Rethinking Stomach Acid - A Naturopathic Approach to Digestive Health

"I am convinced that digestion is the great secret of life." Sidney Smith

With so many people taking acid inhibitors for digestive concerns such as reflux and heartburn, it's no wonder we've come to associate these health problems with too much stomach acid.

Generally however, most people do not produce enough stomach acid and the fact is stomach acid is essential to our digestion and therefore to our health.

Production of stomach acid, aka hydrochloric acid, decreases with age and as many as 8 in 10 adults over 60 have deficient levels. Other causes of low levels include antacid use, stress, infections, and long term vegetarian diets.

Optimal levels of stomach acid are determined using a tool know as the pH scale. This scale ranges from 0 to 14 with the more acidic substances landing lower on the scale (vinegar, lemon juice) and the more alkaline on the higher end (baking soda). A measurement of 7 is considered to be neutral. The ideal stomach environment functions at a pH of 2. Anything above 4 indicates low acid levels and can have serious health complications as a result.

Although not an enzyme itself, hydrochloric acid in the stomach acts as the signal for the release of all other digestive enzymes. In other words, stomach acid doesn't actually do any digesting but creates the optimal environment for the enzymes to do their work.

Symptoms of low stomach acid, or hypochlorhydria, include acid reflux, frequent belching after meals, indigestion, feeling of fullness, gas, constipation, diarrhea, undigested food in stool, and food sensitivities. Long term complications of hypochlorhydria can contribute to nutritional deficiencies, digestive disturbances, and gastrointestinal infections.

Testing

There are a number of tests available to determine your stomach acid levels.

Heidelberg - a state of here art test that involves swallowing a pH sensitive capsule which then transmits information about the stomach environment. The information is printed on a graph and it the gold standard for assessing acid levels.

Baking soda test - although the validity of this test is not supported by research, it can be worth a try, inexpensive, and done at home. Mix one quarter teaspoon of baking soda in a small glass of cold water and drink first thing in the morning before food. Time how long it takes before you burp. If you burp within the first 2 minutes, your levels are likely adequate. Anything between 2-5 minutes suggests low levels and more than five minutes suggests very low levels. It's a good idea to repeat this test three mornings in a row to get an average result and also to repeat after treatment to assess improvement.

HCL challenge - although not completely fool proof, taking a capsule of Betaine HCL midway thru a meal can help identify if your stomach acid levels are adequate or not. Any warmth or discomfort after the meal indicates your acid levels are sufficient. If you do not feel any differently, take 2 capsules at your next meal. Continue increasing with each meal until you feel warmth or reach 5 capsules with one meal. If you get up to 4 or more capsules without any signs of warmth or burning, it is likely that you have very low levels of stomach acid.

Naturopathic Solutions

Nutrition

• Apple cider vinegar with meals. To stimulate an optimal pH during digestion and improve overall function of the system, add 1-2 tablespoons of ACV to 1/4 cup room temperature water and drink before your meal.
• Whole foods diet. To get the most nutritional value from your food, avoid processed and refined foods that are nutrient depleted. Instead, choose foods that are easy to digest and nutrient dense. Consider smoothies, fresh juices, puréed vegetables and soups, and steamed vegetables.
• Identify and avoid food sensitivities. Food sensitivities can both be caused by and be the cause of low stomach acid. When proteins that would normally be digested pass thru a low stomach acid environment into the intestines, they create inflammation and trigger immune reactions. Continuing to consume these food triggers damages the lining of the digestive tract, impairing its ability to produce appropriate enzymes.  It becomes a viscous cycle. Food sensitivity testing is available at The Pear Tree and can identify foods that otherwise may be missed and continue to cause problems. Although challenging to follow, an elimination diet can also be an effective tool to identify food triggers.
• Fermented Foods. A source of probiotics, friendly gut bacteria, fermented foods support digestive function in many ways. Examples include raw sauerkraut, kombucha, miso, and kefir.

Lifestyle

• Chew. This may seem like a simple and obvious strategy, but many of us do not take full advantage of our mouths as part of the digestive process. Teeth and tongue help to breakdown food into smaller, more manageable food pieces. Keeping food in our mouths a little longer while chewing also exposes the food to enzymes in our saliva. It is a conscious effort to chew and ideally food should be chewed until almost in a liquid form (about 30 times per bite). Effectively chewing your food will help your entire digestive system work more effectively.
• Eat when relaxed. When we are rushed or feeling stressed, blood is diverted away from our digestive organs. We also have a stronger tendency to gobble down our food rather than chew it. Schedule time to eat and avoid eating on the run.
• Manage stress levels. Stress depletes digestive function. Manage your stress with healthy strategies such as yoga, meditation, counselling, journaling, and breathing exercises.
• Avoid consuming all your liquids with meals. Drinking larger amounts of water and other liquids with your meals dilutes stomach enzymes. Adding lemon juice or apple cider vinegar to your water helps reduce the impact, however a positive health strategy is to drink most of your daily fluid intake between meals.

Herbs

• Bitters. Various herbs support digestion. By stimulating the release of stomach acid, adequate bile flow and pancreatic enzymes, bitters such as gentian, dandelion, and rhubarb are especially helpful. Speak to your naturopathic doctor for appropriate dosing options.
• Demulcents. If there's been damage to the digestive tract from situations related to low stomach acid, such as reflux or food sensitivities, demulcent herbs may be useful. Demulcents are soothing and healing to the lining of the digestive tract. Aloe Vera can be very soothing for an irritated digestive tract. If you've experienced reflux or heartburn as a result of low stomach acid, Aloe Vera juice on an empty stomach will help reduce inflammation and soothe damage. Other options with similar effects are also available, including licorice root and slippery elm. Consult your naturopathic doctor to determine a herbal solution ideal for your health concerns.

Supplements

• Betaine HCL and Digestive Enzymes. There are cases which benefit from enzymes and hydrochloric acid in capsule form. These supplements provide the necessary amounts of hydrochloric acid and enzymes such as bile, pepsin, lipase, and amylase to support the digestive process. It is important to consult with a naturopathic doctor to ensure you are taking therapeutic doses. It is possible to take too much hydrochloric acid in supplement form and it is not recommended in cases of active ulcers or if you are taking anti inflammatory medications such as corticosteroids, aspirin, or ibuprofen which damage the protective lining of the stomach wall.
• Probiotics. Balancing the bacteria in your digestive tract leads to many positive health benefits. Although fermented foods are great sources of probiotics, occasionally higher doses are needed to rebalance the flora.
• Replace deficiencies. B vitamins, omega 3, fat soluble vitamins (A, D, E, K), minerals (iron, zinc, calcium) and other nutrient deficiencies are common in cases of low stomach acid. If stomach acid has been inadequate for some time, multiple nutritional deficiencies are likely. Blood and hair analysis tests are options which help determine nutritional status and if supplementation is necessary. These tests are available at The Pear Tree. It may be helpful to take a supplement to boost levels before maintaining with diet alone.

Conclusion

Although acid-reducing medications are a common recommendation to address digestive issues, adequate stomach acid levels are necessary for digestive health. Optimal digestion occurs when the stomach environment is at a highly acidic pH of 2. A more comprehensive approach to digestive concerns is to identify and treat the root cause. Often, this means supporting rather than suppressing your body's natural tendencies.