Ep.55 – The truth about stomach acid
19 Jun, 2024

Episode Intro

Should you take hydrochloric acid capsules to increase your stomach acid? This might sound a little bit drastic, but it's frequently said online that low stomach acid is a cause of all kinds of IBS type symptoms, but is it really? In this episode of the Inside Knowledge podcast, I'll share my thoughts on low stomach acid and its role in your digestion. I'll cover how you might know if you've got low stomach acid, and ways that you can help to regulate your digestion to reduce bloating and gas and abdominal pain. So talk about the implications of having low stomach acid on your nutrient absorption and your overall health.

Podcast transcript

The truth about stomach acid

Welcome to episode 55 of the Inside Knowledge podcast. I’m Anna Mapson. Today I want to talk about stomach acid and particularly about low stomach acid and not having enough. I think I will do a separate episode on high stomach acid or managing reflux because that is a kind of separate issue. And as I was planning all the things I want to cover in this 20 minute episode.

It just felt like I wouldn’t be able to give it enough time if I just focused on them both. So we’re going to just talk about low stomach acid. But firstly, let’s just get into what is stomach acid. So interestingly, we produce about one and a half litres of stomach acid every day, which is a huge amount.

If you imagine a big one and a half litre bottle on your table, we’re producing that amount of stomach acid every day. every single day. And it’s really important in helping kickstart our digestive process. It’s very, very acidic as well. So, you know, there’s the pH score and the stomach acid is normally about one and a half to three and a half on the pH level.

And so that’s where we want it to be. We want it to be really, really acidic. Now, the reason it doesn’t burn your stomach is because there’s a kind of mucus lining inside the gut. stomach bag, which helps to protect the lining. When it’s working well, stomach acid helps to break down, proteins that we eat into peptides so they can be better absorbed.

So it’s kind of activating the lining the chemical breakdown of food. In the stomach like there’s a whole mashing up of food like muscular squishing of food together to try and break it down and then there’s also the beginning of this chemical digestion process. Another really important role of stomach acid is it’s there to kill harmful bacteria and pathogens that want to get in through our food.

So this killing off of bad bacteria also happens when stomach acid is high and without it we can be at risk of infections like SIBO, small intestine bacterial overgrowth, or other things like clostridium difficile that can come in through people having low stomach acid. And it’s sort of activating some of the digestive enzymes that happen in the small intestine as well.

So the production of acid in the stomach also triggers the digestive process later on as the food gets down to your small intestine. And I’m going to come back and speak about that in a minute, about B12 and the importance of B12 specifically. But also there are other nutrients that seem to rely on having good enough nutrients.

stomach acid, which includes iron, calcium, magnesium, and as well as those B vitamins that I mentioned. So it’s really important, basically, is the message that I want you to get out of this first intro. Stomach acid is really key to helping us better absorb the foods, the nutrients that we get from our food, and just digesting our food well.

Some of the signs that you might have low stomach acid. would be feeling very bloated, particularly feeling like you get full very quickly and your food sits in your stomach for a really long time. It doesn’t go down, you feel like very heavy and particularly when you’ve eaten a high protein meal.

So if you’ve eaten a lot of meats and this is sitting heavy in your stomach for a long time, this is a potential sign that you have a problem with breaking down that protein. This feeling of fullness or like it’s sitting for a long period in your tummy might also lead to additional belching, like burping air back up, and then also just ongoing fermentation of the food.

Because if it’s not properly broken down and then it gets into the small intestine, that’s where bacteria can start to get to work on it. But then also, like I said, it’s not activating some of those digestive enzymes, which do further break it down in the small intestine. So it just leaves you feeling very heavy, uncomfortable and a lot of the symptoms, which are very similar in IBS.

Now one really important thing I want to stress here is that there is no evidence that having low stomach acid can cause reflux. You will see this absolutely everywhere online that people who’ve got low stomach acid it can lead to you having heartburn and a burning of your esophagus.

That is only down to the sphincter at the bottom of your esophagus, the pipe that travels down from your mouth to the stomach coming open and then whatever is in your stomach, the contents of that coming back up and burning it. So there’s no link between low stomach acid and having reflux. But what you can get is a low stomach acid that has contributed towards things like bacterial overgrowth in the small intestine, which is then causing a lot of bloating and fermentation of the foods that you’re eating.

That creates gas in your small intestine, so inside the torso, you’re getting this abdominal pressure pushing back upwards and that pushing upwards can, in some people, loosen that sphincter or just put pressure on it so that you’re more likely to experience the reflux of that stomach acid into your esophagus.

So whilst you’re Like I said, you will see people talking about this all the time in Facebook groups, blog posts, social media posts. There is no evidence that people who have low stomach acid, that is the cause of reflux. But, like I said, it can lead on to SIBO and other bacteria getting in because you’ve lost one of your lines of defense against pathogens.

