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cimetidine and digestion 101

tanstaafl's picture
tanstaafl
Posts: 1296
Joined: Oct 2010

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.

smokeyjoe
Posts: 1428
Joined: Feb 2011

That much vitamine D3 a day??? Can't this be bad for you??

tanstaafl's picture
tanstaafl
Posts: 1296
Joined: Oct 2010

In unsupervised, unskilled hands, yes. My wife has three layers of oversight and is good on compliance. In comparison to adding another chemo or a targetable biological like Avastin or Erbitux, it's quite favorable. She actually has a prescription for 50,000 iu, we've been making the escalation slowly.

The primary "toxicity" of D3 in the under 50,000 iu range is hypercalcemia, due to inadequately controlled absorption of excess calcium. Excess calcium being a relative term to vitamin D3 intake, more D3 means less (supplemental) calcium intake. We've discussed different levels of vitamin D3 intake before, here. I've noted that high dose protocols are not for casual use, but supervised by experienced doctors, primarily to manage calcium intake, and better target deposition to the bones, a la vitamin K2, rather than K2 deficient bodies with excess calcium putting calcium in the wrong places.

MaggieCat
Posts: 54
Joined: Dec 2011

Thanks again for sharing. I would appreciate a bit more about calcium intake and the whys of management. Bone deposition vs unwanted calcifications in other places...

tanstaafl's picture
tanstaafl
Posts: 1296
Joined: Oct 2010

Might want to follow the links to prior discussion in my blog about D3 and the Prendergast links and google menaquinone-4, vitamin D3 and calcium.

pete43lost_at_sea's picture
pete43lost_at_sea
Posts: 3908
Joined: Nov 2010

http://www.rxlist.com/tagamet-drug/consumer-side-effects-precautions.htm

was feeling dizzy, actually had trouble at yoga yesterday.

i thoght i would do the contraindications and cimetidine search.

yes thank god, they are covered.

i do catastaphising quiet well.

spent most of the day praying that i don't have brain mets, not had dizziness before and have just started cimetidine again.

see the link above. thought i would throw it in here.

researching managing stomach acid balance cimetidine.

i am focused on a healthy gut as possible.

hugs,
pete

ps A large study has recently suggested that elderly people and people with diabetes, chronic lung disease, or an underactive immune system (for example due to treatment such as chemotherapy or radiotherapy, or diseases such as HIV) may have a higher risk of developing pneumonia while they are taking H2 receptor antagonist medicines such as this one. Ask your doctor for more information. While you are taking this medicine you should tell your doctor if you develop a cough or chest infection.

from

http://www.netdoctor.co.uk/medicines/100002524.html

Just what level of immune impairment are they discussing in the studies ? i will check this out one day. but thought i would throw this in here in the digestion 101 thread.
this is the most essential discussion we have ever started in my opinion as everything stops and starts with digestion. absorbing our medications, nutrients and supplements to start with and then the immune system.

http://home.caregroup.org/clinical/altmed/interactions/Drugs/Cimetidine.htm
this link above is worth its weight in gold

cimetidine and dizziness and homocystiene
http://petertrayhurn.blogspot.com/2011/12/cimetidine-and-dizziness-and.html
the implications of my understanding will cause me to adjust and try to find more accurate ways of dealing with these complex interactions. wanted to capture this info on my blog as its essential to getting my protocol correct.

tanstaafl's picture
tanstaafl
Posts: 1296
Joined: Oct 2010

There's are all kinds of problems there HIV, rad, kidney. Although B6+folate+B12 are more frequently mentioned for homocysteine in current medicine, in alternative circles, trimethyl glycine (TMG, betaine) is considered much more effective for homocysteine.

