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.
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.
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.
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
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
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 ofCooking with Food Sensitivities Survival GuideandNourished: 10 Ingredients to Happy, Healthy Eating.
Hi Klara,
Can low stomach acid cause sinus congestion & sinus headaches?
Also, weight loss?
Thank you,
John
Hi John,
Low stomach acid may cause sinus congestion, we recommend talking to your doctor about this! In terms of weight loss, if you aren’t able to break down and absorb the food properly, it can certainly cause weight loss! We definitely recommend following up with an RD and MD to get help!
I’m on a regime that requires talking mega doses of calcium. Since being diagnosed with osteoporosis in 2011, I’ve tried, but not succeeded in finding calcium/calcium magnesium supplements that don’t upset my stomach; mainly because of all the fillers and binders; especially cellulose. I can’t tolerate calcium carbonate either unless it’s supplied as calcium citrate. I did manage to find a few, but the usual the daily dose is four to yield 100%. Since I’m supposed to take 500% daily that means I would have to take 20 a day! Any ideas?
Great question. Our digestive dietitian, Kathleen Tab, RD, LD, CLT advises the following: Most capsules need cellulose as an ingredient to hold it together, unless it is maybe a chewable or powder supplement. Chewable forms will omit cellulose but then need to add additional binders to compensate for that, so a powder supplement could work. Another option would be to ensure adequate dietary intake of calcium and magnesium. You may want to reach out to her for an appointment so she can help you in more detail.
I’m a bit confused about apple cider vinegar increasing stomach acids. I have read this same it information on many websites but have also read on many sites that although ACV has an acidic ph, it has an alkalizing effect on the body. Does the alkalizing effect takes place after it gets absorbed by the body? Can you clarify please?
Hi Debra,
While apple cider vinegar does contain more alkaline nutrients, like potassium, calcium, and magnesium, it actually isn’t enough to make the ACV alkalizing for the whole body. ACV does have an acidic pH and that is how it helps increase the acidity in the stomach, but because of the body’s internal mechanisms, the pH of the ACV won’t impact the entire body.
Hi, is it alright to drink the water/ Apple cider mixture if you have Barretts esophageal? Debra
If anyone is presenting with irritation of the esophagus or stomach such as GERD or gastritis, drinking apple cider vinegar in water is not recommended due to the high acidity of the beverage and the potential for pain and irritation. GERD is commonly seen with Barretts Esophagus, therefore you do not want to make the environment more acidic than it currently is. If you are having symptoms due to the Barrett’s Esophagus, there are other over the counter ailments that may pose less of a risk of irritation.
How does Coffee worsen the problem if it is acidic??
From what I understood the cure is to strengthen the acid by eating acidic stuff?
But when i do drink acidic juices i feel pain in the throat!
Also the acid reflux is causing me Teeth problems! This means my acid is veryy weak or the opposite?
Coffee is not only acidic, but it is an irritant to both the stomach and the esophagus which is why it is a common trigger for many people with GERD. it also weakens the sphincter muscle that is supposed to keep the stomach contents in the stomach. When this happens, the acid can travel into the esophagus and cause the burning sensation and irritation. In severe cases, the acid from your stomach when refluxed can be exposed to your mouth and therefore damage the enamel on your teeth. Make sure to not eat too close to laying down as gravity can pull the stomach contents upwards! The only treatment dietarily is to avoid your reflux triggers and supplements to reduce the symptoms.
Would having low stomach acid be a cause for chronic yeast infections?
Low stomach acid could be a factor in yeast infections as stomach acid if one of your first line defenses against infections. There would be other contributing factors however that would need to be considered such as gut microbiome balance, medication use, stress, diet, etc.
I’ve been taking Betaine HCL + Pepsin for my stomach for over a year now. It works well at the time, but after 1 or 2 months when I run out & I stop taking them, my stomach does the usual bloating, feeling full, nausea, cold feeling in the stomach etc after eating.
