“All disease begins in the gut.” - Hippocrates
Symptoms of Low Stomach Acid
• Bloating, belching and flatulence immediately after meals
• Heartburn (often thought to be caused by too much stomach acid)
• Indigestion, diarrhea or constipation
• Undigested food in stools
• Rectal itching
• Chronic Candida
• Hair loss in women
• Multiple food allergies
• Iron deficiency
• Weak, peeling or cracked fingernails
• Chronic fatigue
• Adrenal fatigue
• Dry skin
• Bone, cartilage, muscle, joint inflammatory conditions
• Lack of desire for meat
• Various other autoimmune disease
Acid reflux is defined as a condition in which acidic gastric fluid is regurgitated into the esophagus, causing heartburn. What the definition doesn’t explain is why it burns or if it has anything at all to do with excessive stomach acid (or, as the medical professionals say, hydrochloric acid (HCL)). Every day I hear my patients assume they have acid reflux, which is a common assumption. They notice the symptom of burning in their stomach so they relate it to an increase of acid but it is often completely off base. The fact is, all the discomfort is actually stemming from too little stomach acid.
The stomach has a mucosal layer which protects the actual tissue from being harmed. It is also what shields it from feeling the burn of stomach acid. At the bottom of the esophagus, where it reaches the stomach organ, there is a very important valve called the lower esophageal sphincter. The main purpose of this valve is to open to let food pass into the stomach and then to close tightly so nothing is able to come back up like HCL. This valve only opens when the contents of the stomach are at a proper state of digestion. If we do not have enough stomach acid, our food just sits there and ferments. If you know someone who is really gassy, say after a meal, this is the culprit. They have fermented food in their stomach which creates gas and will need to be released. Some people will pass gas through their mouth as in a burp. Some people will bloat and cramp until gas is released down in their lower intestines.
More than half of the population has a weak valve. The burping happens from the pressure of the gas. When fermentation of the undigested food is released, so, too, is a little of the stomach acid. The esophagus has no protective coat like the stomach does—it doesn’t need one since it operates in a very alkaline environment. So, with no mucosa lining in the esophagus, we start to feel discomfort. A normal response to feeling discomfort to a particular food is to think that the food is not good and that we need to avoid it, or, alternatively, to suppress the burning with medication. This is the root of the dysfunctional challenge and, by understanding this, we can begin to reverse the damage.
We need to do everything in moderation and balance in order to maintain homeostasis. The pH scale runs from 0 to 14 — a lower number means a higher level of acidity is present, and a higher number indicates a higher level of alkalinity. A pH of 7 is considered neutral. Our stomach organ thrives and stays optimal around 3 pH, where it has a perfect amount of HCL. Our stomach has a high pH environment for multiple reasons. It is our first line of defense against bacteria like Helicobacter pylori (also known as H. pylori), and activates digestive enzymes to help further break down food.
Secretion of HCL is essential to the absorption of B vitamins. HCL is also needed for iron absorption so, without it, even with iron supplements, you will not be able to get access to the nutrients in the supplements. Stomach acid is vital in order to optimally digest food.
For clarification, HCL in the stomach allows our bodies to:
1. Access the minerals from food. (Without HCL, people will get anemic because they are unable to absorb iron, even when they’re on an iron supplement.)
2. Trigger production of pancreatic enzymes, which finishes the breakdown of food once it gets into the small intestine. (Without pancreatic enzymes, food will be left undigested in your stool.)
3. Trigger secretion of bile from the gallbladder
With low stomach acid, all of these functions, as well as the breakdown of protein, will be compromised.
Medication to suppress acid reflux
There are over 16,000 articles in medical literature showing that suppressing stomach acid does not address the challenge of acid reflux. It is common practice to prescribe antacids and acid blockers such as PPOIs, without patients even being tested to see if they have high HCL. The majority of people I see report that they have been prescribed medication without further testing. Prescriptions work on the symptoms, but they lower stomach acid even further. Acid reflex occurs because the stomach contents come out of the stomach along with the gas—it has absolutely nothing to do with having too much stomach acid. We are just exacerbating the fermentation of food by lowering the stomach’s acidity level even further, something which increases more gas which then needs to be released through the valve, which then ends up splashing even more acid into the vulnerable esophagus.
Let’s break down the types of medication:
1. Antacids - These are the typical over-the-counter medications that have great marketing, drugs like Tums, Pepto-Bismol, Rolaids and Alka-Seltzer. These medications neutralize stomach acid to reduce acid reflux, heartburn and other acid indigestion symptoms.
