Do I have high or low stomach acid? With an RD

Do I have high or low stomach acid: woman with heartburn
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Do you have heartburn or reflux and assume (or been told) that it’s because of too much stomach acid? There’s a chance you have the opposite problem–and here’s why that’s a bigger issue than a lot of people think and what you can do.

How stomach acid gets out of control and its symptoms

High stomach acid can happen for a number of reasons. It can be genetic. It can also be due to lifestyle. Certain foods and drinking too much alcohol can cause overproduction of digestive juices.

Symptoms of high stomach acid

With high stomach acid, it’s common to feel your worst on an empty stomach. You might also feel:

  • like you have more gas than normal
  • heartburn or GERD
  • burping or belching with a yucky, sour taste
  • that your symptoms are more bothersome when lying down (you lose the effects of gravity on acid) and at night (you have more digestive juices at night than during the day)
  • eventual ulcers
  • and more

Reasons stomach acid becomes low and what it feels like

When you take these types of symptoms to your doctor, not a lot of discussion follows. You’re probably going to get put on proton pump inhibitors (PPIs) or omeprazole and use antacids on the side. But if you’re taking meds and popping Tums like they’re candy, something else might be going on. As a dietitian, I see patients who have been diagnosed with high stomach acid–but after some investigation, we learn that’s not really what they’re dealing with. They might have hypochlorhydria (low stomach acid) instead.

Low stomach acid can happen over time from medications that are prescribed for high stomach acid. It can also happen from over-the-counter that seem harmless. NSAIDs, like aspirin, are a big one. Issues in the gut, like imbalances or infections like H. Pylori, can also cause low stomach acid and so can nutrient deficiencies.

The reason the high stomach and low stomach acid conditions get confused is that the symptoms can overlap and sound similar. But there are some key differences.

Symptoms of low stomach acid

With my clients with low stomach acid, we see localized symptoms you would expect. But we also see more systemic symptoms as well, and there’s a reason for this. Some of these symptoms are:

  • Bloated after meals, and by the end of the day, feel they look pregnant
  • Not pooping every single day
  • Gas, heartburn, reflux
  • Nutrient deficiencies
  • Skin issues that include fungal infections, psoriasis flares, and eczema

Why low stomach acid has more systemic symptoms

Most of us are chronically stressed. That raises our stress hormone, cortisol. Cortisol’s goal is to reserve your body’s energy for fight-or-flight. In doing so, it diverts resources away from your digestive tract, which is a problem. When that happens, and especially when we live in a constant state of stress, our bodies can’t make enough digestive acid.

Acid affects the gut and immune system

Digestive acids are important. They break down enzymes from our food. But they’re also our first line of defense against pathogens. Digestive acids helps protect us. Without enough digestive acid, we don’t have the chemical barrier we need to help keep unwanted pathogens from taking hold. Instead, we’re creating an environment of poor gut health, where unwanted bacteria and fungus can thrive.

More than 70% of the immune system is in the gut. It makes sense that low stomach acid, or anything that affects our digestive tract, is also going to affect our immunity. We could see immune dysfunction like autoimmune disorders, signs of other inflammation, or problems with candida or other fungal overgrowth.

You can end up with micronutrient deficiencies

When your stomach acid is low and gut bacteria is off, other problems can happen. We start to see deficiencies in B12, iron, and other micronutrients. What makes this worse is that micronutrient deficiencies can lower production of stomach acid even more, creating a cycle of feeling unwell and having symptoms.

Rebalancing your gut if you have hypochlorhydria

If someone has a severe digestive issue, whatever the symptoms, they might get put on a restriction diet. You might feel better–until things are added back in. I disagree with restrictive diets in most cases. But in these situations, I recommend thoughtful testing to decide what things we should temporarily and carefully eliminate. With low digestive acid, we might work on an antimicrobial protocol to help rebalance some of the things that are happening in the gut.

3 pre-meal rituals to help your body produce more acid

There are some simple and easy ways to help support your body to produce more digestive acids. These pre-meal rituals help activate the vagus nerve, which is important for digestion.

  • Take a few deep belly breaths. Count to 5 on the inhale and exhale for longer than 5. Holding the exhale helps your body come out of stress mode and into deep digest mode. If this is too uncomfortable and you’re at home, you can accomplish the same thing by singing/humming really loud or gargling water
  • Clear your mind before you eat. Make an intention to be mindful about not scarfing food down. Chewing well helps activate our digestive enzymes almost immediately.
  • Give yourself time for your meal away from your phone. Take just 15 to 30 minutes away from the computer and just focus. Smell your food. Eat slowly. Experiencing your food through smell and taste helps you produce stomach acid too.

Working with a dietitian if you have digestive symptoms

Dietitians don’t diagnose or prescribe medicine, but we can work with you and your physician. We utilize and interpret test results and panels that are related to your digestion and nutrient status. Then, we can evaluate those with your symptoms and come up with a plan of action. In so many cases, elevated stomach acid can be controlled well with diet. And there are many things we can do to fix micronutrient status and help the body produce stomach acid.

Wendie Taylor, RDN, LD, MBA
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