Does taking them for over a year mean there’s something more wrong with my stomach, as I assumed my stomach would have gone back to normal by now.
Thanks for asking. Here is what our digestive dietitian, Kathleen Tabb says “it is important to make sure you are removing any underlying causes for why you have low stomach acid in the first place. If you have not, then the stomach will not be able to restore adequate stomach acid production and therefore still require supplementation.”
I would recommend that you reach out to have an appointment with Kathleen Tabb, MS, RDN, LDN, CLT so she can help you get to the root cause of your discomfort. –Rebecca Bitzer
Nice article. I struggle with low stomach acid, acid reflux, I.B.S., bipolar depression and iron deficiency, which I have to have infusions. If I eat or drink the wrong things, it’s like my stomach and intestines are at war with each other. A problem I run into is some things that are good for one thing are bad for the other. Once I narrow things down to what I can eat, there’s not much left. I find myself eating mostly lean meats, soft cheeses, sourdough bread, fermented pickles and yogurt. I can’t eat large meals because I get full quickly. I mainly eat small plates or basically appetizers. It’s quite difficult to figure out something new and exciting to eat. I would greatly appreciate any recommendations. I’m on disability and can not afford to go to a dietitian and my doctors don’t have a clue.
Thank you!
The best thing to do would be to try and expand your diet while keeping symptoms at bay. Having too limited of a diet puts you at risk for nutrient deficiencies, and deficiencies can make you feel worse overall. It is easy to feel that recommendations are conflicting but just remember they are generalized. Tolerance is completely different from person to person so discovering your own tolerance is essential and would help with new ideas. Plus tolerance can change as your good gut bacteria do, but they need fiber to flourish.
From the list of foods you’re eating, it seems fermented foods and also animal proteins are well tolerated so that could be a place to start with expansion. For example, seafood as a new protein source, and kefir or kimchi as another fermented food option.
I’ve been struggling with chronic pancreatitis for many years now. It seems to flare immediately after (or during) having stomach problems. My GP and other Drs have always been encouraging me to take PPIs but having tried them for months I’ve stated it makes the problem worse. So that’s as far as they’re willing to help! Having done some of the simple stomach acid level tests that are suggested online I’ve a very obvious lack of stomach acid. Stress levels run high in my life and are something I just have to live with (I was widowed at 38 with 4 children, don’t know any way around that stress!). Could low acid be leading to general poor health, pancreatitis, poor hair & nails, depression, poor sleep, fatigue etc etc?
Low stomach acid can be a contributor to other health concerns secondary to malabsorption of vitamins and minerals that require acid to. This can lead to cracking/peeling/chipping fingernails, or hair loss. Other symptoms include bloating, belching, burning, flatulence immediately after meals, indigestion, food allergies, nausea after supplements, rectal itching, undigested food in stool, and fullness after eating. I have not heard of it being the cause of the additional conditions you mentioned, however poor gut microbiome health secondary to stress and diet may be playing a role here.
I have had bloating now for over a year. The bloating affects my sleep as it puts pressure on my diaphragm and causes issues with breathing, which keeps me awake and I also have mucus buildup that I think comes from acid reflux. So I get attacked by bloating or mucus which keeps me awake. I had colon cancer in 2014 and was cured with a bowel resection. I have a small hiatal hernia, have had acid reflux for years. In 2015 I started taking apple cider vinegar in a glass of water at breakfast and dinner daily for about 5 years, religiously. I’ve been to a gastroenterologist who put me on pantoprazole and my regular doctor put me on DiCyclomine which seems to work the best but not perfectly. I am seeing a functional doctor right now who has prescribed supplements and now has me on a low FODMAP diet. This does not seem to be working and in fact since being on the low FODMAP diet it seems worse. When I eat, the symptoms seem to subside for a while but they always come back. I use the medicine sparingly to the detriment of being able to sleep at night. Is it possible for me to get back to a normal sleep pattern without the medicine and still stop the bloating and mucus? How?
