Why Your Heartburn Might Be LOW Stomach Acid, Not High Stomach Acid
Stomach acid gets a bad rap. The first thought that comes to most people’s minds when you say “stomach acid” is the visual of heartburn and trying to get stomach acid to go away with Tums. But stomach acid is good for you, and it turns out that many people who get heart burn and have digestive issues actually don’t have enough. I know… brain bender compared to what we’re all used to thinking.
Hydrochloric acid, also known as HCL & stomach acid, is an often overlooked factor in digestive issues.
Low HCL can contribute to irritable bowel syndrome (IBS), small intestinal bowel overgrowth (SIBO), gastroesophageal reflux disease (GERD) & food allergies (1). It also contributes to vitamin & mineral deficiencies, which can cause osteoporosis and anemia, including B12 & iron deficiency (1). It is also essential for the breakdown and absorption of nutrients in food & protein breakdown (2).
However, the list of diseases and disorders associated with poor stomach acid output are extensive, and that’s why it really matters for long-term health (3). Check it out.
I know what you’re thinking. Why hasn’t your doctor mentioned this to you? Good question. I discuss the issue below. But before I do, I want to mention, this is also why I believe everyone should have access to a dietitian. What we look for and focus on is not what doctors are looking for and focusing on.
We (doctors and dietitians) should be working together to give people the best care and health because we both know different things. Also, the more that people become aware that a lot of health care decisions are rooted in money and not truly on health, the more they will learn to be their own health advocate.
Think I’m exaggerating by telling you that most health conditions revolve around money and not health?
Let’s start with GERD, the most common digestive disorder in the United States (4).
Heart burn, acid reflex, GERD and indigestion is a massive problem in the United States and is a $13 billion dollar industry.
In fact, $7 billion is spent each year on acid-suppressing drugs, which includes cimetidine (Tagamet HB), ranitidine (Zantac 75), famotidine (Pepcid AC) and nizatidine (Axid AR). And another $4 billion is spent on over the counter (OTC) antacids such as Tums, because people believe that too much stomach acid is their problem, but they are instead being sold a band-aid solution that is not addressing the root problem for many cases (granted, not all cases, some people really will have too much stomach acid (4).
Let’s get specific: the symptoms of heartburn and GERD are caused by stomach acid refluxing into the esophagus. And these drugs and antacids absolutely reduce and eliminate the symptoms of heartburn from acid that is refluxing upwards. What’s a MUST to understand in this conversation is that any amount of acid in the esophagus is going to cause problems and discomfort because the lining of the esophagus is very delicate and is not protected against acid, unlike the stomach.
The myth when you have heartburn it is only caused by too much stomach acid. There’s another way acid makes it’s way into your esophagus.
In fact, too little acid can allow food to sit in your stomach for too long, Once you chew your food, it’s a race for your stomach acid to break it down before it starts to rot and putrefy. When you have too little acid, your food starts to ferment, which creates gaseous pressure that reverses the food and some stomach acid back up into your esophagus. This creates the same burning sensation we all associate with heart burn.
When you keep taking antacid drugs, they block your body’s signal to send out stomach acid and decrease its abilities to create acid, which creates a negative spiral down toward less and less acid, while increasing your dependence on antacids! And meanwhile the root problem that began creating the low stomach acid isn’t addressed.
For more than 100 years, people were prescribed HCL replacement therapy for many symptoms and clinical conditions (5). Before the 1920s, doctors were taught that bacteria and poor environment created a myriad of symptoms that were the result of insufficient stomach acid.
But guess what, “Encouraged by the legal drug industry, medical students are not taught that hypochlorhydria (inadequate stomach acid production) is treatable only with unpatentable, natural replacement therapies. Instead, their education concentrates on hyperchlorhydria (excess stomach acid production) and its treatment with patentable acid blocker drugs and highly profitable over-the-counter antacids.” –Jonathan Wright, MD, The Digestive Theory of Aging (5)
Sad right? Many signs point to the fact that companies know the root problem in a lot of cases is not high stomach acid, but in fact low stomach acid, but they couldn’t make money off it because the things that resolve low stomach acid are not patentable.
