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Stomach Acid--Too Much or Too Little?
Most people believe that excess stomach acid is the reason they sometimes experience acid indigestion and heartburn. Relieving symptoms by reducing or blocking the production of this acid with various antacid medications and products may seem the most logical solution to end the misery. Little do they realize how essential the role of stomach acid is to the digestive process as well as the health of the entire body. Nor does the average person understand the long-term consequences that occur from either neutralizing or interfering with the production of this necessary substance God created in our bodies for a number of valuable purposes.
Unfortunately, decades of research confirming a clear linkage between low stomach acid (whether caused by disease or drugs) and a wide range of serious and chronic diseases is largely ignored by the medical establishment and certainly by the pharmaceutical companies that patent and make large profits from acid suppres
sing drugs. When you take into account the fact that the production of hydrochloric acid decreases with age and incidences of heartburn and acid reflux tend to increase with age, attributing heartburn to excess stomach acid makes little sense. A better understanding of the role hydrochloric acid (HCl) plays in the digestive process makes this fact increasingly clear.
Hydrochloric Acid is a Good Thing
Hydrochloric acid is so strongly acidic that it can dissolve the blade of a razor. One may wonder how the stomach could handle such a considerable degree of acidity (100,000 times stronger than normal blood or tissue acidity) and not digest itself. The answer lies in the fact that the lining of the stomach consists of mucus comprised of 95 percent water as well as bicarbonate that further allow for the neutralization of strong acids. This lining, which is replaced every three days, acts as a barrier to protect the stomach against acid and other stomach secretions
The secretion of HCl is one of the first of a sequence of events that must occur for digestion and nutrient absorption to take place. Optimal digestion and absorption of nutrients only takes place when all the digestive secretions, including stomach acid, are released at just the right times and in the right amounts required to adequately prepare food for each phase of digestion. Although we normally think of acidity in the body as “bad”, the stomach environment actually needs to be extremely acidic (a pH of 2 is ideal) for the proper breakdown of nutrients, particularly minerals and protein. Adequate stomach acid production also provides an “acid barrier” that protects other parts of the body (particularly the intestines) from harmful bacteria and other microorganisms as well as the overgrowth of yeast, fungus and parasites
The Digestive Cascade
Prior to food entering the stomach, pH levels are maintained between 1 and 3 (lower numbers indicate greater acidity). As food enters the stomach, the stretching of the stomach lining signals specialized cells to begin the secretion of gastrin. Gastrin is an important regulatory hormone secreted by another group of cells in the stomach. It regulates the release of HCl and pepsinogen, which is then formed into pepsin if sufficient amounts of HCl are present (the less HCl, the less pepsin is produced). Pepsin is the enzyme that works to break down long chains of proteins into amino acids. Gastrin is needed as well for the production of the mucosa that makes up the majority of the stomach’s lining and for stimulating stomach muscles to contract and churn to mix the food as digestion takes place.
When pH levels within the stomach rise above 3 (less acidic), specialized cells begin to secrete more gastrin. This triggers another type of cell (parietal cells) in the stomach to pump out more HCl, which then lowers the pH level of the stomach. As the pH level lowers, a signal is sent to slow down the release of gastrin, which subsequently decreases the flow of acid. This balanced feedback system involving both acid and gastrin keeps the pH of the stomach at a resting level between 1 and 3 (acid-suppressing drugs typically raise the acid in the stomach to a pH of 5 or greater).
If the secretion of HCl is too low for any reason, the rising levels of pH continue to trigger specialized stomach cells to pump out more and more gastrin to stimulate the parietal cells to produce greater amounts of HCl. As the body tries to compensate for the loss of acidity, continued above-normal gastrin levels may result in a condition known as “hypergastrinemia”. This condition typically occurs in people with an atrophied or non-functional stomach lining, in which the parietal cells are destroyed or damaged and are no longer able to produce HCl. However, it also occurs in people who have taken acid-blocking drugs over a long period o
f time (a standard 20 mg. dose of Prilosec typically results in up to a three to fourfold increase in gastrin levels). Chronically elevated gastrin levels are a key factor associated with an increased risk of developing stomach cancer.
