If you have ever watched television during the weeknight evening hours or had your regular radio programming interrupted by some messages from the sponsors, it is likely that you have been inundated with a slew of advertisements for antacids and acid-suppressing drugs, including the “purple pill” (Nexium), Prilosec, Prevacid, Pepcid AC, Zantac, and numerous other medications that lower stomach acid. Understandably, you may be under the impression that the symptoms of heartburn, indigestion, and gastrointestinal acid reflux disease (GERD) are caused by too much stomach acid. As acid-suppressing drugs are among the most commonly used prescription and over-the-counter medications, the pharmaceutical companies are banking on acceptance of the idea that stomach acid is something that needs to be kept in check. However, in the reality that is not controlled by the powerful pharmaceutical industry and the conventional medical system (both of which have an interest in keeping you ill and dependent on medications), stomach acid is not something to be feared! It is much more likely that your symptoms are being caused by low stomach acid, instead of an overproduction of stomach acid.
Why stomach acid is important
In the infinite wisdom of the human body, the stomach was designed to produce the acid that is necessary for proper digestion of food. When functioning properly, the parietal cells of the stomach secrete hydrochloric acid that bring the stomach pH to a range of approximately 1.5 to 3.0. This is strong enough of an acid that if it were to be dropped on a piece of wood, it would burn a hole through the wood. The inner lining of the stomach is protected from its own acid by a thick layer of mucous and epithelial cells that produce a bicarbonate solution (an alkaloid) to neutralize the acid.
Stomach acid has several important roles including:
- Breakdown of proteins into a form that they can be digested (called proteolysis).
Activation of the enzyme pepsin, which is responsible for protein digestion.
Inhibiting the growth of microorganisms that enter the body through food to prevent infection.
- Proper absorption of many minerals, such as calcium, magnesium, zinc, and manganese.
Signaling when the food (referred to as chyme) is ready to leave the stomach and move into the small intestine for continued digestion.
When the digestive system is functioning normally, food travels down the esophagus to the stomach. The stomach works to ensure adequate mechanical digestion (by churning of the stomach) and production of stomach acid until the chyme is brought to the proper pH level. At that point, the valve at the lower end of the stomach, the pyloric sphincter, is triggered to open and release the chyme into the small intestine. The pH level of the chyme entering the small intestine triggers the release of pancreatic enzymes (to continue with the digestive process) and sodium bicarbonate (to neutralize the chyme to prevent burning of the small intestine).
What happens when stomach acid is too low
When stomach acid production is low, dysfunction throughout the digestive system can occur, leading to numerous symptoms and disease processes. The body’s preference is to keep the chyme in the stomach until it reaches the proper pH level. Therefore, when stomach acid production is low, the chyme sits in the stomach for a longer period of time without the nutrients being broken down properly. At the same time, the low stomach acid promotes an environment that is more friendly to the growth of microorganisms, which are fed by the carbohydrates that become fermented from sitting in the stomach for too long. Eventually, excessive pressure from the bacterial overgrowth and maldigested food results.
The stomach has two valves, the lower esophageal sphincter (LES) (at the top of the stomach) and the pyloric sphincter (at the bottom of the stomach). While the pyloric sphincter is a one way valve, the LES is designed to open both ways. When excessive pressure builds up in the stomach, but the pH is still not at an optimal range to allow opening of the pyloric sphincter, the body identifies only one option to release the pressure: Open up the LES. Opening of the LES allows release of the pressure into the esophagus and that is what commonly leads to the symptoms of heartburn and acid reflux. Even if your stomach isn’t producing enough acid, any amount of acid going into the esophagus will result in uncomfortable symptoms because the esophagus is not designed to handle stomach acid. Frequent opening of the LES toward the esophagus will contribute to a weakened valve that compounds the problem.
