One of the most misunderstood concepts in modern medicine is the role of stomach acid in human digestion. Conventional thinking associates excess stomach acid to conditions such as gastro-esophageal reflux disease (GERD), heartburn, and peptic ulcer disease. This type of thinking is logical, since the burning and sour taste that patients experience at the back of their throats has an acidic taste to it. It is also easy for patients to conceptualize excessive stomach acid fizzing up from their stomach to cause heartburn and reflux. Conventional treatment consists of proton pump inhibitors such as omeprazole and over the counter antacids such as TUMs and alka-seltzer. In this article I will explain how these theories fall short of actual patient outcomes, as well as provide an alternative method to help patients who suffer with GERD and heartburn.
Low stomach acid causes GERD
Many patients are shocked when I tell them that their GERD is likely from low stomach acid rather than high stomach acid. They are further surprised when I tell them the fix for their GERD are treatments and supplements aimed at increasing their stomach acid levels rather than trying to decrease stomach acid. When stomach acid levels are low, patients cannot fully digest their foods. This causes a backup in the system, where undigested food particles can travel back up the esophagus causing the acidic taste in the back of the throat. Additionally, the valve separating the esophagus from the stomach, called the lower esophageal sphincter (LES), does not fully close when stomach acid levels are low. When we increase a patient’s stomach acid levels, they begin to fully digest their food allowing it to continue into the small intestine. They also increase the patency of the lower esophageal sphincter, keeping food and acid in the stomach, not traveling back up the esophagus to the throat.
Stomach acid (HCL) and nutrient absorption
HCL is essential for the absorption of vitamins and minerals from our food. Notably calcium, magnesium, vitamin B12, and iron do not absorb well in a patient who has low stomach acid. Because of this, low stomach acid is associated with vitamin B12 and B9 anemias, iron deficiency anemia, and osteoporosis/ osteopenia from poor calcium and magnesium absorption. In fact, one of the long term side effects of proton pump inhibitor use is the loss of bone mineral density. According to the American Academy of Gastroenterology (ACG), patients should only be on a PPI like omeprazole for a maximum of 8 weeks. The time restriction is due to the previously mentioned issues with vitamin and mineral absorption and the subsequent issues those can cause. Unfortunately, many patients have been on PPI’s for much longer than 8 weeks. Recently I had a patient in her mid 20’s who had been on a PPI since she was in first grade! She had almost completely lost her ability to produce stomach acid and was extremely mineral deficient with chronic anemia, migraine headaches, and debilitating gastrointestinal issues – including GERD.
H. Pylori explained
Another important role of HCL is to protect our gut from opportunistic bacteria. Opportunistic bacteria refer to harmful bacteria in our gut that can cause infection or lead to ulcer formation. Certain bacteria thrive when stomach acid levels are low. H. pylori is the most well known of the pathogenic gut bacteria. Overgrowth of H. Pylori can lead to peptic ulcer disease, an extremely painful condition for any patient who experiences it. One of the best ways to protect against H. pylori is to improve stomach acid levels, as the acid keeps the H. pylori in check and keeps it from overgrowing. Patients who consume NSAIDs such as ibuprofen, aspirin, and acetaminophen on a regular basis are also at increased risk of peptic ulcer disease. I mention this because one of the treatments for patients who take NSAIDs regularly is to put them on a PPI. This may be doubly negative for the patient because the NSAIDs harm the beneficial mucus membranes in the gut lining, while the PPI decreases stomach acid levels which can lead to overgrowth of H. pylori and poor nutrient absorption as described above.
How to increase stomach acid levels naturally
If you determine that your stomach acid levels are too low, here are some natural ways to boost HCL production in the stomach and to ensure healthier digestion:
-Consume apple cider vinegar. Dilute ½ tsp in 10-12 ounces of water and drink first thing in the morning and before bed.
-Consume lemon, lime, grapefruit, and other citrus foods to help stimulate HCL production.
-Use balsamic vinegar as a salad dressing or as a marinade for red meat or chicken.
-Drink celery juice or cabbage juice to stimulate HCL production.
-Chew your food! The physical act of chewing will stimulate HCL production and also help digest your food via adequate release of salivary enzymes triggered in the mouth with chewing.
-Avoid ice water while eating your meals. Ice water decreases HCL production. Drink warm ginger or dandelion tea instead, both increase HCL production. Warm lemon water before your meal is another excellent option.
-Avoid eating starchy carbohydrates when consuming high protein meals. Starchy carbs like rice, potatoes, and fruit, decrease HCL production and thus make protein digestion less effective.
-Finally, make sure you are in a calm and relaxed state before eating your meals. When you are in a stressed state, your body does not produce as much stomach acid. Take 4 deep, slow breaths prior to eating. As an added bonus, reflect on how lucky you are to have an abundance of healthy food to fuel your body. Gratitude is excellent for both your brain and digestive health!
Conclusion
For years it was thought the cause of indigestion, stomach ulcers, and gastric reflux was the presence of too much acid in the stomach. However, it is now known the cause of these issues is actually too little stomach acid. Stomach acid is necessary to ensure the proper digestion of your food, to help protect you from pathogenic bacteria, and to prevent the back flow of food into your esophagus and throat.
Post written by Dr. Riley Kulm, DC. Check out Dr. Riley Kulm’s bio here.
