As a nutritionist running a busy clinic, it would not surprise anyone to discover that the most common complaint relates to gut health. The term IBS gets thrown around a lot, a label given by their doctor to those unfortunate enough to develop gut issues; a catch-all for digestive issues. However, these patients are often left to their own devices to navigate diet or lifestyle changes to help them live with IBS. I look at this very differently. Rather than being a condition in itself, IBS is a collection of symptoms, and it is my role to discover the actual cause of these symptoms. This could be due to bacterial or yeast overgrowth, inflammation, stomach acid imbalance, parasites, dysbiosis or more. Symptoms of IBS can range from acid reflux right through to abdominal pain, flatulence, constipation or diarrhoea. For this article, we are focusing on acid reflux (also can be referred to as heartburn) and GERD (Gastroesophageal Reflux disease). Heartburn is a symptom of acid reflux or GERD and is noted by a pain or burning sensation in the chest.
For those who are unaware, Acid reflux can affect us at any point in our lives, whether short-term or longer-term. Acid reflux, rather simply, is when acid can travel up the oesophagus. Symptoms can include any of the following:
- Pain or burning in your chest
- Unpleasant taste in your mouth
- Bad breath
- Clearing of the throat
- Cough
- Frequent hiccups
- Bloating
- Nausea
- Lack of appetite
It can be made worse by poor diet, obesity, smoking, pregnancy, alcohol, and stress. What often surprises people is another factor for acid reflux is low stomach acid. Some medications, especially anti-inflammatories such as Ibuprofen, can make it worse. Acid reflux can also be a symptom of poor gut health, including poor digestion, weak connective tissue, H Pylori, Hiatus Hernia, and gallstones.
GERD stands for Gastroesophageal Reflux disease, is a more chronic and severe form of acid reflux. It affects the lower oesophageal sphincter, which sits just above the stomach (the upper oesophageal sphincter is at the back of the throat/top of the oesophagus). When we want to eat, the sphincter’s top and bottom open to allow food through the oesophagus and into the stomach. It then closes behind the food to allow for good digestion in the gut. This sphincter can become weak, either due to poor diet, weight, or other health issues. This sphincter weakness can cause our stomach acid and even some food particles to flow upwards, causing us pain and discomfort.
The Truth About Stomach Acid:
Stomach acid is crucial in digestion, nutrient absorption, and immune defence. However, many people misunderstand its function, often blaming excess acid for issues like acid reflux and GERD (gastroesophageal reflux disease). The reality is that low stomach acid, or hypochlorhydria, is often the hidden culprit behind these symptoms. This article provides a comprehensive overview of stomach acid, its role in digestion, related conditions, and how to properly address digestive discomfort.
Stomach acid plays a crucial role in digestion and nutrient absorption. Hydrochloric acid (HCl) is essential for breaking down food, particularly proteins, and activating digestive enzymes such as pepsin. It also helps the body absorb key nutrients, including vitamin B12, iron, calcium, and magnesium. Another important function of stomach acid is its role in immune defence. It acts as a barrier, killing harmful bacteria and preventing infections from taking hold in the digestive system.
Low Stomach Acid (Hypochlorhydria) and Its Symptoms
Low stomach acid can result from various factors, including aging, chronic stress, poor diet, and the use of acid-suppressing medications. When stomach acid levels are too low, digestion slows, and food sits in the stomach for longer than it should. This can lead to fermentation, gas build-up, and pressure, which can force stomach contents, including acid, back into the oesophagus. The result is acid reflux, even though the underlying issue is insufficient stomach acid. Common signs of low stomach acid include bloating, excessive belching, indigestion, heartburn, nausea, feeling full quickly when eating, and nutrient deficiencies that can lead to fatigue, brittle nails, and hair loss.
Conditions That Affect Stomach Acid Levels
H. pylori Infection: Helicobacter pylori (H. pylori) is one of the most common causes of low stomach acid. This type of bacteria can infect the stomach lining, reducing acid production and causing digestive issues. Left untreated, it may lead to ulcers and chronic gastritis.
Small Intestinal Bacterial Overgrowth (SIBO): SIBO occurs when bacteria that should reside in the colon overgrow in the small intestine. Low stomach acid is a significant contributor, as it fails to kill off unwanted bacteria. Symptoms of SIBO include bloating, diarrhoea, constipation, and malabsorptions.
Ageing and Stomach Acid Decline: As we age, stomach acid production naturally declines, increasing the risk of digestive problems, nutrient deficiencies, and infections. Older adults are particularly susceptible to low stomach acid-related issues, including osteoporosis (due to poor calcium absorption) and B12 deficiency.
Low thyroid levels: Low thyroid levels can slow down digestion and reduce stomach acid production, leading to bloating, indigestion and reflux-like symptoms.
