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Goals:

1. Optimize Digestion

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Stomach Acid

Goal: Optimize stomach acid production to improve protein digestion, digestive enzyme activation, and nutrient absorption. Counter the “vicious cycle” of low stomach acid leading to poor nutrient absorption, which in turn perpetuates low stomach acid.

“Jump-start” stomach acid production:

1. Betaine HCL + Pepsin
   • How It Works: Enables nutrient absorption in people with low stomach acid. This supplement directly provides hydrochloric acid and pepsin, promoting protein digestion.
   • Usage: IFM Guidelines
2. Sufficient nutrients
   • Core: Specific nutrients drive stomach acid production.
     • Chloride: an essential nutrient for stomach acid production.
     • Zinc: a cofactor for carbonic anhydrase, an enzyme that is essential for the production of stomach acid.
     • Iron: a cofactor for hydrogen potassium ATPase, an enzyme that pumps hydrogen ions into the stomach lumen to create the acidity of stomach acid.
   • Conditional:
     • Iodine: a cofactor for the enzyme pendrin, which is responsible for transporting chloride ions from the bloodstream into the parietal cells, which produce hydrochloric acid. Important if iodized salt is removed from the diet or if thyroid issues are present. Could be added based on test results or specific diet restrictions.
     • Vitamin B12: necessary for the production of hydrochloric acid, the main component of stomach acid. SIBO complicates matters as B12 is mainly absorbed in the ileum of the small intestine, where it can be intercepted. Sublingual B12 can be considered here.
     • Magnesium: Acts as an ATP energizer. Since the ATPase enzyme is critical for pumping hydrogen ions, sufficient ATP must be available for optimal enzyme function.
   • Usage: These key nutrients taken as supplements.
3. Apple Cider Vinegar (ACV)
   • How It Works: ACV is acidic and may help stimulate stomach acid production.
   • Usage: Often taken diluted in water before meals.

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Digestive Enzymes

Goal: Aid in the breakdown of macronutrients for better absorption.

Support digestive enzymes:

1. Pancreatic enzymes
   • How It Works: Provides protease, amylase, and lipase to aid digestion.
   • Usage: Taken with meals.
2. Lactase
   • How It Works: Provides lactase to aid digestion of lactose.
   • Usage: Taken with meals that contain dairy. Conditional for those with lactose intolerance.

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Bile Acids

Goal: Ensure proper bile flow for fat digestion and absorption, and toxin elimination.

Fix bile flow:

1. Sufficient Nutrients
   • Core: Specific nutrients drive bile production.
     • Choline: An essential nutrient that supports the liver in producing bile, thereby aiding in fat metabolism and detoxification processes.
     • Taurine: An amino acid that plays a crucial role in bile salt formation, helping to emulsify fats and enhance digestion.
   • Usage: Taken as supplements.
2. Ox Bile
   • How It Works: Provides bile acids to aid fat digestion in those without a gallbladder.
   • Usage: Conditional for those without a gallbladder. Taken with meals.
3. Digestive Bitters
   • How It Works: Stimulates the gallbladder to release bile.
   • Usage: Conditional for those with gallbladder dysfunction. Taken before or during meals to promote optimal digestive conditions.

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Motility Support

Goal: Improve the mechanical aspects of digestion to ensure the efficient transit of food and waste through the digestive system.

Improve Gut Motility:

1. Sufficient nutrients
   • Core: Specific nutrients can act as natural laxatives and improve gut motility.
     • Magnesium Citrate: acts as an osmotic laxative, drawing water into the intestines, thus softening the stool and making it easier to pass.
     • Psyllium Husk: adds bulk to the stool, aiding in its passage.
   • Usage: Conditional, primarily targeted for cases where constipation or slow transit is an issue. Re-evaluation is recommended to assess long-term need.

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Testing

Goal: Evaluate digestive function.

Core:

• Essential Nutrient Mini-Panel
  • How It Works: Measures the levels of crucial vitamins and minerals in the blood to assess how well your gut is absorbing nutrients.
  • Usage: Conducted periodically to evaluate the effectiveness of nutrient replenishment strategies and to adjust treatment plans.
• Patient-Reported Outcome Measures (PROMs)
  • How It Works: Consists of brief surveys capturing patient symptoms and well-being, offering additional insights into the digestive function.
  • Usage: Administered at key milestones to evaluate the subjective impact of interventions in the “Replace” phase and adjust treatment plans accordingly.