Low Stomach Acid: Causes and Treatment

Acid reflux, heartburn and bacterial gastric ulcer infections are all conditions related to the digestive system and its secretion of stomach acid.

Digestion

Cortney Good
Desiree Abecassis
@AVogel_ca


22 January 2020

Contrary to mainstream belief where which assumes that the cause of acid reflux is due to the secretion of too much stomach acid, we may look at the opposite to give us an alternate point of view. The popularity and use of mainstream medications such as antacids and PPI's are all too common and are based on the idea that certain digestive conditions are caused by overactive or high stomach acid levels.
In reality, much of the origin of these types of acid-related issues are actually caused by low stomach acid levels.

Let's have a look at absorption and where stomach acid fits into the digestive process

Nutrients that are required for optimal bodily functioning are present in food. We consume food via our mouths and this is actually where the digestive process begins. Food is partially broken down in the mouth by chewing and the secretion of enzymes in saliva, before it travels down the esophagus to land in the stomach.

Once in the stomach, hydrochloric acid (HCl) helps to further digest that food in order to facilitate the extraction of nutrients from it lower down the GI tract. Hydrochloric acid is highly acidic, so much so that it may burn skin if it were to come into contact with it.3 The normal pH level of hydrochloric acid in the stomach should be between 1–3. In those suffering from low stomach acid, also called hypochlorhydria, the pH is usually between 3–5. Achlorhydria is the clinical condition where no stomach acid is present and usually presents with a stomach pH of more than 5.

The main functions of HCl in the stomach include:

  • Helping to properly digest protein by stimulating the secretion of pepsin
  • Helping to digest carbohydrates and fats, especially fat-soluble vitamins A and E, by stimulating the release of pancreatic enzymes
  • Aiding and increasing the absorption of many vitamins and minerals
  • Protecting against harmful bacteria that may enter the body through food by destroying it in the highly acidic environment;
  • Helping to neutralize candida infections by taking care of proliferating negative yeasts and bacteria
  • Regulating gastric emptying and gastric motility

What causes low stomach acid?

Age is one of the most prevalent factors that contribute to a reduction in stomach acid secretions.1 Studies have found that older persons, over the age of 60, experience a significant reduction in stomach acid production. Low stomach acid can also be caused by the overuse of acid-suppressing medications like proton pump inhibitors (PPI), bacterial infection caused by Helicobacter pylori, chronic stress, drinking too much alcohol, taking certain antibiotics and even eating disorders like malnutrition and extreme calorie restrictive diets.

What are the symptoms of low stomach acid?

Let's take a look at some of the most common symptoms that result from having low stomach acid. Keep in mind that some individuals may experience reactions on the skin due to having an underactive stomach:

  • A feeling of fullness after eating a regular meal
  • Bloating
  • Indigestion
  • Flatulence
  • Burping
  • Heartburn
  • Diarrhea
  • Acne
  • Flushed skin (red cheeks)
  • Iron deficiency
  • Vitamin and mineral deficiencies
  • Brittle fingernails
  • Feeling tired and fatigued

Having low stomach acid can result in the ineffective breakdown of foods, specifically protein rich foods. This means that there are fewer essential nutrients available for assimilation. There is also a chance that pathogens ingested cannot properly be addressed or discarded before digested food moves to the small and large intestine (where nutrient absorption takes place).

Here these harmful pathogens can disrupt the balance of good bacteria in the gut, ultimately leading to possible SIBO leaky gut syndrome, food allergies and chronic inflammation.

The Canadian Digestive Health Foundation claims that 1 in 6 Canadians suffer from stomach acid-related digestive diseases like GERD.

Low stomach acid is also associated with a number of chronic health conditions, including:

  • celiac disease,
  • asthma,
  • food allergies,
  • chronic inflammation,
  • eczema,
  • Grave's disease,
  • gallstones and
  • rheumatoid arthritis.

Low stomach acid is tricky to diagnose. A medical doctor will usually take a full medical history, taking into account any symptoms associated with low stomach acid.

At home, a 'burping test' can be self conducted using a solution of bicarbonate of soda to determine the levels of stomach acid.

  • First thing one morning, on an empty stomach, before eating, drinking, brushing teeth.
  • Mix 1/8 tsp bicarbonate of soda to 100mls slightly warm water.
  • Drink the mixture (it may taste slightly salty)

Burping after ingesting the solution 3–5 minutes later may indicate low levels of stomach acid.

A doctor may prescribe medications such as antacids or proton pump inhibitors (PPIs) for heartburn but that overtime may cause the symptoms to worsen by decreasing stomach acid even more. Because low stomach acid leads to decreased digestion, food can begin to ferment and cause bloating and start pushing through the lower esophageal sphincter (LES), causing acid reflux.

By increasing stomach acid, digestion will improve, allowing the LES to close tighter and increase the gastric emptying of food. If there is enough HCl in the stomach, heartburn symptoms and conditions like GERD may actually improve.

Lifestyle and diet changes

Lifestyle and diet changes to improve low stomach acid secretions and bring them back to a healthy level:

  • Avoid caffeine and alcohol
  • Avoid processed food
  • Reduce stress
  • Exercise more
  • Don't drink a lot of fluids during or right before a meal
  • Chew food properly
  • Eat probiotic rich fermented foods such as kimchi and kombucha
  • Reduce acidic foods that can worsen symptoms (tomatoes, orange juice)

Supplements for low stomach acid

Popular supplements to treat low stomach acid include betaine hydrochloride, digestive enzymes, peppermint oil capsules and herbal bitters.

Bitter plants such as those in our Boldocynara (liquid form) and Digestive Aid Complex (tablet form) are an especially effective choice to address low stomach acid and have been used in European and Chinese traditional medicine practices for centuries.

Bitters work by stimulating gastric secretions (HCl), enzymes in saliva and bile production.

Herbal bitters may even work more effectively than just taking a digestive enzyme supplement as these supplements target the digestive enzymes released by the pancreas into the small intestine and the body will begin to re-train to produce its own secretions instead of simply relying on enzymes in supplement form.

A herbal bitter tincture like Boldocynara contains a combination of various bitter and digestive and liver stimulating plants including:

  • Artichoke leaf: which is a liver protector and stimulates the secretion of bile
  • Milk thistle fruit: a powerful liver protector
  • Boldo leaf which aids digestion and stimulates bile secretion
  • Dandelion root which contains antioxidants and helps to reduce inflammation

A combination of these four plants can help increase HCl secretion in the stomach, help the liver work more efficiently to get rid of toxins and stimulate bile secretion to increase fat digestion in the small intestine.

Boldocynara or Digestive Aid Complex (in your preferred format) is a wonderful remedy to address low stomach acid, especially in those suffering from age-related underactive stomach issues. In combination with dietary and lifestyle changes, the symptoms of low stomach acid will greatly improve with the addition of this remedy.
Wishing everyone happy and healthy digestion!
References:
https://nutritionreview.org/2018/11/gastric-balance
https://www.karger.com/Article/FullText/142726
https://emedicine.medscape.com/article/170066-overview
https://www.ncbi.nlm.nih.gov/books/NBK279304/
https://www.ncbi.nlm.nih.gov/books/NBK535425/
https://cdhf.ca/digestive-disorders/gerd/
https://www.nutritionjersey.com/high-or-low-stomach-acid/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991651/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4446506/
https://www.health.harvard.edu/staying-healthy/gut-reaction

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