**Note: There are also other causes that contribute to a malfunctioning LES. Certain foods (e.g. hot peppers, citrus, tomatoes), drinks (caffeine, alcohol), overeating, overweight and obesity, pregnancy, hiatal hernia, and many medications (including NSAIDs, antibiotics, bronchodilators, beta-blockers, calcium channel blockers, nitrates, antidepressants, anti-anxiety, and anticholinergics) are associated with a weakened LES.
Low stomach acid also contributes to digestive problems downstream from the stomach in the small intestine. If the stomach is not able to produce enough acid to bring the pH level of the chyme to an optimal range, after a while, the stomach will be forced to move it through the pyloric sphincter into the small intestine. Because it is not at the proper pH, the chyme does not trigger the release of sodium bicarbonate, which can result in duodenal ulcers. The higher pH of the chyme also does not trigger the release of pancreatic enzymes. The small intestine is not able to break down the chyme properly and the large, undigested particles of food can begin to have a negative impact on the lining of the small intestine. The lining becomes more permeable and allows the undigested food particles to enter the bloodstream where your body’s immune system recognizes them as foreign invaders. This triggers a systemic immune response that can lead to food sensitivities, inflammation, and autoimmune disease. This phenomenon is known as leaky gut syndrome.
Some undigested food particles may continue into the large intestine. This malabsorbed food can lead to a disruption of the normal gut flora (see this post for the importance of gut flora to health and the immune system). The large intestine may become inflamed and subject to a variety of conditions, such as constipation, diarrhea, or irritable bowel syndrome. The disruption of the normal gut flora also impacts your overall immune system and can lead to autoimmune conditions.
Prevalence and symptoms of low stomach acid
Low stomach acid is a common problem in developed nations. According to Jonathon Wright, MD (author of “Why Stomach Acid is Good for You“), approximately 90% of Americans produce too little stomach acid. He arrived at this conclusion after measuring the stomach pH of thousands of patients in his clinic. (While conventional medical doctors sometimes measure esophageal pH levels in particularly difficult cases of acid reflux, they never measure stomach pH levels. As mentioned above, any amount of acid in the esophagus is abnormal and will cause symptoms.)
Because low stomach acid has such a profound impact on overall health, symptoms may affect a variety of body systems and result in conditions that include:
- Indigestion and bloating
- Burping or gas after meals
- Excessive fullness or discomfort after meals
- Constipation and/or diarrhea
- Chronic intestinal infections
- Undigested food in stools
- Food allergies, intolerances, and sensitivities
- Chronic fatigue
- Mineral and nutrient deficiencies (including iron and/or vitamin B12 deficiency)
- Dry skin or hair
- Weak or cracked nails
- Any autoimmune disease diagnosis
Hopefully, by now, it should be clear that covering up symptoms of heartburn, indigestion, and acid reflux by lowering stomach acid production even more through the use of acid-suppressing drugs, is not an effective, safe, or smart way to address the root cause of low stomach acid.
In part II of this series, I will discuss how to address low stomach acid holistically through the healing power of real foods and natural supplements. Stay tuned!
Wright, J. & Lenard, L. (2001). Why Stomach Acid is Good for You: Natural Relief from Heartburn, Indigestion, Reflux, and GERD. Lanham, Maryland: The Rowman & Littlefield Publishing Group.
I’ve been suffering from debilitating stomach pain just below my sternum ,usually a few hours after eating. I’ve cut so many foods out my diet, I hardly know what to eat anymore! I’ve been to 3 Dr.’s, had many tests including an endoscopy and ultrasound and they haven’t come up with a diagnosis other than mild gastritis. Now I’m on Dexilant and Dicyclomine and they only help sometimes. Still getting pain 2-3 times a week. Talked about low stomach acid with my Chiropractor.. I wonder if that could be the cause. Is low stomach acid something that can be seen in an endoscopy, or do you need to be tested specifically for it? Definitely interested in Part II!
Hi Carrie! Low stomach acid is not something that can be seen on an endoscopy, ultrasound, or any other GI imaging tool. It is also not something that most conventional medical doctors will recognize or consider as a diagnosis (although it is well documented in the medical literature that low stomach acid is a problem and can lead to all of these issues). Stomach pH can be measured, but it is simply not a test that is done in conventional medicine. Conventional health care professionals just aren’t trained to view it from this functional medicine perspective.
