False Controversy: Adding or Reducing Stomach Acid
It’s common sense that too much stomach acid can irritate one’s lower esophagus and trigger painful episodic heartburn. But it’s totally counter-intuitive that having too little stomach acid can also lead to heartburn. The older you are the more likely it is that you have low acid. By age 65 about 1/3 of the population has low acid, a significant minority.
If you have anemia or an autoimmune condition, the chances you have low stomach acid range anywhere from 5% up through 50%. Examples of autoimmune conditions:
- Rheumatoid arthritis
- Type 1 diabetes
- Celiac disease
- Crohn’s disease
- Thyroid disease – Hashimoto’s and Graves’
- Sjögren’s syndrome
Only 2% of the US population have documented low stomach acid . However, the actual numbers may be higher. Here’s more on heartburn relief for those with low stomach acid and how to test your acid level at home.
Heartburn Relief for those with Low Stomach Acid
This is why knowing your acid level is important to finding relief from episodic heartburn. Some dietary supplements add acid, whereas others decrease it. So this difference is not a philosophical conflict, it’s science-based reality. A University of Manchester study published in Cambridge Journal confirmed that low stomach acid is becomes more to blame as we age than too much stomach acid for the common indigestion symptoms like heartburn.
Good potent dietary supplements for heartburn relief can fail you because they’re formulated for people with the opposite acid level than yours. Which raises the question, what is your acid level?
The drinking-ACV-for-heartburn advice come from a few different websites and blogs, but most credit one college thesis paper from Arizona State University (so, it is not a peer-reviewed, published study).
Still, the paper’s researcher—a graduate student—conducted a randomized, placebo-controlled, double-blind, cross-over research study that had people either eat a meal with chili (and take nothing), take an antacid after a chili meal, eat chili that had apple cider vinegar added to it, or drink diluted ACV after eating the chili.RELATED STORY‘I Drank Apple Cider Vinegar For A Month’
Those who had vinegar in any form seemed to do pretty well in the heartburn department (similarly to those who took antacids) but, the researcher said, more research is needed.
Other than that, there’s no reputable research on this. Still, this move “works for some individuals with mild heartburn,” says Ashkan Farhadi, M.D., a gastroenterologist at MemorialCare Orange Coast Medical Center and director of MemorialCare Medical Group’s Digestive Disease Project in Fountain Valley, Calif.
3 Ways to Learn Your Acid Level
There are a 3 main ways to learn your acid level: 1) trying both types of natural heartburn supplements, 2) a baking soda home test and 3) doctor administered tests.
1. Try an Acid Reducing Natural Heartburn Supplement 1st: Then Try an Acid Adding Alternative If Needed
Depending on your age you have about a 64% to 100% chance of landing on the right type of heartburn remedy on the first try if you start with an acid lowering formula. NaturCress signals your stomach lining to hold back acid flows. If you have too much acid it is formulated to help remedy your episodic heartburn. If it works for you then you are good to go.
But, if acid reduction does not work for you, then try adding acid before meals with NaturAcid+ Reflux Relief (or Maty’s) which has acedic acid from organic apple cider vinegar. Topping up your acid level at mealtime can help with relief of episodic heartburn when you usually have low acid. You deserve heartburn relief for those with low stomach acid. If neither of these formulas work for you, see a doctor as you may have more complicated digestive issues.
2. Baking Soda Home Acid Level Test
For a low-cost home-based test that delivers reasonably accurate results, all you need is baking soda. As this test is simple and safe, it’s a smart option for regularly checking on your stomach acid levels. However, it has a lot of variables that can trigger false positives or negatives, so you should perform it repeatedly for the most accurate results.
To try it out, mix ¼ tsp of baking soda in four ounces of cold water, and drink the blend first thing in the morning before you eat or drink anything else. Time how long it takes for you to burp. It’s a sign of low stomach acid if it takes more than five minutes or you don’t burp at all.
This home test works by triggering a chemical reaction in your stomach from mixing the base baking soda with stomach acid. The natural response if you have enough stomach acid is carbon dioxide gas, which triggers burping.
3. Doctor Office Acid Level Tests
Your doctor has more sophisticated options for in-office testing of your stomach acid level.
