Is low stomach acid causing your IBS?
What does low stomach acid mean?
Low stomach acid, or hypochlorhydria, is a condition where your stomach does not make enough acid before meals or while you eat. (1) Some stomachs don’t make any acid – this is known as achlorhydria.
Stomach acid breaks down the proteins in your stomach. Low stomach acid means you won’t be able to digest all foods properly.
Your stomach is only one part of the complex system of the gut – learn more about how your gut works.
What happens if you have low stomach acid?
There are a number of things that can happen because of poor digestion due to low stomach acid.
Poor digestion can affect the health of your digestive tract in two ways:
- Your body won’t be able to absorb nutrients.
- If your body can’t absorb specific nutrients, you will not have enough of that nutrient in your body.
- Undigested food particles will be fermented by bacteria. This can result in:
- urgent bowel movements,
- stomach pain.
If low stomach acid is present for a long period of time, or if it is severe, there can be physical changes to the bacteria in the digestive tract. This may result in:
- an overgrowth of bad bacteria in the small intestine (known as SIBO). (2) Recent research shows SIBO may cause IBS.
- Constipation or diarrhea.
- IBS (irritable bowel syndrome). (3)
As you can see, a condition as seemingly harmless as low stomach acid can result in major problems in your gut. These problems may even cause IBS.
How does our body control stomach acid production?
Now that you know how important stomach acid production is to digestive health, it’s important to understand how your body regulates acid production.
Before food even enters your body, the sight, smell or thought of food stimulates your stomach to produce acid. The hungrier you are, the more acid your stomach will produce.
You need enough stomach acid to kill off any bad bacteria or parasites that may have been in your food. If you don’t have enough stomach acid you are more likely to get infections like SIBO and C. difficile. (4,5)
Stomach acid production and aging
As we age, our stomach naturally decreases the amount of acid it produces. This also depends on the food we eat throughout our lives. While about 10% of elderly Americans have low stomach acid, more than 60% of elderly Japanese do. This is because of the difference in their diets. (6)
The time our stomachs take to start producing acid again after we eat changes as we age. A study found that elderly people can take up to four hours for their stomachs to start producing acid again, while the stomachs of younger people take less than two hours. (7, 8)
Because of this, low stomach acid may contribute the following symptoms often found in the elderly:
- poor protein digestion,
- reduced micronutrient absorption,
- an increased risk of bacteria infections (SIBO, C. difficile),
- gas and bloating.
It may also affect the way medications that require an acidic environment are absorbed.
How do you know you have low stomach acid?
Complaints such as gas, bloating, muscle cramps, abdominal heaviness and feeling full quickly can be due to low stomach acid, although some people don’t experience any symptoms.
Other signs may include:
- deficiencies of vitamins and minerals,
- muscle cramps and twitches,
- food allergies,
- dilated capillaries on cheeks and nose,
- brittle and peeling nails, and
- bad breath.
If you’ve been diagnosed with IBS, checking stomach acid levels should be one of the first things your practitioner investigates.
There are two ways for your practitioner to find out if you have low stomach acid.
The Heidelberg test:
The Heidelberg test involves swallowing a capsule containing a pH-sensitive radio-transmitting device. After the sensor is swallowed, gastric acid changes are evaluated before and after ingestion of a baking soda solution. (9) As this test is expensive to run, it is rarely used.
The betaine challenge test: (10)
This test involves taking betaine hydrochloride (HCl) at mealtimes until a noticeable discomfort is reported.
Betaine HCl is a chemical that is used to increase stomach acid. It is by far the most popular and direct means to lower the pH in the stomach (remember, a lower pH is a more acidic environment). Studies have shown that taking betaine HCl can increase the production of stomach acid to normal levels for over an hour. (11)
Other ways to increase stomach acid
Digestive bitters consist of bitter-tasting plants or plant extracts that are often distilled in an alcohol solution. Digestive bitters are common in many herbal medical traditions as a way to assist digestion. (12)
Bitters can include:
- artichoke leaf,
- dandelion leaf,
- wild lettuce or
These can be used individually or in a commercially prepared combination.
Please note that at the time of this writing, there is little information available on the specific dose or ideal preparations.
In some individuals, coffee can increase heartburn symptoms even though it isn’t very acidic.
There are a number of compounds found in coffee that help to stimulate stomach acid production. (13)
Do keep in mind that using coffee as a means to increase stomach acid production has not been studied. Therefore, working with a knowledgeable practitioner is a good idea.
Ok, now you have the information needed to determine if low stomach acid is contributing to your IBS.
Also published on Medium.