Indigestion is perhaps the most common ailment affecting people today, and a multi-billion-dollar-a-year industry has sprung up to provide over-the-counter remedies to sufferers.

Why do so many people suffer from indigestion and why don't traditional remedies for indigestion correct the problem rather than merely provide temporary relief from its symptoms?

The answer to these questions lies in the fact that digestion is a very complex process.

It is very difficult to know exactly which step in the digestive process is at fault. The symptoms of indigestion (dyspepsia), heartburn, flatulence, bloating, nausea and cramps are vague. And there are no lab tests to define the exact problem.

The homeostatic challenge test -- described in the last few articles -- was devised to overcome that problem, and is easily implemented into any chiropractic office.

Dyspepsia has many causes, so let's start by looking at one of the most common -- hypochlorhydria. Best and Taylor report achlorhydria -- lack of HCI secretion in the stomach -- was found in 14-20% of patients in the hospital for conditions other than gastric disease or pernicious anemia.

Evidence has also been presented that the incidence of hypochlorhydria showed a definite increase in patients over 50 years of age who are free of gastric disease. Some studies even report as high as 25-35% of elderly patients have this condition.

Achlorhydria is diagnosed when the pH of the gastric contents fails to drop below 6.5 following maximal stimulation. Interestingly, the "resting pH" of the stomach (when it's not producing HCI) is normally 5.0 to 6.0, according to Guyton.

HCI is critical for proper protein digestion in the stomach not because of its digestive powers, but because it adjusts the pH of the stomach to allow protein digestion to occur.

HCI reduces pepsinogen to the active proteolytic enzyme, pepsin, and maintains the highly acidic pH needed for pepsin's activity.

The secretion of HCI and pepsinogen are governed by separate mechanisms as evidenced by the pepsinogen concentration in the gastric juices of achlorhydric patients being very near normal in many cases.

Guyton confirms HCI is elaborated by the oxyntic (parietal) cells and pepsinogen from the chief cells of the stomach. This means the body may be producing enough pepsinogen but is still unable to properly digest protein because of insufficient HCI.

The question arises, what can be done to increase the amount of HCI in the stomach? It would seem logical, and certainly is traditional, to recommend betaine HCI supplements to those experiencing hypochlorhydria. However, as we are about to see, that is not an effective remedy.

While betaine HCI supplementation is very popular, it is not an effective agent to improve digestion. The simple reason is that HCI does not digest food, as we have outlined above. The FDA ruled a few years ago that no digestive claims can be made for betaine HCI, other than being a methionine donor for protein metabolism in the liver.

This always bring howls of protests from doctors and manufacturers who extol the virtues of betaine Hydrochloride. All I ask is that you don't shoot the messenger. Hang onto the concept of maintaining homeostasis and forget about prescribing "magic bullets," and look at the biochemistry involved.

The oxyntic (parietal) cells of the stomach take the necessary ions from the blood which implies that the blood must be able to spare an adequate supply of these ions.

Remember, the first priority of the body is to maintain a blood pH of 7.4. Therefore, if the blood is struggling to prevent its pH from becoming more alkaline, it will want to retain its H+ or acidic ions and may not be able to lend sufficient amounts to the digestive process causing hypochlorhydria.

There is a "Catch 22" here, because the body normally receives most of its acidity by digesting protein. It doesn't require much protein, and it can certainly come from a vegetarian diet, but it must be properly digested regardless of its source.

If we simply increase the amount of acidity in the body by adding betaine HCI or even vinegar, we may relieve the symptomatology that brought the patient to the office, but prolonged treatment will throw too much acid into the blood and eventually exhaust the body's alkaline reserves.

That will jeopardize the availability of the alkaline bicarbonate ions which the blood must provide for the activation of the pancreatic enzymes in the small intestine.

Therefore, it should be obvious that using acid supplementation is not the answer to indigestion caused by hypochlorhydria. The ideal way to correct this problem is to help the body maintain a normal acid/alkaline balance in the blood and, at the same time, reduce the amount of HCI that needs to be secreted.

Improving protein digestion with food enzymes that "pre-digest" food in the stomach is the correct approach.

There is a simple in-office test designed to indicate if a betaine hydrochloride preparation is an effective digestive aid. Instructions for performing the test are contained in the booklet The Homeostatic Challenge Test.