If you ask your doctor for something to help relieve acid reflux/heartburn, you will likely be prescribed a Proton Pump Inhibitors (PPI’s) such as ‘Omeprazole’ or told to try some antacids from the local pharmacy. These types of medications are effective for high stomach acid. But acid reflux and heartburn can also be caused by low stomach acid.
While the symptoms of reflux certainly involve acid and the stomach contents regurgitating into the oesophagus, this theory doesn’t explain why it happens. Let’s take a look at current research on the causes of acid reflux/heartburn, why suppressing stomach acid production isn’t ideal and what you can do to relieve your symptoms.
Stomach Acid & Enzymes
Before I go further, let me briefly explain the workings of your stomach and the role of hydrochloric acid (HCL) and digestive enzymes.
The action of swallowing moves food down the oesophagus and delivers it to your stomach where protein digestion occurs with the help of hydrochloric acid (HCL) and the digestive enzyme, pepsin, which is activated by HCL. Pepsin breaks the protein (found in meat, legumes, nuts and seeds etc) into smaller chains of amino acids known as peptides.
Food is mixed together with these gastric juices by the churning of the stomach. The acidic environment of the stomach not only facilitates the breakdown of proteins it also helps to kill off any nasty bacteria.
Once food is passed into the stomach it is kept there by a band of muscle called a ‘sphincter’ which snaps shut preventing the food from pushing back up the oesophagus. If the sphincter muscle isn’t working properly it can cause ‘heartburn’.
The stomach also secretes ‘intrinsic factor’ a substance that attaches itself to vitamin B12 allowing it to be absorbed. Vitamin B12 is bound to proteins in food and can only be released when food is broken down in the stomach by HCL and pepsin. Without adequate stomach acid and digestive enzymes our absorption of nutrients may be compromised.
What else could cause stomach acid problems?
Many other factors can contribute to stomach acid and related problems. Most commonly:
- A poor diet
- Ageing – leading to Insufficient stomach acid and low production of digestive enzymes
- Bacterial infection (e.g. Helicobacter Pylori, SIBO)
- Yeasts/fungal infections (e.g. candida)
- Non-steroidal anti-inflammatory drugs (NSAIDS)
- Nutrient deficiencies such as zinc, Vitamin C, B6 & B12, glutamine (contributing to the risk of developing anaemia, cardiovascular disease, dementia or osteoporosis)
- Weakening of the lower oesophageal sphincter causing the stomach acid to flow backward up into the oesophagus (acid reflux). This is also known as gastrointestinal reflux disease (GERD).
- Hiatus hernia
- Spinal nerve issues/structural misalignment
Simple natural methods of measuring stomach acid
- Beetroot test: after consuming beetroot the colour of the urine is checked; if the colour is pink (beeturia) that means that the stomach acid is low, but if clear there is sufficient stomach acid. Beeturia is caused by the betalain pigments in the beets, breaking down and being excreted.
- Lemon juice test: in case of stomach pain, have a tablespoon of lemon juice. If this relieves the pain, you may have low stomach acid. If it makes your symptoms worse, then you may have too much stomach acid.
- Baking soda test: mix ½ teaspoon of baking soda into ½ glass of water and drink it 10-15 minutes before eating the first meal of the day. This mixture should trigger the secretion of acid. The by-product of this will be CO2, even in the first 90 seconds, up to 3 minutes. If this doesn’t happen, it means that the stomach is not acidic enough. Early and repeated belching may be due to excessive stomach acid (but don’t confuse these burps with small little burps from swallowing air when drinking the solution). Any belching after 3 minutes indicates a low acid level. The test should be performed 3 consecutive mornings to find an average. Because the time frames can vary person-to-person, as well as how they drink the solution, this test is only a good indicator therefore you might want to do more testing to determine your stomach acid.
- Betaine HCL challenge test: start with one capsule/tablet of betaine HCL and increase gradually until the feeling of warmness in the stomach occurs. It is possible to take up to 10 pills before some people experience this feeling.
- The Heidelberg Stomach Acid Test: this is the gold standard medical test for low stomach acid levels, and although costly, it will give exact, non-biased results to analyse stomach acid. It works by using a small capsule with a radio transmitter that records the pH of the stomach as you drink a solution of sodium bicarbonate. The result of the test is a graph showing the pH levels at regular intervals of time.
- Quantum physics technology can also identify and help!
Steps you can take to prevent stomach acid problems
Although your body is very adept at manufacturing enzymes to digest carbohydrates, protein and fat, sometimes it may not produce enough. This can happen for a number of reasons, as mentioned above.
Below are some recommendations to support healthy stomach acid levels:
- Lose weight if relevant – it may be best to see a naturopath or nutritionist to help you with a personalised weight loss programme.
- Low-carbohydrate diet has been shown to significantly reduce symptoms. Avoid all refined sugars and carbohydrates (e.g. pasta, bread). Simple meals based around a source of protein (meat, fish, eggs, legumes) and vegetables work well. Avoid snacking and eating late in the evening.
- Minimise alcohol and caffeine which can contribute to acid reflux.
- Thoroughly chew each mouthful of food and eat smaller meals.
- Incorporate bitter greens into your diet: rocket, endives etc.
- A pinch of sea salt in each glass of water assists the stomach to secrete gastric acid.
- 1-2 dessertspoons of apple cider vinegar (ACV) in ½ glass of water is recommended 10 minutes before meals, particularly the main meal.
- Often supplementing with Betaine HCI or digestive enzymes is all that’s needed to support healthy digestion.
– Betaine HCL (with or without pepsin) improves low stomach acid, helps with acid reflux and also assists in healing the gut mucosa. It’s also one of the best gut supporting supplements!
– Digestive enzymes taken just before a meal can be taken before a meal with ACV. These also assist greatly with bloating and wind!
- Bitter drops or digestive bitters which stimulates the digestive process including digestive enzyme production, bile secretion, and stomach acid levels may be added to ACV before meals. Bitters can also be used after meals to ease an upset stomach, indigestion, bloating or heartburn is being experienced. Examples include gentian, dandelion root, celandine, barberry, boldo, Oregon grape, gotu kola and wormwood.
- Just 1-2 teaspoons a day of Manuka Honey can also assist low stomach acid production, can actually improve symptoms of stomach ulcers(!), as well as SIBO (small intestinal bacterial overgrowth).
- Aloe Vera (part of my Detox Cocktail) contains ‘mucopolysaccharides’ which are recognised for their healing anti-inflammatory and anti-bacterial properties – helping to promote healthy mucus secretions in the intestines. Not only does this restore the protective coating it maintains the ideal environment to encourage proliferation of friendly bacteria.
- Osteopathy, massage etc can also assist any structural issues impacting the gut.