The High’s and Low’s of Stomach Acid

High Stomach Acid/ Reflux/ Indigestion/ discomfort or burning pain in your sternum – we’ve all experienced that nasty symptom at some point but are you sure it was due to high stomach acid? Did you know that low stomach acid can cause similar symptoms?  

by Amy Angus, ND

Patients are often really surprised when I tell them that although they may need antacids to control uncomfortable digestive symptoms I need to establish if their symptoms are due to high or low stomach acid.  More alarming is that low stomach acid/ Hypochlorhydria, is one of the most common – and most often overlooked and misdiagnosed – digestive issues.

Unfortunately doctors don’t check to see if you are suffering from high or low stomach acid and if you suffer from repeated reflux symptoms you will most likely be prescribed a proton pump inhibitor (PPI) such as esomeprazole (Nexium/ Guardium) Omeprozole (Losec), Pantaprozole (Somac), Lanzaprosole (Prevacid) or you may reach for an antacid over the counter.

A little acknowledged fact is that stomach acid is vital for good gut health and the use of ant-acids long term has some significant negative side effects.  There are important digestive functions that rely on sufficient stomach acid, so the use of long-term PPI’s does come with consequences. 

When food enters the stomach, the stomach distends and releases hydrochloric acid (HCl). HCl is extremely important for digesting food, particularly proteins and meats. Sufficient stomach acidity is also necessary to trigger the valve to the small intestine to open and to activate the release of additional digestive secretions.

Stomach HCL is needed for : 

• Stimulating the pancreas to secrete digestive enzymes (so that we can break down our food and absorb the nutrients)
• Calcium, zinc, copper, iron, magnesium, folic acid and selenium and B12 absorption 
• Stimulating the gallbladder to secrete bile to emulsify fats. (Bile is needed for motility of the bowels as well as the absorption of certain nutrients: A, D, E and K which are all fat soluble).
• It breaks down food proteins into amino acids: if this process is not efficient undigested food proteins can be misinterpreted as dangerous invaders by the gut’s immune system, which can lead to systemic inflammation and leaky gut.
• We are consuming bacteria/ viruses and fungi without realising it: the acidity of the stomach kills these before they can cause us harm.
• Sterilize the small intestine to prevent bacterial overgrowth.
• Prevent parasites and other gut pathogens from gaining traction in your digestive tract.
• Keeping commensal bacterial species at the correct level (species that are usually found in the gut in low numbers).

There are specialised valves in our stomach that require the right acidity level to open or close.  If there is not sufficient stomach acidity it can delay our food to pass into the small intestine.  This leaves the food to sit and putrefy in the stomach. Eventually seeking escape, it moves up into the oesophagus where the tissues are not designed to acidity and result in the uncomfortable reflux feeling.  This causes many cases of heartburn or “acid reflux” misdiagnosis of high stomach acid.

Do you have one or more of these low stomach acid symptoms?

• Burping, bloating, and gas within 30 to 60 minutes after meals, especially protein
• Indigestion, heartburn, acid reflux
• Feel like you have a brick in your stomach after eating meat
• Nausea when taking vitamins and supplements
• Desire to eat when not hungry
• Undigested food in stool
• Diarrhea
• Fatigue
• Gut infections
• Bad breath (this is due to bacterial overgrowth in the intestines)
• Iron deficiency anaemia
• Deficiency of vitamin B12, calcium, magnesium

Causes of low stomach acid

There are a few factors but the most common are: 

• poor diet
•  chronic stress
• chronic inflammation
• medications such as antacids or proton pump inhibitors
• deficiencies in nutrients necessary to make stomach acid
• gastric surgery
• Un-managed hypothyroidism. The stomach depends on sufficient thyroid hormone to produce HCl. In addition, the brain depends on thyroid hormone to communicate efficiently with the digestive organs.
• Aging. As we age, we start to lose enzyme production and autonomic nervous function. Therefore, it’s not uncommon once past the age of 70 to need supplemental HCl because cells have started to degenerate and are not as efficient in producing HCL.
• H. pylori – .  An H. pylori bacterial infection suppresses stomach parietal cells and inhibits absorption of iron, vitamin B12, and calcium. With an H. pylori infection you may not have enough HCl to sterilize the gut, which can lead to SIBO.  It is important to note that H. pylori can be asymptomatic and is highly contagious. It is recommended for all members of a family living together to be tested if one person is infected as it can lead to certain gastric cancers long term. If you have done a complete microbiome test with us: this has been checked. 

So what can be done for reflux?  First: Understand the cause:  

• is it the foods you are eating?  We can test for food intolerances. 
• Is it stress related? We do a lot of cortisol stress testing. 
• it is it a nutrient deficiency?  Leave this to us to help identify.
• Or is it simply that you are not producing enough HCL?

All these things should be taken in to consideration BEFORE commencing long-term PPI’s and usually we can avoid the need for the PPI’s  all together. 

Please note that PPI’s should NEVER be stopped suddenly – you will experience rebound reflux:  that’s when your cells responsible for producing gastric acid “awaken “and start working again with great enthusiasm often causing patients to incorrectly assume they must need the PPI.

It should be done in a graduated method, and I like to use herbs and nutrients along it to protect the stomach whilst we get things back to normal. 

If this is something you struggle with then why not book an appointment today and get your digestive health back on track.

FAQs About Stomach Acid