“LOW stomach acid?!? Nonsense!” Dr Lucy, ObGyn snapped. “Shanice has PCOS and acid reflux. What she needs is a weight loss meal plan that will reduce her acid levels!”
I smiled (because I knew she’d say that) and calmly replied:
‘‘With all due respect Doc, it’s not Shanice’s weight that keeps her up at night.
But the stabbing stomach pain.
And the recurrent nightmares about her becoming the next bald humpty-dumpty – her words, not mine – because she’s always so knackered, she keeps dropping and breaking stuff.
These are all signs of low stomach acid. Think about it: won’t her inability to digest foods cause nutrient deficiencies that will mess with her sex hormones? And insulin levels? And contribute to her PCOS symptoms?”
… [The ectoplasmic silence oozed through the phone. Yeah, like in Ghostbusters cartoons .]
“Shanice seems to be feeling happier. I hope you know what you’re doing,” Dr L. said as she hung up.
👋🏼 Yo! What’s up, y’all! Shari here.
And today is #WillStomachAcidPleaseStandUpDay!
No, that’s not a thing. But it should be.
Because let me ask you something. What do the following warning signs have in common?
- Anovulatory cycles (it is possible to get your periods even if you haven’t ovulated)
- Bloating, burping, gas, flatulence
- Brain fog
- Brittle fingernails
- Chronic clogging of your drain (a.k.a. scary hair loss)
- Constipation and/or diarrhea
- Extreme fatigue (like ‘needing a nap after you shower’ kind of fatigue)
- Feeling abnormally full even when you haven’t eaten excessively
- Food in your poop
- Food sensitivities and intolerances
- Intestinal infections (parasites, yeast, candida)
- Killer joints (nope, not talking about ganja here)
- Metamorphosing into The Irritable Hulk during your periods (and non-period days as well…)
- Nutrient deficiencies
- Period pain
- Skin issues like ‘crocodile skin’, psoriasis or eczema
- Small intestinal bacterial overgrowth
- Snowflakes (euheum… dandruff) on your shoulders
- Stomach cramps
You guessed it! Low stomach acid.
But how you ask? Great question ma friend.
In this article, I’m going to share the following with you:
B. Low Stomach Acid Warning Signs
- Do you have low stomach acid? (+ how to test)
Why don’t teenagers pop Tums?
You’re probably thinking ‘What kind of stupid question is that?’
But hear me out.
We’ve all seen those indigestion/heartburn commercials where people suddenly feel better after taking acid suppressing drugs.
And the conventional theory goes like this:
- You have acid reflux.
- You take medications to reduce acid.
- Your symptoms go poof.
- This means acid reflux = too much stomach acid.
Do you think this makes sense? Yes? Then check the graph below – it shows the average change in stomach acid levels between ages 20 to 80 (from Wright, 2001 p.20).
See how, as we age, the incidence of heartburn and reflux diseases RISES as stomach acid levels PLUMMET.
So, if part (D) of the above analogy was true, teenagers (high stomach acid levels) should be plagued with acid reflux. And should, therefore, be popping acid suppressing drugs like there’s no tomorrow.
But that’s not the case.
This low stomach acid theory is flimsy! Antacids and their cousins provide relief! 🤨
Oh no lady – the ‘theory’ is rock-solid.
Michaela B., 71 years-old (real patient, name changed for privacy)
Michaela came to see me because she could no longer bear her crippling stomach pain. Turned out she started antacids when she was 45 years old, a few months after her husband was diagnosed with terminal liver cancer.
Below is her heartburn prescription ‘landmarks’:
- 1992: Tums, as needed
- 1994: Tums, after each meal and milk of magnesia in between meals
- 1997: Gaviscon and tums after each meal
- 2005: Nexium 20mg once every 2 weeks + milk of magnesia 1 to 2 times per day
- 2008: Nexium 20mg once a week
- 2012: Nexium 40mg before each main meal
- 2017: Omeprazole 20mg upon waking up and before bed, Nexium 40mg before each main meal
Let’s do some logical thinking now.
IF Michaela had excessive levels of stomach acid, those acid-reducing meds should have solved her acid reflux, right? Right.
Then, how is it that her reflux episodes became more frequent? And why did she have to switch to stronger drugs, and higher doses of said drugs to get some relief?
Because her low stomach acid was triggering her symptoms and her medications were further reducing her stomach acid levels.
In fact, stomach acid plays such a crucial role in your overall health that the stomach has specialized cells named parietal cells. These cells have 2 jobs:
- Produce stomach acid
- Secrete intrinsic factor which helps the body absorb vitamin B12
Yet another story, Shari… And you didn’t answer the Q above.
Hold your horses: here’s another analogy to drive my message home.
Let’s say you shaved your knuckles when grating some beets. Your hand will sting when you wash them with water. Would you then say that:
- The burning sensation was caused by too much water.
- Water doesn’t normally cause any painful sensation when it touches your skin unless the skin is bruised.
Option 2, right?
