Stomach acid is a digestive hero, not a villain

Optimal digestive health is essential for lifelong health and vitality. Breaking any component of the digestive process leads to downstream symptoms such as poor intestinal motility, bacteria overgrowth, and a dramatic decrease in vitamin and mineral absorption. Over time, maldigestion can lead to any number of chronic diseases such as IBS, hypothyroid, hormonal imbalance, and even headaches and fatigue. All medical textbooks explain in detail the role stomach acid plays in the digestive pathway, yet conventional medicine ignores the consequences of acid suppression and often promotes it to treat lifestyle choices and poor eating hygiene. The worldwide antacids industry is expected to reach $6.56 billion in profits by 2026. Much of that represents OTC medications like Prilosec and Nexium that anyone can buy without consulting a physician or pharmacist. Billions of dollars every year are spent on the myth of “too much acid.” Commercials on tv even promote eating in excess and taking a pill to cure that supervillain stomach acid from burning your throat and causing damage. Many feature largely overweight men eating huge portions of processed foods. Is it any wonder we get acid reflux and burning from that?

The myth of too much acid

If we were to believe the myth of too much stomach acid, then it would make sense to suppress acid production to almost zero. The old acid blockers simply neutralize stomach acid, however, the new proton pump inhibitors decrease acid production by up to 95% for the day. Taking these medications for even a few short weeks can stop acid production in its tracks. During the days and weeks of medication-induced hypochlorhydria, barely any acid is produced at all, and coming off those medications can cause the body to produce more acid than normal leading to rebound acid reflux. Many people take this rebound as a sign they just produce way too much acid, when in fact, too much acid is an extremely rare condition.

Fact- acid reflux or dyspepsia is a sign of too little acid or acid in the wrong place.

Heartburn, indigestion, and acid reflux are common today because of lifestyle factors and poor diet, not too much acid. Lifestyle factors that influence our digestion the most are simple eating hygiene habits. Eating hygiene is a learned habit and as a society, we have learned to swallow without chewing, get our monies worth with larger portions, eat even when we are stressed, eat frequently because we don’t eat enough fat and protein, and watch tv while eating instead of being mindful of our food how our gut feels. These habits don’t make the stomach magically start producing more acid, instead, studies show a reduction in hydrochloric acid as well as a reduction in pancreatic enzymes and decreased motility in the GI tract. Basically, when we eat in a rushed, stressed state with little regard for chewing or tasting our food, we freeze digestive processes.

If you are like I was many years ago and like countless others taking acid reducers, you might be confused. Why then do I have a reduction in symptoms when I reduce the acid? The answer lies in the physical function of the “blender” and the “gatekeeper.”

The blender and the gatekeeper

Our stomachs are typically the size of our fists. Eating more food than your stomach can handle stretches the stomach and does not allow it to actually churn the food. Think of your stomach as a blender. If the blade can’t rotate because it’s packed full, then how can our stomachs mix the food well? If you fill the blender with a whole lot of solids and not enough liquids, you will get a chunky mass that doesn’t pour well. The liquid is important for breaking down or emulsifying the food. This liquid is the hero, hydrochloric acid. Without hydrochloric acid, we cannot break down our food adequately.

The gatekeeper, or lower esophageal sphincter (LES), guards the lower end of the esophagus. The LES is a muscular valve that opens to permit food and liquids to pass easily into the stomach and is the only time it is intended to be open. It is supposed to shut down as soon as food has passed and blocks acid from going back up into the esophagus. When the gatekeeper is working properly, it really doesn’t matter how much acid we have in our stomachs because it is kept in the right place. If the LES is dysfunctional, due to structural abnormalities or poor eating hygiene, then acid can start to surge into the esophagus causing heartburn symptoms. Even small surges in acid can cause significant pain and inflammation. Over time the lining can become even more irritated and inflamed leading to reflux esophagitis, ulcers, or even the most serious condition, Barrett's esophagus. Stomach acid is not to blame in this scenario, but lifestyle factors that contribute to a poor functioning sphincter.

What makes stomach acid a hero

Passive immune function

Hydrochloric acid is an integral part of our passive immune function and the first defense against pathogens that we ingest through our food and water. Most bacteria cannot survive in an acidic environment and our stomachs remain pretty sterile except for a few key commensal species such as H. Pylori and Lactobacilli. If our stomach acid barrier is minimal, then we become vulnerable to invading species that can set up camp in our intestines as they pass from the stomach to the small intestines. These new bullies on the playground cause drastic changes in the terrain of our microbiome leading to an imbalance in bacteria species called dysbiosis. Dysbiosis can lead to chronic conditions such as IBS with constipation or diarrhea, acid reflux, overt pathogen infections, and vitamin and mineral deficiencies.

Normally our intestines have a degree of permeability that allows nutrients to pass through the gaps between cell walls called tight junctions. When these gaps are too wide it allows for inadequately broken down food and bacteria components to pass into the bloodstream. This is known as “leaky gut.” Gluten consumption is a known cause of leaky gut. Gluten stimulates the release of a protein called zonulin which directly affected the tight junctions.

