Stomach Acid: Do You Have Too Much or Too Little?
Stomach acid (also known as hydrochloric acid) plays a crucial role in the entire digestive process. Contrary to common belief, both excess and insufficient stomach acid can contribute to acid reflux or heartburn. In this article, we'll explore the nuances of stomach acid levels and how they relate to the discomfort of heartburn and GERD (Gastroesophageal Reflux Disease).
The Heartburn Dilemma
Heartburn, characterised by a burning sensation in the chest, is often mistakenly attributed to high stomach acid levels only. Yet, it's essential to recognise that low stomach acid levels can also produce similar symptoms.
An often-overlooked fact is the vital role stomach acid plays in maintaining good gut health, and the prolonged use of antacids can have significant adverse effects. There are crucial multiple digestive functions that rely on an adequate amount of stomach acid, making the long-term use of proton pump inhibitors (PPIs) come with certain consequences, namely nutrient deficiencies.
When food enters the stomach, it expands, prompting the release of hydrochloric acid (HCL). HCL is instrumental in many functions such as digestion of food, nutrient absorption, microbial defense and protein breakdown.
Sufficient stomach acidity is also essential for triggering the opening of the valve to the small intestine (called the pyloric sphincter) and activating the release of additional digestive secretions such as bile and pancreatic enzymes.
When stomach acidity is too low, the valve leading to the small intestine can remain closed and food starts to stagnate and decompose in the stomach, causing gas and indigestion. This can result in the escape of the stomach contents into the esophagus, triggering the upper valve (called the Lower Esophageal Sphincter or LES) to open instead, resulting in acid reflux. This is how the misdiagnosis of heartburn or "acid reflux" as high stomach acid happens.
A word on GERD (Gastroesophageal Reflux Disease)
GERD is a chronic condition where stomach acid regularly flows back into the esophagus, causing irritation and inflammation. It's crucial to differentiate between occasional heartburn and GERD, as the latter requires long-term management.
Certain foods can cause GERD flares such as:
Acidic foods (e.g., citrus fruits and tomatoes)
Alcohol
Caffeine
Chocolate
High-fat foods
Peppermint and Spearmint
Spicy foods
You can try to limit those if you have been diagnosed with this condition. It is also helpful to make sure you do not eat less than three hours before lying down or sleeping as it may worsen acid reflux.
How to Distinguish from Low versus High Stomach Acid Levels
Let’s break it down a little bit. Note that as we age, stomach acid production declines. The older you are, the more likely your reflux is caused by too little stomach acid (hypochlorhydria) instead of too much. In younger individuals and children, the same symptoms are usually due to true hyperchlorhydria.
In cases of Low Stomach Acid, the following consequences can occur:
Digestive issues: Insufficient stomach acid can impede proper food breakdown, leading to fermentation and gas production. This can exert pressure on the lower esophageal sphincter (LES), allowing stomach acid to reflux into the esophagus. Burping or feeling very full after a meal could be a sign of low stomach acid.
Nutrient Absorption: Low stomach acid may compromise the absorption of vital nutrients, contributing to indigestion and other digestive discomforts. If you have low vitamin levels or iron levels, it is a key indicator that digestion and/or absorption is impaired.
Bacterial Overgrowth: If you were able to get testing done and have found that you have Helicobacter Pylori or SIBO (Small Intestinal Bacterial Overgrowth), these are very good indicators that your reflux is likely due to lowered stomach acid production.
Conversely, in cases of High Stomach Acid, we commonly see:
Classic Heartburn: Excessive stomach acid can overwhelm the LES, permitting acid to escape into the esophagus, resulting in the classic symptoms of heartburn.
Gastric Ulcers: Prolonged high acid levels may contribute to the development of gastric ulcers, intensifying discomfort and raising the risk of complications. A caveat that will get confusing here is that if you have H. Pylori, the gastric ulcers are usually due to this infection damaging the lining of the stomach walls. This is why it is important to test for this bacteria (through an urea breath test or via stool) if you have known ulcers or reflux symptoms.
Signs of Low versus High Stomach Acid
Put more simply, here are signs that might suggest the possibility of low or high stomach acid:
Low Stomach Acid Signs:
Bloating, burping or gas shortly after meals
Feeling full quickly
Fatigue after meals
Undigested food in stool
High Stomach Acid Signs
Classic heartburn
Sour taste in the mouth
Nausea or vomiting
Distinguishing between high and low stomach acid based solely on symptoms is challenging. Consultation with a health practitioner is essential for an accurate assessment.
The Baking Soda Test
If your symptoms are mild (or even if you are curious but have none of the above symptoms associated with unbalanced stomach acid levels), you can always try the at-home Baking Soda test. Note that this test hasn’t been proven scientifically yet but has obtained good anecdotal evidence. This is not a diagnostic tool and should be used for guidance only.
Some people even have no symptoms at all or symptoms that seem unrelated such as cough, difficulty breathing or a feeling of a lump in their throat. This is known as Silent Reflux.
How to Balance Stomach Acid Levels Naturally
There are a few ways you can improve your situation without medication. No one should be on Proton-Pump Inhibitors (PPIs) or H2 Blockers long term as they can cause a lot of nutritional deficiencies and digestive conditions such as SIBO.
Dietary Adjustments: Including fermented foods and bitter herbs (there are many blends existing on the market) prior to meals can stimulate digestion and secretion of stomach acid. If your mucosa is irritated, avoid spicy foods, caffeine and alcohol.
Lifestyle Changes: Eating smaller meals, chewing thoroughly and avoid lying down after eating. A short walk after a meal does wonders. Stress management also contributes to optimal stomach acid function so I usually recommend a few rounds of mindful breathing before eating.
Supplementation: If herbal bitters don’t cut it for you, you could supplement with Betaine HCL. However not everyone should try supplementing with it so only do so under the supervision of an experienced practitioner.
Understanding that heartburn isn't exclusively linked to high stomach acid opens up new avenues for managing this common condition. Striking a balance in stomach acid levels through mindful lifestyle and dietary choices can pave the way for improved digestive health and reduction of symptoms. If heartburn persists or is severe, please seek professional guidance for an accurate diagnosis and appropriate treatment.