2. Acid Reducers: Histamine antagonists and Proton Pump Inhibitors (PPIs) - These types of medications suppress the production of stomach acid. Histamines are what stimulate acid production, so doctors prescribe Histamine antagonist. Some common ones are Pepcid and Zantac.
The second type of acid reducer prescribed for heartburn and acid reflux are Proton Pump Inhibitors (PPIs). Ranked in the top 10 ten most prescribed drugs, a 2010 study found that, of 946 patients receiving PPI therapy in a hospital setting, only 35% were prescribed PPIs for an appropriate upper GI diagnosis. Some of the popular ones I hear most often are Nexium, Prevacid and Prilosec, or other medications that end in the suffix “prazole” (omeprazole, pantoprazole, esomeprazole, etc.). In 2014, Americans filled more than 170 million prescriptions for acid blockers, falling only behind statins in total cost expenditure worldwide.
Proton pumps are responsible for gastric secretion (aka how much hydrochloric acid will be released to break down the food you eat). To be able to do this, a proton needs to attach to the proton pump. Without the proton attaching, the proton pump basically can’t be turned on to stimulate the production of HCI.
When we mess with the perfect organic structure of the body, we mess with the life cycle itself, and balance is lost. In the digestive tract, when we muddle up the balance of pH in one organ, it affects all the organs, because the natural rhythm is thrown off. Opportunistic pathogens, bacteria, fungus and yeast all increase.
The main bacteria that causes concern is Helicobacter pylori (H. pylori). Typically found in the stomach, this bacteria thrives in an alkaline environment. It is capable of making an acidic environment more alkaline.
Unchecked, H. pylori will eventually allow big food molecules into the bloodstream. Food molecules don’t belong in the bloodstream and will in turn cause an “allergic reaction” (aka leaky gut). The body is never working against you by sneezing, swelling or itching—it is simply trying to eradicate the challenges at hand. Your body will always give you warning signs and will try to get rid of whatever is creating the imbalance. As H. pylori is addressed, so are all of the allergies that have been created by the body barriers being cross-contaminated.
The symptoms of H. Pylori infections can also be seen in people suffering from osteoporosis, tendinitis, and other chronic inflammatory diseases and autoimmune challenges like arthritis. Inflammation of the protective lining of the stomach is called Gastritis, the most common cause of which is H. Pylori.
It’s not that H. Pylori is the one and only factor. Autoimmune disease needs an increased intestinal permeability to develop. Intestinal permeability is what we describe happens when H. pylori digs itself into the gastrointestinal cell lining, the gut wall, and lets large food particles or material pass from inside the gastrointestinal tract through the cells lining the gut wall, into the rest of the body. Since we know that is how H. pylori thrives, we know it is one large part of the puzzle as to why we have so many cases of chronic autoimmune disease and arthritis. Leaving the system vulnerable to this type of bacterial proliferation will also induce endogenous toxicity because of the toxins bacteria and yeast produce. This byproduct will accumulate in the joints and various muscle groups. Improper use of medication is allowing H. pylori to thrive, but it’s never too late to turn our health around.
There are three at-home tests that are safe and effective enough to determine if you have enough stomach acid. The one to try first because it’s simple and easy is with baking soda (sodium bicarbonate) and your natural stomach acid (Hydrochloric Acid). When we ingest baking soda, it results in carbon dioxide gas that will cause you to burp. The timing of this test is important. It must be done first thing in the morning before you eat or drink anything, and you will want to do this test three days in a row to get the best accuracy. The theory is, if you make enough natural hydrochloric acid, you will belch within two to three minutes. If you end up belching sooner, it means you have excessive hydrochloric acid. If you belch later than three minutes, then the hydrochloric acid in your stomach is low and needs to be addressed.
1. 1/4 teaspoon baking soda (about $3 dollars at any grocery store)
2. A cup to drink from
3. 4 to 6 ounces of cold water
4. Something to stir with (like a spoon)
5. A timekeeper (use your phone, a stationary clock—anything to keep time with)
6. Something to record with (writing utensil and paper, your phone, etc.)
First thing in the morning, before eating or drinking anything, and before putting anything in your mouth, mix the baking soda (1/4 teaspoon) in your cold water (4 to 6 ounces). Time how long it takes for you to belch. Keep going up to five minutes. Stop at five minutes regardless of whether you have belched or not.
If you belch:
Under 2 minutes: you have excessive Hydrochloric Acid in your stomach
Between 2 and 3 minutes: you have normal Hydrochloric Acid in your stomach
Anything above 3 minutes: you have low Hydrochloric Acid in your stomach
Remember, this is not set in stone. It is meant to give you an idea of whether you need to start taking some preventative measures. If you fall in the “low” category of the above test, move onto Test 2 below to get better accuracy.
