Low stomach acid is common in celiac disease and dermatitis herpetiformis. It is also common in the general population, as well, affecting 50% of people age 60 years and about 80% by age 85 years. Nevertheless, low stomach acid is not generally looked for as a cause of acute and chronic disorders that rob health with far-reaching effects.
Is Low Stomach Acid New?
No. Low stomach acid (hypochlorhydria), has been well investigated much of the past century in both the general population and those with gluten sensitivity. For example, a 1985 study investigating gastric acid secretion in 116 subjects with dermatitis herpetiformis found that 41% had low stomach acid and 26% were achlorhydric (no acid). Of those older than 50 years, 47% were achlorhydric. When compared to subjects with celiac disease, the frequency of achlorhydria was significantly higher in those with dermatitis herpetiformis than in those with coeliac disease. There was no correlation between achlorhydria and small intestinal villous atrophy (damage).
Why Is Low Stomach Acid Overlooked?
Failure to understand nutrition and malabsorption…an area of science that is barely taught in medical schools is a big factor. Also, little money is made in the management of too little acid production unlike its opposite condition, too much acid production. Consider that two antacid pills, Nexium® and Prevacid,® totaled $7,523,382,000 in sales for 2009 according to Drugs.com.
What Are Common Symptoms of Low Stomach Acid?
- Feeling uncomfortable with bloating or feeling sick after eating
- Belching, burping and gassiness in the upper abdomen after meals
- Full too long after meals
- Food backs up/indigestion
- Diarrhea with undigested food in stool
- Nausea after taking supplements
- Bad breath
- Food allergies
- Itching around the rectum
- Dilated blood vessels in the cheeks and nose
- Iron deficiency
- Mineral deficiencies
- Folic acid and vitamin C deficiency
- Abnormal gut flora (microbe population)
- Chronic intestinal parasites
- Chronic candida (yeast) infections
Some Symptoms of Nutritional Deficiencies Resulting From Low Stomach Acid:
- Fingernails that are weak, peel, brittle or have ridges
- Thin, brittle, or weak hair
- Dry and/or weak skin
- Low resistance to infection
- Premature aging
Understanding Stomach Acid Production and Function
The stomach digests incoming food into a liquid state, thereby releasing nutrients so they can be absorbed by the small intestine. Powerful stomach muscles churn food and mix it with gastric juice, dissolving and breaking it down. Gastric juice is produced by gastric glands located in the stomach lining. These numerous, microscopic glands produce about 3 liters of juice a day.
Gastric juice is composed of a high concentration of hydrochloric acid and the enzymes, pepsin and gastric lipase. Hydrochloric acid is secreted by parietal cells on the margin of the gastric glands. This powerful acid keeps the stomach at a very low pH of 1.5 to 3.5 to dissolve food and kill most organisms that are swallowed with food.
Hydrochloric acid is necessary to breakdown proteins together with the enzyme pepsin. Pepsin digests protein in the acid environment ( pH of 1.5 to 2) provided by hydrochloric acid. Low acid makes food like meat, eggs and milk hard to digest.
Hydrochloric acid dissolves minerals such as potassium, iron, calcium, zinc, copper and magnesium out of food and gives them a positive or negative charge. Unless minerals get charged, they cannot be absorbed. Folic acid and vitamin C also need low stomach acid for absorption.
Parietal cell activity decreases with age thus causing both low stomach acid and vitamin B12. Vitamin B12 absorption needs the action of parietal cells to secrete intrinsic factor. This glycoprotein combines with vitamin B12 (extrinsic factor) to prevent its digestion and promote absorption in the small intestine.
How Is Stomach Acid Tested?
Methods for measuring gastric acid include both invasive and non-invasive techniques. Invasive tests include the conventional gastric acid aspiration tests, gastric pH measurement techniques and endoscopic methods. Non-invasive methods use urinary analysis, breath analysis, serum pepsinogens assay, scintigraphic techniques, impedence tomography and alkaline tide for measurement of gastric acid
Here’s a home test: drink lemon juice or some other acid in water and see if you burp. If your stomach is more alkaline than the acid you take, gas is formed and you burp.
1. Eat or drink some acid-containing food with meals to help digestion. Examples are yogurt, kefir, wine, lemon juice, citrus juice/fruit, unpasteurized apple cider vinegar, rice vinegar, pineapple juice/fruit, and any juice with ascorbic acid or citric acid. You can eat use relishes, cabbage slaw, salads, and condiments such as mustard, mayonnaise and ketchup made with safe vinegars, sauces made from tomatoes, pickles, sauerkraut, pickled beets, and so on.
2. Eat smaller meals (5 instead of 3 meals) and chew food thoroughly.
3. Take enzyme supplements to help digest your food.
4. Take a multivitamin/mineral like one a day that says gluten-free.
5. Take a probiotic with acidophilus and bifidus to restore these microbe populations...they feed and repair the cells of the lower small intestine and colon and guard against unfriendly bacteria. More info at http://glutenfreeworks.com/category/celiac-disease/celiac-disease-symptoms/dysbiosis-bacterial-imbalance/
1. Image of gastric gland from http://biology.about.com/library/organs/bldigeststomach.htm
2. Libonati, C. “Recognizing Celiac Disease.” 2007. Gluten Free Works Publishing. Fort Washington, PA
3. Tabers Cyclopedic Medical Dictionary. 2001 FA Davis Company, Philadelphia.
4. Dickey W. Low serum vitamin B12 is common in coeliac disease and is not due to autoimmune gastritis. Eur J Gastroenterol Hepatol. 2002 Apr;14(4):425-7.
5. Ghosh T, Lewis DI, Axon AT, Everett SM. Review article: methods of measuring gastric acid secretion. Aliment Pharmacol Ther. 2011 Apr;33(7):768-81. doi: 10.1111/j.1365-2036.2010.04573.x.
------------------------ Author Information: Cleo Libonati, RN, BSN Cleo Libonati is a Co-Founder of Gluten Free Works, Inc. She is the author of Recognizing Celiac Disease. She can be reached by E-mail.