One question I am asked or overhear quite frequently about is digestion woes. Whether it is lack of appetite, acid reflux, gas, bloating or discomfort after meals, this problem affects more of us than we'd like to admit. Specifically, low stomach acid can set us up for a whole series of digestion mishaps that we might immediately think of as caused by too much stomach acid. We have become more educated in now knowing that ulcers aren't necessarily caused by too much stomach acid but rather a bacteria that destroys the mucosal lining of our stomach, allowing acid to irritate the cells below. Also, we rely heavily on the strongly acidic environment of our stomach to kill pathogens and bacteria on our food and begin the digestion process of proteins and amino acids. Maybe the word “acid” itself sounds scary or dangerous and has prodded us towards a fear of anything acidic; battery acid, the drug Acid, heck even the acidic saliva from the monster in the Alien movies (that acid burned a hole RIGHT THROUGH the floor!!). Whether we know it or not, though, we want an acidic environment in our stomach and to an extent in our small intestines, and I will give some examples why and some solutions for low acid in this article.
First things first! How acidic is our stomach?
The pH of our stomach is very low, which means it has less potential for hydrogen (hence “pH”). The pH of our stomach acid is close to 1; the stomach's parietal cells produce hydrogen and chloride and move them across a concentration gradient millions of times more acidic than their own cells; producing hydrochloric acid(HCL). This is why we don't store intact stomach acid in cells, because it would burn right through our organs, instead the cells combine these elements and concentrate them to create this acidic environment. Aside from killing potentially harmful bacteria, parasites and viruses we rely on the acidic environment to initiate the conversion of pepsinogen to pepsin, which begins the breakdown of proteins. An acidic environment is also required for the activation of intrinsic factor, which facilitates the absorption of B12; lack of intrinsic factor can lead to pernicious anemia, limiting red blood cells synthesis.
Another reason we want enough total stomach acid is because it combines with the food we digest to form chyme, or a mass of partially-digested food and stomach acid. This is where many people mistake low stomach acidity, calling it gastric reflux or heart-burn, for high stomach acidity. Too little total stomach acid cannot bind with larger meals or meals that contain large amounts of protein and fat, which pushes the acid upwards in the stomach, rather than emulsifying with the food. This can create that high burning feeling in the upper stomach and throat that feels like acid reflux/heart-burn. Enough total acid, however, will emulsify all the food and will set off a sequence of important digestive functions into the small intestines.
So far, we haven't even left the stomach and there's already a handful of reasons we want plenty of HCL. The last few reasons are the ones we may totally miss out on because it is hard to link the actions in the stomach and those in the intestines based on how we feel after meals. Many of us still think of the stomach as our digestion and absorption site, when really it is the sanitizing, emulsifying, protein splitting and alcohol absorbing site. Aside from absorbing alcohol, the stomach is really setting us up for proper digestion and absorption further down the line. This is imperative to understand because once we start paying attention to the signs of low stomach acid, these far reaching affects become clear. Common signs of low stomach acid(there are too many to list them all) are as follows:
-Bloating, belching or flatulence immediately after meals
-Sense of over-fullness or that food is just sitting in stomach
-Undigested food in stool
-Dry itchy skin, acne, cracked weak fingernails
-Nausea after taking supplements
-Abnormal gut flora
Many of us experience one or some of these symptoms at one time or another. Our stomach acidity should remain relatively constant but can easily flux up or down depending on our lifestyles and eating habits. A few things come to mind that would affect total HCL production. A low protein diet may down-regulate acid production; when more protein and/or fat is added back in, symptoms listed above may appear as the stomach is now not used to digesting that much protein. Another would be athletes consuming large amounts of daily food to either gain weight or fuel performance. Sometimes total acid production cannot meet the demand leading to the bloating, gas and undigested food in stool listed above. This is counterproductive to the athlete's goals as they now are not absorbing much of the food being eaten. Another would be stress and lack of sleep which promote hunger hormones leading to increased acid production in the anticipation of eating more food.
So, what the heck is HCL doing for us down the line?
Interestingly, our digestive system operates on it's own separate nervous system branch, often called the “second brain”. What is different about the digestive system compared to how the nervous system affects our muscles is that there is no direct stimulation of digestive functions through the nerves. All of the actions within the digestive system take place through hormone signaling. This is why it is important to have healthy and fully functional digestion from the top-down. Any initial dysfunction affects the entire process.
HCL bound to food leaves the stomach and enters the duodenum, which is the beginning of the small intestines. Bile is released to emulsify fats for digestion and absorption. There is still an inherent acidity left to the food entering the small intestines and we want that because the acidic environment stimulates Secretin in the intestines. Secretin then stimulates enzyme and insulin release, as well as secretion of bicarbonate to alkalize the HCL bound with the food. We also want the food entering the small intestines to be partially digested by HCL because it stimulates CCK. CCK inhibits further HCL release in the stomach, makes us feel full, increased motility and stimulates enzyme release.