If you are taking pain medication (NSAIDs or Corticosteriods) on a daily basis, it is highly irritating to the stomach lining. Mixing it with Betaine HCL can cause more irritation, so avoid Test 2. Test 2 is great for those who are not on daily pain medication and just want more of an idea about the quantity of their stomach acid.
For this test, you’re going to supplement with Betaine Hydrochloric Acid (HCL) during the middle of a meal and determine the stomach acid levels by how you feel. It has been reported that 80% of the population will show positive for low stomach acid activity.
There are only two outcomes to this test—yes, that you need Betaine Hydrochloric acid or, no, you have plenty of digestive acid. It is also important to find a Betaine Hydrochloric acid supplement that incorporates pepsin. Pepsin is an enzyme that helps break down protein even further. This test also requires a high red meat quality meal. If you do not eat red meat, this test will not work for you.
1. A supplement of Betaine HCL that contains pepsin
2. At least 6 ounces of cooked red meat (how it is cooked does not matter)
In the middle of eating your 6 ounces or more of cooked red meat, take orally 1 pill of your Betaine HCL supplement. Continue to eat the rest of the meal. That’s it.
Take note of how you are feeling through the rest of the meal and after. If you feel no different or you feel good, it means you have lower activity of stomach acid. If you have distress of any kind, like burning, or a sensation of heat, it means you have too much.
So, if you finished this test and you feel normal or good, then it’s a sign to start using techniques to improve your digestive stomach acids.
This test needs zero equipment, as long as you have a hand available to feel some pressure points of the body. These pressure points have been used for over 5000 years in an ancient healing art form of Traditional Chinese medicine. People wouldn’t be using it for thousands of years if it were super complicated. I will break the test down into simple language so it’s easier to understand.
Every nerve that comes from the vertebra has a purpose and origin. The nerves that get hyperactive and deficient with acid reflux are associated with Thoracic vertebra T5-T9, which is basically between the shoulder blades, right where the esophagus, LES, and stomach meet. In acupuncture, the back points that are associated with these vertebra are treated, as well as some corresponding points throughout the body. Where the ganglia of these nerves meet, there will be tenderness or pain to the touch in the front of the body. If you locate these points and they are tender, it signifies that there is inflammation and decreased stomach acid. As the stomach becomes balanced, the points will no longer be tender.
1. Locate the xiphoid process with your left hand.
2. Run your fingers over to the edge of the ribcage.
3. Press down on the edge of the ribcage and around the area and notice if it is tender.
Techniques to Improve HCL in the Stomach In Order to Improve Digestion
When we are trying to improve digestion, we need to first understand what it is that we are trying to accomplish. Your health is the key to enjoying life to the fullest. You'll want to listen to your body’s wisdom so you can return to optimal wellness.
A question that I and other medical professionals always ask is where do you lie on a 1 to 10 scale of discomfort? This will give you a way of monitoring your progress at home.
0 = No Pain
1-3 = Mild Pain (nagging, annoying, only slightly interfering with your day)
4-6 = Moderate Pain (interferes with your day)
7-10 = Severe Pain (disabling; unable to perform throughout the day)
There are three things we need to do: Soothe, Repair and Rebuild.
1. Soothe the current irritation naturally - replace the chemicals
2. Repair the current challenges - anything involving inflammation
3. Rebuild and maintain the natural environment of the stomach
This is for when you are experiencing acid reflux or heartburn. Pain is stressful and we need to tackle it first. We have already learned that stress can cause additional challenges with the functioning of the stomach acids and the ability to digest. Let’s accomplish pain relief as quickly and as naturally as possible. Here are a few things you can do to soothe the burn.
1. One half to one full teaspoon of baking soda (sodium bicarbonate) in an eight-ounce glass of water will help neutralize stomach acid and ease the burn of acid reflux. This is not an everyday thing, only in emergency situations. Or, a safer option is to make a tea by mixing a few drops of lemon juice in warm water with half a teaspoon of baking soda.
2. Make some chamomile tea. It sounds so simple, and it is.
3. Aloe vera juice can be your esophagus’s best friend. It is beautiful for soothing burning sensations anywhere in the body. I would recommend 6 ounces any time you feel a burning sensation.
