Stomach Acid and Digestion: Why It Matters for Gut Health

The human digestive system is a marvel, it really is. It’s a system of evolutionary engineering, and at its core lies a substance often misunderstood and underappreciated: stomach acid. Stomach acid is so misunderstood in fact, many  people think they have too much of it and it’s what is causing their digestive issues.

Stomach acid is a potent cocktail of hydrochloric acid and other components and isn't just a simple digestive fluid; it's a cornerstone of our overall health, impacting everything from our immune system to our nutrient absorption. However, in recent decades, we've seen a surge in the use of proton pump inhibitors (PPIs) – medications designed to suppress this vital acid without confirming if indeed there is an overload. While PPIs have their place in medical treatment, their widespread and often indiscriminate use raises serious concerns about long-term health implications and often work against repairing digestive issues. Actually they don’t just work against solving the problem, they cause more.  

In this article, I want to do a dive deep into the multifaceted role of stomach acid, explore the mechanisms and effects of PPIs, and critically examine the balance between their therapeutic benefits and the risks. I want you to walk away knowing the ins and outs of this topic because it’s so important – it's crucial to understand  digestive health and the unintended consequences of manipulating complex biological systems.

The Multifaceted Role of Stomach Acid: Beyond Simple Digestion

1. The Chemistry of Digestion

Stomach acid, primarily composed of hydrochloric acid (HCl), creates an environment with a pH typically ranging from 1.5 to 3.5. This extreme acidity serves multiple crucial functions:

• Protein Denaturation: The acid unfolds proteins, exposing their peptide bonds. This isn't just about breaking down food – it's the first step in a cascade of enzymatic reactions that allow us to extract amino acids efficiently.

• Enzyme Activation: The acidic environment is essential for converting pepsinogen to pepsin, a key proteolytic enzyme. Without this acid-mediated activation, our protein digestion would be severely compromised.

• Mineral Solubilisation: Many minerals in our diet, particularly iron and calcium, require this acidic environment to become soluble and thus absorbable. The implications here extend far beyond nutrition – they impact everything from oxygen transport to bone health.

2. The Immune System's First Line of Defense

The stomach's acidity isn't just about digestion – it's a very formidable antimicrobial barrier:

• Pathogen Neutralisation: Many ingested pathogens, including bacteria, viruses, and parasites, are effectively neutralised by stomach acid. This isn't a minor function; it's a critical component of our innate immune system.

• Microbiome Regulation: The acid barrier helps maintain the delicate balance of our gut microbiome. By preventing the overgrowth of potentially harmful organisms, it supports the proliferation of beneficial bacteria further down the GI tract which can lead to SIBO and leaky gut.

• Biofilm Disruption: Some pathogens form protective biofilms. Stomach acid can disrupt these structures, exposing the microorganisms to both the acid itself and to immune responses. For anyone who doesn’t know what a biofilm is; A biofilm is a complex community of microorganisms that adhere to surfaces and to each other, forming a slimy, protective matrix. This self-produced matrix is composed of extracellular polymeric substances (EPS), mainly polysaccharides, proteins, and DNA. Biofilms can form on various surfaces, including living tissues, medical devices, and within the gastrointestinal tract. In the context of digestive health, biofilms can protect harmful bacteria from stomach acid and other antimicrobial defences, potentially contributing to chronic infections or dysbiosis. The ability of stomach acid to disrupt these protective structures is crucial for maintaining a healthy balance of microorganisms in the gut.

3. Nutrient Absorption: The Gatekeeper of Nourishment

Stomach acid plays a pivotal role in nutrient absorption, affecting far more than just protein digestion:

• Iron Absorption: HCl is crucial for converting dietary iron from its ferric (Fe3+) to ferrous (Fe2+) form. This conversion is essential for iron absorption in the duodenum. The implications here extend to oxygen transport, energy metabolism, and cognitive function.

• Vitamin B12 Utilisation: Acid is necessary for releasing vitamin B12 from food proteins and for its subsequent binding to R-proteins. This process is critical for B12 absorption and impacts everything from nerve function to DNA synthesis.

