Do you have heartburn? You know, that burning sensation in your esophagus and throat? If that’s you, you’re not alone. About 15 million people worldwide experience it. Maybe you’ve been diagnosed with Gastroesophageal Reflux Disease (GERD) which is the most common digestive disorder in the United States. And your practitioner told you it was due to too much stomach acid.
But what if the real cause of your heartburn is not too much but too little stomach acid? Scientific research has been showing this to be the case.
The Lower Esophageal Sphincter, LES, is the muscular valve between the stomach and the lower part of the esophagus. The LES has the job to keep acid from entering your esophagus. Normally the LES only opens for liquids and food to pass into your stomach or when belching. But when you have GERD and heartburn, your LES is not functioning properly. Instead stomach acid is allowed into the esophagus which causes that burning sensation in the sensitive esophageal tissues.
What is Stomach Acid?
Your stomach lining produces hydrochloric acid (HCL) which is a fluid used to break down foods for easier digestion. It also helps your body absorb nutrients more easily as food moves through your system. In order to break down foods, from meats to plants, your stomach acid must be highly acidic.
We measure liquids on a pH scale from 0 -14. The lower your pH level, the stronger the acidic levels. Battery acid has a pH of 0. Pure water is neutral at about 7. But stomach acid usually has a pH of 1 – 2, so still very acidic.
Now it is strong enough to burn your skin. On average, each day, you produce up to 17 cups of gastric juice, which includes stomach acid. HCL is important in helping both in digestion and immunity. It breaks down protein, helps you absorb essential nutrients, and helps control viruses and other bacteria that might infect your stomach.
How Does the Stomach Lining Avoid Being Burned?
It has a few tricks: a protective alkaline substance to help neutralize the acid, and the lining produces mucus for protection. In addition, your stomach only makes acid when needed, when food arrives.
So stomach acid is a good thing – God created it for our bodies. However, if you have too much or have too little, there are problems.
What Happens if You Have Too Little Stomach Acid?
Did you know that 2-12% of the population have low stomach acid? The medical term is Hypochlorhydria. So that is a deficiency of stomach acid. If you don’t have enough, you cannot digest food properly, especially protein, or absorb nutrients which leads to indigestion and malnutrition. Sometimes too little stomach acid can lead to being more at risk for infections which can damage digestive system.
If you have too much stomach acid, it’s called hyperchlorhydria. Your symptoms may feel similar to having too little. Most people think they have too much and use medications such as Protein Pump Inhibitors like Prilosec or an antacid like Tums. However, symptoms of acid reflux, GERD, heartburn can also be caused by too little stomach acid. Poor digestion from lack of stomach acid can create gas bubbles that rise up in your esophagus and throat which carries the stomach acid with them, resulting in that burning feeling.
If you have low stomach acid and cannot digest or absorb protein or B12 or minerals, you may experience anemia, which affects the nervous system and will make you tired, moody, weak, and you may experience some cognitive issues. Calcium and magnesium deficiencies can lead to osteoporosis or loss of bone.
Undigested food in your digestive system can ferment leading to gut bacteria overgrowing in the small intestine (Small SIBO). Also this may cause overgrowth of other bacteria such as H. pylori which can cause ulcers and chronic gastritis, inflammation of the stomach.
Often doctors prescribe Protein Pump Inhibitors, PPIs. In fact, almost 20% of adults regularly use acid-lowering medications like PPIs. However, almost 70% of people experience little to no benefit from them which makes the low stomach acid condition worse. Heartburn and GERD seem to increase with age, leading scientists and doctors to believe that lowering stomach acid will fix the problem. But if stomach acid levels decrease with age but the incidence of heartburn increases, then there has to be something other than stomach acid to blame for GERD and reflux, right?
What are causes and risk factors?
Gastritis – long-term stomach inflammation including an autoimmune gastritis in which the body destroys the stomach’s parietal cells that produce gastric acid.
Autoimmune diseases in general may cause low stomach acid. Any allergic reactions may cause the lining of the stomach and intestines to become inflamed which decreases release of stomach acid.
Other digestive conditions
Over age 65 – as we age, cells age and cells that produce stomach acid can die off
Infections like H Pylori infection or bacterial overgrowth like SIBO, Small Intestinal Bacterial Overgrowth
History of ulcers
Past stomach surgery like gastric bypass, affects stomach acid production
Chronic stress – significant over time, affects production of stomach acid
Pregnancy
Consuming too much food or alcohol
Hiatal hernia
Reclining after eating
Eating spicy or fried fatty foods
Acid reducing medications – PPIs, antacids, H2 blockers can cause low stomach acid. PPIs are really intended for short term use, now they are overprescribed and often used long term for GERD and heartburn. They can cause the acid secreting glands to eventually stop working. Plus, taking them too long can lead to osteoporosis, bone fractures, gut infections, Vitamin B12 deficiency, mouth ulcers, and sore tongue.