Limited studies, cited in Cochrane Reviews, suggest that vitamin C, even 1 gram per day for young children, is extremely important for pneumonia survival. This latter "insurance lite" approach is not one the high dose, therapeutic vitamin C regimens proposed by doctors FR Klenner, Thomas Levy or Robert Cathcart (not for late stage renal disease). Also one has to suspect other nutrient issues like minerals, some amino acids, and vitamins, esp. D3.

pete43lost_at_sea's picture
pete43lost_at_sea
Posts: 3908
Joined: Nov 2010

This is about d3

nutrient affected by drug: Cimetidine

• mechanism: Cimetidine reduces the liver's ability to activate vitamin D through hydroxylation.

• nutritional support: Lab tests can determine blood levels of 25(OH)cholecalciferol, the activated form of vitamin D. If too low, a prescription for an activated form of vitamin D would be required as activation of a regular vitamin D supplement would be vulnerable to blockage by the cimetidine.

tanstaafl's picture
tanstaafl
Posts: 1296
Joined: Oct 2010

Our blood levels of vitamin D reflect both absorption efficiency and the first hydroxylation step. More ordinary, cheap vitamin D3 seems to usually do the job. On 1200-1600 mg per day of cimetidine, along with "big D", my wife's blood level is over 300 ng/mL (over 750+nmol/L) of hydroxy-D3.

Again, to any concerned, the high dose vitamin D3 is professionally prescribed, and her blood carefully monitored to avoid calcium overload (or vitamin D and calcium depletion with CRC and chemo).

pete43lost_at_sea's picture
pete43lost_at_sea
Posts: 3908
Joined: Nov 2010

http://jtcs.ctsnetjournals.org/cgi/content/full/116/2/312

the idea its use suppress suppressor lymphocytes and hence provides a boost is interesting, i was looking into its methods of operstion, thanks for the answers to my qyeries.

i have also found a cheap source of natto in sydney, its a great source of the long lasting k2

its detailed on blog

tanstaafl's picture
tanstaafl
Posts: 1296
Joined: Oct 2010

Natto vitamin K2 is mostly MK7 (a storage form found in the liver) and "great" amount is relative. I think natto is an excellent source of MK7, nattokinase and fermented products, but really large amounts of MK4 appear to be a separate issue, like a 100x more in the MK4 form, the only natural menaquinone I've seen tumor inhibition data on, with big vitamin C.

pete43lost_at_sea's picture
pete43lost_at_sea
Posts: 3908
Joined: Nov 2010

my integrative gp warned me of all soy and fermented soy.
taking his advice.

i figure i can hammer the vit k mk4 while breakfast lunch and dinner for the same effect.
long lasting is nice. i got a little mk7 in the lef super booster softgels. my integrative gp smiled at me when i showed him some of the good quality supplements. the info exchange is a to way street.

i have to bring him up to speed on cimetidine. he is a bit of a guru on pppi issues so after i sell him on the clinical trial info re cimetidine he will be perfect to help me manage the gut issues. i know this is an area you know well, but you cannot write scripts and order bloods tests.

its just a releif for me to have an integrative gp to supervise the little cocktail i have created for myself.

despite the results of the rgcc molecular tests int gp advised keeping all keep protocols going. i am hammering querctin 2000mg break lunch and dinner. my tumour cells die when exposed to it. here is hoping those greeks did a good job and it translates to results where it counts. in my body. measuring the ctc's in a few months will be interesting. obviously the cea next week will also be interesting.

http://www.health.harvard.edu/fhg/updates/do-ppis-have-long-term-side-effects.shtml

smokeyjoe
Posts: 1428
Joined: Feb 2011

Pete what did he say about soy??

pete43lost_at_sea's picture
pete43lost_at_sea
Posts: 3908
Joined: Nov 2010

he said to check back with him in 3 months he may have changed his mind.

so even though i take some risks, i'll skip soy, fermented soy.
avemar well i know its fermented, got to check into that.
as its kind of interesting i am keeping it going.

it was about a 2 hour consult yesterday, he did see other patients. glad i have a memory like an mp3 recorder hahaha!!!!!!

hugs,
pete

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