The importance of stomach acid is often overlooked, but is a critical piece to the puzzle when trying to support your body and maintain a healthy digestive system. So why is stomach acid looked at as a “bad thing?” Why are patients automatically put on medication to reduce stomach acid by their doctors? Why are antacids like Tums all over TV commercials?
Many of us struggle with symptoms relating to stomach acid, and look through the lens as stomach acid is a problem that needs to be eradicated by suppressing it. Like most symptoms pertaining to our health, the more we try to squash the noise with a bandaid, the louder the noise gets.
Once prescribed a PPI (proton-pump-inhibitor) the normal treatment time for using this medication is about 12 weeks, but most patients are never weaned off of this medication. Instead, they are usually going back to the doctor needing to increase the dosage with time. Suppressing stomach acid can have detrimental outcomes for our health. Those on long-term use of PPIs and antacids are susceptible to a weakened immune system, vitamin and mineral deficiencies leading to conditions like osteoporosis, and an even more impaired digestive system and microbiome that becomes very imbalanced. It is fully out of my scope to tell you to stop taking your PPI and antacids. But, while working with the prescribing doctor, I have helped clients completely get off of these medications by supporting and nourishing their stress management and digestive system which better helps the timing of acid production while reducing symptoms.
What is stomach acid?
The parietal cells that live along the stomach lining secrete stomach acid, or hydrochloric acid (also known as HCl) in order to create an acidic environment in the stomach, where the pH is around less than 2. This is just acidic as a battery! If HCl got onto your skin it would burn through. Your stomach has very thick muscle tissue that protects the acid from eating away at the stomach itself!
HCl acts as the lead domino, creating an effect that contributes to the process of adequate and healthy digestion from north to south.
Roles of HCl:
Responsible for the chemical breakdown of our food
Required to help convert pepsinogen into pepsin which helps break down protein into amino acids
Activates intrinsic factor which is needed to absorb vitamin b12
Lowers the pH of the stomach to sterilize food and kill pathogens like bacteria, viruses and parasites.
Triggers the pyloric sphincter to open so food does not stay in the stomach too long. (Hence lack of acidity can slow down motility, keeping food in the stomach for too long potentially leading to bacterial overgrowth). This delay in gastric emptying can contribute to the feeling of reflux or GERD (gastroesophageal reflux disease) because the acidic food is staying in the wrong place for too long, causing acid to touch tissues of the esophagus and throat.
Triggers the release of the next set of digestive juices in the small intestine like sodium bicarbonate, pancreatic enzymes and cholecystokinin hormone which tells the gallbladder to release bile to stimulate digestion and break down fats.
Keeps the microbiome balanced, so microbes don’t feed off of mal-digested proteins.
Keeps intestinal lining in tact, reducing permeability or “leaky gut”
When supporting our digestion we always want to prioritize order of operations from the north-to-south process. Oftentimes, when someone is experiencing GI-related symptoms further along in the digestive process, (like indigestion, bloating, gas, constipation or diarrhea), they are likely also experiencing deficiency in stomach acid. By looking at a client’s presenting symptoms, their Nutritional Assessment Questionnaire, an HTMA test and a GI-Map markers, I can piece together the status of your stomach acid and how this is impacting your health. We don’t always feel GI-related symptoms but can still present with low stomach acid, also known as "Hypochlorhdria". I’ve also had clients come to me struggling with acid reflux or GERD, thinking it’s because they are making too much stomach acid. In conventional medicine, when this occurs, the patient is put on a proton-pump-inhibitor (PPI) or anti-acids to reduce stomach acid. Not only is this ineffective long-term, but suppressing stomach acid creates a host of additional health consequences downstream. There are very few and far between cases where a client actually needs to reduce their stomach acid. These symptoms of indigestion or heartburn are commonly due to poor digestion from LOW stomach acid levels. When there is not enough HCl present to digest food, gas bubbles are created that rise into your esophagus and throat, carrying stomach acid with them. The body almost tries to then overproduce stomach acid to overcompensate for the lower levels. This is where the burning sensation comes to play.
