Acid reflux, heartburn and indigestion are common complaints that I see in my clinic with clients reporting symptoms such as bloating, gas, belching, constipation, a burning sensation or heavy feeling in the stomach. Often people mistake low stomach acid for high stomach acid. When they experience reflux and heartburn, they understandably think that what feels like too much acid must be just that. Usually, it’s the opposite: the problem is too little stomach acid, which is a common condition called hypochlorhydria (hypo=low, chlorhydria=stomach acid).
Instead of addressing the root cause of low stomach acid we go to the doctor who might prescribe an antacid, which can be extremely dangerous (more on this below). Let’s delve into why we really experience acid reflux and indigestion, the problem with acid-blocking drugs, and what you can do to address your stomach acid levels and the health of your digestive tract.
Why Does Low Stomach Acid Feel Like High Stomach Acid?
Our stomach is an acidic environment, which is a requirement to help us break down our food. The stomach lining is tough and can manage the acidity, which normally has a pH of 1.5 to 2.5.
When our stomach does not make enough acid, food sits in the stomach and begins to ferment. The fermentation causes the release of gas. The gas needs to go somewhere, so it goes up and causes burping. Sometimes when the gas escapes some of the stomach contents, which are acidic, make contact with the esophagus. A lack of stomach acid also weakens the sphincters that separate the esophagus from the stomach, causing them to open slightly so the stomach contents splash upwards. The esophagus doesn’t have the protection that the stomach has and then you might experience acid reflux or heartburn.
When the stomach produces enough acid, food moves along the digestive tract in a timely manner and reflux does not occur.
Why Do People Stop Making Enough Stomach Acid?
There is a specific type of cell called a parietal cell that produces stomach acid. Its function begins to diminish when it’s stressed. Various factors that can stress a parietal cell include:
- Overeating
- Stress (and eating when upset)
- Alcoholic beverages
- Eating too rapidly
- Overconsumption of protein
- Dairy
- Fatty foods
- Smoking
The good news is that we can restore the function of the parietal cells. By eating a whole foods diet and supplementing certain digestive-enhancing remedies, the parietal cells can once again do their job.
Why is Low Stomach Acid Dangerous?
Stomach acid is one of our first lines of defence against pathogens and food antigens. When we consume these substances, our stomach acid destroys them, preventing them from entering circulation.
A bacteria known as H. Pylori thrives when the stomach doesn’t make enough acid. H. Pylori has been shown to cause ulcers and is also associated with Barrett’s Esophagitis and oesophageal cancer. H. Pylori also decreases the secretion of intrinsic factor, which is necessary for adequate absorption of B12.
Testing To See If You Have Low Stomach Acid
There are a couple of tests used to determine the level of stomach acidity. The first one is a medical test and the second is an easy test that can be done by anyone.
Test #1 The Heidelberg Capsule Test (HCT): In the HCT, the doctor gives you a pill to swallow that relays the acidity of the stomach to a monitor. The doctor can then record how your stomach increases its acid (or not).
Test #2 The Stomach Acid Challenge (SAC): In order to do this test you’ll need hydrochloric acid capsules called betaine hydrochloride (available in any health food store). At your first meal take 1 capsule and notice if you feel a warm or burning sensation. If you do, discontinue the test immediately. If not, increase the dosage to 2 capsules at the next meal of the same size. If you don’t feel a warm or burning sensation, increase to 3 capsules. Increase up to 7 capsules if you don’t experience a warm or burning sensation. If you feel the sensation reduce your dosage by one capsule and consume that amount at every meal. Consult with a trained practitioner when doing the Stomach Acid Challenge. Do not perform the test if you currently have or have a history of ulcers or gastritis.
Being able to consume more than one hydrochloric acid capsule with a meal is an indication that you might have low stomach acid.
The Problem With Taking Acid-Blocking Drugs for Acid Reflux
Drugs can save lives and do. They are a triumph of science over some of the most deadliest conditions. Drugs have great value in treating acute ailments, life threatening conditions, and for pain control. They fall short in the treatment of chronic conditions, many of which are due to poor diet and lifestyle.
Doctors commonly prescribe a class of drugs called proton pump inhibitors (PPIs) for acid reflux. PPIs work by shutting down the parietal cells that pump hydrochloric acid (HCl) into the stomach. As a result, we greatly decrease our stomach acid production and this supposedly helps us prevent or heal our problems. Canadian doctors dispensed 33 million PPI prescriptions in 2016.
One of the most popular PPIs worldwide is a drug called Nexium, which raked in 7.7 billion dollars in sales in 2014. It’s indicated for erosive esophagitis, a condition that involves injury to the esophagus due to acid reflux. However, it is often prescribed when a patient complains of any upper GI discomfort, usually a result of low stomach acid. Doctors are over-prescribing PPIs and then we are taking them for far too long.
When a client presents with symptoms that would normally be considered a problem of too much stomach acid in the average doctor’s office, I treat them for low stomach acid and they experience a complete recovery.
Health Risks of Taking Drugs for Acid Reflux and Indigestion
Proton pump inhibitors carry many risks, and it’s a very important and misunderstood topic. These are some of the negative health consequences of taking PPIs.