HCl provides the “acid trigger” to the digestive cascade in more ways than one. When the contents of the stomach have been sufficiently bathed in stomach acid, the presence of the acidified “chyme” (partially digested food) sends a signal to the pyloric sphincter that the chyme is ready to enter the small intestine for the final phases of digestion and absorption (the pyloric sphincter is the muscular ring that separates the lower stomach from the small intestine). At this point, the production of HCl is inactivated, which results in the pH level of the stomach rising.
When the acidified chyme comes in contact with the lining of a portion of the small intestine (duodenum), the release of another hormone (secretin) signals the pancreas to discharge bicarbonate ions to increase alkalinity as well as key enzymes (that only work in an alkaline environment) to “finish off” the digestive process. At the same time secretin is released, another hormone (CCK) activates the release of bile to the scene of the small intestine for the purpose of digesting any fats.
How Antacid Drugs Impair Digestion
Because proper digestion is all essential to the health of the body, interrupting or inhibiting the “digestive cascade” at a key juncture with the use of acid neutralizing or acid blocking drugs creates serious repercussions that adversely affect long-term health. This would especially apply to what is known as “proton pump” inhibitors, which reduces acid secretion around the clock by poisoning an enzyme and disabling the acid-producing mechanism, leaving the person taking them with chronic low stomach acid and increased gastrin levels.
In addition, when these drugs are taken, they cause the pH o
f the stomach to rise before the HCl has sufficiently broken down the chyme in the stomach. In this case, the elevated pH level brought about by suppressing HCl causes the pyloric sphincter to open and release partially digested food into the small intestine prematurely. Not only does this occurrence prevent the body from getting all of the nutrients it needs from the consumed protein, but large particles of undigested proteins can make their way through the wall of the intestine into the blood stream and cause a number of health problems, ranging from food allergies to autoimmune disease.
As you can see, removing the “acid trigger” not only reduces stomach acid but it also reduces levels of hormones that trigger secretions of pepsinogen, pepsin, secretin, CCK, pancreatic enzymes, and bile. All of these secretions are critical to the complete digestion process that allows foods to be fully broken down into their smallest components so that nutrients can be properly absorbed and utilized by the cells. In his book, Why Stomach Acid is Good for You, Dr. Jonathan Wright likens normal stomach function to the first domino in a row – if it doesn’t fall as it should, the rest will not either. Hopefully, you now have a better idea of how an adequate amount of stomach acid is the key trigger that sets the digestive processes in motion.
Nutrient Deficiencies Caused by Low Stomach Acid
As was emphasized in last month’s article on “The Key to Good Digestion”, a person can eat the healthiest food available and yet experience nutritional deficiencies if that food is not properly digested and absorbed. Multiple nutritional deficiencies result when nutrients cannot be extracted due to low stomach acid, the most serious of which is poor protein digestion. For protein to be sufficiently broken down and absorbed, the ideal pH of the stomach should be between 1 and 2. Adequate protein is needed by the body for structural integrity and to heal injured tissue. Healthy hair and nails is another bonus of usable protein levels. According to Dr. David Brownstein, a holistic medical doctor who regularly tests his patients for levels of stomach acid as well as nutrients, a number of degenerative disorders, such as fibromyalgia, chronic fatigue syndrome, cancer and arthritic conditions may occur in conjunction with the lack of adequate protein absorption.
Another important function of HCl is to break mineral bonds apart so the body can assimilate and use them. A pH of less than 3 is needed for this to occur. Those who regularly neutralize or block their stomach acid risk excess dietary mineral loss, particularly of iron, calcium and zinc (studies show that Tagemet and Pepsid both decreased zinc absorption by 50%). These minerals are likely not to be absorbed when the pH of the stomach is too high (so much for taking Tums for calcium! 
Vitamin B-12 deficiency is often found in older people who have low stomach acid due to the loss of the parietal cells that secrete it. People on acid blocking drugs often experience the same condition. The reason for this is that vitamin B-12 must be bound to a protein (meat, eggs, etc.) to enter the body. For its absorption to take place, the vitamin molecule must be separated from the food protein with the help of stomach acid and pepsin. Once it arrives in the small intestine, it must be rebound to what is called “intrinsic factor” before it can be released into the bloodstream. It so happens that the same cells that produce and secrete HCl secrete intrinsic factor. Based on his clinical experience, Dr. David Brownstein has discovered that almost all of his patients who were on antacid drugs were deficient in Vitamin B-12. Vitamin B-12 deficiency is typically associated with fatigue, fibromyalgia, anemia, neurological disorders, depression, confusion, and dementia. The absorption of another B vitamin, folic acid, is also adversely affected by low stomach acid. Folic acid is vital for keeping the cardiovascular system healthy by reducing levels of homocysteine (high levels of this amino acid is linked with increased risk of heart disease) and for preventing certain birth defects.