What contributes to low stomach acid?
In practice, about 95% of my clients come to me with symptoms of Hypochlorhydria, whether they realize it or not! There are many factors contributing to lower stomach acid which is why it can be very common.
Factors that reduce stomach acid include:
High levels of stress: when we are chronically stressed, our brain tells the digestive system to down-regulate. This can cause your stomach to release less acid.
Eating a plant-based diet, not eating enough animal protein: Digesting animal protein increases the hormone gastrin which triggers the production and secretion of HCl. Those who eat a vegan diet are typically lower in stomach acid since their bodies are not being told to produce as much to support digestion.
Nutrient deficiencies: Minerals are the precursors to stomach acid production. Typically those who are also low in minerals, like zinc, may produce less HCl. Being low in B vitamins can also contribute to low HCl levels. This becomes a vicious cycle because we need higher levels of B vitamins and Zinc to help produce HCl, and without HCl we can’t absorb these nutrients from food.
A poor diet high in processed foods: Processed foods and sugars can cause inflammation in the stomach which decreases stomach acid production.
Food sensitivities
Gut infections like bacterial H. Pylori or parasitic overgrowth
Overconsumption of alcohol
Aging: We naturally produce less stomach acid as we age.
Symptoms associated with Hypochlorhydria:
Feeling unusually full after meals, like the food is just sitting in your stomach
Burping after meals
Producing more gas
Diarrhea in the morning or after meals
Heartburn or GERD
Constipation
Bloating
Abdominal discomfort
Struggle digesting protein
Nausea
Peeling nails
Food sensitivities
How to support HCl production:
Again, digestion is a north-to-south process, so intervening whenever we can along the way will help give your stomach the right signal to produce enough acid. Below are some tips to consider, while also working with a practitioner who is able to guide you through the process.
Manage Stress: Practice eating in a relaxed state, so your body’s digestion is fired up and you are allowing the process of producing HCl to occur. You can try 4-7-8 breathing before meals to help direct your attention towards being relaxed.
Add some bitters to your meal or start your meal off with some bitter veggies like an arugula salad. Bitter stimulates the production of HCl.
Add apple cider vinegar and some lemon juice to water and drink this 15 minutes before the meal to help create an acidic environment in your stomach.
Reduce drinking water with meals as this can dilute the concentration of acidity in your stomach.
Make sure you are eating enough protein with your meals. If you usually under-eat protein or are coming from a plant-based diet, the key is to add in more protein at a slow rate. Starting with ground meats can be easier to digest too.
Try the HCl challenge to figure out your dosage of a high-quality hydrochloric acid supplement, like Hydrozyme by Biotics, with a practitioner who is knowledgeable about HCl dosing and titrating. Never try taking supplements without the guidance of a practitioner.
References
Guilliams TG, Drake LE. Meal-Time Supplementation with Betaine HCl for Functional Hypochlorhydria: What is the Evidence?
Guilliams TG, Drake LE. Meal-Time Supplementation with Betaine HCl for Functional Hypochlorhydria: What is the Evidence? Integr Med (Encinitas). 2020 Feb;19(1):32-36. PMID: 32549862; PMCID: PMC7238915.
Nutritional Therapy Association. Digestion Module. Date retrieved April 5, 2024.
Restorative Wellness Solutions. Anatomy & Physiology Module. Date retrieved April 5, 2024.
Tariq R, Singh S, Gupta A, Pardi DS, Khanna S. Association of Gastric Acid Suppression With Recurrent Clostridium difficile Infection: A Systematic Review and Meta-analysis. JAMA Intern Med. 2017;177(6):784–791. doi:10.1001/jamainternmed.2017.0212
Thiel A. Integrative Therapeutics. The Role of Hydrochloric Acid (HCl) In Aiding Digestion. Date retrieved 5/20/2023. https://integrativepro.com/blogs/articles/the-role-of-hydrochloric-acid-hcl-in-aiding-digestion
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