Well, that’s the same thing with stomach acid. If it crawls up the esophagus, it will irritate the delicate lining of your food pipe, causing a burning sensation.
Any amount of stomach acid in the esophagus is going to cause symptoms because the esophagus is NOT designed to handle any amount of acid.
Now, let’s say you put some waterproof band-aid on your bruised knuckles before you wash your hand. You’re unlikely to feel a thing.
This is how antacids (like milk of magnesia, tums, Pepto-Bismol, Alka-Seltzer, Rolaids, and Gaviscon) neutralize any acid that goes up the esophagus. But many brands also contain ingredients like aluminum which can cause constipation + trigger autoimmune flares.
If you open the tap to wash your bruised hands and there’s no water, your knuckles won’t sting. Similarly, if no acid goes up the esophagus you won’t get any symptom.
And that’s how proton-pump inhibitors, PPIs (like Nexium, all the ‘prazole’ drugs) and H2 blockers or H2 antagonists (like Axid AR, Pepcid AC, Zantac, and Tagamet) work. They practically stop stomach acid production:
- PPIs can block the enzyme the stomach cells need to produce acid for up to 3 days!
- H2 blockers make the stomach cells less sensitive to the stimuli that would trigger acid production.
Let’s leave ‘symptom suppression’ to Western medicine. And focus on WHAT is causing the symptom in the first place 👇🏼.
How low stomach acid causes acid reflux
The current scientific reasoning is that the stomach’s lower esophageal sphincter can dysfunction and cause reflux.
The human English version of the above:
You’ve got a main door in your house through which you can enter or leave your house. I would guess that this main door is usually kept close. But what if, a gust of wind could open the door? What would the wind bring with it?
Similarly, your stomach has two main doors. But I’ll talk only about the upper door named LES (lower esophageal sphincter) today.
So, LES separates the stomach from the lower end of the esophagus. See my drawing below . (Do you like it? Or does it show I’m a terrible ‘artist’?)
She only relaxes (opens) to:
(1) let in foods or liquids that you’ve swallowed
(2) let out gas (burps) and vomit.
That’s it; LES isn’t supposed to open for any other reason except if she malfunctions (as is the case in reflux disease).
Low stomach acid or a LES that’s gone cray-cray?
No, LES didn’t go crazy: she’s being compelled to open.
In his book ‘Heartburn cured’, microbiologist Norm Robillard, PhD explains that, in some cases, the body may be unable to digest the carbs you eat. So, bacteria in your digestive system get high on those carbs and well, they fart.
And since the bad bacteria have been fed, they’ll reproduce like a mogwai after midnight. Results: bacterial overgrowth.
Too many bad bacteria + Poorly digested carbs = More gas which spells ‘Open Sessssammme’ for LES. Results: .
As the gas increases pressure in your abdomen, you may ‘feel pregnant after eating’. This forces the LES to open and let out some of the gas.
The more pressure the gas leaves the stomach with, the more likely it is to drag along your stomach’s content. Read: the acid in your stomach (even if you have ‘two drops’ of acid) and undigested food.
But what causes carb malabsorption?
Stomach acid stimulates the release of pancreatic enzymes in the small intestine. In other words, the pH must be low enough for the enzymes to be secreted.
Pancreatic enzymes promote the digestion and absorption of carbohydrates.
Low stomach acid = HIGH pH which means that pancreatic enzymes will not be secreted. And carbohydrates will not be broken down completely.
But wouldn’t the acid kill ’em bacteria? So, how do they overgrow?
See? I knew I wasn’t the only one with the inquisitive mind. Up here ma friend .
But you kinda answered your own Qs. Because, yep, stomach acid is like Mr. Wick to bacteria – they’re doomed if they cross path with it.
Usually, parietal cells (which help your stomach produce acid) maintain a very low pH in the stomach – the more acidic the stomach milieu is, the lower the pH.
However, low stomach acid increases the pH and the stomach becomes less acidic. Now, guess who’s happy? The bacteria – these nasty fellows thrive at a pH above 4.
As explained, the more bacteria you have in the stomach, the more gas they’ll produce. And the more gas there is in your stomach, the higher the pressure will be and the greater the risks of reflux.
Taking antacids when you have low stomach acid = A very high price to pay 😱
Taking one dose of PPIs – yes, those drugs are the most common antacids prescribed – can reduce your stomach acid by 90%…
Why is it such a problem?
Well, let’s talk about the functions of stomach acid first.
(Of course, Shari, please do take more of my life with your lovely explanations.)
✋🏼 Mea Culpa. But I won’t be able to sleep tonight if the concept of low stomach acid isn’t clear for you. And not sleeping at night messes my digestion BIG time – good morning stiff and aching joints! (See what I did there? 😆)
1. Stomach acid is one of your 1st lines of defense against parasites, bacteria, or viruses.
You ate a taco gone bad? And you’ve got low stomach acid?
It’s highly likely that you’ll end up with food poisoning 😕.
Stomach acid also keeps yeast and bacteria in check – this is why antacids can often cause small intestinal bacterial overgrowth.