Protection from Bacteria, Yeast and Fungus
Another primary reason the stomach produces acid is to kill the bacteria and other pathogenic organisms in our food. Healthy amounts of stomach acid prevent toxic bacteria from colonizing in the gastrointestinal tract and contributing to gastrointestinal disease. People whose stomach acid levels are lowered with acid blocking drugs are far more at risk for serious bacterial infections as well as the overgrowth of abnormal forms of yeast and parasites. If a person has a healthy supply of HCL, they likely will not need to worry about an e-coli outbreak. It is when the pH of the stomach rises above five that bacteria can thrive, leaving the body susceptible to serious bacterial infections. Toxic substances excreted by harmful microbes get absorbed by our cells and then
are spread all around our bodies.
H. pylori is a bacteria known to cause excess acidity and stomach ulceration. It occurs in approximately 20 percent of people less than 40 years old and 50 percent of those over 60 years of age. It is one of the leading causes of prolonged high levels of gastrin that can lead to gastric (stomach) cancer. Low stomach acid is one of the most common predisposing factors to the occurrence of an H. pylori infection. If normal pH levels (pH 1-3) are maintained in the stomach, H pylori infections rarely occur. Although convention treatment for H. pylori involving antibiotics and proton pump inhibitor drugs effectively eradicates the bacteria, a high rate of reoccurrence is common when long-term acid blocking treatment is used (according to Dr. Brownstein, anything over four weeks is long-term).
What Really Causes Heartburn or Acid Reflux?
Although advertisements for “acid relief” give the average person the impression that heartburn occurs because of too much acid in the stomach, the fact is that any amount of acid that winds up in a place other than where it is supposed to be (i.e., the stomach with its acid-protecting buffer) will cause the pain of heartburn and GERD. Heartburn pain is a direct result of irritation to the esophagus, which occurs when the lower esophageal sphincter (LES) is not functioning properly for some reason. The LES is a muscular ring at the bottom of the esophagus that opens to let food into the stomach and then closes after the food has passed.
Its purpose is to prevent acidic stomach contents from entering the esophagus where it could burn the esophageal tissue.
When acid levels rise, the pH of the stomach drops, which causes the LES to shut itself as it senses the increased acidity. Even in severe cases of GERD, (gastro esophageal reflux disease), actual testing of stomach acid levels revealed hypochlorhydria (low stomach acid) in over 90 percent of the cases. Low stomach acid is actually the mo
st common cause of heartburn. Other contributing factors may be involved in episodes of heartburn or acid reflux that either cause the LES to malfunction, irritate the esophageal lining or directly force acid juice back up through the LES into the esophagus.
A prime example would be eating greasy foods. It is difficult for HCl to penetrate foods cooked in grease or overcooked proteins. Since the acid cannot be readily absorbed into these foods when they are eaten to break them down, it continues to be produced and may end up as “excess” stomach acid. Wouldn’t it make more sense to not eat the greasy food that is preventing stomach acid from doing its job instead of suppressing its production?
Other factors that contribute to episodes of heartburn and acid indigestion include:
- Excess abdominal fat (puts pressure on the stomach and weakens the sphincter over time)
- Overeating (stomach contents are forced through the sphincter by an excess volume of food)
- Gas from fermentation of food from poor digestion (pressure from gas presses against the sphincter)
- Hiatal hernia
- Pregnancy (growing fetus compresses the entire upper GI tract)
- Alcohol and/or nicotine decrease function of the LES
- Dehydration
- Foods such as fats, chocolate, coffee, mints (especially spearmint and peppermint), sugar, and onions
- Acidic citrus fruits and tomato-based foods, spicy foods, carbonated beverages, and coffee can further irritate an already inflamed esophageal lining
- Eating food allergens (especially cow’s milk and dairy)
- Medications that weaken the LES by relaxing muscles (either ones surrounding airways and blood vessels and/or those that comprise much of the GI tract). Examples include bronchodilators used to treat asthma, aspirin/NSAIDS, channel and/or beta-blockers that lower blood pressure, Valium, Demerol, Tetracycline, Quinidine, and Nitroglycerine
- Activities such as coughing, wheezing, bending from the waist, heavy lifting, straining during bowel elimination, and certain types of exercise that increase pressure within the abdomen and force stomach contents through the LES when it is full and/or the LES is already weakened
- Reclining – causes stomach contents to remain in the upper portion of the stomach longer - standing helps draw the stomach contents away from the LES.