So what do you do about it? You take your power back into your own hands. First, start looking for the symptoms of poor stomach acid production.
YOU NEED HCL FOR ESSENTIAL NUTRIENT ABSORPTION:
That’s a lot of symptoms! And many of them are - at their core - caused by poor nutrient absorption. That’s because many vitamins and minerals are dependent on HCL to be absorbed, and if you have low stomach acid, these nutrients will not be absorbed optimally.
For example, if you have iron anemia, it may not resolve with supplementation due to low acid production. Because even though you are taking it, you are not ABSORBING it - not even the pill. This is also a root issue for why despite eating a “perfect & healthy” diet, you can become sick.
Health is about what you are absorbing, not just what you are eating.
VITAMINS THAT NEED HCL TO ABSORB:
Zinc (super important skin nutrient!)
This is one of the reasons a highly restrictive diet like the vegan diet can become very problematic for people and cause poor health. Besides being a low source for essential nutrients including vitamin B12, calcium, iron, and zinc, to add to the complexity, these nutrients are needed for HCL production, but will also NOT absorb well with low HCL. See how it can become a vicious cycle?
Some of my clients will come to me saying that meat doesn’t make them feel well or that they bloat after eating it. Some of them have stopped eating meat or gone vegan. But this isn’t necessarily the meat that is causing the distress, it can be a symptom of low stomach acid.
So if you stopped eating meat because it caused heartburn, you need to know that this potentially wasn’t a long term fix to the initial problem, which can be low stomach acid. (6) You need to figure out why the low acid production started in the first place, rather than just removing foods that reveal the problem.
If you don’t investigate the issue further, it could cause more serious health issues later down the road.
Does this mean that meat eaters are completely in the clear? No, because obviously low acid is caused by many things and shows up in many ways. However, meat eaters do seem to fair better because they are usually getting the needed nutrients more often without having to micromanage their dietary choices.
STOMACH ACID IS YOUR IMMUNE SYSTEMS FIRST LINE OF DEFENSE:
HCL is your body’s #1 defense against disease-causing bacteria, viruses, pathogens and parasites. (6) Read that again slowly. Stomach acid is needed to protect you from harmful bugs/bacteria that can enter your system. If enough stomach acid is present, you’ll be able to fight bacteria and parasites via the presence of HCL. However, if you do not have enough acid, they are able to survive and get into your small intestine and move to your large intestine because your defense system did not work. These bugs can then become nice and cozy and begin to create digestive disturbances, eventually leading to more chronic symptoms, many related to the skin. This is why it is not uncommon to see many skin conditions, be it acne, roseacea, dermatitis, eczema and even psoriasis start to happen in conjunction to gut symptoms including burping, bloating, gas, diarrhea, constipation, and cramping. In fact, according to this study, 40% of those with acne have hypochlorhydria (low stomach acid). (7)
WHAT CAUSES LOW HCL?
One word. Stress. We know it’s bad, but I think most of us underestimate just how far-reaching and detrimental its effects are on our bodies.
Stress can be physical (a poor nutritional diet, disease, running marathon, etc), emotional, or mental, stress disputes the efficient way our body was designed to function.
If you aren’t relaxed, your body won’t send or receive the signal to release HCL to digest your food properly. Eating in a stressed state (again, physically, mentally, or emotionally) sets you up for digestive issues and low stomach acid from the start.
OTHER THINGS THAT LIMIT HCL:
Drinking large amounts of liquids while eating. I’m talking excessive amounts. I have clients worry that they shouldn’t drink any water or liquids at all, but I haven’t seen research that it truly helps.
Any antacids, drugs, or medication will reduce HCL and have the potential to damage good bacteria that supports digestion.
Getting insufficient amounts of protein.Limited protein changes your body’s production of HCL. When you stop eating meat, your HCL production goes down, and you should know it makes it harder to start eating meat again if you choose to do so.