If you’re working with a skilled functional medicine doctor, you can get a sense of your stomach acid levels from a complete blood count (CBC) and comprehensive metabolic panels (CMP) test. These routine tests provide insight into your base levels of stomach acid, especially if you receive them regularly
Generally, the indicators that your doctor will look for include the following:
- Low Iron levels: Having low iron is a common sign of hypochlorhydria, as iron requires stomach acid to be properly absorbed.
- Low Phosphorous Levels: low phosphorous levels, especially when paired with a vitamin D deficiency, is a sign of low HCL levels.
- Abnormal Serum Protein and Globulin Levels: If your serum and globulin levels are above or below where they should be.
- Low Chloride Levels: Hydrochloric acid contains plenty of chloride, so low chloride levels (anything under 100) are a sign your stomach acid levels are below standard levels.
- High BUN Levels: a BUN level (blood urea nitrogen) above 20 can be a sign that your system doesn’t have enough stomach acid to deal with nitrogen waste in the bloodstream.
The Gastric Acid Secretion Test
If your stomach acid problems seem severe, your doctor might recommend a gastric acid secretion test. As the test is both invasive and expensive, it’s usually saved for extreme cases. The test requires you to receive a hormone injection that stimulates your stomach cells to release acid, and then tubes are inserted into your stomach via the esophagus to suck out existing stomach acid. The acid that is collected is then measured and tested for its pH level. A small amount with a high pH level is a sign something is wrong.
The Heidelberg Stomach Acid Test
Considered to be the gold standard for stomach acid testing, the Heidelberg stomach acid test provides precise results about the status of your stomach acid. You will need to fast for twelve hours before the test and then swallow a small electronic capsule. Immediately after, you will drink a baking soda solution to neutralize any HCL in your stomach naturally. The electronic capsule will record the time it takes your stomach to restore its acidity levels, which will determine whether your stomach acid levels are low.
Low Stomach Acid and Health
Stomach acid is scientifically known as hydrochloric acid (HCL) because its chemical composition is one part hydrogen to one part chloride. This compound is critical for the digestive process. When your stomach acid levels are lower than normal, your system will struggle to absorb essential minerals and proteins, which can lead to deficiencies. Likewise, stomach acid is responsible for killing harmful bacteria that enter with your food.
Low stomach acid, also known as hypochlorhydria, is a condition that can lead to numerous health problems. Without adequate acid levels, you will leave your stomach vulnerable to disease and painful side effects, including the following:
inflammation stomach pain nausea rheumatoid arthritis cancer small intestinal bacterial growth (SIBO) acid reflux heartburn malnutrition leaky gut syndrome general skin problems
Risk factors for Low Acid
Risk factors for hypochlorhydria, according to Heathline include:
- Age. Hypochlorhydria is much more common as you get older. People over the age of 65 years are most likely to have low levels of hydrochloric acid.
- Stress. Chronic stress may decrease production of stomach acid.
- Vitamin deficiency. Deficiency of zinc or B vitamins may also lead to low stomach acid. These deficiencies may be caused by inadequate dietary intake or by nutrient loss from stress, smoking, or alcohol consumption.
- Medications. Taking antacids or medications prescribed to treat ulcers and acid reflux, such as PPIs, for a long period of time may also lead to hypochlorhydria. If you take these medications and are concerned that you have symptoms of low stomach acid, speak with your doctor before making changes to your medications.
- H. Pylori. Infection with H. Pylori is a common cause of gastric ulcers. If left untreated, it can result in decreased stomach acid.
- Surgery. Surgeries of the stomach, such as gastric bypass surgery, can reduce production of stomach acid.
How Low Acid Causes Heartburn
There are at least three ways on low stomach acid leads to heartburn and one may have combination of them at once. They basically include signaling the lower esophagus valve (LEV) and increasing pressure in the stomach. Understanding this is important in achieving heartburn relief for those with low stomach acid
One reason is that if your acid is weak it will not trigger the closure of the lower esophagus valve (LEV) at the bottom of your esophagus which keeps acid out after food or liquids pass by. Weak acid may not trigger the organic sensors that trigger the valve to close. But even weak acid can irritate the esophagus because it does not have the protective mucus that protects your stomach lining. Irritation = heartburn.
