizers or stomach remedies.

Alkalizing remedies for stomach disorders are among the most popular and profitable of the patent medicines on the market. The chief reason for this is that indigestion is one of the commonest of complaints of ailing mankind. Almost one-half of all patients who visit a doctor or clinic complain of indigestion. Many of those who do not seek medical care have been "educated" to diagnose their ailment from misleading and fear-provoking advertisements and to treat themselves with one or more of the multitude of stomach remedies on the market.

For more than a century it has been known that the normal stomach secretes hydrochloric acid and that this acid has a specific function in digestion. It helps digest food and it destroys bacteria that gain entrance to the stomach. Acid in the stomach is a sign of good gastric function and good health and, for a conscientious physician, there would be no more reason to counteract "gastric acidity" than to remove a normal colon because of constipation. Both are necessary for good body function.

Improved diagnostic procedures have permitted a more re-fined examination of the stomach juices than was formerly possible. It is now known that the amount of acid in the secretion varies widely in different individuals and that perfect digestive health can be compatible with a high or a low acid secretion. In fact, the variability of acid secretion is simply another expression of the variability in structure and function characteristic of all living things. It is true that in many patients with indigestion, the stomach juices may yield a high percentage of acid. But even when the indigestion is associated with a high acid secretion, it has never been proven that the acid itself is responsible for the indigestion.

It is also well known that the acid secretion of the stomach varies a good deal in the same person from time to time, de-pending often on the kind and quantity of food or liquids taken. Alcohol, tobacco and spices can produce a temporary rise in acid; most important of all, it has been shown that emotional disturbances have a profound effect on the amount of acid juice secreted by the stomach.

The trouble began when the erroneous assumption was made by some doctors that because a person's stomach contained a large amount of acid, any dyspeptic symptoms from which he happened to be suffering at the time were due to the acid.

"Sour stomach" and "heartburn" are among the commonest complaints of the dyspeptic, but it has never been proved that these symptoms are caused simply by the presence of a high acid secretion. A high acid content of the stomach generally means either that it is normal for that person or that it is simply one manifestation of a digestive disorder. In other words, hyperacidity may be normal and not associated with any digestive disorder; or, if it is, it must usually be considered a symptom of some underlying disorder and not a disease in itself.

As a matter of fact, it is a common medical observation that many instances of dyspepsia are associated with a low or even total absence of acid in the stomach. "Heartburn," "Sour stomach," gas and other symptoms, commonly assumed to be associated with an excess of gastric acid, may occur in people with a total absence of acid in the stomach. In pernicious anemia, for example, there is no acid in the stomach, and yet symptoms such as "sour stomach" or "gas," commonly attributed to hyperacidity, may occur.

It has also been discovered that with increasing age, the amount of acid in the stomach becomes less, so that by the age of sixty about one in every four persons will show a complete lack of acid in the stomach. In no case is it possible to determine the amount of acid in the stomach from the recital of symptoms.

If hyperacidity by itself does not cause indigestion, then why does sodium bicarbonate (baking soda) or an alkalizing powder relieve, even though only temporarily, "heartburn," "sour stomach" and other symptoms? There is no completely satisfactory explanation.

The relief may be due to the sedative effect of the alkalion the mucous membrane of the stomach, to smoother activity of the stomach muscles, or to the release of carbon dioxide and the satisfaction that many people get from belching. Whatever the explanation, it is generally agreed that in relatively few instances is the relief due mainly to any neutralization of the acid.

The effect of alkalizers on the stomach is similar to the effect of aspirin on fever. The temperature is reduced, but the cause of the fever is not eliminated. Likewise the symptoms of indigestion may be temporarily relieved by the use of an alkali, but the cause of the indigestion is not eliminated. Since alkalizers give only temporary relief and since "acid indigestion" is merely a symptom of an underlying disorder, the sensible way to treat indigestion is to discover the cause of the symptoms.

Indigestion has many causes. In some people an attack may occur after drinking alcohol or after smoking. More often, indigestion is caused by sensitivity to certain specific foods such as chocolate, apples, cabbage, onions, berries, milk or eggs. Eating even small quantities of one or another of such foods may cause an attack of indigestion. Obviously the best way to treat such attacks is to prevent them. Doctors have learned how to detect sensitivity to foods by placing patients on so-called "elimination diets." By a process of trial and error, the foods to which a patient is intolerant are detected. Elimination of these from the diet leaves the patient permanently free of symptoms.

More common than food sensitivity as a cause of indigestion are emotional disturbances. A famous doctor once called the digestive tract "the mirror of the soul" because of its tendency to reflect emotional difficulties.

That the mind and emotions may have a profound effect on the harmonious activity of our organs is a medical truism. Almost everyone knows that feelings of comfort and peace of mind are necessary for good digestion. Discomfort, anxieties and conflicts, both conscious and unconscious, disturb digestion.

While disturbance of emotions is very often responsible for digestive disorders, there are a large number of dyspeptics whose trouble is due to organic disease of the digestive tract, particularly to ulcer. Indigestion may also be due to disease of other organs, such as the gall bladder or appendix. In fact, acute appendicitis is a very common cause of acute indigestion, and thousands of people die in the United States every year because of ignorance of this fact. The proper treatment for acute appendicitis is an operation, not an alkalizer or a laxative. An acute attack of pain in the abdomen, with or without gas, belching, nausea, heartburn or vomiting, requires immediate care and not a popular indigestion remedy.