Hydrochloric acid is essential to the digestion of large food particles and protection from bacteria that can survive in an acidic environment. Without enough stomach acid, we risk creating a microbiome community that is unstable and damaging to the lining of our small intestines.

Fact- Intestinal permeability can lead to bacteria components leaking into our bloodstream and causing an immune response. This is known as “leaky gut.”

Digestion and absorption of protein

The secretion of stomach acid triggers the production of pepsin. Pepsin is an enzyme that is required for the initial digestion of protein. If acid levels are depressed, then pepsin levels will be as well, which results in large protein components making their way into the small intestines. Pepsin acts on the protein molecule by unwinding it into smaller components like amino acids and peptides. Proteins must be denatured into amino acids and peptides for complete absorption. Essential amino acids are amino acids that cannot be manufactured by the body and must be consumed in the diet. Insomnia and depression are two common chronic diseases that can be a direct result of protein maldigestion. The essential amino acid tryptophan is the necessary precursor of melatonin and serotonin, without enough tryptophan, our bodies cannot produce adequate amounts of these key neurotransmitters.

Proteins that are unable to be digested and absorbed may actually make their way into our bloodstream when a leaky gut is present. The body can react to these proteins as foreign because they are not normally seen in a healthy GI tract in their unbroken state. This can mount an immune response and gradually lead to food allergies and even more heartburn symptoms.

Digestion and absorption of vitamins and minerals

Hydrochloric acid separates minerals from proteins and prepares vitamin b 12 to actually conjugate with an enzyme so it can be absorbed later on in the small intestines. Minerals such as iron, magnesium, copper, zinc, and calcium, and vitamins like folic acid depend on stomach acid for their digestion. The breakdown of vitamins and minerals requires an optimal pH. If there is not enough acid then the normal chemical reactions cannot take place and nutrient absorption and digestion may not occur. If hypochlorhydria persists for a long time, selective malnutrition can occur affecting more than just our digestive tract.

While I was taking a proton pump inhibitor several years ago, I began to experience extreme muscle cramping in my lower extremities. Being a pharmacist, I knew that a side effect of my acid reducer was magnesium deficiency. Low magnesium can lead to other complications such as constipation, headaches, cramps, and even insomnia. I began taking a magnesium supplement and never had cramps again. I often had tension headaches as well and didn’t put two and two together until several years later. In 2018, I had several epiphanies with regard to my overall health and I began to realize how this sort of band-aid way of thinking was leading to even more health consequences and ultimately, not correcting my mineral and vitamin deficiencies. I was able to stop the acid reducer and change my life.

Fact- If we don’t break down proteins, minerals, and vitamins into smaller components, we can’t absorb them properly.

Other factors impacting stomach acid production

Stress- Studies have shown that if we are in a sympathetic dominant state the body can see an 80% reduction in digestive secretions. Don’t eat in a rushed or stressed state. Relax during meals and eat slow. Enjoy your food! Proper eating hygiene can keep you from having symptoms of bloating, belching, and stomach pain after a meal.

Medications- I’ve already alluded to the acid-reducing medications that negatively impact stomach acid but other drugs can affect the lining and therefore integrity of the stomach. Medications such as non-steroidal anti-inflammatory drugs can be corrosive to the lining by damaging the parietal cells and causing them to decrease acid production.

Too many minerals- The stomach requires a specific pH for optimal digestion. Changing the pH even slightly leads to malabsorption. Consuming too many alkaline products like the aluminum hydroxide and magnesium hydroxide combo Maalox or sodium bicarbonate or baking soda can decrease the pH too much and hinder digestion.

Age- The number of people with hypochlorhydria increases with age to as much as 75 percent after age sixty. This is mainly due to a loss of cells that produce the acid. This condition is known as atrophic gastritis and even people without heartburn have this condition. It is a major cause of declining stomach acid levels and leads to serious disorders like osteoporosis, accelerated aging, small intestinal bacterial overgrowth, allergies, anemia, and skin problems.

Caution

Occasional heartburn is usually pretty benign. It is annoying but doesn’t require a ton of medical intervention if you make lifestyle changes. However, if you suffer from it regularly without any steps to get to the root cause it can lead to long-term health consequences and Barrett’s esophagus which can lead to cancer. I always suggest seeking out a functional medicine doctor or pharmacist who can help you find the root cause of your heartburn. If you are currently taking acid reducers, it might be time to take a look at why you started those meds in the first place. Most people will require a slow tapering strategy to wean off the medication or symptoms of acid reflux will return.

A true hero

Stomach acid truly gets a bad rap these days. Without stomach acid, we cannot fully digest our food, and therefore we cannot fully absorb vitamins, minerals, and protein. Without stomach acid, we cannot have optimal health. We need stomach acid to live our best life. If you are interested in learning more about stomach acid and why we need it, please check out an amazing book by Dr. Jonathan Wright entitled “Why Stomach Acid is Good For You.”