It’s All About Stomach Acid
Stomach acid, that is. And the medical literature states that statistically, over 90% us aren’t producing enough. Surprise! It may seem hard to stomach the fact that acid suppressing drugs make up a seven-billion-dollar industry in the United States, yet are actually making us sicker.
- Well, isn’t acid a dangerous, corrosive, ulcer-causing substance?
- And why then do acid neutralizing substances like calcium carbonate (TUMS) make heartburn feel better if the problem isn’t too much acid?
- What would low stomach acid really feel like?
To answer these questions, one must first look to the anatomy of digestion. Here I’ll focus mainly on the stomach. We, as people who eat, should know what happens when we swallow our food. So, here we go!
The main idea is that digestion is a north to south process. Food is supposed to enter the mouth and exit the…well, you know. Between these two points are many organs that process and distribute the nutrients in our food. Digestive problems arise when any organ in the digestive process is out of whack, and for many people, the first organ that has the potential to wreak real havoc on the whole cascade of digestive events that follow is: the stomach. Within the stomach is a critical substance that has gotten a lot of very negative press over the years, and that is…stomach acid (a.k.a hydrochloric acid or Betaine HCl).
PART 1: FUNCTION AND DYSFUNCTION
- Why is stomach acid important?Stomach acid performs three major functions:
- Food entering the stomach prompts hydrochloric acid to be secreted, which bathes the food and quickly kills any pathogenic bacteria, viruses, or parasites that may be on the food.
- The stomach then churns the food and continues to secrete acid until the the contents of the stomach reaches a very acidic pH, between 1.5 to 3.0. For comparison, pure lemon juice has a pH of 2. Only when the stomach contents are this acidic can digestion of proteins, minerals like iron and calcium, and vitamin B12 take place.
- Once the food has been sufficiently acidified, it must move on south. The precise acidity of 1.5-3.0 is what prompts the valve at the bottom of the stomach to open and allow the food to pass into the duodenum, the first part of the small intestine. And, it is the presence of highly acidic food in the duodenum that prompts digestive enzymes from the pancreas to be released and start further breaking down our food so we can get energy, build cells, and live!
- What does low stomach acid (hypochlorhydria) feel like?
Let’s take the three functions above and see what happens without enough stomach acid (either due to your body not producing enough, or the use of an acid-suppressing or acid-neutralizing drug)
- People with low stomach acid get food poisoning or “stomach flu” more often than those who have adequate stomach acid. Hydrochloric acid is a potent disinfectant and prevents infestation of whole-body parasites and pathogenic bacteria.
- Unlike fats and carbohydrates, which are broken down later in the digestive tract, the stomach is the only place where complex proteins can be broken into amino acids to be absorbed in the small intestine. It is the stomach acid that breaks down these proteins. Without enough stomach acid, proteins are not cleaved into their smaller amino acid components which the body can metabolize and use for building tissues. Amino acids are also the building blocks of enzymes, hormones, and neurotransmitters like seratonin and dopamine, which we know are two of the “feel good” brain chemicals.Absorbing Vitamin B12 also requires adequate stomach acid and “intrinsic factor” for digestion. Most people eating vegan diets must supplement this essential vitamin found in high-quality animal protein. But even those who eat meat can be Vitamin B12 deficient and suffer from “pernicious anemia” if their stomach acid is too low.Another type of anemia is called ”iron deficiency anemia”. A quick search of the John’s Hopkins Health Library states that: “Any abnormalities in the gastrointestinal (GI) tract could alter iron absorption and result in iron-deficiency anemia. Surgery or medications that stop stomach acid production will also decrease iron absorption.” If you’ll permit a personal side note, in college I was made aware that my iron was low when I volunteered to donate blood for the first time. I was rejected due to low hemoglobin levels. (The body uses iron to build healthy red blood cells full of hemoglobin.) The lab technicians at the blood bank instructed me to eat a lot of meat and leafy green vegetables. I tried to do this for the next few years and was rejected on at least 3 more occasions. Finally, I educated myself further and took steps to increase my stomach acid production. Just recently I went in to donate blood again and miracle of miracles, they pricked my finger and pronounced me clear to donate! I’m still on the lower end of normal, but it’s something I continue to work on.
