Stomach acid- Do you have enough?
So many of us think stomach acid is an enemy that should be quelled. You or someone you love has most likely felt much better after taking an acid suppressing medication. Set all of that aside with your disbelief for 5 minutes while I walk you through the roles of stomach acid in your digestive and immune systems, and show you how having enough stomach acid not only relieves very uncomfortable symptoms, but also helps you to avoid some chronic diseases.
In which body functions is stomach acid, and most specifically adequate stomach acid, a key player?
Many! And they are all absolutely essential to your health.
STOMACH ACID'S ROLES IN YOUR DIGESTIVE SYSTEM:
Stomach acid is responsible for breaking down our food's proteins into their smaller components, amino acids. It does this directly and by activating the release of digestive enzymes.
Stomach acid kills pathogens including bacteria, viruses, and worms that we eat and drink.
An adequate amount of stomach acid triggers complete closure of the upper sphincter of your stomach, preventing the seepage of stomach contents or "chyme" into your esophagus, a symptom know as heartburn or acid reflux.
Stomach acid is necessary for getting minerals, including calcium, magnesium, zinc, iron and trace minerals, from our food. It is also necessary for getting vitamins B12 and C from food.
Stomach acid stimulates the secretion of bile (which digests fats) and pancreatic enzymes (which digest carbohydrates).
Stomach acid creates a more acidic environment in your small intestine, contributing to an environment where bacteria and fungi are less likely to thrive.
WHAT'S THE TAKE-AWAY ABOUT STOMACH ACID'S ROLE IN YOUR DIGESTIVE SYSTEM?
Without adequate stomach acid, you cannot get all of the minerals out of your food. You cannot adequately digest proteins. Sadly, digestion of carbohydrates and fats is indirectly also reduced.
Without enough stomach acid, you are more likely to fall prey to acute infections such as food poisoning, and chronic infections such as dysbiosis in the lower digestive tract.
Lastly, and this is the one that really surprises people, you are more likely to have acid reflux if you don't produce enough stomach acid!
It's this last point that you demands an explanation, as it is completely counter to what we have all been taught, and what it feels like to get heart burn. If your stomach hasn't made enough acid to digest your meal, the chyme in your stomach won't be acidic enough. The sphincter, which is a muscle like a rubber band that tightens the top of your stomach, won't close all the way and therefore won't keep the stomach's contents down in the stomach/out of the esophagus.
I think of this like a yellow light at a stoplight. When the light is yellow, it is not always a strong enough warning to prevent people from driving through the intersection. It's the red light that indicates that the intersection is closed, that prompts people to hit the breaks. When the chyme isn't acidic enough, the stomach's upper sphincter won't close all the way, allowing chyme (which most often does have some acid in it) to creep into the esophagus. Also in this scenario, this person will experience upper GI bloating or a feeling of fullness in their stomach (and by this I mean the organ of the stomach, not the belly which also includes the lower digestive tract and other organs) for a while after eating, beacuse their food isn't being digested in a timely manner.
This sensation is entirely different from the one people who need to have less stomach acid experience- a burning or stabbing inside the stomach which accompanies a stomach ulcer. It is important to note that not everyone with stomach problems has low stomach acid, a.k.a. hypochlorhydria. Some people do really make too much stomach acid, or make too much stomach acid for the condition of their stomach.
Unfortunately for the general population, most people fall into the low stomach acid camp, not the high stomach acid camp, though most people with reflux symptoms are treated with stomach acid blocking medications, which, by the way, are only approved by the FDA for temporary use. For a very well researched read on the dangers of proton pump inhibitors, read this article written by Chris Kresser. I recommend his article if you have a loved one, especially an elderly person, taking PPIs. There are better ways to support digestion that don't include risk factors such as bone fracture, malnutrition, heart attacks, kidney disease, and dementia.
ARE THERE OTHER DIGESTIVE IMPACTS OF LOW STOMACH ACID PRODUCTION?
Yes! There are! These symptoms stem from proteins (which should be digested in the stomach) making their way into the lower digestive tract, where we should only have amino acids, the smaller piece of proteins. Once there, proteins pass into places they don't belong, interact with our immune system and feed bacteria that we don't want in our bodies. These symptoms include:
Lots of gas, belching or burping after eating. The farts are usually of a stinkier variety than those produced by a person with adequate production of stomach acid, as the undigested food is fermenting, producing gas. The burps are frequently smaller and more discreet- I'd call them air burps, the kind that just creep up and out of people.
Lack of interest in meat (in non-vegetarians)
Bloating and distention, especially starting an hour after eating. For people with low motility (movement of food and gas) in their gut, this bloating will often get worse as the day goes on.
