The surprising truth about low stomach acid

When we think of digestive issues like heartburn, bloating, and indigestion, our minds often jump to the idea of too much stomach acid. I know in my conventional medicine training these symptoms were treated with a proton pump inhibitor (PPIs) to lower the acid and 👏 voila! Symptoms resolved and please don't take those for more than two weeks. Once the PPIs were stopped, a few months later symptoms would often come back. Conventional thinking: let's do another round of PPIs and have you see the gastroenterologist.💥Problem Solved 💥

But what if I told you that, in many cases, the problem is actually the opposite? Low stomach acid, or hypochlorhydria, is a lesser-known but surprisingly common issue that can cause a range of digestive discomforts. Trust me, I've been there! Yet, it's often misdiagnosed as high stomach acid, leading to treatments that might actually make the problem worse.

The Overlooked Role of Stomach Acid

Stomach acid, primarily composed of hydrochloric acid (HCl), plays a crucial role in the digestive process. It helps break down food, absorb nutrients, and protect against harmful bacteria. When your stomach doesn't produce enough acid, this process gets disrupted, leading to symptoms that are often mistaken for excess acid. These can include:

• Bloating and gas
• Heartburn or acid reflux
• Indigestion and stomach pain
• Nutrient deficiencies (especially B12, magnesium, calcium, and iron)
• Chronic fatigue
• Skin issues like acne or eczema

Common Causes of Low Stomach Acid

Low stomach acid can be triggered by several factors, and understanding these can help you address the root cause of your symptoms:

• Age: As we age, our bodies naturally produce less stomach acid. This decrease can start as early as your 30s, but it becomes more pronounced over time. 
  • What's mind boggling here is that in the United States over 50% of adults over the age of 65 are on a proton pump inhibitor (lowers stomach acid). 
• Medications: Proton pump inhibitors (PPIs), antacids, and certain other medications are commonly used to reduce stomach acid, but their long-term use can lead to low acid levels and associated problems. PPIs should be used for no more than two weeks at a time, yet a study published in the Journal of the American Medical association found that up to 65% of adult on PPIs have no documented reason to be on them. 
• H. Pylori Infection: This common bacterial infection is known to damage the stomach lining and reduce acid production. It often goes undiagnosed but can be a significant contributor to digestive issues.👋 This was my problem! 
• Stress: Chronic stress impacts your body in numerous ways, including reducing stomach acid production, which can exacerbate digestive issues. 👋Also my problem! 

The Misdiagnosis Trap: Low Stomach Acid vs. High Stomach Acid

The symptoms of low stomach acid can mimic those of high stomach acid, particularly when it comes to acid reflux. This confusion happens because low acid levels can cause the lower esophageal sphincter (LES) to relax improperly, allowing stomach contents to escape back into the esophagus. This results in that familiar burning sensation, leading many to reach for antacids or acid blockers, which only exacerbate the underlying issue.

Research has shown that hypochlorhydria is more common than many realize, especially as we age. A study found that nearly 30% of people over the age of 60 suffer from low stomach acid. Another study highlighted that hypochlorhydria is associated with an increased risk of certain bacterial infections, as the low acid environment allows harmful bacteria to thrive.

The Risks of Long-Term PPI Use: A Heartfelt Caution

Okay- time for me to get up on my soap box real quick. In clinical practice I commonly saw proton pump inhibitors prescribed inappropriately. Proton pump inhibitors (PPIs) and antacids are among the most commonly prescribed medications for acid reflux and heartburn. However, these medications can have unintended consequences, especially when used long-term. By reducing stomach acid even further, PPIs can contribute to nutrient deficiencies, digestive imbalances, and an increased risk of infections.

I see many patients who have been on PPIs for years, believing they were treating excess stomach acid when, in fact, their symptoms were due to low stomach acid. This is why it's so important to get to the root of the problem rather than simply treating the symptoms.

If you're currently taking PPIs or antacids and still struggling with digestive issues, I urge you to consider whether low stomach acid might be the real issue. The risks of continued use without proper diagnosis are significant, but with the right approach, it's possible to restore your stomach acid levels and improve your overall health.

The Ripple Effect: How Low Stomach Acid Impacts Your Health

Low stomach acid doesn't just cause digestive symptoms; it can have a cascading effect on your overall health. Without adequate stomach acid, your body struggles to absorb essential nutrients from food, leading to deficiencies that can affect everything from your energy levels to your immune function. Over time, this can result in more chronic issues, such as:

• Digestive Enzyme Deficiency: Without enough stomach acid, your pancreas may not get the signal to release digestive enzymes, further complicating digestion.
• Gut Dysbiosis: A lack of stomach acid can lead to an imbalance in gut bacteria, known as dysbiosis, which is linked to conditions like IBS, SIBO, and leaky gut.
• Weakened Immune System: Since stomach acid acts as a barrier to pathogens, low levels can make you more susceptible to infections, particularly gut-related ones.

Could Low Stomach Acid Be Your Issue? Here’s How to Find Out

If you've been struggling with persistent digestive problems and suspect that low stomach acid might be to blame, it’s essential to get the right diagnosis. Functional lab testing can provide clarity by assessing your stomach acid levels and identifying any nutrient deficiencies that may have arisen as a result.

Want to know right now? You can do a quick at home test with baking soda. Mix 4oz of water with 1/4 tsp of baking soda and drink it on an empty stomach. If you have enough acid, you'll burp within 3-5 minutes. 

The good news? Low stomach acid is treatable. By addressing the root cause, you can not only alleviate your symptoms but also improve your overall health and well-being.

Ready to Take the Next Step?

If any of this sounds familiar, I encourage you to book a call with me. Together, we can explore your symptoms, discuss testing options, and create a personalized plan to restore your digestive health. Don't let a hidden issue like low stomach acid keep you from feeling your best. Take action today and start your journey towards better health!

References:

1. Ali H, Fatima K, Junaid K, et al. An Updated Systematic Review and Meta-Analysis to Determine the Association between Iron Deficiency Anemia and Helicobacter Pylori Infection in Low and Middle Income Countries. Annals of King Edward Medical University. 2021;27(1):101-112. doi:10.21649/akemu.v27i1.4414
2. Bruno G, Zaccari P, Rocco G, et al. Proton pump inhibitors and dysbiosis: Current knowledge and aspects to be clarified. World Journal of Gastroenterology. 2019;25(22):2706-2719. doi:10.3748/wjg.v25.i22.2706
3. Hayes KN, Nakhla NR, Tadrous M. Further Evidence to Monitor Long-term Proton Pump Inhibitor Use. JAMA Netw Open. 2019;2(11):e1916184. doi:10.1001/jamanetworkopen.2019.16184