Low stomach acidity can prevent the body from properly digesting certain nutrients. How are you supposed to know if you have low stomach acid? What should you eat (or not eat), and what effects can this have on your health?
I’ve seen quite a bit of buzz on the internet lately pertaining to concerns around low stomach acidity. Now, this is actually a true medical condition that people can have, and it does have potential health consequences that are important. However, like most things food and nutrition-related, there’s a ton of misinformation out there. So let’s unpack low stomach acidity, how to know if you have stomach acidity issues, and where to go from there.
But first, what is normal stomach acidity?
Before we dive into low stomach acid, let’s talk about normal stomach acidity. Our stomach is a really special organ in the body. It secretes hydrochloric acid in order to help breakdown the food that we eat. Hydrochloric acid is extremely acidic, which means the normal pH of our stomach is very very low (acidic). The pH in our stomach is between 1.5 and 3.5 while our blood pH is a little above 7. Because of the high acidity of our stomach, it contains special cells called parietal cells to protect itself and secretes mucus. If it didn’t have these special protective mechanisms, our stomach would essentially digest itself. An important thing to note is that the rest of our body doesn’t have these protective mechanisms against stomach acid. That’s why acid reflux, when stomach acid leaks back into the esophagus, feels so painful. Anyway, I’m digressing a little because I think our bodies are so dang cool. Back to stomach acid. :P The acidity of our stomach is extremely important not only to digest the food we eat, but also to kill any harmful pathogens that we may ingest.
So what’s low stomach acid?
There are two conditions in which a person’s stomach acid is lower than normal: hypochlorhydria and achlorhydria. Hypochlorhydria results when the gastric cells in the stomach secrete less hydrochloric acid than would be normal. Achlorhydria is when those same cells just aren’t secreting hydrochloric acid at all. This results in the pH of the stomach being higher than normal, and can impact digestion and the body’s ability to protect itself from disease.
What are the nutritional implications of low stomach acid?
One of the biggest potential implications of low stomach acid is bacterial overgrowth. Without stomach acid to destroy potentially dangerous pathogens, your risk for illness and infection increases. From a nutritional perspective, the high acidity of the stomach is also extremely important in order to properly digest and absorb many nutrients. Protein, for example, requires an acidic environment in order to be denatured and absorbed. Minerals such as iron, magnesium, and calcium also require that acidity. Deficiency of these minerals can lead to anemia and bone and muscle issues like weakness, tingling, or cramping. Many vitamins also require high acidity to be absorbed. Vitamin C, Vitamin D, Vitamin B12, and folic acid specifically may become nutrients of concern with low stomach acid.
What causes low stomach acid?
There are a variety of different conditions that can cause or increase the risk of developing low stomach acid.
Age
Those 65 and older are at increased risk of low stomach acid. Simply put, as we age some of our body systems don’t work at their full capacity anymore.
Stress
Honestly, stress is a potential cause for practically every health condition. Short-term stress likely won’t have a huge impact, but chronic stress may decrease stomach acid production.
Medications
Antacids and Proton Pump Inhibitors (PPIs) are widely prescribed for those who experience heartburn, indigestion, and/or GERD. These medicines are prescribed specifically to reduce stomach acid production. If used inappropriately or overused, there’s the potential for these medications to work too well and thus reduce stomach acid production too much. According to the American Gastroenterological Society, however, there’s limited evidence to either support or refute the claim that long-term PPI use causes achlorhydria or hypochlorhydria. If you have specific concerns about any medications you’re on, always consult with your physician. It’s never a wise idea to take medications differently than prescribed, or simply stop taking them altogether without consulting your doctor.
Surgery
Specifically, gastric (stomach) surgery, particularly surgeries like gastric bypass where a large portion of the stomach is removed. The removal of gastric cells that secrete hydrochloric acid can impact the ability of the body to produce enough stomach acid.
Helicobacter pylori (H. pylori) Infection
When left untreated, H. pylori can cause stomach ulcers. This damage to the lining of the stomach can reduce its ability to produce and secrete adequate hydrochloric acid.
Autoimmune Disorders
Particularly any malabsorptive disorders or those that influence the digestive tract. Make sure to chat with your doctor if you have any questions about whether or not your specific autoimmune disorder could be influencing gastric acid production.
What are the symptoms of low stomach acid?
There are a ton of possible symptoms of low stomach acid.