Increased Rates of Clostridium Difficile (and Other Infections)
We ingest billions of bacteria per day, found on our hands, food, surfaces, and in the air. As I mentioned at the beginning of this post, one of the most important lines of defence our body has from being infected by various pathogens is sufficient stomach acid. As these microorganism enter the stomach, the acidic environment destroys them. PPIs are a major contributor to hospital-acquired C. dificile infections, because they prevent patients from properly killing off the ingested bacteria with stomach acid.
People who take PPIs are three times more likely to develop a severe form of diarrhea called pseudomembranous enterocolitis. Other infections related to PPIs are pneumonia and salmonella.
Malabsorption of Calcium, Magnesium, Iron, and Vitamin B12
In order to absorb minerals you need to secrete large amounts of stomach acid. PPIs are linked to malabsorption and deficiences in calcium, magnesium, iron and Vitamin B12. These play an important role in our health including bone density, energy levels, cardiovascular health, immunity and more.
As we age, the ability to produce stomach acid goes down. Elderly individuals already have compromised digestion without adding a PPI. Everyone’s absorption of calcium and other nutrients is inhibited by PPIs, but it is especially dangerous in the elderly as this may increase their risk of osteoporosis.
Fractures
As discussed above, PPIs decrease the absorption of calcium, a mineral particularly important for bone-density maintenance. As a result, long-term use of PPIs appears to predispose individuals to the development of hip fracture. This meta-analysis of 18 studies of 244,109 fractures found that PPIs increased the risk of hip, spine, and any-site fractures.
Kidney Disease
PPIs are associated with an increased risk of acute kidney disease – they are a frequent cause of acute interstitial nephritis and in some cases this can lead to renal failure. PPIs are linked to a 20-50% higher risk of chronic kidney disease.
Dementia
Elderly patients who take PPIs may be at a greater risk of dementia. Researchers suggest this may be because PPIs inhibit absorption of Vitamin B12, which is crucial for brain and nervous system health, or because they prevent patients from clearing amyloid plaques from their brains.
Gut Microbiome Changes and SIBO
Our digestive tract is home to many different types of bacteria. Some are beneficial and some are not. We don’t need to eliminate all of the bad bacteria, we simply require the proper balance – we mainly need more of the beneficial bacteria. PPIs can change the composition of out gut microbiome and in some cases lead to Small Intestinal Bacterial Overgrowth, or SIBO.
Cardiovascular Events
In 2007 Astra Zeneca discovered that those who took their drug, Nexium, were at an increased risk for cardiovascular events. Canadian researchers then furthered the findings in 2009 showing that PPIs eliminate the anti-platelet benefits of Plavix, and increase the risk of a second heart attack. Since then, other studies show that taking PPIs boost the risk of myocardial infarctions (heart attacks).
We should understand that, even though I’ve listed the negative aspects of PPIs, there is a time and a place for drugs. What I’m attempting to illustrate is that it is important to understand the risks associated with drug use for suppressing symptoms, and to consult with a practitioner who uses drug therapy as a last resort, only after exploring non-invasive diet and lifestyle interventions.
How to Banish Acid Reflux and Restore Digestive Function
Imagine you went the gym every day and worked out the same muscle. Eventually you would get tired, then weak, and then injured. The digestive system is the same way in that if you over-stress it, it gets tired, then weak, and possibly injured. Here are some ways that you can build and maintain your stomach acid.
Digestive Bitters
Bitters have been one my greatest tools in alleviating acid reflux and improving digestion with clients. There is a full description of digestive bitters here, but generally they help us stimulate our gastric juices, enhance secretions of the liver, pancreas, stomach, and small intestine, provide enzyme catalysts that improve nutrient absorption, and protect the liver.
Betaine Hydrochloride
If you are low in stomach acid, taking Betaine Hydrochloride can give your stomach the break it needs in order to start producing enough stomach acid on its own. Consult a qualified practitioner to assess whether you are deficient and how to dose HCl.
Lemon Juice or Apple Cider Vinegar
Lemon juice or apple cider vinegar prime the stomach for digestion.
Avoid Foods That Trigger Reflux
This includes fried foods (especially those fried in vegetable oils), dairy products, gluten, refined sugars, caffeine and sodas.
Eat Foods That Help With Acid Reflux
Grab an extensive list of foods that help with acid reflux here, including beneficial foods like turmeric, ginger, dark leafy greens, pineapple and wild fish.
Don’t Forget About the Cephalic Phase
We all know what happens when we picture biting into a big juicy slice of lemon. It’s almost impossible not to start salivating. The cephalic phase of digestion relies on our senses and even imagining food to stimulate the release of digestive juices, readying the stomach for the food. Read about it in detail here.
Support Overall Digestion
Stomach acid production occurs at the beginning of the digestive cascade, but the entire digestive tract works in harmony. Ensure your digestion is functioning well through the best foods, herbs and supplements that support digestion.
Digestion is where everything begins and everything ends. It must be working optimally in order to have optimal health. It is not difficult to figure out if you’re low in stomach acid, and correcting this problem can have huge benefits!
Advanced Clinical Focus:
Digestion and
GI Health
Gain a deep level of understanding of the digestive process and how to apply targeted evidence-based interventions for common conditions.
