cimetidine and digestion 101

America seriously abuses acid inhibitors, a habit that creates other problems. Long time readers know that I think highly of cimetidine as a molecular therapy for those adenocarcinoma patients biomarked with CA19-9 (and CSLEX1), the supermajority of advanced colorectal cancer patients, as literally the first aid.

All that cimetidine can't help digestion of important nutrients like B12, proteins and minerals among others. A seeming paradox. What did we do?

Three major components (not all) of digestion are stomach acid, pancreatic enzymes and bile. If our body doesn't produce enough of them, they can be replaced. Common supplements are betaine hydrochloride, pancreatin, and combo digestive formulas with ox bile. Also medium chain triglycerides (12 carbon fats, like lauric acid, or shorter) don't require bile. We use various coconut oils, or light refined fractions, to get MCT. We use essential fats too, gamma linolinec acid (GLA) and fish oil (for DHA and EPA in high dosage per LEF.org).

Conventional medical wisdom is that pancreatic enzymes (PE) can (or should) do the whole job for both the PE and hydrochloric acid. The most insightful book I've ever seen on stomach acid is Jonathan V Wright's "Why Stomach Acid Is Good for You: Natural Relief from Heartburn, Indigestion, Reflux and GERD" (2001). Wright reviews medical science on stomach acid starting 190 years ago, and 30 yrs of proton inhibitor marketing influence. You can read parts of the book online, but glad to have bought the book. If someone wants a more prosaic source, they can go get a 15 lb graduate medical text on gastroenterology and read 1-2 chapters there and get part of the practical detail on stomach acid plus some spiffy graphs.

Betaine hydrochloride is the most common acid replacement. We use the cheapest, most common large size, "10 grain" (625-648 mg) + pepsin. We take 1-2 tablets with the first food and if that isn't be enough (oink, oink), wait 5 minutes or so, and take another 1-2 tablets, etc. Since my wife is at 35,000-40,000 IU vitamin D3, these betaine HCl tablets have calcium content that has to be totaled, even with the extra vitamin K2.

Pancreatic enzymes. If short on stomach acid and/or diabetic, pancreatic enzyme production may be insufficient. We typically use 1 or 2 of the enteric coated 1400-1600 mg (1x equivalent) e.g. 1400 mg of (1x)pancreatin equivalant = 350 mg of 4x pancreatin, with meals or in between. Pancreatin usually has a high calcium content, varies with manufacturer. With both high vitamin D3 and pancreatin use, we have to total the calcium content.

Also prebiotics can be helpful with the digestive system and flora. These are complex carbohydrates, oligiosaccharides and polysaccharides, some formerly called mucopolysaccharides, that are fermented in the gut to yield short chain fatty acids, most preferably, n-butyrate. Onion with inulin, and okra are two food sources I like.