Stomach acid, or gastric acid, is a fluid containing a mixture of hydrochloric acid, potassium chloride, and salt. The acid lowers the pH of the meal which sterilises it, and also activates pepsin, an enzyme that breaks down protein. Acid secretion also stimulates the pancreas and gall bladder. Secretions in the stomach and the rest of the digestive system are regulated by both hormonal and neural mechanisms.

A low level of acid secretion (hypochlorhydria) causes indigestion with symptoms such as bloating, burping, flatulence, acid reflux and constipation. It is associated with parasites, stomach cancer, infections (Vibrio, Helicobacter pylori), and nutrient malabsorption.

Low stomach acid may be caused by poor eating habits combined with a nutrient-deficient diet that is largely comprised of junk food. Other factors are chronic stress, medical drugs, dysbiosis, hypothyroidism, atrophic gastritis and pernicious anaemia.

A decline in secretions is also part of aging due to reduced blood supply to the stomach and atrophy of the glands. The aged may also experience long-term medication side-effects (antacids, NSAIDS, antidepressants), or conditions such as adult-onset coeliac disease and osteoporosis. Other common symptoms of aging are ulcers, glossitis, loss of taste, problems swallowing, heartburn, and vitamin B12 malabsorption. Loss of taste and appetite mean the elderly often have irregular eating habits, and as a result, are deficient in the nutrients necessary for acid synthesis.

Low acid can be tested by sipping dilute apple cider vinegar (ACV) with a meal to see if symptoms such as burning and discomfort are ameliorated (low acid), or worsen. This can also be done by taking a betaine hydrochloride tablet midway through a small protein-rich meal, which should improve symptoms if acid is low. There is also the rather inaccurate bicarb soda test: half a teaspoon mixed with a little water is drunk on an empty stomach and should produce burps within five minutes as stomach acid turns the soda into carbon dioxide.

A gastric string test can also indicate acid deficiency: a piece of cotton string 30 cm long is attached to a gel cap and then pulled back out of the mouth after a minute and wiped with a pH strip. It should indicate a pH of 1-3. Alternatively, there is the more technical Heidelberg test which involves swallowing a pH probe (gastric pH).

Treatment

General

A proper eating routine should be established where time is taken away from work in order to eat in a relaxed fashion. Food should also be chewed adequately, because this activates the parasympathetic nervous system which controls digestion. Hormonal regulatory signals that control appetite, satiety and secretions, are easily disrupted by routine overeating, so meals should be reduced in size and simplified, as with acid reflux treatment.

Proton pump inhibitors (PPIs) or H2-receptor blockers should be gradually tapered off and ceased over several weeks. A stool test will identify the presence of any infection or parasites, as well as pancreatic insufficiency. A hair mineral analysis (HMA) will help identify any mineral deficiency, indicting malabsorption due to low acid or poor diet. It also shows heavy metal toxicity. Test B12 and iron.

Diet

A diet comprised of nutrient-dense wholefoods protects nutrient status. Zinc, B-vitamins (1,2,6) and protein are necessary for the synthesis of stomach acid. Iodine derived from ocean fish or kelp is needed to support the thyroid. Kefir, yoghurt or probiotics will protect against dysbiosis.

The supplement betaine hydrochloride plus pepsin can be taken with meals if a change in eating routine and diet do not help. Dilute apple cider vinegar can be sipped with a meal, while fruit juices and sugary drinks should be avoided. Meals should be simplified to one course and snacks such as nuts and seeds taken between main meals.

Herbs

Secretions can be stimulated with a class of herbs called Bitters to see if the problem resolves before resorting to betaine supplements. These include gentian, wormwood, fumitory, agrimony, centaury, artichoke, and white horehound. These are taken 15 minutes before a meal and may also include a bitter coffee or even chewing dandelion leaves. Sipping lemon in water also helps but should be done only shortly before meals to protect the teeth, and not for several hours in the morning before breakfast. Dilute apple cider vinegar goes with the meal.

Cell Salts

Ferrum phos to treat anaemia. Calc phos is to strengthen the constitution and bones, and improve nutrient absorption.

Disclaimer: this article is intended for the purpose of general education only, and is not a substitute for diagnosis, treatment advice, or a prescription that is given in a consultation with a qualified physician.