Stomach acid–the why and the what
Stomach acid, also called Gastric Acid, is made on demand when you eat via the parietal cells that line your stomach. Those parietal cells use various minerals to help make stomach acid–the latter which is mainly composed of hydrochloric acid, potassium and sodium, and will usually have a pH of 1.35 to 3.5 (Wiki), i.e. it’s all highly regulated. It’s purpose is to keep your pH levels down. Other cells in your stomach produce bicarbonate to help buffer the acidity, as well as mucus to help protect your stomach lining from the aciditiy.
What does stomach acid do for me?
Two key benefits: absorption and protection. When food hits your stomach, it’s your stomach’s gastic acid that begins the breakdown of protein and most minerals with pepsin to prepare for the important absorption of key nutrients (like iron B12, Vit. D and MORE) in those foods for your health and well-being. It also helps knock out bad or dangerous bacteria.
Low stomach acid also leads to non-optimal levels of neurotransmitters/amino acids (chemicals which transmit signals from one cell to another and play a huge role in your health and well-being).
How hypothyroidism negatively affects your stomach acid levels
Just as hypothyroidism can result in the drying out of your skin and hair, it also seems to lower the levels of stomach acid in many thyroid patients, possibly by lowering your amount of parietel cells. The result? The absorption of important nutrients is reduced, and you can find yourself with non-optimal or low levels of iron, B12, Vitamin D and more. And you won’t have the protection you once had against bad forms of bacteria, causing their over-growth (dysbyosis). Symptoms can include delayed excessive gas as that bacteria enters your intestine. (Long term antibiotic use can also cause the same overgrowth.)
Acid reflux (GERD), heartburn, and indigestion–high levels of stomach acid? Nope.
Turns out that it’s our low levels of stomach acid which cause the Big 3: acid reflux (where our undigested stomach contents press up into our esophagus via a now-relaxed esophagus value and we feel the small amount of acid), heartburn (the burning sensation in our esophagus) and indigestion (impaired digestion due to poor breakdown or bad bacteria).
And sadly, our doctors have been putting us on Proton-pump inhibitors (PPIs) like Omeprazole (Prilosec) or Lansoprazole (Prevacid) or Esomepraxole (Nexium) and more, all acid suppressors…and as if our symptoms come from excess acid! Or we head to our local pharmacy or grocery store and load up on antacids like Rolaids, Tums or others. So though they can mask symptoms, we are now made even worse.
You can even have diarrhea from low stomach acid due to the inadequate digestion and pH issue of low stomach acid. Some speculate that inflammatory bowel disease is the result of low levels of stomach acid.
Aging and low stomach acid
Research has found that the older your body gets, the lower your secretion of stomach acid can become. This happened to the elderly mother-in-law of the creator of this site, even without being hypothyroid, and she did much better with her digestion once she added Apple Cider Vinegar to her morning and bedtime water.
Low stomach acid and Candida
Patients have discovered that increasing the acidic level of their stomachs can slow the growth of candida. (By the way, if you have candida, do an internet search for “baking soda candida”)
Low stomach acid, Lactose and/or Gluten Intolerance
Many patients are surprised to discover that their intolerance to milk products, called lactose intolerance, is actually a symptom of poor levels of stomach acid. And as happened to the husband of the creator of this site, his lactose intolerance completely went away once he started to give himself Apple Cider Vinegar (see below) in his morning drink.
Even many cases of gluten intolerance can be connected to low stomach acid for some individuals. They have found that when they improve their acid levels, they are less sensitive to gluten to some degree.
- Treating one’s hypothyroidism, especially with natural desiccated thyroid (NDT), has helped reverse the problem of low stomach acid. It can also be important to treat low cortisol/low aldosterone to return stomach acid levels to normal.