Getting too many starchy carbohydrates. Your body doesn’t release HCL when you’re eating starches, and if you’re eating high amounts of starches with something like protein that needs the HCL to break down, it can cause digestive distress.
WE EAT IN A STRESSED STATE:
Our body’s autonomic nervous system has two main signals. Sympathetic, aka fight or flight, which allows us to react quickly in an emergency state. This is the stressful state of the body. Your parasympathetic mode is the opposite; allowing the body to rest and digest. When consuming food we must be in a parasympathetic state in order to digest properly and for HCL to be secreted.
Is you’re stressed, all of the long-term survival mechanisms that are not needed in that immediate moment take a back seat, such as reproductive function, digestion, hormone balancing, metabolism and detoxification. Your body will focus on only whatever it needs to do in that moment to keep you alive. Therefore, eating on the run is going to severely impact your ability to digest your food properly. Many of my clients found improvements with digestive symptoms simply by making time to stop, breathe, and eat mindfully. Heather will work with them to develop better breathing patterns and relaxation and mindfulness cues while eating. It makes a difference!
It is important to also know that stomach acid also triggers the peristaltic wave that moves food through the digestive system (what moves your stool through and is important for not being constipated), and releases pancreatic enzymes to further breakdown macronutrients & the absorption of micro-nutrients.
Again, its all connected, so if the start of digestion is “limited”, the rest of the digestive process is “limited” and will absolutely result in issues.
CERTAIN FOODS CAN INCREASE STOMACH ACID
Celery is a natural source of sodium, as I discuss in Critical Conversations podcast episodes 22 and 23, which is necessary for the body's production of hydrochloric acid (HCL). Which is one of the reasons why eating too little salt can cause health issues. (8)
Celery is an old folk remedy for heartburn and the above reason is why. Remember, despite what you have been led to believe about heart burn, low stomach acid is more to blame than too much stomach acid for the common indigestion symptoms associated with heartburn (11), and celery helps reverse low stomach acid.
OTHER WAYS TO INCREASE YOUR HCL LEVELS
Note: If you have any history of ulcers or esophagus irritation, you MUST work with a practitioner to make sure you do not flare these issues.
Lemons contain necessary acids to balance an over alkaline environment.
Raw Apple Cider Vinegar.
Is an acid that can support the secretion of HCL.
To use: Take 1 tsp in 4-8oz of water 5-10 minutes before a meal.
These support digestive function by stimulating bitter receptors on the tongue, stomach, gallbladder and pancreas which promotes digestive juices such as stomach acid, bile and enzymes to breakdown food & absorb nutrients.
Take 1 tsp mixed in 4oz of water or as directed on bottle to stimulate your body’s own HCL production.
Besides promoting healthy gut bacteria, fermented foods have the ability to stimulate your body’s own production of HCL.
It sounds simple, but increasing your HCL levels naturally using these methods can do wonders for your digestion and how you feel after eating!
THE HCL CHALLENGE:
There are several ways you can test your hydrochloric acid. I recommend checking out this fantastic article by Dr. Jockers for the directions on how to do this. NOTE: You should not do this test without medical supervision if you have any ulcers. You should also always have baking soda water ready (Add 1/4 t baking soda to 4-6 ounces of water) to drink when doing any of these home tests as this will neutralize any discomfort, if it arises.
One warning: Do not take HCL without medical supervision if you are taking any anti-inflammatory medications including corticosteroids, aspirin, indocin, ibuprofen (Motrin, Advil), or other NSAIDs. Taking these drugs with HCL may damage the GI lining and increase bleeding or cause an ulcer.
Thanks for reading this article. Remember to always ask questions, including the life-changing question of “How does this make me feel?” You can take your power back and create healing and vitality in your own body. You just have to be willing to make one small change at a time. - like focusing on ways to support HCL in your body.
You’ve got this!
Jonathan Wright, MD, The Digestive Theory of Aging
CDC’s Second Nutrition Report: A comprehensive biochemical assessment of the nutrition status of the U.S. population: https://www.cdc.gov/nutritionreport/pdf/4page_%202nd%20nutrition%20report_508_032912.pdf