Arguably (after the chewing process in your mouth) the stomach is the first important step in the digestive process. So let’s look at the role of gastric acid and problems associated with low gastric acid levels.

In my practice, I see patients with issues ranging from atopic (allergic) and dermatological presentations (eczema, asthma, acne, psoriasis, shingles) to chronic conditions like Lyme’s, ME/CFS and IBD/IBS or rarer forms of autoimmune conditions and even mood disorders (depressive episodes and anxiety). Though all have very different issues, the one common factor in almost every case is a compromised or poorly working digestive system. Years of processed or sugary foods and poor dietary habits, stress, stimulants, and antibiotic or antacid treatments can do some serious damage to the gut. Maintaining a healthy digestive tract is paramount to achieving optimal health, because poor digestion can cause a multitude of seemingly unrelated problems, and is often the starting point for systemic inflammation and related conditions.

Arguably (after the chewing process in your mouth) the stomach is the first important step in the digestive process. So let’s look into the role of gastric acid and problems associated with low gastric or hydrochloric (HCL) acid levels.

Gastric acid is one of the main digestive juices secreted by special cells in the stomach, together with several enzymes and something called intrinsic factor (which helps absorb vitamin B12). Its primary role is to activate the enzyme pepsin, which then helps digestion by breaking down proteins into amino acids for absorption. These are in turn used as building blocks for the body as well as for neurotrasmitters such as serotonin, melatonin, dopamine and others. In addition, the acidic stomach environment inhibits the growth of many potentially harmful microorganisms, in effect acting as a first line of defense against a number of pathogens, including food-borne ones. Stimulation and regulation of gastric acid is carried out by the autonomic nervous system (parasympathetic (via the vagus nerve) and sympathetic) as well as several hormones and chemical compounds (including histamine which is also linked to immune system function and inflammation). These tidbits of information are important when trying to understand gastrointestinal disturbances and conditions, for instance why stress is often such an important factor in IBS.

Many people believe the mainstream view that symptoms related to reflux and dyspepsia, poor digestion, food intolerances, bloatedness and nutrient malabsorption are related to an excess of HCL rather than a deficiency, and often take medications such as proton-pump inhibitors or “antacids” to help manage the symptoms (if you are on proton-pump inhibitors you must wean yourself off of these slowly, preferably with the help of a professional and never stop suddenly). However, though it may be that some people produce excessive levels of HCL, in many cases the above symptoms are actually linked to an HCL deficiency and such medications can aggravate the problem in the long term.

 

Below are some indicative (though not determinative) symptoms associated with low gastric acid.

Halitosis – Bad breath	Sense of fullness or discomfort after regular or small meals	Indigestion and bloating	Burping or gas after meals	Easily broken finger nails
Reflux, heartburn or GERD/GORD	Malodorous perspiration	Desire to avoid breakfast	Feeling better if avoiding food	Loss of appetite for meat or veganism
Anaemia unresponsive to iron	Cramps or burning pain in lower chest area	Gastric reactivity to vitamin supplements	Post meal sleepiness	Diarrhoea shortly after meals
Chronic diarrhea or constipation	Black or tarry stools	Undigested food in stools	Food allergies, intolerances, and sensitivities	Weak or cracked nails, or dry skin or hair

Low hydrochloric acid levels are very common. The older you are, the more likely you are to have low levels. There are a number of reasons for this, including stress, change in the gut mucosa due to age and the long-term consequences of nutrient deficiencies.

Gastric acid deficiency can lead to increased gastric infections, conditions linked to malnutrition, fungal or bacterial imbalance (dysbiosis), poor absorption of essential micro-nutrients (such as in the case of anaemia, vitamin B12 or vitamin D deficiency), Clostridium difficile, vulnerability to H. pylori (increasing risk of gastric ulcers and stomach cancer), SIBO (Small Intestine Bacterial Overload), increased risk of fractures or osteoporosis (due to poor calcium absorption), localised and systemic inflammatory reactions, autoimmune or other immune system issues, and many other conditions.

 

HCL LEVEL TEST

Here is a rudimentary (indicative only) home test to check your HCL levels:

Mix 1/3-1/4 teaspoon (depends on teaspoon size) of sodium bicarbonate (i.e. baking soda – making sure you get the aluminum free variety) in about 25cls of water (about half a normal sized water glass). Drink this mix about 15 minutes after waking in the morning but before eating or drinking anything else (including water). Then, with a stopwatch, begin counting how long before you begin to burp. Do this over 2-3 days to get an average.

