Could Low Stomach Acid Be Causing Your Heartburn Symptoms?

I would say that the majority of my clients will experience heartburn or reflux on a daily basis, and many have been prescribed an antacid. 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 most people with acid reflux actually have low stomach acid and antacid medication worsens this problem and can lead to other health concerns.

Why do you need stomach acid for digestion?

The role of digestion is to allow vitamins, minerals, and amino acids to be absorbed by the body, but to keep out foreign proteins, bacteria, viruses, fungi and anything else that comes in from the mouth or nose.

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?

If you have low stomach acid, you may have symptoms like bloating, belching, burning, flatulence immediately after meals, indigestion, food allergies, nausea after supplements, rectal itching, undigested food in stool, and 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.

low stomach acid

What is a low stomach acid 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.


6 Natural Remedies for Heartburn

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.


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


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. Add in the acid

low stomach acid oranges

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.


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!

Updated November 2021.

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!

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.