Symptoms of Low Stomach Acid
Abdominal pain
Bloating, gas
Diarrhea, constipation
Undigested food in poop
Reflux
Heartburn
If you have hypochlorhydria for a long time, but don’t know it. You could be eating a healthy diet but you’re not absorbing it due to low stomach acid. So then you may have symptoms caused by nutritional deficiencies such as:
Brittle fingernails
Hair loss
Fatigue, weakness
Paleness
Numbness, tingling in hands and feet
Memory loss
Headaches
How is Low or High Stomach Acid Diagnosed?
At home – As a screening tool, the baking soda test can be done. First thing in the morning (don’t eat, drink, or take medications yet) mix ¼ tsp of baking soda in 3-4 ounces of water. Stir and drink. Time yourself to see how long it takes to burp. If you burp in 2-3 minutes, you probably have adequate stomach acid. If you don’t burp for 5-6 minutes or longer, you probably have low stomach acid.
Conventional doctors may run these tests:
SmartPill test – You swallow a small capsule with a wireless transmitter and it measures gastric acid levels.
Heidelberg pH test – You swallow small capsule which measures pH levels in the stomach. Then you drink a baking soda solution to neutralize stomach acid. The test measures how long it takes your stomach to return to baseline acid levels.
Gastric string test – You swallow a capsule that has a string attached to it. Then the string is pulled out after 10 minutes. The string is tested with pH paper. A normal pH is one or two. Low stomach acid might be 3 – 5. Severe is above 5.
Blood tests
How is Low Stomach Acid Treated?
Find out the root cause –So what is the underlying reason. Once you identify the cause, treatment can be planned. It might be a side effect of another medication so your doctor can adjust it. Or maybe you have a bacterial infection so may need medication or herbals for that.
Your doctor may prescribe PPIs temporarily if it is too high. Remember these should not be taken long-term due to lasting chronic side effects.
If low, you may need supplemental hydrochloric acid, like an HCL supplement such as betaine hydrochloride which you take with meals. Some of the supplements may also be combined with the enzyme pepsin which helps digestion. Sometimes you may be able to take these temporarily and then you can discontinue them.
Nutritional deficiencies – if you have nutritional deficiencies, then vitamins, minerals, and supplements may help such as iron, calcium, magnesium, and B-12.
What are Steps You Can Do?
First, go see your medical practitioner. You may need some of the diagnostic tests indicated above.
Dietary practical modifications include:
Eat protein first – stimulates stomach acid production at the beginning of a meal
Limit fluids with meals – drink only small amounts during meals – just enough to take supplements and not choke. Otherwise, limit drinking to 30 minutes before or after eating.
Avoid overly fatty and processed foods – harder to digest and has few nutrients
Eat a variety of foods – protein, veggies, fruit, nuts and seeds, whole grains
If having pain, it might be easier to eat easily digestible foods such as stews, soups, smoothies, slow cooker meals that are softer rather than raw foods or crunchy and tougher foods.
Eat smaller meals
Take small bites and chew thoroughly
Finish last meal of day 3 hours before bedtime – allows digestion before lying down
Eating probiotic foods – but be cautious if have bacterial overgrowth
Digestive bitters – herbs that stimulate the stomach to make more stomach acid. These include: Caraway, dandelion, fennel, ginger, milk thistle, peppermint, and goldenseal. Also taking ACV or lemon juice at the beginning of a meal may help acidify the stomach contents. But be cautious with the ACV or lemon juice – you don’t want to take these if you have too high stomach acid.
Taking supplemental HCL as noted above.
I’d recommend you work with a practitioner who really understands stomach acid because you don’t want to use ACV, lemon, or supplemental HCL if you actually have hyperchlorhydria – too much acid. That will make symptoms worse. And you want a professional who understands your other conditions as well.
What’s the Prognosis?
Having too low stomach acid or too high shouldn’t continue long–term due to long-lasting symptoms and illnesses that can be caused by either. But often the condition can often be reversed using a temporary treatment of medication plus diet and lifestyle modifications with supplements. However, it all depends on your underlying cause. But the good news is there are some things you have control over and can do. I work with clients who have this conditions but we work as a team with your doctor. If you’d like to explore how we can work together, click here to schedule a free 20-minute consult.
I am a National Board Certified Health and Wellness Coach who helps women over 40 who have fatigue, digestive issues like bloating, constipation, heartburn, brain fog, weight issues, and thyroid and autoimmune problems. I work with you and as a team, we focus on nutrition and lifestyle factors to help you have more energy, decrease bloating, and fit into those favorite jeans again. You can do this! You just might need some help from someone who’s been there herself and worked with clients – helping guide, support, and encourage you each step of the way. Contact me here to set up a free strategy session to see how we can work together. — Leah Cheshire, NBC-HWC