Ways to Naturally Relieve Heartburn and Acid Reflux
If heartburn or acid reflux is a problem for you, you may first want to see if you find any of the following practical suggestions helpful:
- Eat smaller meals
- Limit food intake during the hours just before bedtime
- Avoid the types of foods and drugs that tend to cause acid reflux
- Get possible food allergens out of your diet
- Drink more water
- Eliminate refined sugar, which is a direct stomach irritant
- Minimize activity that might increase intra-abdominal pressure – bending or heavy lifting
- Elevate the head of your bed using four-to eight-inch blocks.
Rather than using drugs that merely suppress symptoms by disrupting normal GI function, it is far better for your long-term health to use safe and natural substances that work more with the body’s physiology rather than against it to restore healthy gastric function. The only time it may be too late for an entirely natural strategy to work is if there is already significant damage in the esophagus.
Bitter herbs may be used to increase the body’s own natural digestive secretions and hydrochloric acid production. For mild to moderate cases of heartburn, indigestion or bloating, they work well to stimulate the secretion of gastric acid, bile, pancreatic enzymes and saliva, and help to prime the mouth, esophagus and stomach for digestion (acid and enzyme secretion is controlled by nerves that are triggered by the smell or taste of food). One note of caution - since bitters work by stimulating cells in the lining of the stomach, results may not be effective in cases where the stomach lining is severely atrophied. Commonly used bitter herbs are:
- Barberry bark
- Caraway
- Cardamom
- Dandelion
- Fennel
- Gentian root (seems to be the most highly recommended)
- Ginger
- Goldenseal root
- Hops flowers
- Milk thistle
- Peppermint
- Safflower
- Wormwood/Artemesia
- Yellow dock
The use of bitter herbs to stimulate stomach acid along with other digestive secretions and processes works more effectively if herbs are actually tasted (versus just swallowing a pill or capsule containing the herb). While the powdered herb may be emptied from a capsule and directly taken or made into a tea, small amounts bitter herbs are generally consumed in liquid form (tinctures) dissolved in as little water as possible to maintain the bitter taste. Bitters should be sipped approximately 15 minutes before a meal.
If indigestion persists, trying swallowing one to two tablespoons of raw apple cider vinegar or lemon juice in as little water as possible during early part of a meal (some recommend adding honey). Gradually increasing the quantities of lemon juice or vinegar will often relieve symptoms. If this remedy helps, you know that your symptoms are indeed the result of insufficient stomach acid.
Hydrochloric Acid and Pepsin Supplementation
Herbalists and natural health practitioners believe it is always preferable to use herbs to stimulate the body’s own production of hydrochloric acid rather than allowing it to become dependent on a substance that it is capable of making itself. Dr. Jonathan Wright, who has taught natural biochemical medical treatments since 1983 and is the medical director of the Tahoma Clinic in Kent, Washington, also supports the use of these natural substances. However, in his practice he does use supplemental HCl (generally in the betaine hydrochloride form) and pepsin together if a patient’s gastric analysis test results show that the stomach’s ability to produce normal levels of HCl is low or if there is damage or atrophy to the parietal cells or stomach lining. Dr. Wright claims (as does Dr. Brownstein based on his clinical experience) that a good 90 percent of tests run on patients with heartburn related issues reveal low stomach acid production. Unfortunately, few conventional physicians today bother to actually determine the state of acid secretion in the stomach before routinely prescribing drugs that lower stomach acid production even further.
