Could Low Stomach Acid Be Causing Your Heartburn Symptoms?

I would say that the majority of my clients will experience heartburn or reflux at some point in their life, and many have been prescribed an antacid medication. This is not that abnormal considering acid reflux medications are one of the most prescribed medications in the US today. There are also many occasions where my clients have been on acid reducing medications for 10+ years!! Some have accepted it as a way of life, while others are looking for natural remedies for heartburn to provide them some relief.

With new information on health and nutrition emerging sometimes daily, it can be overwhelming to figure out what is the right path for you.

While most doctors will prescribe antacids to control stomach acid production and therefore help reflux, some doctors, like Dr. Jonathan Wright, believe in doing the exact opposite!

In his guide, Why Stomach Acid is Good for You, he explains that some people with acid reflux actually have low stomach acid. This would mean that antacid medication worsens this problem and can lead to other health concerns. This belief of low stomach acid, also called hypochlorhydria is also a concept that will be seen in the functional medicine/nutrition field. But what exactly is stomach acid and why do we need it?

Why do you need stomach acid for digestion?

The role of digestion is to allow vitamins, minerals, and amino acids to be digested and absorbed by the body. Your stomach is one of the most acidic parts of your body, and this is because of stomach acid! The high acidity levels play a vital role in killing foreign proteins, bacteria, viruses, and fungi so they do not travel to the small/large intestine and cause infections.

First step in digestion, is ingestion!

When we eat something, we chew it up, swallow it, and it goes down the esophagus into the stomach.

The stomach is the only part of the digestive system that is sterile. There are billions of bacteria (good and bad) in our mouths, nose, and intestines. The function of the stomach acid is to kill anything that is unwanted which has traveled into the body as we breathe in or swallow.

So basically, acid is in the stomach because it is supposed to be there!

The stomach acid is also responsible for deconstructing proteins into useable building blocks for the body to use, and for breaking down vitamins and minerals in order for them to be absorbed by the body and carry out their function.

Some of these vitamins and minerals include vitamin B12, folic acid, zinc, calcium, and iron. Once the stomach acid breaks down the nutrients, it goes into the intestines to be absorbed.

How does low stomach acid cause acid reflux?

Acid reflux is really a disease of the muscle at the end of the esophagus that leads to the opening of the stomach, called the Lower Esophageal Sphincter, or LES for short. This flap acts as a gatekeeper.

It opens to allow food to travel down the esophagus into the stomach, and also keeps it from going the other way.

So what happens if the LES isn’t working properly?

Acid reflux! The symptoms you get with heartburn is from the acid being in the wrong place. The esophagus and small intestine were not built to handle the acidity that is quite normal for the stomach, so the discomfort is coming from acid touching the sensitive lining of the esophagus.

Excess stomach acid is blamed for being the cause of acid reflux, which is why most people are using antacids and acid blockers to manage their discomfort. However, in about 90% of cases, the actual cause of acid reflux is low stomach acid.

This means, those antacids you are taking are providing temporary symptom relief but can have a negative impact on your health.  Confused? Let me explain.

low stomach acid

Like we talked about above, the stomach is meant to be an acidic environment for many reasons. If our stomach acid decreases (whether due to natural causes like aging or with medication use), it will make the stomach less acidic.

When the stomach isn’t acidic enough, the LES is not signaled to close properly and remains partially open. And this then allows acid to go back up into the esophagus, causing reflux symptoms.

So why doesn’t everyone know about low stomach acid?

Why do we still use acid blockers and antacids like candy? There could be a few reasons. Dr. Wright’s book does point out that antacids are a $7 billion a year industry.

The money and the marketing make sure our pillboxes stay full.

The other could be a lack of training! Some doctors haven’t delved into some natural remedies for heartburn, but maybe willing to try!

What are low stomach acid symptoms?

  • Bloating
  • Belching that is excessive
  • Flatulence immediately after meals
  • Indigestion
  • Nausea after supplements
  • Rectal itching
  • Undigested food in stool
  • Extreme fullness after eating

Prolonged low stomach acid can contribute to allergies, asthma, skin disorders, rheumatoid arthritis, insomnia, osteoporosis, GI infection, and depression. It can also cause malabsorption of different vitamins and minerals and proteins which can lead to leg cramps, cracking/peeling/chipping fingernails, or hair loss. Common low vitamin levels are seen in zinc, calcium, iron, vitamin B12 to name a few.

low stomach acid

How do we test for stomach acid?