In my follow-up post, I will talk about the easiest way to determine if you have low stomach acid, which can be done through trying some natural treatments and seeing if they help with symptoms. In your case, guidance by a health professional that is well versed in treating low stomach acid and other digestive issues would be recommended. There are some whole food options that most people are safe to try on their own, but in your particular case, you have to approach it carefully because of the gastritis. You don’t want to risk making your symptoms worse. You mentioned that you’ve cut a lot of foods out of your diet, but you may not have yet found the culprit(s) to your symptoms. Dietary changes and protocols that set a foundation for healing the gut likely would be necessary in your case, prior to starting any supplementation for low stomach acid. Hope that helps! I hope that you find some relief and answers soon.
Try visceral massage from a properly licensed RMT (registered massage therapist). It worked for me but my symptoms were not as severe. Also my RMT had thousands of hours of training with a focus on visceral massage. Basically I think she told me my diaphragm wasn’t sitting right, she got those muscles surrounding my stomach to release and it seemed to help my digestion on the whole. Good luck! I am not a medical practitioner but something worth researching! Be sure to research your RMT as well.
My functional doc suggested taking a tblspn of vinegar diluted a bit with water prior to eating meal. Digest with a straw, he said, because vinegar can remove tooth enamel. He said notice if it helps digestion then you have low stomach acid. If its worse you have too much stomach acid. Hmmm. Makes sense.
Hello! Drinking water with vinegar in it (the straw is a great idea) is a natural way to stimulate stomach acid production. Has it helped you?
Hey Katy…. I have been given Ganaton total by my Doctor and I guess it’s for acid reflux. But my symptoms seem more like due to low stomach acid. Should I continue ganaton total.. What do you recommend?
Hi Jowin- I’m not familiar with Ganaton and I can’t advise you to go against your doctor’s orders. But I would recommend that you continue to do your own research into this. Acid reflux is often linked to low stomach acid and taking steps to improve the stomach acid can be helpful for many people. Best of luck to you!
Hey Katy, I am using honey with cold water before eating. This helped a lot in imcreasing my stomach acid.
I’ve not heard of this method, but I’m glad that it’s working for you!
Yeah it works I read about it from this article http://pcela.rs/honey_stom_ac.htm
Let me know if you feel this method is valid 🙂
Where can I access part two of this Blog? What are your recommendations for increasing stomach acid? Or do you advise digestive enzymes?
Hi Lynn! You can access part 2 here: http://katyhaldiman.com/natural-solutions-to-increase-stomach-acid-and-improve-digestion/. Digestive enzymes can helpful in many cases, but there are other factors that usually need to be addressed as well.
Very informative article. Thank you for the excellent knowledge. I am glad that I came across this article. I am facing many issues related to the low stomach acid. Reading your article has helped me connect the dots. Now I will try to heal it. Thank you again.
From one Health Care Professional to another,this is by far one of the best blogs / articles I’ve read. I’ll be sure to refer some of my Physical Therapy clients here for meaningful information.
Hi Dr. Dre! Thank you for your kind words. Thanks for stopping by!
Hi Katy… apart from normal acid reflux symptoms (most of them match with the list above) i am noticing that my month lips become very dry after eating also i start getting dandruff immediately after eating can you please shed some light on my symptoms
I’m so confused, I’m sorry but I don’t understand why regular doctors can’t recognize or consider as a diagnosis? I’m paying $300 just to speak to one that it says he does. Can you explain that to me please, I just wish I have that kind of money. Thank you for all the information.
Hi Sandra! Unfortunately, conventional medicine does not recognize the role of low stomach acid in contributing to acid reflux or being a problem. It’s just not the way that medical education is structured these days. You may want to consider working with a nutritional therapist or functional health practitioner that charges more reasonable rates–they are out there. I wish you the best of luck!