Talking about reflux actually leads me on to the main cause of low stomach acid, which is taking a proton pump inhibitor PPI. These are used to stop the production of stomach acid in order to remove the symptoms of heartburn and acid reflux, so they they block the cells in your stomach lining from producing

stomach acid. So having heard why stomach acid is so important, you might be thinking, oh well, I don’t want to take a proton pump inhibitor to block the production of stomach acid because stomach acid is really key and I need it. However, it’s also really important that you don’t burn your esophagus with acid because that can lead to conditions like Barrett’s esophagus where it’s actually changing the structure of the the cells in the lower part of the esophagus due to repeated exposure to acid from the stomach and that can potentially lead on to esophageal cancer.

So it is really important in that condition to keep on taking that . There are lots of other reasons why you would take a proton pump inhibitor. Sometimes when you get given antibiotics, they will also give you one in that is in order to protect the lining of your stomach.

Also, if you are someone who takes a lot of pain killers, particularly things like ibuprofen. So I’m talking about non steroidal anti inflammatory drugs, things that are often given short term for inflammatory pain, like joint pain, muscular pain, that sort of thing. If you’re someone who regularly takes these drugs, then you’re also going to need to take proton pump inhibitors or something to reduce down your stomach acid.

And that is because, They can really affect the stomach lining and can lead to stomach ulcers if you take a lot of painkillers like that. Particularly if you take them on an empty stomach, they will end up damaging your stomach lining.

Another cause of low stomach acid could be a bacterial infection called Helicobacter pylori or H. pylori. This bacteria is pretty common, most people have it, but not everyone will have a problem with it. So it’s when it gets out of control and overgrows, then it produces this enzyme that neutralizes our stomach acid.

You can have a test for Helicobacter pylori with your doctor, and that is a really good way to rule out problems with stomach acid.

Often a stool test is one of the best ways to look for the antigens to this bacteria. And if you are found to have it, sometimes it’s treated, what’s called with a triple therapy, which is two antibiotics and a PPI. And you take that for two weeks or so, but your doctor would do that for you.

Um, so it’s worth getting a test for, um, Helicobacter pylori, if you are concerned. The other reasons for low stomach acid, one of them is aging. Just as we get older, it’s thought that we produce less stomach acid, and this might be down to nutrient insufficiencies, changes in our lifestyle, and just kind of general wear and tear type aging.

So people in their 80s and 90s may struggle with protein digestion, and this can also be a problem, because. In your 80s and 90s you may have more problems with your teeth as well and trouble chewing up things like meat, which is why well cooked foods are really important as you get older to keep up high nutrition as people are aging.

And then the, uh, Other big cause of low stomach acid is chronic stress. So when we are stressed, we tend to produce a lot less stomach acid and just general digestive juices. And that is because our focus for our body is on that fight, flight or freeze response. So we’re putting our energies into our skeletal muscles away from the digestive system and you’re not in a rest and digest state.

If you’re interested in trying to test your own stomach acid at home, what are your options? Well, unfortunately, there isn’t anything at home that can test it. Scientifically give you a result. You might see people recommending that you take some bicarbonate of soda in water and then wait until you burp.

Now this is a thought at work because the bicarb is reacting with your stomach acid and it’s thought that if you burp, Then it means that you’re getting a good reaction of your stomach acid and you’re waiting to see how long it took for you to burp. Unfortunately, there isn’t any scientific evidence that this does correlate to high or low stomach acid and wouldn’t be a good test.

The other thing that people will suggest is that you take betaine hydrochloride Which is hydrochloric acid tablets in order to see if this re acidifies your stomach. And some of the suggestions are to take this until you feel a burn. So you take one at one meal, if you don’t feel any sort of burning in your stomach, you take another two at the next meal, then you take three and so on.

And some people might end up taking seven or eight tablets, which is really quite a lot of hydrochloric acid to be ingesting.

Again, this isn’t really a good method for you at home to judge whether you’ve got good stomach acid or not. In a hospital setting, doctors can use a little capsule that you swallow, sometimes it’s called a Heidelberg capsule and it measures how much stomach acid you’re producing. So, they’re able to really see how much is there in a fasted state and then as you have food in your stomach and that can be a much more rigorous assessment of your stomach acid.

I don’t normally recommend people take hydrochloric acid tablets to help with low stomach acid. I would much rather people work out why their stomach acid is low in the first place and then see what we can do to try and increase it in other ways. There really aren’t many studies showing that taking hydrochloric acid tablets helps. I found one very small study was only using six people and they were healthy.

So the researchers gave them a PPI twice a day in the run up to the study so that they had low stomach acid. Their pH was above 4 which is more alkaline than it should be Like I said, it should have been one and a half to three and a half.

It’s like the ideal pH for your stomach So this was higher which means low stomach acid and then they were given some capsules of betaine HCL and they were given 1, 000 500 milligrams, which is quite a lot and in this time the pH fell rapidly Which means their stomach acid went up as the pH went down And that definitely did work.