Unfortunately, there is no gold standard test. If you think you may have low stomach acid, your doctor can check the acidity of your stomach to make sure it is within normal range using stool testing or investigating with a device called a Heidelberg capsule. This test is not used as often as endoscopies to assess for reflux but it can be a measurement tool.

6 Natural Remedies for Heartburn

Now that we know what to look for symptom wise, here are some natural ways to manage reflux if it caused by excessive stomach acid production.

1. Decrease the foods that can cause the opening of the esophagus to weaken

LES is responsible for keeping acid inside the stomach, and if the muscle is weakened it may allow acid back into the esophagus. By reducing these foods, you may see some improvement in your heartburn.

low stomach acid coffee

These foods include higher fat dairy products, processed meats, fried foods, chocolate, caffeinated beverages such as tea, coffee, and soda, mints (especially peppermint and spearmint), sugar, alcohol, and onions.

You may also have food sensitivities that are causing your reflux, which can be evaluated with testing. If the classical reflux triggers do not manage your symptoms, often I will investigate further with comprehensive stool analysis testing.

 

2. Decrease foods that may irritate the esophagus

diabetes friendly party food

Although the following foods do not cause acid reflux, they can cause more irritation to your esophagus. And if you already have an irritated esophagus from acid being where it shouldn’t, eating these foods can be extremely painful.

Try to reduce citrus foods and juices, tomato-based foods, spicy foods, pepper, coffee, and carbonated beverages. Once the problem is fixed and the irritation is healed you may find you can tolerate these without pain.

 

3. Check your medications

Certain medications can cause the LES to weaken and let more acid up into your esophagus or cause esophageal irritation.

Please talk to your doctor before stopping any prescription medications.

Photo by Laurynas Mereckas on Unsplash

Medications that can weaken the LES include:

  • Bronchodilators (e.g. theophylline, albuterol, ephedrine)
  • NSAIDs
  • Calcium channel blockers (e.g. Cardizem, many
    others)
  • Beta-blockers (e.g. Inderal, many others)
  • Diazepam (Valium)
  • Nitrates (e.g. nitroglycerin)
  • Demerol

Medications that can irritate the esophagus include:

  • Aspirin
  • NSAIDs
  • Tetracycline
  • Quinidine
  • Potassium chloride tablets
  • Iron salts

 

4. Reduce the size of meals and eat more frequently

thanksgiving

Large meals often put a lot of stress on our digestion and can cause acid reflux. Since acid is a crucial part in actually breaking down the food in your stomach, the bigger the meal, the more acid that needs to be produced!

If this big meal often comes at the end of the day, it can increase symptoms when lying down to go to sleep. If you have trouble sleeping at night, raise the head of the bed about 30 degrees.

 

5. Avoid tight clothing and exercising after a meal

6. Support gastric acid production

There are some other natural remedies that can be used to restore your stomach acid, and hopefully, provide relief from reflux symptoms. Using digestive bitters before a meal can stimulate acid production, which will rebalance the acidity in the stomach and keep the LES closed.

Taking Apple cider vinegar or lemon juice in water can also help to stimulate the acid production needed for digestion, or you could consider HCl supplements. HCL supplements should only be used under the supervision of someone who has experience with the products as it can cause pain.

6. Supplementation

Photo by Angel Sinigersky on Unsplash

Since low stomach acid can cause vitamin malabsorption, you may want to consider vitamin and mineral deficiency testing.

Your dietitian can use your results to write you a personalized supplement plan to correct those deficiencies to make sure your body is running properly!

More Resources:

Here are some of our own recipes which are low in citrus foods/ juices, tomato-based foods, spicy foods, and pepper that you can try on your own!

Interested in more digestive insight from our dietitians? Check these out!

Want dietitian-approved products to make managing your condition easier? Below you’ll find products written by our very own dietitians!

Would you like personalized help from one of our dietitians? We’re here to help!

Blog reviewed and updated April 2025

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Klara Knezevic is a registered dietitian nutritionist based in Maryland. She has over a decade of experience in the nutrition field and currently serves as the CEO and co-owner of Rebecca Bitzer and Associates, one of the largest nutrition private practices in the country. Klara is passionate about sharing practical nutrition tips to help you feel confident in the choices that you make. Coauthor of Cooking with Food Sensitivities Survival Guide and Nourished: 10 Ingredients to Happy, Healthy Eating.

Kathleen Tabb is a registered dietitian based in Maryland. She specializes in digestive conditions such as irritable bowel syndrome (IBS) and has extensive training through her master’s degree in integrative and functional nutrition. She is passionate about looking at her clients holistically to illuminate the root cause of their concerns in order to improve health and quality of life