If it takes 1-3 minutes: normal levels

If it takes 3-5 minutes: normal to slightly low levels

If 5-7 minutes: low levels

7+ minutes: potentially no gastric acid

 

So are there some natural ways to improve stomach acid production? The answer is yes…

 

HOW TO INCREASE STOMACH ACID NATURALLY

Bitters	In herbal medicine, bitter herbs in low doses can increase stomach acid though care needs to be taken since it may not be appropriate for everyone. One of my preferred herbs for this is Gentian (Gentiana lutea). Taking 10 drops about 5-15 minutes before each meal will help stimulate both saliva and gastric acid production. If too strong, other alternatives include artichoke (Cynara scolymus), Yarrow (Achillea millefolium) and Swedish Bitters.
Lemon juice and Cider Vinegar	Drink a small amount of fresh lemon juice or apple cider vinegar added to room temperature water about 15-20 minutes prior to eating. It is important that the water is not too cold because cold water can interfere with digestion. If using lemon, squeeze half an organic lemon in 10 cls. of water. For apple cider vinegar, start with 1 teaspoon in 10 cls. of water (you can increase the amount slowly over time up to 5 teaspoons). If consuming apple cider vinegar or lemon juice in water regularly, swish a little plain water around your mouth to protect the enamel of your teeth. You should see improvements after several weeks.
Other herbs for digestion	Digestive teas containing aromatic herbs can help the digestive process, control bloating and gas, improve absorption and keep microbial load down. Try herbal teas containing cinnamon, ginger, cloves, fennel, black pepper and cardamom.
Avoiding stomach irritants	Eliminate/avoid alcohol, caffeine (as well as teas (other than herbal)), and nicotine since these increase symptoms.
Regular calm meals	Sitting down, being calm, thoroughly chewing your food, eating at least 2 main meals at regular times and not eating too much in the evening will all help regulate the digestive processes.
Dietary changes	Reduce or avoid sugars; Add fermented foods to diet (includes yogurts and kefir, sauerkraut and other fermented vegetables, miso), etc. Add vegetables high in betaine such as spinach, beets, leafy greens as well as whole grains and sea food
Saccharomyces boulardii	Saccharomyces boulardii is one of my favorite probiotics. It is a probiotic yeast that resists low stomach PH, helps protect and regenerate gut mucosal cells, and stimulates production of some enzymes. It also helps keep fungal growth in check.
Zinc	Zinc is necessary for the production of stomach acid. In addition to supplementation, zinc can be found in shellfish (especially oysters and crab), meats (especially beef, chicken and lamb), legumes such as mung beans, lentils and chickpeas, almonds and cashews, alfalfa sprouts, spinach, nettles, seeds (especially pumpkin, sesame and sunflower), dark chocolate or cacao.
Vitamin D	Ensure you have optimal levels of vitamin D to help your immune system work properly since low levels leave you open to infection by impacting on calcium bioavailability which is required for the body’s ability to deal with stress.
Vitamin B	Particularly thiamine (vitamin B1)
Salt	Include high quality unprocessed salt (sea salt like Guerande or Himalayan) into your diet to give your body the raw material (chloride) and other trace minerals to build the acid.

 

And of course, don’t forget to speak with your local friendly herbalist to get individualised advice on your specific symptom picture.

 

Warmly,

Sabrina

 

 

References

 

[1] The Role of HCL In Gastric Function And Health

by Michael Ash / Thursday, 20 January 2011

[2] McColl KE. Effect of proton pump inhibitors on vitamins and iron. Am J Gastroenterol 2009; 104(suppl 2):S5–S9

[3] Howell MD, Novack V., Grgurich P., et al. Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med 2010; 170:784–790.

[4] Lombardo L, Foti M, Ruggia O, Chiecchio A. Increased incidence of small intestinal bacterial overgrowth during proton pump inhibitor therapy. Clin Gastroenterol Hepatol 2010; 8:504–508.

[5] Yang YX,Lewis JD, Epstein S,Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 2006; 296:2947–2953.

[6] Weeks, P. Make Yourself Better. 2012. Singing Dragon, London