Increasing HCl levels 
causes the pH levels of the stomach to drop, which commonly eliminates heartburn, gas, bloating and indigestion by causing the LES to close itself more tightly as it senses increased acidity. You may wonder, “if such natural herbs and supplements work so effectively, why don’t I hear about results from research and studies conducted using them?” The answer is simple – the funds that support most of the medical research in this country are only available for products that can be patented, which exclude natural substances. Since there is no real profit in investigating, developing and manufacturing such products, they are often discredited as “unproven” as far as the FDA and medical establishments are concerned because they represent competition that is safe, effective, and inexpensive.
If you are not aware of a doctor knowledgeable in integrative or alternative medicine, you may contact the American College for Advancement in Medicine – www.acam.org to learn if any are in your area. If you cannot obtain access to one and want more understanding of how to apply this information to your own situation, I would recommend that you obtain a copy of Dr. Wright’s book for further details on how to transition from antacid medication to natural remedies as well as for information on what tests are available to monitor improvements in nutrient absorption. In addition to Why Stomach Acid is Good for You, Dr. Wright also has a more recent book on this subject called Your Stomach – What is Really Making You Miserable and What to Do About It (available from Amazon for $10.20 – unfortunately, I was not aware of this book prior to writing this article).
Concluding Thoughts
As with everything in natural health, it’s all about discovering the underlying root causes of a condition and then giving the body what it needs to regain balance and restore normal function. Even though antacids and acid-blockers may relieve symptoms, it is far better to take the appropriate steps to remove what is truly causing heartburn, indigestion and acid reflux rather than to take drugs that disrupt the natural gastrointestinal environment, worsen the cause and exert harmful effects on the overall long-term health of the body. Since God designed HCl to work in our bodies as a key component of the digestive process, I would like to suggest that you would be far better off to reconsider the use of a product that neutralizes or blocks a substance designed to protect your health and help you absorb the vital nutrient you need for a strong and healthy body.
Sources:
Why Stomach Acid is Good for You by Jonathan V. Wright, M.D.
Drugs that Don’t Work and Natural Therapies That Do! by David Brownstein, M.D.
Herbal Help for Heartburn, Indigestion and Related Digestive Difficulties
Digestive Bitters Tonic is a digestive strengthening formula that contains bitter herbs to stimulate digestive secretions and increase digestive function in the stomach, small intestines, and pancreas. This formula helps with the absorption of nutrients and functions of the liver and gallbladder, which include cleansing, detoxification and the secretion of bile to help digest fats. Contains gentian, cardamom seed oil, orange peel tincture, dandelion, and red raspberry syrup. Recommended to be taken 15 minutes prior to meals.
Safflower is an herb that is used as a digestive aid to neutralize waste acids and stimulate natural hydrochloric acid production.
Other Herbs that Naturally Stimulate Digestive Secretions
Symptomatic Solutions
Aloe Vera is a soothing and healing herb to mucus membranes that may be sipped in water to relieve heartburn and inflammation of the esophagus.
Stomach Comfort is a combination of natural ingredients that provide an alternative to antacids for soothing occasional occurrences of heartburn, indigestion or gas. The alkalinity of the calcium carbonate helps neutralize stomach acid while alginic acid protects the mucus lining of the esophagus against acid irritation, and helps reduce the discomfort of back washed stomach acid. Slippery elm bark calms the digestive tract and ginger root, papaya fruit and licorice root concentrate work together to stimulate natural stomach secretions and aid in proper digestion. Licorice root has also long been used to support healthy stomach function. Note: Stomach Comfort is not recommended for ongoing use but as an occasional and temporarily means of symptomatic relief to be used while underlying causes for heartburn and acid indigestion are being corrected.
PDA is a digestive aid supplement that contains betaine hydrochloric acid and pepsin. Taking this product on a constant basis reduces the need for the body to make its own hydrochloric acid and is not recommended except in cases where the body is unable to produce sufficient quantities on its own.
Copyright © 2008-2015 Lucinda Bedogne, CNHP, CNC
Reader Comments...
| 2012-09-27 09:31:01 "This was a great explanation. I've forwarded it and saved it, but I am still confused about the acid/alkaline balance in our body. I've heard we eat too many acid-producing foods, but is it a different kind of acid than digestive hydrochloric and pepsin?" - Kathy |
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