5. Honey, honey, honey! Take a spoonful of organic honey or mix it in hot water for a tea. Add it to either the baking soda or chamomile tea for relief of even your most severe symptoms. According to the medical research, it is proven to reduce inflammation in the esophagus, preventing damage by removing free radicals, which is important because reflux is caused by free radicals that damage cell lining in the digestive tract. Honey is an antioxidant and free radical scavenger. It will coat the mucous membrane of the esophagus which will contribute to longer-lasting relief. Honey is also antibacterial and antiviral. Raw honey will kill bacteria and fungus. It is a natural antiseptic. Honey also contains natural hydrogen peroxide, making it effective at treating wounds. Makuna Honey is the most effective, but any type will work to soothe the discomfort as long as it is organic.
6. There is an acupuncture point on the wrist that is proven to stimulate the muscular lower esophageal sphincter so it is able to regulate the closing of the valve to keep acid down. The LES becomes 40% stronger with stimulation to this point. In Traditional Chinese medicine, it is called Pericardium 6 (P6) or Nei Guan. P6 can be located three fingers below the wrist on the inner forearm, in between the two tendons. This is the point that the popular seasick bands are trying to stimulate for the same reason. It will help to keep the valve strong and closed to prevent you from throwing up.
Locate the point by turning your hand over, palm facing up. Apply downward pressure between the two tendons. Stimulate this area with massage for one minute. When receiving acupuncture, you would have this point stimulated for 20 minutes with a needle.
You are now armed with quick, effective and, best of all, natural ways to soothe the burn and replace medication that harms your stomach’s organic balance of acid.
Now that we’ve covered the quick fix by soothing away the discomfort, it’s time for phase 2: repair. Many people will never have had an episode of discomfort, in which case they won’t even need phase 1 (i.e., to soothe), and can just jump right to repairing. Even if you never had symptoms, it’s smart to do repairs if you test positive for low stomach acid. In the repair phase, we will be working on the lining of the stomach, fixing the damage so you’re one step closer to optimal. Here are things you can do to repair and achieve optimal health:
1. Ginger has been time-tested and documented. It prevents ulcer formations better then prescribed medication, with an eightfold greater potency. The anti-inflammatory properties will start to repair the inflammation that has formed, not only in the esophagus and stomach, but in the rest of the body as well. Fresh ginger root is best and can be added to any recipe or smoothie. You can also simply eat some thin slices of ginger daily (like the amount served when you order sushi). Fresh ginger will have a light and spicy taste.
2. Okra (abelmoschus esculents) is wonderful at repairing the mucosal lining of the stomach because of its gelatinous consistency and healing properties. Studies show it also prevents H. pylori from attaching. Okra is a great source of fiber, supports the immune system, and is great for eye and heart health. As mentioned previously, low stomach acid is associated with B-vitamin deficiency. Okra is a rich source of B complex vitamins, which helps to maintain proper functioning of the gastrointestinal system. Okra will not only repair inflammation, but it will also help to heal the stomach lining, providing relief of pain. Okra can be used in supplement form or enjoyed all on its own. Fresh okra is in a pod form and you will want to remove both ends and cut into slices.
3. Fermented probiotic dairy products reduce the risk of disorders associated with high degrees of gastric inflammation and mucus depletion. Common bacteria in yogurts are streptococcus thermophilus and, another one with a bigger name, lactobacillus. My personal preference is to take an oral probiotic supplement because it sometimes can be hard to consume enough yogurt and fermented food. Probiotic pills can be encapsulated so more nutrients make it through the stomach alive, and taking non-enteric coated pills with or 30 minutes before a meal offers a better chance of probiotic survival in the gut, as reported in the December 2011 issue of “Beneficial Microbes.” That being said, you need to make sure your probiotics supplement also has prebiotics. Probiotics feed off of prebiotics (things like prebiotic insulin) and are a requirement for colonization in the gut. So, make sure prebiotics are within your probiotic supplement.
4. Adaptogen herbs lower cortisol. Cortisol is formed during stress which, as we discussed earlier, is one of the key components that causes damaging effects by lowering stomach acid and increasing inflammation. Licorice Root (radix glycyrrhizae) and turmeric (curcuma zedoaria) are great for, not only lowering cortisol levels, but for the treatment of gastric inflammation. Best of all, together they kill H. pylori. It has been revealed in studies that, within fifteen minutes, turmeric and licorice can kill 100% of the H. pylori it is exposed to.