Nausea after eating or taking supplements
Undigested food in your poo
Downstream chronic digestive disorders including SIBO&/SIFO, IBS, IBD, diarrhea, constipation
H. pylori, chronic candida, other creatures that are a symptom of microbiome imbalances
Itchy anus. This is often caused by worms that have made it past the inadequate stomach acid.
SO, WHAT'S THE BIG DEAL? A LITTLE INDIGESTION NEVER KILLED ANYONE, RIGHT?
Au contraire! There is even more to all this trouble than just discomfort. The digestive system is the center of our being. It is our fuel source. It is estimated that 80% of the immune system is located around your digestive tract. 90% of your serotonin is produced there, as is 50% of your dopamine, as well as a significant portion of over 30 other neurotransmitters. A healthy digestive system is as important to your well-being as a healthy nervous system. In fact, as research on your microbiome and immune system catches up with what folk medicine practitioners have known all along, some scientists are even beginning to call the digestive system our "second brain".
Without proper amounts of stomach acid to digest proteins, your immune system starts identifying and targeting various proteins as dangerous invaders. Remember how your immune system is wrapped around your intestines? Well, this is where things can go from bad to disasterous. The immune system shifts to autoimmune reactivity when proteins are present in the small intestine. This leads to a person developing food sensitivities or allergies. People with autoimmune diseases should work with a health care provider who is familiar with treating low stomach acid and proactively managing autoimmune conditions to see if they would benefit from stomach acid support. I would dare say that most if not every functional medicine clinician has seen various symptoms of autoimmune conditions reduced through ensuring that people have adequate stomach acid production while they go through a process of at least temporarily removing the foods that the body had begun reacting to.
SYMPTOMS OF LOW STOMACH ACID AFFECTING MORE THAN JUST YOUR DIGESTIVE SYSTEM:
Multiple food allergies or sensitivities
Skin breakouts, adult acne, eczema, psoriasis & rosacea
Iron and other mineral deficiencies due to problems in mineral absorption
Weak or cracked fingernails and cracks in the fingertips also due to problems in mineral absorption, primarily zinc
Low energy, mood, and mental function due to decreased vitamin B12
Poor immune function due to decreased Vitamin C absorption and increased immune reactivity
What's the take away? We all really really need stomach acid, and enough stomach acid at that.
WHO SHOULD WORK WITH A PRACTITIONER TO ASSESS THEIR STOMACH ACID STATUS?
Because the stomach, like the rest of our body, loses vitality and function as it ages, the incidence of low stomach acid increases as a person's age increases. Many middle aged to elderly people need stomach acid support to prevent malnutrition, even if their diet is sufficiently nutrient dense.
Other people at risk of low stomach acid production include vegetarians, and people who have a history of vegetarianism. When you don't eat meat, your body de-prioritizes the production of stomach acid, as vegetable proteins are not as hard to break down as animal proteins. As we've seen, however, stomach acid does more than just break down proteins. It stimulates a cascade of digestive secretions throughout the digestive tract. It gets the minerals and vitamins B12 & C from your food. Symptomatically, a vegetarian or ex-vegetarian who has skin conditions, allergies, or other autoimmune conditions should consider looking into their stomach acid status.
Pregnant women will often notice that they crave carbs and are not at all interested in protein. I know I was this way with both pregnancies, especially during the first and last trimesters. If only I had known at the time that I was experiencing low stomach acid! Supporting stomach acid production during pregnancy ensures that mom will eat and enjoy protein. As I discussed above, preventing low stomach acid has other benefits, including ensuring adequate mineral, vitamin, and protein absorption from food and preventing the immune system's reaction to improperly digested food. In the case of a pregnant mom, these benefits extend to both mom and baby.
Lastly, stress can play a role in lowering stomach acid production. These days, we are all hip to the dangers of fight/flight mode, which is frequently triggered in us modern humans. When we are in fight/flight a.k.a. stressed out, our circulatory system decreases blood flow to our non-essential organs- read: our digestive systems. Hence the name for our opposite mode, rest/digest, which is where we operate when not under stress. When we eat when we are stressed, we are most likely not having adequate stomach acid production, as our body is focusing it's efforts elsewhere. If you find that you suffer from some of the digestive symptoms above but do not have any of the progressed symptoms of immune problems or nutritional deficiency, let this be a gentle reminder to have a practice in place of relaxing before and during the enjoyment of your food. Every state of health is on a spectrum. As the sages of old said, it is wiser to prevent an illness than to treat one.
Do you feel like you might need stomach acid support? Schedule an appointment to come in and see me to reinstate your digestive health.