Heartburn, indigestion and other signs of low stomach acid – and what you can do about it
Time to read: 5 minutes
The inability to digest your food properly is more of a problem than most health professionals know about. You could be eating the perfect diet, spending loads of money on all the popular supplements etc. but if you have digestive issues like damaged gut lining or low stomach acid (hypochlorhydria) then you won’t be able to break down your food properly and absorb those essential nutrients. I’ll talk more about gut lining integrity in another post, this post will cover stomach acid levels.
Read on to find out how to test your stomach acid levels easily at home.
Some common symptoms of low stomach acid include:
- Burping, bloating, wind after meals, burning sensation
- Feeling especially full after meals
- Heartburn/indigestion/acid reflux
- Intolerances/food allergies
- Rectal itch
- Acne/dry skin
- Iron deficiency/anaemia
- Adrenal fatigue
- Chronic fatigue
- Poor immunity
- Intestinal parasites
- Gut bacteria imbalance (dysbiosis)
- Undigested food in your stools
- Gastric ulcers
- Vitamin B12 deficiency
- Other nutrient deficiencies
"PPI medications are among the best sellers in pharmacies, they are also among the top 10 most commonly prescribed medications in the world "
Low stomach acid (hypochlorhydria) is the main cause of indigestion, which is the opposite of what the majority of people (and health care professionals) think. The immediate reaction from a lot of Doctors is to prescribe proton pump inhibitor (PPI) medication to ease the symptoms of reflux and indigestion, without investigating whether the reflux symptoms are caused by too little, or too much stomach acid or hydrochloric acid (HCL).
Heartburn and indigestion are so common that approximately 25% of the population experience them at least once per month .
Some causes of low stomach acid include:
- Zinc deficiency (this is a two-edged sword - to make sufficient stomach acid you need good zinc levels, but you also need stomach acid to absorb zinc from your diet)
- A diet rich in processed foods
- Mineral deficiency (certain minerals are needed for the production of stomach acid)
- Some medications
- Helicobacter Pylori infection – this infection neutralizes and decreases the secretion of stomach acid
- Excessive caffeine and/or alcohol consumption
- High carbohydrate/low protein diet
- Aging – the production of HCL slows down as you age
Reflux is so common in the general population that PPI medications are among the best sellers in pharmacies, they are also among the top 10 most commonly prescribed medications in the world . Common names for these medications are Omeprozole, Pantaprozole, Lanzaprosole or just about any medication ending in ‘ozole’ or ‘osole.’
Unfortunately, there are many side effects of these PPI family of medications, as they suppress stomach acid production which is needed to break down proteins and necessary for the absorption of a range of vital nutrients. Long term PPI use is linked to an increased risk of vitamin and mineral deficiency, particularly calcium, iron, magnesium, vitamin B12, vitamin C .
These PPI medications are meant for short term use, the guidelines stating 4 to 8 weeks. Longer-term usage is only recommended for patients who have structural damage or changes to the oesophagus such as Barrett’s oesophagus or erosive esophagitis. However, for the vast majority of the population this isn’t the case, so a maximum of 8 weeks is the recommended duration. I couldn’t even tell you how many clients I’ve spoken to who have been on PPI medications for years, even decades.
An easy test to see if you have high or low stomach acid (or ideally, optimal levels)
In the morning, first thing, before eating or drinking anything (or brushing your teeth) do the following:
- Add approx. ¼ of a teaspoon of sodium bicarbonate to 100ml of lukewarm water
- Give it a quick stir and drink it
- Set a stopwatch immediately
- Wait for a burp, it may not be a big burp. Your reaction time is what we are waiting for
Baking soda (basic) and stomach acid (acidic) create a chemical reaction in your stomach that give off carbon dioxide, this is the burp response.
→ Optimal burp time is less than 3 minutes, ideally 1-2 minutes
→ If you burp before 1 minute your stomach acid is too high and we need to calm down your digestion
→ If you burp between 2-3 minutes you have slightly low levels of stomach acid
→ If you burp between 3-5 mins your stomach acid is low
→ Anything after 5 minutes means that you have very low or no stomach acid (achlorhydria)
There is specific nutritional advice depending on your results. Ideally, this test should be done daily for 3-5 days first thing in the morning to get a more accurate picture of your digestive capacity. This test is not the most scientific method but can give us a pretty good ‘ballpark’ picture of your digestion and stomach acid production.
The medical model generally looks to replace your body’s own function with medication. However, from the perspective of Nutritional Medicine, we are looking to restore the body’s own function of producing the right amount of stomach acid. We seek to give the body the right nutrients and cofactors required and a push in the right direction for this to happen naturally.
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Imhann F, Bonder MJ, Vich Vila A, et al. Proton pump inhibitors affect the gut microbiome. Gut. 2016;65(5):740-748. doi:10.1136/gutjnl-2015-310376
Kines K, Krupczak T. Nutritional Interventions for Gastroesophageal Reflux, Irritable Bowel Syndrome, and Hypochlorhydria: A Case Report. Integr Med. 2016;15(4):49-53.
Heidelbaugh JJ. Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications. Ther Adv drug Saf. 2013;4(3):125-133. doi:10.1177/2042098613482484