Now, what was interesting is this was in a fasted state so they didn’t have any food in their stomach and It was only temporary. So it only lasted for about an hour after taking the The supplements, then the stomach acid changed and went back to its normal PPI induced low stomach acid rate. What they did in another follow up research study, which was quite interesting, is when they had a very small meal, so only 300 calories, 1, 500 milligrams of HCL was less effective.

So if, you can imagine, if you were eating a bigger meal, which might be anywhere up to 1, 000 calories, if it’s your main meal of the day, You might need a lot more of the betaine HCL to get to the same effect of stomach acid. Another thing that’s really important to say is if you do take these tablets at home, you must take them with food.

If you start taking stomach acid tablets to increase your stomach acid on an empty stomach, there is a good chance that you will damage the lining of your stomach because it needs to have, food in there as well to try and get your digestive juices going. Part of the reason that I don’t often recommend taking these tablets is that we don’t have the research that says it’s safe, that says what the correct level is that you should take.

Like I said, that was only two studies that I could find which had really tested it in a thorough way, and they were on a tiny group, just six people. And so I think we need to wait until we have more studies and more evidence before we could say that this is definitely a safe way to approach low stomach acid.

One of the things you can do at home though is to start your meal with bitter tasting foods or, bitter drinks as well. You can even get herbal supplements which help to stimulate your digestive juices. So you use these around 20 to 30 minutes prior to a meal, so sometimes it’s hard to remember, but you can either get little tinctures that you put in water, or You hold in your mouth and it gets your Digestive juices going.

I have also seen one which is quite good Which is a spray and you just spray it into your mouth and it has a whole range of bitter tasting herbs These are often things like gentian and dandelion and they can be good for kick starting your digestive process however I will also say there is not much evidence about these either, but some people do find them helpful And they’re relatively safe in a way Although you must always obviously check That if you’re going to start taking anything with herbs in it that it doesn’t interact with any medication that you’re already taking.

The other thing that is really good for stimulating stomach acid is coffee. And so people who’ve got reflux and high stomach acid are often told to cut down on coffee. So that is something else that helps to increase your stomach acid, but also just any bitter foods. So also thinking about. bitter tasting greens like rocket, dandelion leaves.

You can actually eat them and these are really good ways to start the meal. Radicchio or like endive. It’s also quite bitter. This, can be a good salad starter. So, some natural ways to get some stomach acid going. People often ask me as well about drinking apple cider vinegar and whether this can help.

So, vinegar I think has a pH of about 2 to 3, so it may help to reduce your stomach acid a little bit if you want to put vinegar on dressings and use it with your salad, you don’t necessarily need to be drinking vinegar. If you do want to have apple cider vinegar, or any vinegar, there’s no special thing about apple cider vinegar, really.

Obviously, some apple cider vinegar has got the mother in it, which has got some good bacteria, it’s kind of fermented. However, percentage wise, and like actually how much you’ll be getting, you know, could be any sort of vinegar. But if you are going to drink vinegar, what I’m saying is, make sure it is diluted.

Do not drink it neat. Because it can hurt your insides as it’s going down your esophagus and it can lead to a bit of burning, which would not be great. The best way to improve your stomach acid is to firstly, if you’re worried, I would speak to your doctor and see if you’ve had a test for Helicobacter pylori.

If you haven’t, try to ask to get that test done. You can get them done privately as well, but obviously if you can get it done through your doctor, That’s one way of doing it. Um, check that you haven’t got that, because if you have, it can be treated, can be tested again, and check that you’re okay. So that’s one.

way to remedy it. The second thing though is to really work on your mindful eating. So go back and listen to episode two, if you’ve never heard that episode, which is one of the first things I started off on this podcast shouting about, is how important it is to eat slowly, chew our food, and sort of manage your approach to digestion.

Getting into that rest and digest calm way. I know this is much harder to implement than taking a supplement and so it feels easier to take something or just to want a quick solution to, whereas actually changing the way you eat, it sounds really basic but it has got an impact. About 20 percent of our Gastric acid secretion is done through the cephalic stage of digestion.

So that is like the brain stage. Before you even put any food in your mouth, you are kick starting the process of digestion by engaging with the thoughts of food, thinking about the smells, the texture, what it is you’re going to eat. So a really good thing for you to do if you’re worried about low stomach acid would be to start thinking about food 30 minutes before the food.

Take a little bit of time to chew your food really well when you do eat it. Sit upright at a table if you can. Sit upright, chew the food, put your knife and fork down in between each mouthful and just really make sure you’re eating slowly and as relaxed state as possible. There could be lots of reasons why you might have some issues with digesting certain foods, or why food sits heavily in your stomach, and it might not just be down to low stomach acid.

That is why, ideally, you will go back to your doctor and ask them about this, or work with a nutritional professional who specializes in IBS or SIBO, someone like me. And if you want to work with me, I offer three month programs called The Gut Reset, where I will take you through a whole series of food reintroductions, supplement changes, and lifestyle changes that will be tailored to you and your specific needs.

Okay, I’m going to leave it there for this week. Thank you very much for listening to this episode of the Inside Knowledge. Better digestion for everyone.

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