Kelsey Marksteiner: Okay. So yes, burping can definitely be related to low stomach acid and I would recommend thinking about how it’s presenting first of all. Because for me there’s two options the way I think about burping. There’s either that it’s low stomach acid-related only or it could be SIBO-related. And then SIBO is usually kind of combined with low stomach acid as well. So the two overlap, but the burping can be there without SIBO as well and just related to low stomach acid, but then you also need to be digging deeper. Why does this person have low stomach acid in the first place? So you want to think about those two options and they present a little bit differently.
When someone has SIBO and they have burping, I find that there’s usually a lot of bloating and there may even be excessive flatulence as well. There’s just too much gas overall and it’s coming out both ends. And so that would definitely lead me to think more about SIBO as what’s the underlying cause of this burping. Whereas if someone’s not really experiencing a whole lot of bloating, you know, they don’t really have many stool changes or anything like that. Or if they’re just having little bits of food in the stool that are undigested, that to me would speak more to the low stomach acid only. But again there’s a lot of crossover between low stomach acid and SIBO. So you know, if you can it’s probably worth screening them for SIBO even if there isn’t a whole lot of bloating just to rule that out because when you start to think about low stomach acid, SIBO can be one of the things that causes that like I mentioned before.
So if possible if the patient is willing to get the SIBO test, I would do that regardless because it’s going to help you out either way. You want to know if this person has SIBO so you can treat that because it may be playing into the burping on its own, or it may be feeding into the low stomach acid production. So when someone has a lot of burping, those are the kind of thoughts that go through my mind first. And before you even start on an antimicrobial protocol if they do have SIBO or if you’re not sure, you’re waiting for results, you can certainly try some HCl and see if that helps. It often does because it is very much related to low stomach acid. I have to say I haven’t really heard of belching being related to high stomach acid and I’ve never had anybody who I could say fits that description. So to me I wouldn’t really be thinking that way. Though I guess it’s probably, I guess it’s possible. I’ve just never seen it in my own practice.
So I would definitely be thinking more about low stomach acid. But what you could do is have them try hydrochloric acid if they get that burning or warming sensation right away with one pill of that, then you know they may have high stomach acid and you need to figure out what’s causing that and then see if that helps the belching. But for most people with burping they’re going to, like I said, have low stomach acid and so you do that hydrochloric acid protocol where you, you know I typically start them with one HCl pill and work their way up and see if that helps. Now I would also add that I do typically add some digestive enzymes with that or I like to use Now Foods’ Super Enzymes which has a little bit of HCl in it as a starting place and then we can add on HCl on top of, you know pure HCl with with a little bit of pepsin on top of that. And for a lot of people with burping, the digestive enzymes themselves help a lot too. Even though it’s more related to just overall not having a lot of stomach acid, just the extra digestive enzymes I find tend to help as well just sort of help digest other parts of their food as well; so their carbohydrates, their fats, their fibers, things like that.
So I would probably, at least I can tell you what I do. I would start them on something like Now Super Enzymes because it has digestive enzymes and HCl, and then add extra HCl on top of that. But if you are really convinced that it’s only stomach acid that’s missing here, you could certainly just do HCl and do that protocol on its own.
The reason I would more be more likely to do the digestive enzymes with HCl is if they are also telling me they have undigested food in their stool. So in that case that’s pretty much a red flag for me to definitely include digestive enzymes or see how they do with them at least. So I guess if you had someone who really didn’t have many stool changes, it was just the burping, you can just try the HCl. But for the most part I think at least most of my clients tend to do better if it’s the, if you use digestive enzymes in combination with HCl to start with.
So I would start there as you’re waiting to get results back for for SIBO. If SIBO is an issue, obviously you want to deal with that. I have to say that with my burping clients, SIBO is very, very common and once that’s treated, the burping usually goes away. Because I find it less common for people to have burping without bloating just because obviously burping is typically gas related, and so someone with SIBO is going have a lot of excessive gas in their digestive tract. And it tends to come one way or the other. It either stays there and is really, really excessive bloating, or it goes up or goes down or both in combination with also having bloating. So if someone has a lot of bloating and they’re having belching, chances are they have SIBO, in which case treating that SIBO does wonders. That is the number one thing that kind of just gets rid of it right away for most people, so I find that screening, like I said, for SIBO is going to be a really, really good option if you can do that, if your patient is willing. Even if they don’t have all of the symptoms, I probably would with anyone who is complaining of burping a lot. I’m trying to think if there’s anything else I would think of with a burping client.
Sometimes I guess you do have people that are burping and they’re getting refluxate coming up as well. So there’s a GERD component where again, you know that HCl can be useful. Sometimes though, for a lot of my GERD patients, I actually don’t necessarily start with HCl because, and it totally depends on the person themselves. But if they’re describing a lot of pain and just kind of feeling inflamed in their esophagus or just tenderness, that kind of thing, I like to heal that tissue first. So starting with something like slippery elm or marshmallow root, those demulcent herbs that coat, soothe and heal that inflamed tissue. If you start without doing that and you just give them HCl, I have had some people who probably could use some hydrochloric acid to raise their stomach acid, but they just can’t tolerate it because it bothers them on the way down. So it’s getting that capsule is disintegrating somewhere along the line in the esophagus and they’re getting more burning because it’s sort of irritating that already irritated tissue. Why they’re having that capsule disintegrate early like that I’m not sure, but it does bother some people. So you do have to be aware. It doesn’t necessarily mean that they don’t need the hydrochloric acid, it just means that you may need to focus on healing that esophageal tissue first. And my favorite way to do that is with demulcent herbs like I just mentioned. So slippery elm, marshmallow root, DGL; DGL can be really good just because you can get it in little chewables as long as the person tolerates a little bit of fructose because that’s included in most of those chewables. But otherwise you need to do a powder because you actually, you need that herb to come in contact with the tissue that you’re hoping to heal. So if you have them take a capsule it’s going to go too far down before being activated. So powder or chewable for any of those things is going to be great to heal that tissue first. And then of course the burping tends to go away once you’re able to add the hydrochloric acid in. If this person’s reflux is related to low stomach acid and they’re kind of getting burping along with the reflux.
So I think that’s it. That’s really what I would recommend is screen for SIBO because it’s really common with people who have excessive belching, especially if they are describing a decent amount of bloating as well. But otherwise maybe start with some digestive enzymes and hydrochloric acid, work your way up on the hydrochloric acid if needed. If your patient has reflux and they maybe can’t tolerate the hydrochloric acid at first, give them some demulcent herbs like slippery elm, marshmallow root, DGL to help to heal and soothe that tissue before adding the HCl in and try that again after they feel like some of that reflux or at least some of that inflammation and tenderness has dissipated. And then they should be able to tolerate the HCl and that should hopefully help the burping that goes along with the reflux that they’re having.