Disease of the heart or lungs may also cause digestive disorders. With increasing age the frequency of organic disease increases; after forty, serious organic disease of the stomach, intestines and other organs is very commonly the cause of chronic indigestion.

Because of the serious nature of many instances of indigestion, a reliance on alkalizers or other "stomach remedies" may simply invite disaster. This is particularly true for older adults. The use of alkaline powders or tablets to relieve chronic dyspepsia and the delay in seeking medical advice has taken a high toll in human life and well-being. Alkalizers such as Alka-Seltzer, advertised for "gas in the stomach," "sour stomach," "heartburn" and "flatulence" due to "hyper-acidity of the stomach," give a false sense of security and frequently mask the symptoms of serious disorder. By what ingenuity of diagnosis it is possible to state that these symptoms are attributable to "hyperacidity," only a patent-medicine advertiser knows. Far too often, alkalizer addicts turn out to have ulcers or even more serious organic disease. The exploitation and deception of the public in this respect is one of the many crimes chargeable against the patent-medicine industry.

Beyond giving a false sense of security, the taking of alkalizers sets up a hazard serious enough to have brought about a marked decline in the use of antacids such as sodium bicarbonate in medical practice. We refer to the hazard of alkalosis. The specter of acidosis is far less to be feared, even though there are no statistics available as to the number of people who have suffered from or succumbed to alkalosis.

The early symptoms of alkalosis may be mild and may re-semble just those symptoms of dyspepsia for which alkalizers are usually taken. The condition may pass entirely unrecognized even when medical attention is obtained. This is particularly true if the alkalies are taken with a restricted diet. Only when severe symptoms of poisoning appear is the diagnosis usually made, and then it may be too late.

While the body normally possesses adequate defenses against an assault by acid or alkali, these defenses are some-times impaired. If the kidneys are diseased, for example, an important bulwark against acidosis or alkalosis is lost. In fact, it has been found that it is especially in people with dis-eased kidneys that alkalosis from indiscriminate use of alkalies is likely to occur.

Many doctors feel very strongly about the danger of alkalosis. Dr. Arthur F. Hurst, a renowned English physician, who has had a large experience in the treatment of digestive disorders, has stated in an article in Practitioner (October, 1936):

"... I have seen patients who were thought to be dying from uremia [final stage of severe kidney disease], but were really suffering from severe alkalosis, and were saved by discontinuing the use of alkalies and by giving ammonium chloride [an acid drug].... So prevalent is this condition that the possibility of alkali poisoning should be remembered whenever a patient who was not hitherto known to be suffering from renal [kidney] disease develops uremic symptoms.... I believe that more deaths must result from unrecognized poisoning with alkaline powders than from accidental poisoning with the barbiturates [sleeping drugs]." In a recent communication from Dr. Hurst to the writer, he states that he does not consider his statement in the least exaggerated.

While many doctors may not go quite so far as Dr. Hurst, all agree that dosing with alkaline remedies has passed the bounds of common sense and good health. Certainly anyone with a history of a kidney ailment, and elderly people, who frequently have some degree of impairment of kidney function, should refrain from habitual dosing with alkalizers.

Because of the potential danger of alkalosis and other disadvantages in such alkalies as sodium bicarbonate, many doctors have given up their use over prolonged periods. But while prolonged, habitual dosing with alkalies presents a distinct hazard, occasional use is another matter. A pinch of baking soda is usually sufficient. And when added to 1/2 glass of warm or hot water, its sedative effect on the stomach may be enhanced. Most alkalizers or antacids contain sodium bicarbonate and other alkaline salts.

For the occasional attack of dyspepsia due to alcohol, hurried eating or emotional stress, ordinary baking soda will work just as well as any of the patented remedies. Three ounces of Bisodol cost about 50c; three ounces of baking soda cost about ic.

The addition of so-called enzymes such as diastase to alkalizers is just so much twaddle. They have never been proved to have any value in treating disturbances of the digestive tract. If flavor is desired, to or 15 drops of essence of peppermint or i or 2 drops of oil of peppermint may be added to the water (Turns, in fact, consists largely of peppermint and chalk). If an effervescing drink is preferred, the baking soda may be taken in seltzer water.

Among the best known of the dozens of "alkalizers" on the market are:

Bisodol
Sal Hepatica
Bromo-Seltzer
Alka-Seltzer
Peptans Cal-Bis-Ma
Alkaline-Seltzer
A1-Caroid Papsomax
Alka-Zane
Citrocarbonate
Tums
Phillips' Milk of Magnesia
Phillips' Milk of Magnesia Tablets

The list above is composed of products which, either be-cause of their composition or the claims made for them, may be considered as alkalizers. Some are not alkalizers in the true sense of the word; that is, their alkaline ingredients are present in negligible quantities, and only as a mask for other drugs in them. These are the effervescing alkalizers, and include Alka-Seltzer, Bromo-Seltzer, Sal-Hepatica and others.

Most such products contain tartaric or citric acid as well as the alkali, and when added to water there is an interaction between the acid and alkali; that's what makes them bubble. The really active ingredients in these products are such varied drugs as acetanilid, aspirin, bromides, Glauber's salt, or bismuth compounds.

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