If all of that seems to confusing, here's the downstream effects of proper HCL production:
-Sense of fullness
-Increased motility (to help you move food through your system)
-Enzyme release for nutrient absorption
-Insulin release for storage of nutrients
-Inhibits further unneeded HCL production
Lucky for us if you're feeling bloated, too full after meals, gassy, tired or partially digesting your food, there are some easy fixes. The problem may run deeper but it is always wise to try some natural and easy methods first. As you may have guessed these remedies all rely on eating acidic foods to get us back on track.
Apple Cider Vinegar
This one is quite easy to use and only requires that you either A. take a spoonful of apple cider vinegar before meals or B. make enough salad during the day with apple vinegar dressing to elicit the same results. You could dilute the vinegar in water and drink it but to be honest, it isn't all that unpleasant. Apple cider vinegar has the nice addition of malic acid, which is found in apples. This acid is less harsh than the kinds found in other vinegars which is why is goes down easier on its own.
Eating acidic foods stimulates further acid production which is why apple cider vinegar works so well. Other liquids that elicit similar effects are coffee and alcohol. The reason I wouldn't recommend coffee and/or alcohol at every meal to help with digestion are obvious, though it would make for one interesting day! Also, coffee and alcohol increase motility to an extent that you may go to the bathroom sooner than needed, leading to unformed stool.
Bitters work by increasing saliva production, HCL, pepsin, bile and enzyme release. This classically can be seen by the act of drinking a digestif after meals, an alcoholic drink often containing bitters. I'll lump ginger in with bitters as well as it has been shown to increase production of digestive enzymes and hormones as well.
Pickled foods carry the same benefits as vinegar for increasing HCL production, as they are typically brined in a high acid and salt environment. The added benefit of fermented foods is that they are often both acidic AND cotain live cultures which aid our natural bacteria in absorbing food, producing hormones like melatonin and serotonin and killing off microbes and other pathogens that are harmful to our system. In addition, many fermented foods also produce lactic acid during the fermentation process, which help acidify our small intestines enough to be unfriendly to harmful bacteria.
Lactic Acid Containing Foods
Lactic acid, as mentioned is found in many fermented foods. It is produced by bacteria such as Lactobacillus and Strepococcus. Lactic acid is responsible for the pleasant tang in pepperoni, yogurt, sauerkraut and sourdough bread, among others. The two lactic acid producing bacteria mentioned are also important in being antiobiotic, antiherpes, destroy E.Coli and Staphylococcus bacteria. The beneficial L.bulgaricus bacteria found on fermented dairy was actually named after Bulgarian peasants because of their love for yogurt.
Another great affect of ingesting lactic acid containing foods is that the bacteria's L. thermopolis and the previously mentioned L.bulgaricus, help to prevent and stop diarrhea and firm stool. This can be the reason so many people find hard cheeses so binding as they contain high amounts of these bacteria and lactic acid which can be so effective in firming stool that they constipate.
One last aside is that sourdough bread is baked with a starter or fermented batch of flour and water with live bacteria. The bacteria produce lactic acid during the bread's mixing and rising process which actually feed on gluten proteins found in wheat. This reduces the bread's ability to rise but has the added benefit of making the bread more friendly for gluten-intolerant people.
Yeah, no duh. Except that for some people, chewing means three chews before a swallow and for others it could be 25. Even those with plenty of HCL will find it hard to emulsify, digest and aborb food if it enters the stomach largely intact. Don't become obsessed with this BUT, start to pay attention to the number of chews you take before swallowing. Unless its pudding, yogurt or some other really soft food, less than 20 is not ideal, and closer to 30 for meat and firmer foods. Instead of religiously counting every bite, pay attention to your initial number, if its around 10-20, just make sure you teach yourself to chew a few more times than you think you need and turn it into a habit. Large, unchewed pieces of food are a sure way to render all of the advice I just gave ineffective, so make sure you follow this one if nothing else!
To wrap up, I would encourage you to listen to the signs your body is giving you. If you eat a particularly large meal or one high in protein and/or fat and experience some or all of the symptoms listed above, low HCL could be your issue. Try some of the more accessible options here first, such as making a salad or two a day with 1 to 2 tablespoons apple cider vinegar and see how you feel. If you need some additional support consider drinking some ginger tea, adding bitters to water or just increasing your overall consumption of pickled, fermented and lactic acid containing foods.
If all else fails, HCL can be purchased in tablet form and works quite well. I prefer starting people off with something more friendly such as digestive enzymes which usually also contain a small amount of HCL to work in conjunction. A brand I have found helpful is Now Foods Super Enzymes, taken with each meal. Some people find immediate relief and improvement with this simple addition while cleaning up their food choices, working on chewing and incorporating pickled, fermented or bitter foods.
Remember, just because you put it into your body doesn't mean its being utilized and absorbed how you intend. Don't throw away your time and money on undigested food and live in a constant state of discomfort, bloating and gassiness. If none of this helps, shoot me an email or Facebook message and I can point you in the right direction.