Another reason low stomach acid is thought to lead to heartburn is that it is not strong enough to kill some bacteria which generate gas in your stomach. The gas they make increases the pressure inside the stomach, which pushes acid up into the esophagus if your LEV valve is not in perfect working order. Even weak acid can cause irritation and thus heartburn.
Another possible mechanism is that to compensate for low stomach acid your stomach mechanically works harder to start digestion of proteins. This overly active churning and squeezing motion in the stomach causes pressure to build and stomach acid to splash, or back up into the esophagus.
This should be a useful overview about heartburn relief for those with low stomach acid. NaturCress Stomach Acid Control for Occasional Heartburn and NaturAcid+ Reflux Relief are natural reflux remedies available online.
Supplemental Acid Dose
“I have noticed that supplemental acid certainly seems to help some people, but megadosing is not needed” according to Dr. Michael Ruscio, DNM, DC in “Apple Cider Vinegar for Bloating and Digestive Issues” December 21, 2019 in his blog.
Ashkan Farhadi, M.D., a gastroenterologist at MemorialCare Orange Coast Medical Center and director of MemorialCare Medical Group’s Digestive Disease Project in Fountain Valley, Calif. recommends taking it (apple cider vinegar) on an empty stomach (that’s your best bet for bringing your stomach pH down).
Apple Cider Vinegar and Acid Reflux
(From Healthline) Apple cider vinegar is generally made from crushed apples. Bacteria and yeast are added to ferment the liquid. At first, the liquid is similar to a hard apple cider because of the alcohol content. More fermentation changes the alcohol into vinegar.
Organic and raw apple cider vinegar are both allowed to ferment naturally. These liquids are unfiltered and typically take on a brownish, cloudy appearance. This process leaves behind the “mother” of the apple.
The mother is a cobweb-like substance found at the bottom of all bottles of organic apple cider vinegar. Nonorganic apple cider vinegar is pasteurized, and the mother of apple is removed.
It’s thought that the mother is rich in enzymes, proteins, and pectin. Because of this, organic varieties are considered the gold standard when used to treat health conditions, such as acid reflux.
A graduate thesis did find that raw or unfiltered apple cider vinegar may prevent heartburn. It’s generally accepted as safe to consume a small amount of apple cider vinegar.
Apple cider vinegar may interact with certain medications, including diuretics, laxatives, and heart disease medications. Don’t use apple cider vinegar if you have an ulcer, as it can aggravate your symptoms. “In general, the risk of using apple cider vinegar for acid reflux is minimal.” –Medical News Today.
Gastric Acid Basics
Digestive Fluid or Gastric acid, gastric juice, or stomach acid, is a digestive fluid formed within the stomach lining. With a pH between 1 and 3, gastric acid plays a key role in digestion of proteins by activating digestive enzymes, which together break down the long chains of amino acids of proteins. Gastric acid is regulated in feedback systems to increase production when needed, such as after a meal. Other cells in the stomach produce bicarbonate, a base, to buffer the fluid, ensuring a regulated pH. These cells also produce mucus – a viscous barrier to prevent gastric acid from damaging the stomach. The pancreas further produces large amounts of bicarbonate and secretes bicarbonate through the pancreatic duct to the duodenum to neutralize gastric acid passing into the digestive tract.
Acetic acid is – as the name suggests – an acid. This means that the vinegar that contains it will also be acidic. On the pH scale, where 0 is the most acidic thing possible and 7 is completely neutral, vinegars typically have a value of about 2.5. In comparison, this makes vinegar less acidic than lemon or lime juice (which have a pH around 2) and more acidic than orange juice (which has a pH of 3.3 or higher). Stomach acid is generally more acidic than all of these; it averages around 1.5 on the pH scale. These may seem like minor differences, but be aware that the pH scale is logarithmic – stomach acid with a pH of 1.5 is actually ten times more acidic than vinegar with a pH of 2.5 and a hundred times more acidic than an orange juice with pH of 3.5.
Caution: If you are currently taking Proton Pump Inhibitors or H2 Blockers, don’t attempt using supplemental acids until you have successfully weaned off of them. Do not attempt to wean yourself off of these medications on your own. Get advice from your doctor on how to do this safely. The last thing you want to experience is a rebound in gastric acid production.