- So, what happens if the stomach contents aren’t acidic enough to disinfect the stomach and prompt the bottom valve of the stomach to open at the appropriate time? Well, what would happen to any real food over time if left out in a warm place? You guessed it…bacteria in the stomach happily go to work eating and digesting this food (that is supposed to be our food!). Carbohydrates ferment, proteins putrefy, and fats rancidify. All this funky action produces: gas. The stomach starts to bloat up, and the rotten food puts pressure on the valves both at the top and bottom of the stomach. The top valve leads to the esophagus, and when the pressure and bloating becomes too much for the weakening valve, stomach contents push up into the esophagus. The esophagus is not coated with a thick protective layer of mucus like the stomach!Now here’s the key for heartburn: Most people produce at least some stomach acid. So let’s say that the fermenting, putrefying, rancid stomach contents are at about a pH of 5. This is too alkaline of a pH to prompt the lower stomach valve to open, but when a pH of 5 refluxes back and hits the sensitive esophagus through the top valve, that’s plenty acidic to irritate and cause heartburn. TUMS work because the calcium carbonite neutralizes the acid in the esophagus. But the problem originates in the stomach.
- What do you think? Fascinating, no? 🙂Now, I am not a medical doctor and do not diagnose, treat, or cure any disease. However, I can highly recommend that if your doctor intends to put you on a acid-neutralizer like Maalox, or an acid -suppressor like Pepcid or Prilosec (there are many others), you should ask to be tested to make sure you are among the 10% of people who actually over-produce hydrochloric acid. Many doctors will not want or know how to test for actual stomach acid production. That’s why you can try some of the tips below first and decide for yourself whether you’re in the majority of people who are in need of more stomach acid.
PART 2: SOLUTIONS
- Stimulating stomach acid production
- Some people may feel better simply by ingesting a traditionally prepared acidic food or drink before a meal in order to stimulate stomach acid production. Most of these can be found in health food stores. Some examples include:
- raw apple cider vinegar– 1 tsp diluted in 1/2 cup water
- naturally fermented sauerkraut or other fermented vegetable such as pickles or kimchi – 1 Tbsp
- milk or water kefir, or kombucha – 1/4 cup
- Other people find that a preparation of bitter herbs, also called Swedish Bitters, stimulates stomach acid production and helps reduce indigestion symptoms – 1 tsp diluted in 1/4 cup water
For both options above, eat/drink the small amount indicated about 15 minutes before a meal and note reactions or improvement of symptoms during and after the meal.
- Some people may feel better simply by ingesting a traditionally prepared acidic food or drink before a meal in order to stimulate stomach acid production. Most of these can be found in health food stores. Some examples include:
- Dosing Hydrochloric AcidIf neither of the above two options gives significant effect, you may need to start supplementing with hydrochloric acid. Don’t worry, you don’t have to drink acid! It is a powder in a capsule that you don’t taste (unless you open it!) The best thing about supplementing with HCl specifically is that it does not make the body dependent on supplementation. Betaine HCl supplements basically “train” the stomach to begin to produce its own stomach acid, so eventually you wean naturally off supplementation.
One caveat: Jonathan Wright, in his book Why Stomach Acid is Good for You, cautions:
People that are “high risk” shouldn’t take Betaine HCL without supervision.You’re high risk if you’re consuming any anti-inflammatory medicines. Examples of those are: corticosteroids, aspirin, Indocin, ibuprofen (Motrin, Advil) or other NSAIDs. These drugs can damage the GI lining and supplementing with HCL could aggravate it, increasing the risks of bleeding or ulcer.
That said, if you have tried stimulating stomach acid production in the steps above, and haven’t felt any burning or discomfort above your belly button, doing a simple HCl dosing challenge is the key to determining if stomach acid is indicated for you. Because everyone is different, I cannot make a recommendation of how many capsules of HCl you should take. That’s why you must do the dosing challenge.
How to do the dosing challenge
- The brand of HCl with pepsin that I recommend over the counter is from NOW Foods
- If the preview mode in the PDF below looks strange, just click “download” at the top and the file should be fine. Click here and download a PDF that you can print out and put on your refrigerator that describes how to find your dosage. (I give this to my nutritional therapy clients when we suspect low stomach acid production.)
Much of the data for this article comes from one of the required reading texts in my nutritional therapy program: Why Stomach Acid is Good For You by Jonathan V. Wright, M.D. It is actually a very interesting read and I would recommend it to people who feels this subject is applicable to themselves or to friends and family.