2. Stomach acid is needed to activate the enzyme pepsin.
Pepsin is a substance that initiates protein break down into amino acids. Your stomach is made of protein. Guess what would happen if pepsin was always in an activated form…
Low stomach acid = Low pepsin activation = amino acid deficiency
And if you lack amino acids, your body won’t be able to have the ingredients it needs to produce neurotransmitters. These are chemical messengers that help your brain cells talk to each other.
- Brain fog
- Irritability and mood swings
- Other mental issues over time
3. Nutrient absorption depends on Acid levels in your stomach.
Would you agree that your body needs nutrients to produce healthy hormones and for your thyroid (and other organs) to function optimally?
“You are what you eat” doesn’t make sense. You could eat healthy foods and still be unhealthy.
Because once you’ve eaten, what does your body do with that food?
Translation: can you stomach produce enough acid to:
- Trigger the release of bile from your gall bladder?
You see, the contents of your stomach need to be acidic enough when they enter your small intestines to promote bile release. Without bile, your body will have issues absorbing fat-soluble vitamins A, D, E, and K as well as various antioxidants like CoenzymeQ10 (CoQ10) and carotenes. And omega-3 fatty acids.
- Start the cascade required for the absorption of various nutrients?
I’m talking about zinc, iron, calcium, folate (B9), methylcobalamin (B12), pyridoxine (B6), and nutrients such as thiamine (B1), riboflavin (B2), and niacin (B3) which are attached to protein.
4. Stomach acid can protect you against infections.
Your stomach’s pH needs to be low (acidic) enough to kill bad bacteria such as:
- Clostridium Difficile
- Other nasty bugs
Low stomach acid can also put you at risk of small intestinal bacterial overgrowth which refers to excessive growth of bacteria in your small intestines.
5. Stomach acid helps you tolerate the food you eat.
If you can’t break down proteins (because your stomach can’t produce enough acid), these can appear undigested in your intestines. Since that’s not normal, these undigested proteins can confuse your immune system and cause unpleasant reactions. Or trigger autoimmune flares.
And if your stomach is regularly unable to produce enough acid, you could be at risks of developing:
- Food allergies
- Food sensitivities
- Food intolerances
See how the acid in your stomach plays a ginormous role in your overall health? Therefore, taking antacids can result in a host of health issues (with a huge medical bill).
Now, let’s move to 2 frequently asked questions.
If low stomach acid is the real problem, how come there are a bajillion types of acid-blocking drugs on the market?
Because these drugs are cash cows for Big Pharma. The following facts speak for themselves:
- 64.6 million: The number of prescriptions filled for reflux disease in 2004
- $6.3 billion: The sales for Nexium, the 2nd most sold drug in the U.S. in 2010
What tests can i do to see if i have adequate acid levels?
Let’s start with the cheapest test. But please keep in mind that, as far as I know, there are no scientific studies that prove this method is either reliable or accurate. It’s still worth a try though.
1. The baking soda test
What you’ll need: 1/4 teaspoon of baking soda mixed in a glass of cold water (about 150ml /5oz).
“Procedure”: Drink the baking soda mixture first thing in the morning, before brushing your teeth, and drinking or eating anything. Note down how much time you take to burp – wait up to 5 minutes.
How to analyze your results:
- Do the test on 5 different days.
- Take an average of the time you take to belch. If it takes:
– 1 to 2 minutes: you likely have enough stomach acid.
– 3 to 4 minutes: your stomach acid levels are probably low.
– 5 minutes or more: you likely have very low stomach acid levels.
2. The betaine HCl challenge test
What you’ll need: One betaine HCl pill (Dr. Jonathan Wright suggests using one pill that includes pepsin and a maximum of 650mg of betaine HCl.)
“Procedure”: Eat about 6oz of animal protein. Mid-way through your meal, take the betaine HCl pill and finish your protein. And pay attention to your body.
How does this test work?
- Normal acid levels: You’ll feel a burning sensation / hotness in your stomach.
- Low acid levels: You won’t notice any difference. Or you’ll feel much better than you usually do when you eat a big chunk of animal protein.
Note: NSAIDs and corticosteroids put you at risks of stomach ulcers. And when taken with betaine HCL, they can increase the risk of gastritis. So, check with your doctor before trying this test or supplementing.
And the most accurate test for low stomach acid goes to …
3. The Heidelberg Stomach Acid Test
This test (backed by over 140 scientific studies) can cost about USD350 and is rarely covered by health insurance.
You’ll be asked to swallow a small pill that has a radio transmitter + a baking soda solution. The radio transmitter will record your stomach acid levels as you drink the solution. And you’ll get a pretty graph as the one from pH capsule below.
Super. Now I know I have low stomach acid.
What now, genius? And how does that affect my lady parts and immune system?
Uhmm, I was supposed to cover what to do in this post. But decided not to make an ‘ebook kinda post’. So, be on the lookout for part 2 of this series.
In the meantime, I’d love to hear from you: what a-ha moments did you have while reading this post? Share in the comments below . And do ask any Q you might have.