Do you burp after meals? How about get so bloated, you want to unbutton your pants? Does food feel like it just sits in your stomach?
These are all tell-tale signs you might be suffering from a really common but not-well-known condition: low stomach acid, also called hypochlorhydria.
Stomach acid has a bad rap – most people are familiar with antacid medication for heartburn or indigestion, and (understandably) assume that stomach acid is bad for you and must be decreased.
But surprise – the complete opposite is actually true. In fact, adequate stomach acid is a crucial part of the healthy digestive process. And, in my clinical experience, far more people have low stomach acid than high!
Today, let’s talk about why stomach acid is so key, what it feels like when yours is low, and how we can treat this common issue easily and naturally.
The Truth About Stomach Acid
Stomach acid – scientific name hydrochloric acid (HCL) – is one of the key steps in the digestive process.
During the gastric phase of digestion, food you chew and swallow travels down the esophagus and into the stomach. There, distention (literally the stretching of the stomach by the addition of food), triggers the production of acetylcholine (ACh), which then triggers parietal cells in the stomach to release stomach acid.
But even before you start eating, just the sight, smell, and thought of food can also jumpstart the secretion of stomach acid via activation of the vagus nerve. This is called the cephalic phase of digestion.
The stomach is specially designed to handle the incoming acid – the stomach is lined with lipoprotein rich membranes that protect it from being burned by the acid. (Other parts of your body don’t have this same protection – which is why when stomach acid gets into the esophagus, it causes a burning sensation.)
Once secreted by the parietal cells, stomach acid performs several key functions:
- It kills any pathogens that may have come in with food (i.e. the kind of bacteria that cause food poisoning) or hitched a ride on the saliva from the mouth, where tons of bacteria live.
- It activates pepsin to start protein digestion
- It stimulates bile production and release by the liver and gallbladder, so fats can be emulsified and digested
- And finally, it triggers the release of pancreatic enzymes in the small intestine, where the partially digested food from the stomach (called chyme), is broken down and absorbed into the bloodstream
What Happens When Stomach Acid Is Low
When stomach acid is low for any reason, it can impact all aspects of digestion.
Low stomach acid can slow and stall out the digestive process – leading to discomforts like burping, bloating, stomach pain, and even (surprisingly) cause heartburn and acid reflux symptoms.
And while these are the symptoms most people notice (and complain about) first, they are actually just the tip of the iceberg.
More troublingly, low stomach acid can have a huge impact on your body’s ability to absorb nutrients from the food you eat. Stomach acid is essential for breaking down protein into digestible amino acids, and for the absorption of certain key nutrients like iron and vitamin B12. Without these key nutrients, the body is unable to repair tissues, produce hormones, and create neurotransmitters – all things necessary to feeling happy and vital!
Finally, low stomach acid also is a common factor in the development of food sensitivities, because it is stomach acid that triggers the release of digestive enzymes in the small intestine. Lack of enzymes is often to blame for food reactions – the one most people are familiar with is lactose intolerance, where a lack of lactase enzymes cause digestive issues like gas, diarrhea, and pain.
If you’re eating a high-quality, nutrient-dense diet but still struggling with symptoms of nutrient deficiency like brittle hair and nails, poor skin quality, cravings, and fatigue – or you have ever-increasing food sensitivity – low stomach acid could be the reason why.
What Causes Low Stomach Acid?
Stomach acid gradually decreases with age, and levels can start to drop as soon as age 40.
In most people, environmental factors are the main cause of low stomach acid. These include:
- Stress – the big one that no one likes to talk about! Stress impacts all phases of digestion, and especially the production of stomach acid and other digestive fluids
- Low protein diet – this is often a “chicken and the egg” situation, since eating less protein is often a result of those with low stomach recognizing protein-rich foods don’t make them feel well, and consciously or subconsciously cutting back. On the other hand, eating low protein can cause the body to naturally downregulate acid production (since less is needed to digest protein).
- Low zinc status – zinc is an essential cofactor for stomach acid production, and the modern diet is fairly low in zinc-rich foods like oysters.
- Eating on the go – like stress, eating in a hurry or while distracted can prevent the body from shifting into the “rest and digest” parasympathetic state needed to complete all the phases of digestion adequately.
- And finally – using over-the-counter or prescription acid-reducing medications.
Are You Using Antacids?
Antacids include over-the-counter and prescription PPIs (proton-pump inhibitors) like Prilosec or Nexium, H2 blockers like Pepcid or Zantac, and antacids like Rolaids or Tums. They work by either blocking the production of stomach acid, or neutralizing acid in the stomach.
These are some of the most commonly used drugs in the world. And, when used the right way, they can be extremely beneficial. But, many people take these drugs daily for years without any idea of the potential side effects.