Stress: Stress has a profound effect on digestion. Long-term stress can suppress stomach acid production, leading to poor nutrient absorption and slowing gastric emptying.
Medication: Long-term use of acid-reducing medications, such as PPIs or antacids. Weight loss injections such as Wegovy or Ozempic dramatically slow down digestion, and this, in the long term, will disrupt our digestion, particularly our stomach acid.
Liver or gallbladder dysfunction: The liver and gallbladder play a role in digestion by producing and storing bile, which helps break down fats. If the liver is sluggish or the gallbladder is dysfunctional, digestion of fats is impaired, leading to bloating, nausea, and discomfort after meals. Low stomach acid contributes to poor bile flow, making digestion even more difficult. Conditions like gallstones or bile acid insufficiency are common in those with low stomach acid.
Diabetes and gastroparesis: People with diabetes, particularly those with uncontrolled blood sugar levels, may develop gastroparesis, a condition where the stomach empties too slowly. This can cause food to remain in the stomach longer, leading to fermentation, reflux, bloating, and nausea. Diabetic neuropathy (nerve damage) can affect stomach acid production by interfering with nerve signals that stimulate digestion.
Many people are treated with acid-reducing medications like proton pump inhibitors (PPIs), but these, when the overall cause is not identified, could exacerbate the problem. By reducing stomach acid further, they can exacerbate digestive issues, increase the risk of infections such as C. difficile and pneumonia, and contribute to nutrient deficiencies, particularly B12, folic acid, calcium, and magnesium. Studies have also linked prolonged PPI use to kidney disease and osteoporosis. While these medications may provide temporary relief, they fail to address the root cause of acid reflux and GERD, and in some cases, they can make symptoms worse over time.
The Good and Bad of Proton Pump Inhibitors (PPIs)
PPIs are commonly prescribed to reduce stomach acid and treat GERD and ulcers. While effective for short-term use, they come with risks:
Pros of PPIs:
- Effective at healing ulcers and reducing severe acid reflux symptoms
- Helpful in managing GERD when lifestyle changes aren’t enough
- Can prevent complications in people with Barrett’s oesophagus
Cons of PPIs:
- Long-term use can lead to nutrient deficiencies (B12, magnesium, calcium)
- Increased risk of infections like C. difficile and pneumonia
- There is a higher likelihood of rebound acid hypersecretion when stopping PPIs suddenly
- May contribute to kidney disease and osteoporosis over time
- Stopping a PPI suddenly can cause rebound hypersecretion of acid as the body tries to reset/rebalance, but this can be supported naturopathically.
Our diet can really affect our gut health and overall health. Poor-quality food, highly processed, high in sugars and unhealthy fats, will impact our gut. Excessive caffeine and fizzy drinks will also make our gut health worse. Some foods may also become more difficult to tolerate, commonly wheat and gluten, beans and pulses, high fodmap foods, fermented foods and even dairy. This can be confusing when general advice for gut health includes some of these foods, which is why it is vital to seek professional advice to identify the true cause. For example, fermented foods and fermentable fibre are great for a healthy gut, but these will make your symptoms worse if you have an overgrowth issue, such as SIBO.
Lifestyle changes can further support healthy digestion. Eating smaller, more frequent meals prevents excessive stomach stretching and pressure, which can contribute to reflux. Thoroughly chewing food before swallowing can help stimulate digestive enzyme production and ensure that food is broken down properly before it reaches the stomach. Avoiding lying down immediately after eating is another simple but effective strategy, as gravity helps keep stomach contents where they belong and reduces the likelihood of acid reflux.
For those with persistent symptoms, targeted supplementation may help, but should always be undertaken with professional guidance, as it is vital to identify the true cause of the acid reflux, or you could make your symptoms worse. Betaine HCl with pepsin can help increase stomach acidity and improve digestion, particularly in those with confirmed low stomach acid. Digestive enzymes can support the breakdown of proteins, fats, and carbohydrates, easing digestive discomfort. Some people find that diluted apple cider vinegar before meals can aid digestion by naturally acidifying the stomach, though this approach is not suitable for everyone and should be used with caution.
Understanding stomach acid balance is key to tackling acid reflux and GERD effectively. Rather than suppressing acid production, identifying the root cause—whether it is low acid, bacterial infections like H. pylori, or conditions such as SIBO—can lead to more sustainable relief. By making dietary and lifestyle changes and, where appropriate, considering natural supplementation, it is possible to restore proper stomach acid levels and improve overall digestion. Before making any significant changes or starting supplements, it is always best to seek professional advice to ensure the right approach for individual health needs.
If you are struggling with digestive discomfort, it may be time to reconsider the common misconception that stomach acid is the enemy. In many cases, it may actually be the missing piece in your gut health puzzle.
Always consult a healthcare professional before making significant changes or beginning new supplements to ensure the best approach for your individual health needs.
By Sarah Flower, Nutritionist.