• Calcium Dynamics: The acidic environment helps solubilize calcium salts, making them available for absorption. This process is intricately linked to bone health, muscle function, and cellular signalling.

4. The Orchestrator of Digestive Processes

Stomach acid doesn't work in isolation – it's a key player in coordinating various digestive processes:

• Hormone Signalling: The presence of acid in the stomach triggers the release of various hormones, including secretin and cholecystokinin. These hormones regulate pancreatic secretions, gallbladder contraction, and intestinal motility.

• Gastric Emptying: Acid levels influence the opening and closing of the pyloric sphincter, regulating the passage of chyme into the small intestine. This timing is crucial for optimal digestion and absorption.

• Feedback Mechanism: The acidity of the stomach contents provides feedback to the enteric nervous system and the brain, influencing appetite, satiety, and overall digestive function.

Proton Pump Inhibitors: A Double-Edged Sword

PPIs work by irreversibly binding to and inhibiting the hydrogen/potassium adenosine triphosphatase enzyme system (H+/K+ ATPase) of gastric parietal cells. This "proton pump" is the final step in acid secretion, making PPIs  incredibly effective at reducing gastric acid output. Common PPIs include:

•  Omeprazole (Prilosec)

•  Esomeprazole (Nexium)

• Lansoprazole (Prevacid)

• Pantoprazole (Protonix)

• Rabeprazole (Aciphex)

• Dexlansoprazole (Dexilant)

Each of these drugs has subtle differences in pharmacokinetics and pharmacodynamics, but they all share the core mechanism of proton pump inhibition. They are used to medically help conditions like: 

• Gastroesophageal Reflux Disease (GERD)

• Peptic Ulcer Disease

• Zollinger-Ellison Syndrome

• Stress Ulcer Prophylaxis

The issue with PPIs is that while they can be effective in treating certain acute conditions, their long-term use and over-prescription have become a significant concern in the naturopathic community. Many naturopaths find that PPIs often complicate their efforts to restore gut health in their clients. These medications can mask underlying issues and potentially create a cascade of new health problems. This situation has become a persistent challenge for practitioners working to address the root causes of digestive disorders and promote holistic gut health. Some of the issues with PPIs include:

1. Nutrient Deficiencies: 

• Vitamin B12: Reduced stomach acid can impair B12 absorption, leading to deficiency and potentially causing neurological issues and anaemia.

• Magnesium: PPIs can interfere with magnesium absorption, potentially causing muscle weakness, tremors, and irregular heartbeat.

• Calcium: Reduced calcium absorption may increase the risk of osteoporosis and fractures.

•  Iron: Impaired iron absorption can lead to anaemia and fatigue.

2. Increased Risk of Infections:

• Clostridium difficile: The reduced acidity in the stomach can allow harmful bacteria like C. difficile to thrive, increasing the risk of severe gastrointestinal infections.

• Pneumonia: PPI use has been associated with an increased risk of community-acquired pneumonia.

3. Gut Microbiome Disruption:

• Altered gut flora can lead to dysbiosis, potentially contributing to various health issues including digestive problems, immune dysfunction, and even mood disorders.

4. Kidney Problems:

• Long-term PPI use has been linked to an increased risk of chronic kidney disease and acute kidney injury.

5. Dementia Risk:

•  Some studies suggest a potential link between long-term PPI use and an increased risk of dementia, though more research is needed in this area.

6. Rebound Acid Hypersecretion:

• When stopping PPIs, many people experience a temporary increase in acid production, which can make it difficult to discontinue the medication.

7. Masking Underlying Issues:

• By suppressing symptoms, PPIs may mask underlying conditions such as food intolerances, bacterial overgrowth, or even early-stage stomach cancer.

Naturopathic Approaches to Improving Stomach Acid

From a naturopathic perspective, the goal is to address the root cause of digestive issues rather than simply suppressing symptoms. Here are some natural approaches to support healthy stomach acid production and overall digestive health:

1. Dietary Modifications:

• Eliminate trigger foods: Common culprits include processed foods, caffeine, alcohol, and spicy or acidic foods.

•  Increase fibre intake: This can help promote regular bowel movements and support a healthy gut microbiome.

• Consume fermented foods: Foods like sauerkraut, kimchi, and kefir can support digestive health and provide beneficial probiotics.