Repair and rebuild go hand in hand, although there is one thing that stands out in the rebuild phase—we need to understand what we are rebuilding. Throughout this chapter, we have been talking about stomach acid that is too low and the havoc that can cause. The rebuilding of stomach acid is vital to accomplishing optimal health and the freedom that comes from a properly functioning digestive system. Most of the rebuild phase is best implemented before consumption of a meal—15 minutes prior would be ideal. That being said, doing anything is better than doing nothing at all. This can be accomplished in a few ways:
1. A great at-home method for improving acid in the digestive system is taking apple cider vinegar before each meal. Apple cider vinegar contains acetic acid which will increase acid within the stomach and regulate the pH. It also contains B vitamins and trace minerals that get depleted when we are not properly digesting our food. It is also antibacterial and acts as an antimicrobial agent. Apple cider vinegar contains healthy acids like isobutyric, acetic, propionic and lactic acid that can control the growth of unwanted yeast and bacteria in your stomach and throughout your body. A tablespoon will be plenty, but it needs to be taken before every meal. Not all apple cider vinegar is created equal, so we need to look for a few things when purchasing for this purpose. It is imperative to ensure that you are using a top-quality organic, unfiltered (raw) apple cider vinegar that comes with the “Mother.” The Mother makes the apple cider vinegar look cloudy. If apple cider vinegar is pasteurized, the Mother culture has been removed, and so has a lot of the nutritional benefits. The mother culture consists of good bacteria, enzymes, pectin, proteins and minerals. If it is challenging to drink due to taste, add honey and a little bit of water.
2. Add Betaine Hydrochloride to your daily diet. The easiest way to obtain more Hydrochloric acid in your diet is by supplementing with a Betaine Hydrochloride. Betaine Hydrochloride is an acidic form of betaine, a vitamin-like substance found in grains and other foods, and it increases the level of hydrochloric acid in the stomach necessary for proper digestion and assimilation of nutrients from food. Look for Betaine Hydrochloride supplements that also contain pepsin. Pepsin is a protein-digesting enzyme that can function in an acidic environment. There have been studies showing that, if HCL is low, so is pepsin.
3. Digestive bitters will also rebuild deficient acid in a roundabout way. Remember, we are working systemically with our body, not just biomedical. Meaning, we need to treat the whole system to sustain and achieve optimal functioning. Bitters will work amazingly if you still have some acid-producing capacity. They encourage digestive enzymes, bile & HCL production. They help produce saliva to start the beginning process we need for digestion. There are lots of bitter tinctures available for consumption. Gentian, globe artichoke, hops and dandelion root are some of the safest and most effective herbs at stimulating gastric acid. Ginger is also a great digestive stimulant. Bitters must be tasted in order to experience their benefits—they are unable to be taken in capsule form. To help begin the process of digestion, add approximately 15 drops of a bitter formula to a small glass of water or a few drops on the tongue 15 minutes prior to a meal. Also, it can be added to salad dressings.
4. Exercise to strengthen the lower esophageal sphincter (LES). As mentioned earlier, the LES is the door to the stomach, and it should normally stay closed. When gas needs to be released from the stomach from foods fermenting, the LES valve opens, which allows the gas to be released, but it also splashes up some stomach acid. Because it is a muscle, over time, the LES becomes weak. A great, simple way to exercise the LES is through a breathing technique. This technique is called belly breathing. This exercises the diaphragm, which surrounds the weakened LES. The LES is an involuntary muscle, which means it’s not consciously controllable. But by working on what supports and surrounds it, we are able to work on the LES. Great, right?
Simply place your hands on your belly and breathe deeply. Push the belly out with your breath and exhale gently. Start by deep belly breathing, inhaling and exhaling 20 times, 3 times a day--when you first wake up, in the afternoon, and before bedtime. If you would like to do 5 reps before eating, that would be extremely beneficial as well.
You will want to make this a daily practice.
After working so hard on repairing and rebuilding your stomach acid, we will want to prevent it from ever becoming out of balance again. There are a few things that lead to lower digestive acid, which, not only puts pressure on the digestive system, but on other organs and bodily functions as well. The following would be beneficial to incorporate into your daily lifestyle, regardless of the amount of hydrochloric acid in your stomach.
To sum up: digestion is a natural process and quite easy to maintain. Use these helpful tools to figure out where you stand in regard to your own stomach acid, and see if it has caused some of your mysterious symptoms. You are now fully aware of the importance of HCL and how it keeps the body in balance. Keep your stomach acid maintained and you will be well on your way to optimal health.
1.The Annals of Otology, Rhinology and Laryngology in July 2012reported.
2.Originally published in Guidelines for drinking-water quality, 2nd ed. Vol. 2. Health criteria and other supporting information. World Health Organization, Geneva, 1996.
13.(Toxins - Types and Sources) .