tine enzymes. Because the normal stomach acid stimulates the pro-
duction of pancreatic enzymes in the small intestine, I prefer to use
betaine hydrochloride without additional digestive enzymes in most
cases.
Reflux
GERD — gastroesophageal reflux — has become a commonly diag-
nosed problem in both children and adults. Drugs to treat the symp-
toms are among the biggest sellers, yet people still have the symp-
toms. In true cases of GERD, stomach contents back up into the
esophagus, causing irritation, with symptoms occurring mostly after
meals, or when lying down or bending over with the head below the
waist. In severe cases, ulceration can occur in the esophagus. Most
people have less serious but sometimes very uncomfortable symp-
toms associated with bloating due to gas. This often comes from eat-
ing starchy or processed carbohydrates, especially at the same time as
eating dense proteins, overeating and other causes of gas (see sidebar
on gas). Reducing or eliminating carbohydrates, including lactose
from dairy, often eliminates the symptoms of GERD. In other cases,
poor stomach digestion (not enough stomach acid) causes the symp-
toms as discussed above.
Don’t Water-Down Your Meals
Maintaining a healthy stomach is important during meals. Stress may
be the biggest and most common culprit. But drinking water with
meals adds another stress to stomach function. People commonly
consume a glass or two of water during a meal. This can reduce the
stomach’s ability to effectively digest its food and increase the
amount of air in the stomach, another potential stress that reduces
digestion. For many people, drinking water with meals becomes a
habit because they do not chew their food well. Proper chewing mois-
tens food sufficiently eliminating the need for additional liquids.
Small amounts of wine or other non-sweetened alcohol as a liquid can
help digestion, but other than that, liquids should be consumed
between, not during meals. Drink water about 15 or 20 minutes before
meals and about an hour aftermeals.
THE GUT • 263