2. Lifestyle Changes:

• Practise mindful eating: Chew food thoroughly and eat in a relaxed environment to support proper digestion.

• Manage stress: Chronic stress can negatively impact digestive function. Techniques like meditation, deep breathing, and yoga can be beneficial.

• Avoid eating close to bedtime: This can help reduce nighttime reflux symptoms.

• Avoid drinking water with your meals. 

3. Herbal Remedies:

• Bitter herbs: Gentian, dandelion root, and artichoke leaf can stimulate digestive secretions, including stomach acid.

• Deglycyrrhizinated licorice (DGL): This can help soothe the digestive tract and support the mucosal lining.

• Ginger: Known for its anti-inflammatory properties, ginger can aid digestion and reduce nausea.

4. Nutritional Supplements:

• Betaine HCl: This supplement can provide additional stomach acid for those with low production. (Note: Should only be used under professional guidance so book a consult with your naturopath)

• Digestive enzymes: These can support the breakdown of food, especially in cases of insufficient enzyme production.

• Zinc carnosine: This can help support the integrity of the stomach lining.

5. Acupuncture:

   - Traditional Chinese Medicine approaches, including acupuncture, may help regulate digestive function and reduce symptoms of acid reflux.

6. Reiki and Energy Healing: 

• Reiki, a form of energy healing, is sometimes incorporated into naturopathic care for digestive issues. While scientific evidence for its efficacy in treating specific digestive disorders is limited, some practitioners and patients report benefits:

• Stress Reduction: Reiki may help reduce stress and promote relaxation, which can indirectly support digestive function. Chronic stress is known to negatively impact digestion and can exacerbate symptoms of acid reflux and other gastrointestinal issues.

• Balancing Energy: According to Reiki principles, the practice aims to balance the body's energy systems. Practitioners believe this can support the body's natural healing processes, potentially benefiting overall digestive health.

• Complementary Care: Reiki is often used as a complementary therapy alongside other naturopathic treatments. It may help some individuals feel more comfortable and relaxed during their healing journey.

• Mind-Body Connection: Reiki sessions can provide a space for individuals to connect with their bodies, potentially increasing awareness of dietary and lifestyle factors affecting their digestion.

7. Hydration:

   - Ensure adequate water intake between meals to support overall digestive health.

8. Apple Cider Vinegar:

• Asmall amount of apple cider vinegar in water before meals can help stimulate digestion. (Note: This should be approached cautiously as it may exacerbate symptoms in some individuals)

9. Mindful PPI Reduction:

• For those currently on PPIs, work with a healthcare provider to develop a plan for gradual reduction, incorporating natural supports to ease the transition. Things might feel worse before they feel better. 

It's important to note that while these naturopathic approaches can be effective for many people, they should be implemented under the guidance of a qualified practitioner. Each individual's situation is unique, and what works for one person may not be appropriate for another. Trust me when I say, gut  health can be very complicated and low stomach acid might just be one of a long list of interconnected issues going on. 

I want to reiterate that while PPIs have their place in medical treatment, their long-term use comes with significant risks and they might not be the appropriate treatment for your reflux. By understanding the crucial role of stomach acid and adopting a holistic approach to digestive health, many people can find relief from their symptoms without relying on acid-suppressing medications (especially when acid might not actually be the issue). The key lies in addressing the root causes of digestive issues and supporting the body's natural ability to maintain balance and health. 

If you're experiencing any gut symptoms such as bloating, diarrhoea, constipation, pain, anxiety, reflux, or other related issues, I strongly recommend booking a consultation with me or a naturopath you connect with. It's crucial to understand that gut health is intricately linked to many other bodily systems, from your nervous system to your immune health. The old adage "good health starts in your gut" is true, and addressing gut issues can have far-reaching positive effects on your overall well-being. If you take away just one thing from this article, let it be this: prioritise your gut health. It's a fundamental step towards achieving and maintaining optimal health.

I invite you to check out my Gut Love program HERE which has helped many women say goodbye to their gut issues. And remember, you can always book in a FREE 15 minute consultation HERE to talk about whether seeing a naturopath is right for you.