Research has shown that PPI use can lead to the development of Small Intestine Bacterial Overgrowth (SIBO), which causes bloating, diarrhea, constipation, food intolerances, and stomach pain. In one study, more than half of people on a PPI for 12 weeks developed SIBO. In addition, research has shown PPI use is a risk factor for candida overgrowth, as well. The connection between PPIs and both candida and SIBO is likely due to the reduced ability of the body to kill pathogens that come in on the food you eat or with your saliva.
The irony with antacids is that most people take them to address the symptoms of low stomach acid – bloating, gas, indigestion – without realizing that they are actually just compounding the problem by further reducing acid levels.
How Do I Know If I Have Low Stomach Acid?
Testing for stomach acid levels is possible with a test called the Heidelberg acid test. However, this test is extremely difficult to come by, and most doctors and practitioners don’t have access to it.
Instead, I use an advanced stool panel to look for several key specific bacterial indicators of low stomach acid. Specifically, I look for these bacteria:
- Pseudomonas – this bacteria grows on poorly digested proteins that may be present due to low stomach acid. It also commonly occurs with food sensitivities, as undigested proteins are a main driver for triggering an immune response to foods. If you have high pseudomonas, and especially with food sensitivities, think about raising your stomach acid levels!
- Streptococcus and enterococcus – these gram-positive, aerobic species naturally occur in the oral microbiome, gut microbiome (found in the large intestine), and upper respiratory tract. However, they can overgrow or become infectious. Streptococcus commonly causes strep throat and upper respiratory infection, and if stomach acid is low, can infect the stomach. Enterococcus strains are common in dental infections (and found in up to 90% of infected root canals), and if stomach acid is low, can also infect the stomach.
- C. difficile – I always work on raising stomach acid levels in those with chronic or recurrent infection with this organism. C. difficile infection can be life-threatening in some cases, causing bloody or profuse diarrhea requiring hospitalization, and is commonly seen in medical settings after the use of broad-spectrum antibiotics. But it also often shows up on stool panels with minor or moderate symptoms, not requiring hospitalization. In addition to raising stomach acid levels I use herbs and probiotics to treat this.
- H. Pylori – this common infection thrives in a low-acid environment and even deconjugates stomach acid in order to make its host more hospitable. Ironically, PPIs are often used as part of the treatment for the ulcers and gastritis H. pylori can cause, continuing the cycle. Importantly, however, H. pylori is not always a problem. If levels are high or symptoms like ulcers, gastritis, rosacea, upper GI gas and bloating are also present, it may need treatment. For low or normal amounts of H. pylori, raising stomach acid levels is often all that is needed!
- Klebsiella– this bacteria is common in the oral microbiome, but high levels are associated with inflammatory bowel disease like ulcerative colitis and Crohn’s disease. Because klebsiella is common in the mouth, elevated levels are often a sign stomach acid isn’t doing it’s job of killing bacteria in the stomach.
(Interested in a stool test like this? Book a free 15-minute consult here to learn more about stool testing and get started!)
How to Support Healthy Stomach Acid Levels Naturally
Creating a customized plan to support your digestion is what I do best. Every person is unique, and needs a unique protocol for best results. But, in general, these are some of the strategies I turn to again and again:
- Supplemental HCL – supplemental betaine HCL paired with pepsin (a digestive enzyme that specifically helps with protein digestion into amino acids) can be extremely helpful. One 6-week study in 97 people with indigestion found that taking betaine HCL and pepsin significantly reduced symptoms like stomach pain and burning.
One word of caution: supplemental betaine HCL may not be right for those with ulcers or gastritis. If you have these conditions, try one of the other suggestions or book a free consult for one-on-one support.
- Adequate B vitamins – B vitamins have thousands of benefits, one of which may be better stomach acid levels. One study found that increased B vitamin intake lowered risk of acid esophagitis. In addition, low stomach acid levels can hinder B vitamin absorption, increasing your need.
- Apple Cider Vinegar – this is a long-time fix for low stomach acid. Try taking a shot of ACV or dilute it with water to drink with meals. Be sure to rinse your mouth with plain water after drinking ACV.
- Ginger – helps to stimulate the digestive system. Try ginger tea or ginger chews.
- Bitters – bitter flavors stimulate the vagus nerve and tell the body food is coming, promoting the release of HCL and other digestive secretions like enzymes and bile. Try taking a bitter tincture directly on the tongue before eating.
Put Low Stomach Acid in Perspective
If you suspect low stomach acid, taking these simple steps to raise it can help you feel a lot better.
But in my clinical experience, low stomach acid is very rarely the only problem!
It either comes on as a result of other issues – like poor nutrient status and stress – that need to be dealt with, or causes other issues, like SIBO or candida overgrowth that require separate treatment.
If you’re dealing with digestive issues of any sort, I would be honored to support you in healing. Having struggled with health issues myself, I know exactly how debilitating they can be, and what vibrant health feels like (it’s AMAZING!) – and I want that for you, too.
We have a variety of plans and approaches to fit your health needs, schedule, and budget – but Step 1 is always a free, no-obligation chat with my team to learn about you and your concerns.