The Impact of Low Stomach Acid On Your Gut Health
Healthy digestion begins in your upper digestive tract. When problems here arise, food cannot be broken down properly and this has a follow-on effect in your lower digestive tract. Hypochlorhydria is the scientific name for low stomach acid. It’s a common condition that increases with age. If you’re someone who experiences chronic digestive issues, indigestion, food intolerances, or unexplained nutrient deficiencies, chances are you could have low stomach acid.
Why is stomach acid so important?
Every day your body makes 1-3L of stomach acid containing hydrochloric acid, digestive enzymes and binding products. We need stomach acid to break down protein, carbohydrates and fats, absorb essential vitamins & minerals, and to kill harmful microorganisms. Your stomach acid should have a PH of less than 3. Many processes are reliant on this acidic PH, such as the regulation of your pyloric sphincter (the gate between the stomach and small intestine), and the release of bile & digestive enzymes in your small intestine. If not enough stomach acid is produced, the PH can increase to 3-5 which inhibits these essential processes. This is what can happen:
Food is not broken down properly in the stomach and ingested microorganisms are not properly destroyed.
Food can sit in the stomach for longer periods. This leads to acid reflux and indigestion.
Nutrients aren’t absorbed in the small intestine, leading to nutrient deficiencies.
Gut lining becomes irritated and inflamed, leading to leaky gut & food sensitivities.
Microorganisms take up home & cause dysbiosis, candida & parasite infections.
Bacteria translocate from the large to the small intestine, causing SIBO.
Undigested food can excessively ferment in the large intestine causing symptoms of IBS such as gas, pain and bloating.
Conditions associated with low stomach acid:
Acid reflux/indigestion - Acid reflux and indigestion are commonly thought to be due to too much stomach acid. However, in most cases, they are caused by too little stomach acid. If the stomach PH is not acidic enough, unbroken down food tends to stay in the stomach for an extended period leading to symptoms of acid reflux & indigestion. Antacids and proton pump inhibitors (PPIs) are commonly prescribed but they do not target the root cause and make things much worse over time.
Intestinal hyperpermeability (leaky gut) - Food that is not properly broken down in the stomach can then go on to irritate and inflame the lining of the small intestine, which causes leaky gut and allows particles to enter the bloodstream [1]. Leaky gut is commonly linked with autoimmune conditions, food allergies & sensitivities.
Nutrient deficiencies - When not enough stomach acid is produced, absorption of key nutrients including calcium, iron, folate, B6, B12 and essential amino acids is impaired [2]. Deficiency of these nutrients can have a major impact on many body processes.
Food allergies/sensitivities - Lack of stomach acid prevents the proper breakdown of proteins which then make their way into the bloodstream. The body then forms an immune response resulting in allergies or sensitivities [2].
Dysbiosis, candida & parasites - Low stomach acid prevents the elimination of harmful microorganisms which can then go on to reside in the large intestine [1]. This can make someone more susceptible to parasites, candida, food poisoning, and excessive pathogenic (bad) gut bacteria.
SIBO - Low stomach acid promotes the translocation of bacteria from the distal bowel to further up the digestive tract, causing an overgrowth of bacteria in the stomach and small intestine [2]. This is known as small intestinal bacterial overgrowth (SIBO). Long-term use of proton pump inhibitors (ie. Nexium) which lower stomach acid, is associated with an increased risk of developing SIBO.
IBS - If foods are not broken down properly, when they reach the large intestine, excessive fermentation can occur causing gas, pain, bloating, and other IBS symptoms [1].
Skin conditions - A huge percentage of people who experience acne, rosacea, eczema, psoriasis and other skin conditions have hypochlorhydria. This is due to the effect that low stomach acid has on absorbing key nutrients required for skin health, as well as disrupting intestinal microflora and causing leaky gut [3].
Anxiety and depression - Deficiency of key nutrients required for neurotransmitter production and brain function such as B6, zinc, folate, omega 3 & amino acids can occur. Intestinal hyperpermeability, systemic inflammation and dysbiosis are also strongly linked with psychological conditions [3].
Autoimmune conditions - Low stomach acid may be associated with autoimmune conditions due to the immune dysfunction caused by leaky gut & dysbiosis [1].
Hormonal imbalance - Low stomach acid can cause a deficiency of key nutrients required for hormone production such as magnesium and certain amino acids. This can contribute to conditions such as PMS.
Causes of Low Stomach Acid
Dehydration - The stomach requires water to produce stomach acid, therefore dehydration can lead to hypochlorhydria.
Chronic Stress - When we are in fight or flight mode our body prioritises survival over digestion. We produce less stomach acid, saliva and enzymes when we are in a constant state of stress. There is a huge link between stress and digestive problems.
Nutrient deficiencies - We need key nutrients to create stomach acid such as zinc, B vitamins and amino acids. Deficiency can lead to hypochlorhydria.
Eating quickly - It’s common for people to eat on the run, while doing work or while watching TV. This puts our body in fight-or-flight mode and bypasses the cephalic phase of digestion which is important for stomach acid release.
Age - Stomach acid levels decrease as we get older, therefore extra support may be needed. Those aged 65 or older are most at risk.
Medications - Antacids and PPIs such as Nexium are commonly prescribed in cases of acid reflux & indigestion. Studies are finding that these medications have terrible side effects and long-term use will decrease the production of stomach acid over time, making things much worse. Other medications such as the pill can deplete nutrients required for stomach acid production.
Surgeries - Stomach-related surgeries such as a gastric bypass can decrease the production of stomach acid.
H.pylori infection - H.pylori infection can cause stomach ulcers & can decrease stomach acid production over time if left untreated.
Excessive alcohol intake - Alcohol intake can increase stomach acid short term, however, over time it depletes the body of essential B vitamins, zinc and magnesium which are required to make stomach acid.
Symptoms of Low Stomach Acid
Bloating especially after meals
Acid reflux or indigestion
IBS symptoms
Brittle hair and nails
Food sensitivities & intolerances
Burping & excessive gas
Feeling overly full after meals
+ more
How to increase stomach acid
Stay hydrated
Ensure you’re drinking at least 2L of water daily and an extra 1L per hour of exercise.
Consume bitter foods
Drink a glass of lemon juice or apple cider vinegar diluted in water 15 mins before meals. Add bitter foods to your meals such as kale, rocket, and dandelion greens.
Avoid drinking with meals
Avoid drinking large amounts of water or other beverages with meals as this dilutes and reduces the acidity of the stomach.
Correct nutrient deficiencies
Ensure you’re eating lots of foods high in iron, zinc, B vitamins, magnesium and protein. Supplementation may be necessary depending on your level of deficiency. Get your levels assessed by a practitioner.
Practice mindful eating
Sit down to eat without distractions. Put your phone away and turn off the TV. Chew your food slowly and pause between bites. This stimulates stomach acid and promotes proper digestion.
Work with a practitioner
If you think you may be experiencing low stomach acid, the best thing you can do is work with a naturopath or other health practitioner who can create a treatment plan tailored to your needs. When it comes to treating hypochlorhydria it’s really important to identify and treat the root cause, otherwise, things will get worse over time. A practitioner will also investigate and treat problems that low stomach acid may have contributed to such as food sensitivities, SIBO, leaky gut or dysbiosis.
If you’re interested in working with me to heal your gut, please contact me.
References:
Clinical Naturopathic Medicine - Leah Hechtman (2019)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238915/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048199/