Digestive System Symptoms
Burping, bloating, upset stomach, nausea, indigestion, heartburn, acid reflux, diarrhea, gas, undigested food in stools, abdominal pain, GI infection, bacterial overgrowth
Other symptoms
Protein deficiency, anemia, other nutritional deficiencies (calcium, magnesium, Vitamin B12), fatigue, brittle fingernails or hair, tingling, numbness, vision changes, osteoporosis
A very important thing to note here is that all of these possible symptoms could also be symptoms of an entirely different condition unrelated to your stomach acid. It’s incredibly important to see your doctor if you have concerns and get an official diagnosis. Which brings me to the next part of this post!
How do you know if you have low stomach acid?
If you meet one or more of the conditions above for increased risk and are experiencing multiple symptoms of low stomach acid it’s time to see your doctor! There is a ton of misinformation on the internet about at-home tests you can do to diagnose low stomach acid, but spoiler alert–none of these tests have any scientific validity behind them. Go see your doctor. They can test your stomach acidity to find out what the pH is and then use that information to figure out if your stomach acidity is normal, high, or low. Ingesting baking soda and all this other garbage I’ve seen online absolutely CANNOT prove that you do or don’t have low stomach acid. PLEASE go see your doctor.
Is there a treatment or a cure for low stomach acid?
Yes, it can be successfully treated! Treatment varies depending on the cause of your low stomach acid, so go see your doctor to determine which course of treatment is best for you. If low stomach acid is caused by H. pylori infection, for example, an antibiotic should resolve the issue. If it’s caused by inappropriately taking antacid medications, adjusting the dose should clear up the issue. There are also hydrochloric acid supplements available which your doctor may prescribe to help increase your stomach acidity. One final note here: I’ve seen people recommending that you just take hydrochloric acid supplements immediately before consulting your doctor. Please don’t do this. Remember, treatment is going to vary depending on what is causing your low stomach acid. Just because HCl supplements make you feel better doesn’t mean that the underlying problem is fixed. That’s why seeing your doctor, getting a proper diagnosis, and figuring out the root cause of the problem is so important!
If I have low stomach acid, are there things I can change about my diet to better manage my symptoms?
Here’s another area where there’s a ton of misinformation on the internet. If you think you have hypochlorhydria or achlorhydria, or if you actually do have a diagnosis, go talk to your doctor about treatment. There are several things that may help with symptoms, but there’s really not a lot of evidence to back them up.
Possible dietary recommendations that may help include:
- Being vigilant with food safety. This is literally the only recommendation that has actual, strong scientific proof to back it up. If your stomach acidity is low, you are at a much greater risk of foodborne illness. Make sure to properly cook all meals, avoid cross contamination, thoroughly wash fresh produce, and avoid undercooked or raw meat, poultry, eggs, and seafood.
- Eating smaller, more frequent meals. There’s really not a lot to back this up, but it’s not likely to be harmful, so go for it if you think it’ll help.
- Eating more acidic foods. Again, minimal evidence to support this. While I don’t think you should avoid acidic foods, I wouldn’t recommend loading up on them. Eating a lot of acidic foods can damage tooth enamel, among other things. Personally, I wouldn’t recommend this one.
- Avoiding more difficult to digest foods. Some foods, like red meat, may be more challenging for your body to digest with low stomach acid. If you notice particular foods exacerbating your symptoms, bring this to your doctor. They may recommend avoiding some of these foods for a while, although with proper treatment you should be able to properly digest them anyway.
- Eating more fermented foods. The logic behind this is that fermented foods contain bacteria that have already partially broken down the fibers/proteins, thus making them easier to digest. Again, there’s not a lot of proof behind this claim, but as long as your fermented foods are coming from a safe source (stay away from homemade fermented foods for food safety concerns) they shouldn’t be harmful and may help.
- Drinking your meals. This one concerns me for so many reasons… And there’s no evidence to suggest that you should just avoid solid foods entirely. But if you do enjoy the occasional smoothie, protein shake, etc there’s no reason to stop enjoying these beverages.
Have I mentioned that you should go see your doctor if you’re concerned about low stomach acid. :P No, but seriously, there’s a lot of misinformation about “natural” ways to diagnose and treat low stomach acid which is extremely concerning to me. Hypochlorhydria and achlorhydria are potentially serious conditions with potentially serious causes. Basically, they’re not something to play around with at-home to see if you can solve yourself. So please, if you have concerns, go see your doctor and have a conversation about it, get an official diagnosis, and an official treatment plan.