BY DR. ERIN STEFANACCI
Low stomach acid, scientifically known as hypochlorhydria, is extremely prevalent in developed nations. Some practitioners believe that the number of individuals in America with low stomach acid is around 90%!
During my time working in the pharmaceutical industry, antacids or acid-suppressing drugs such as Nexium, Prilosec, Protonix, Aciphex, and Prevacid were so commonly prescribed we kept them in a special section called the “fast rack”. This was a section of space reserved for exactly what you may think, fast moving medications. Unfortunately, not much has changed since I left the industry four years ago; stomach acid-reducing medications are still some of the most commonly used drugs today. So common in fact, over-the-counter acid-reducing medications have sales similar to toothpaste and deodorant. Yikes!
Clearly the pharmaceutical industry has done their job with marketing the “importance” of maintaining little to no stomach acid. Spending millions in DTC (direct-to-consumer) advertising, the pharmaceutical companies have guided our beliefs towards trusting that the symptoms of heartburn, indigestion, and gastrointestinal acid reflux disease (GERD) are caused by too much stomach acid. In the reality that is not controlled by the pharmaceutical giants, it is far more likely that these symptoms are being caused by low stomach acid, rather than an overproduction of stomach acid.
The Importance of Stomach Acid
Our bodies are incredibly intelligent. All processes within the body are happening for a reason, including the production of stomach acid. Production of stomach acid is through secretion of hydrochloric acid from parietal cells, which work hard to maintain our stomach acid pH to be around 1.5 to 3.0. That is almost the same acidity as battery acid! In fact, if you were to put a drop of stomach acid on wood, it would eat right though it. Fortunately, we have epithelial cells that secrete a bicarbonate solution, protecting the lining of our stomach from the acidic environment.
Stomach acid is good for a variety of things including:
Digestion of proteins
Killing off destructive microorganisms that enter the body through food
Aiding in absorption of Vitamin B12 and certain minerals such as Copper, Iron, Magnesium, Zinc, just to name a few.
Signaling when food is ready to move on from the stomach for further absorption in the small intestine
So what is supposed to happen when we take a bite of food?
Once we chew and swallow our food, it travels down our esophagus into the stomach. The food is then churned along with stomach secretions to make chyme. Once the proper acidity is reached a valve at the end of the stomach (the pyloric sphincter) is opened so food (and bicarbonate solution – to prevent damage) can pass into the small intestine for further digestion.
The Risks of Low Stomach Acid
When we interrupt our production of stomach acid by taking antacids, numerous symptoms and disease processes can occur.
Symptoms and disease-processes associated with low stomach acid (hypochlorhydria) include:
Bloating and gas following meals
Irritable bowel syndrome
Undigested food in stools
Dysbiosis or SIBO
Leaky Gut Syndrome
Autoimmune Diseases such as Hashimoto’s
Our bodies prefer to keep chyme in the stomach until proper acidity is reached. When stomach acidity is low, chyme sits in the stomach for a longer period of time causing improper breakdown of food, disrupting proper absorption of vitamins and minerals. It also creates a breeding ground for bacteria (think H. Pylori) because the protein and carbohydrates start to putrefy and ferment. Eventually, excessive pressure happens from overgrowth of bacteria and undigested food.
When excessive pressure from low acidity builds up in the stomach there is only one way out… through the LES. Located at the top of the stomach is a sphincter called the lower esophageal sphincter (LES), when pressure in the stomach builds the LES opens up to let the pressure out. Due to the fact that your esophagus is not designed to handle any bit of stomach acid, opening of the LES commonly leads to heartburn and acid reflux.
**Note: There are also other causes that contribute to a malfunctioning LES. Select foods (e.g. hot peppers, citrus, tomatoes), beverages (caffeine and alcohol), overeating, obesity, pregnancy, hiatal hernia, and 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 plays a role in digestive problems in the small intestine (SI). After sitting in the stomach for an extended period of time, chyme is forced to move to the SI through the pyloric sphincter. Unfortunately, due to pH interruption, bicarbonate solution is not released when the chyme moves into the SI creating a risk for duodenal ulcers. Not only that! The improper pH of chyme does not stimulate pancreatic enzymes resulting in large, undigested food particles to pass through the small and large intestines, undigested. Over time these undigested food particles can cause tears in the lining of the small intestines, allowing the food particles to enter the blood stream where our bodies recognize them as foreign invaders. Known as “leaky gut”, this triggers an immune response leading to inflammation, chronic fatigue, and auto immune conditions. When an undigested food particle makes it to the large intestine, it disrupts the balance of gut flora and can lead to constipation, diarrhea, or irritable bowl syndrome. Disruption of normal gut flora has also been linked with depression and anxiety.
Check yourself for Low Stomach Acid
There are a couple ways to check yourself for low stomach acid:
The Beet Test
Eat 1 beet or drink some beet juice, if your urine turns pink or red it is likely that you have low stomach acid or disruption in gut flora. There is a pigment in beets called betalain and if not properly metabolized it will be excreted in urine. If you can not digest beets properly, it is likely that it is happening with other foods as well.
The Apple Cider Vinegar Test
About 20-30 minutes prior to eating a meal dilute 1/2 tablespoon of apple cider vinegar in 6 ounces of water and drink down. If, after eating, this improves symptoms of low stomach acid such as heartburn, bloating, acid reflux, etc., it is likely that you have low stomach acid.
In the next part of this post I will discuss how to holistically address low stomach acid. Stay tuned!
In health and happiness,
Dr. Erin Stefanacci, DC