- Swallowing daily supplements with healthy acids added to water or your favorite juice, such as one tablespoon Apple Cider Vinegar (ACV) or lemon juice, has helped many. Preferable brands of ACV are unfiltered, unheated, and unpasteurized (Braggs is one, but there are others). You can also disguise the ACV in water with flavored stevia, or Vitamin C packets, or more. Do NOT drink ACV by itself–it can burn your esophagus. Two notes: 1) if you have high potassium, you might want to avoid ACV and use lemon juice or Betaine below instead. 2) If you have a peptic ulcer, you’ll need to first work on healing that. Cabbage Juice can help, says this study. Other forms of healthy acids may do the trick as well.
- Over-the-counter hydrochloric acid, often known by the brand name Betaine, has helped. (Note: if you get diarrhea with Betaine, it may reveal that you also have h-pylori)
- The herb called Swedish Bitters may be worth a try, as it’s stated to help raise hydrochloric acid levels. It’s been recommended in the treatment of Candida, as well.
- Restoring your iodine levels may improve stomach acid production as well, as some articles suggest.
- Eradicating the bacteria H-Pylori can be key for some.
As you give yourself back the acid you need, absorption of key nutrients returns, which helps your parietal cells produce acid better all over again.
Many patients also turn to using a quality Probiotic along with their healthy acid supplements. Probiotics contain healthy bacteria as a way to start balancing out the abundance of bad bacteria.
Note: If you have been on Proton-pump inhibitors (PPIs) like Prilosec or over-the-counter digestive aids like Rolaids or Tums etc for an extended period, and want to get off, it’s recommended not to stop cold turkey, but to wean off to avoid some side-effects of withdrawal. Janie’s husband went off cold turkey, and had heartburn for a week and poor tolerance for acids . It eventually subsided, and he returned to using ACV until he could get his hypothyroidism better treated.
Ways to test if you have low stomach acid (even though it’s a given for most thyroid patients if you find yourself with low nutrients like iron, B12, Vit. D or more)
- Baking Soda test (non-scientific): After you have gotten up in the morning, and before eating or drinking, mix about 1/4 tsp baking soda in a cup of water and drink it down. Watch to see if you have burped in the next 2 – 3 minutes (stomach acid and baking soda react to form carbon dioxide gas). If you do NOT, you probably have low stomach acid. NOTE: one test is not definitive. You have to do this test at least 3 mornings and see if you have more “No, I didn’t burp in 2-3 minutes”, then Yes, I did. This test is only a rough indication.
- Betaine HCl Challenge Test (non-scientific and not to be done if you have peptic ulcers): You will need to purchase Betaine, preferably the 600 mg pills, at your local health food store–a man-made hydrochloric acid. Your goal is to find out how many tablets it takes to feel a warmth or burning in your stomach. Patients with normal stomach acid levels would feel this with one, or sometimes two pills. On the first day, take one right before or at the beginning of large meal. On the second day, take two before or at the beginning of a large meal. On the third day, take three before or at the beginning of a large meal….etc up to the 7th day and 7 tablets, if needed (some versions of this test go up to ten days and 10 tablets). The more tablets you have to take to feel that warmth, the more likely you have low stomach acid. NOTE: if this test produces excess burning in the beginning, it’s a sign you have too much stomach acid and this test should immediately stop. Otherwise, this test is only meant to be used until you feel that burn/warmth, which could happen before the seventh day.
- The Heidelberg Stomach Acid test (scientific): This is a test you’ll have to ask your doctor about, and thus, is far more exact than the above, but can be costly–more than $300 US. You are instructed to drink a baking soda solution (sodium bicarbonate) as well as swallow a capsule with a tiny pH meter and radio transmitter (radiotelemetry). It will analyze the pH of your stomach acid. NOTE: you will need to be off any Proton Pump Inhibitors or over-the-counter stomach aides for about five days. This test takes about an hour or slightly more time.
P.S. Low aldosterone, which causes low levels of sodium, can promote low stomach acid, since the acid needs salt to exist!
***A research study which connects hypothyroidism to low stomach here.