Low stomach acid is a common issue I see in practice, yet it doesn’t often get much attention when discussing gut issues.

And the reality is, it can be commonly associated with symptoms all the way down your digestive tract. If you think about it, it’s one of the first points of contact for food, and if it doesn’t do it’s job properly then that will flow on through the rest of the digestive system.

Then we’ve got food that isn’t properly digested in the small and large intestines, potentially triggering inflammation and the immune system, and this has a huge impact on the vagus nerve!

Suddenly you’ve got some brain fog, or nervous system dysregulation, as well as gut symptoms, and you can’t figure out what the trigger food is, because it’s not the food at all. It’s your low stomach acid not digesting your food.

Why stomach acid is important

The breakdown and absorption of our foods is complex, but we don’t really give it much thought beyond our dinner plate. The reality is that there is a well-orchestrated set of processes that occur after you eat your first mouthful of food to the time you pass a bowel motion, which help your body to extract the nutrients out of your food (and leave the waste).

In the stomach we secrete Hydrochloric acid, aka stomach acid or HCL, for several reasons such as:

To digest your protein
- HCL initiates protein digestion by converting a substance called pepsinogen into the enzyme pepsin. Pepsin is responsible for breaking apart our protein into smaller molecules which is much more readily absorbed by the small intestine. Without adequate HCL secretion protein digestion is not efficiently initiating and allows undigested larger protein molecules to be absorbed into the systemic circulation which can trigger food sensitivities and intolerances.
To assist with carbohydrate and fat digestion
- Stomach acid also supports the digestion of carbohydrate, fats and the fat-soluble vitamins A and E, by stimulating the release of pancreatic enzymes and bile into the small intestine. This allows them to be broken down further into vitamins and minerals the body can use.
To support vitamin and mineral absorption
- The bioavailability and release of vitamins and minerals such as folic acid, ascorbic acid, beta-carotene and iron, are enhanced with HCL secretion. In contrast low stomach acid can reduce the absorption of certain minerals and trace elements such as calcium, magnesium, zinc, copper, chromium, selenium, manganese, vanadium, molybdenum and cobalt leading to mineral deficiencies in the body. You can start to see the overflow effects of having low stomach acid, can’t you!
To protect us from pathogens
- As well as breaking down and absorbing vital nutrients, stomach acid also plays a role in maintaining a sterile environment in the stomach. It does this by neutralising orally ingested bugs and pathogens before they get further into the body, preventing bacterial and fungal overgrowths of the small intestine.
- Research has shown that Escherichia coli (E Coli) is inactivated when the stomach acidity is high and conversely, when it is low, it is associated with conditions such as Small Intestinal Bacterial Overgrowth (SIBO) and candida. There is also a strong correlation between low stomach acid and an increased risk of a Helicobacter pylori (H. pylori) infection, which is a major cause of gastritis, gastric ulcers, gastric carcinomas and B-cell gastric lymphomas.

Symptoms of low stomach acid

Symptoms will often present several hours after eating and can include;

indigestion
heartburn
reflux
a desire to eat when not hungry
a sense of fullness after meals
bloating under the ribs
nausea
burping
flatulence
constipation
diarrohea
undigested food and fibres in your stool
food sensitivities

And this only really covers what digestive symptoms can be linked to low stomach acid. It doesn’t go into what could happen if bugs can’t be neutralised, or if your minerals drop too low, or even if inflammation is left unchecked in the gut and vagus nerve.

PPIs for reflux and heartburn

These days in clinic I am seeing more and more patients including children, that are experiencing upper digestive complaints like indigestion and heartburn, who have been prescribed medications by their GP such as Nexium, Pariet, Losec, Somac or Zoton.

These types of medications are called proton pump inhibitors (PPi) and as the name suggests, are designed to inhibit your gastric acid secretions to help with symptom control. The problem with this is that this gastric acid, known as Hydrochloric acid or HCl, is secreted in our stomachs to do several important roles that are crucial to digestion and nutrient absorption.

If we inhibit this secretion for too long, we can open the door to a myriad of other digestive complaints that may develop into more chronic health conditions.

How can I improve my stomach acid levels and provide symptom relief?

Firstly, you really need to know if your stomach acid is high or low, and why that might be the case. There are some common natural alternatives and habits that you can use to help improve your stomach acid levels instead of going on medications like PPIs. If these don’t work, it warrants further investigation as to why your stomach acid and digestive health are off balance. As stomach acid production also naturally declines as we age, it is important to instil daily habits that promote acid production sooner rather than later.

Ways to improve stomach acid and digestion include:

Take bitter herbs before meals. Herbs such as gentian (Gentiana lutea) have been used in Europe as a digestive aid for centuries, especially in formulas such as Swedish bitters. Gentian contains the bitter substances gentiopicrin and amarogentin, which act on our taste bud receptors to stimulate the secretion of saliva in the mouth and hydrochloric acid in the stomach. Bitter herbs are more effective if taken before meals as they prime the digestive system for food.

Consume fermented foods before meals. Fermented foods such as sauerkraut, beet kvass and/or apple cider vinegar can also prime the digestive system for food. They are best consumed 10 minutes before meals and do a similar job to bitter herbs.
Avoid drinking beverages with meals. Consuming fluids with meals dilutes your stomach acid concentration and reduces the acidity of the stomach. This can impair digestion and promote bacterial overgrowths.
Check your zinc status. Zinc is essential for stomach acid production. As zinc is used for over 200 biochemical functions in the body and, if we do not consume enough in our daily diet, we can often fall short and stomach acid production may be impaired. Zinc levels can be determined in several ways from red blood cell testing to examining the health of your nails and should be considered if you have symptoms that indicate low stomach acid.
Supplementing with Betaine Hydrochloride and pepsin. Betaine Hudrochloride (HCl) and pepsin are nutritional supplements that have been used safely for many years to restore normal gastric acidity and support your digestive function. The timing and dosing of supplements like these are dependent on your symptoms and their severity.