It seems like you have had quite the journey with your digestive ailments. Unfortunately, I do not want to give nutrition advice without knowing your whole clinical picture. Luckily, it seems that you have a good team of physicians right now. What we need to remember about digestive issues is trial and error are essential in order to find out what works, whether that be diet, supplements, stress reduction, or a combination of all the above. This does require patience since some things do take time. For you, maybe additional testing such as stool testing would be useful since symptoms could be related to the intestinal tract, not only the stomach.
I’ve been suffering for over a year now with what I presume is LPR. I have bad throat, regurgitation, bad breath, lots of bloating after pretty much every meal and anal itching. I was put on PPIs which then was proceeded with respiratory issues and more bloating and stomach pains. Currently trying acid watcher diet and have somehow flared up and got worse. Does eating an alkaline diet make symptoms worse if you have low stomach acid? I told docs PPIs wasnt working and they just say keep taking them. It’s so hard to know where to turn. Should I be trying a supplement to help with low acid levels and if so which ones? I’m in UK. Thanks
An alkaline diet should not necessarily make symptoms worse for you. At times, low acid diets can be quite restrictive therefore eliminating foods that potentially helped your symptoms in the past. For example, I always recommend starchy foods with meals to help coat the stomach and reduce acidity. With a diagnosis of reflux, it may not be the best idea to trial apple cider vinegar or HCL, but maybe a soothing tea of your choice.
Hi, good article. A couple of months ago I was with silent reflux, and muscle tension dysphonia. Symptoms were continual seasonal cough, & hoarse voice. A camera down my throat showed a sticky substance. I’ve followed what is basically an Alkaline diet ever since. I’ve lost weight that I didn’t need to. I’m fit, slim, walk around 50 miles a week and play golf. Recently the cough has returned and my Arthritis has come back with a vengeance. I took Diclofenac for 20 years but stopped them as it was thought they contributed to my sudden appearance of Tinnitus.
My question is: what painkillers can I take? Ibuprofen doesn’t last long enough to get a good sleep. I can’t go back to Diclofenac. Do I need to reintroduce some acids in to my diet again?
Hi I have had hiccups now for the past 2 years I had endoscopy,barium meal and it revealed I had acid reflux hence weakening of the esophagus sphincter which they believed could be the cause of the acid irritating my diaphragm. I’m just recovering from the laparoscopic operation to tighten my sphincter.Unfortunately I still have the hiccups especially after eating. I never had any burning in my chest and throat ever could this be because the acid is weak hence no burning.I’ve noticed that my stomach is always bloated after eating so yesterday I tried cider vinegar raw 3 tablespoons full and immediately the hiccups stopped which has never happened before.Do you think it’s possible that I might have low stomach acid and that the hiccups are being caused by the bloating due to undigested food also I am a competing bodybuilder who eats 6 clean meals a day ?
After any sort of gastrointestinal surgery, it is possible that symptom improvement takes longer than expected. People with silent reflux may never experience the burning in the chest but still have irritation present. You may want to be careful with too much ACV in water as it can worsen the irritation of the tissues in the esophagus.
Bloating is a very difficult symptom to treat dietarily and medically because it is not always clear why it is happening. One thing to think about is the size and makeup of your meals, but also the pace of your eating. If you are more prone to eating large meals in a day and eating them fast, try and slow this down. Hiccups can occur because of swallowed air and fast eating. Chewing adequately and eating slowly is a great approach to reduce post meal discomfort because your stomach doesn’t have to do as much work. You could start there and then reach out to your physician about your continued discomfort. I hope this helps!
Hi, I need help. I have been diagnosed with acid reflux and was given PPI’s to use and had to change diet and stopped all processed foods and take aways.
After 2 months(March 2021) of using PPIs I started to have burps non stop. I went to see Gastro Spcecialisit and conducted a H pylori test that came back negative. I stopped using PPI because I was told that the main cause of the burps I have low stomach acid. I then starte to use some home remedies ginger , chamomile tea and lots of veges. I stopped eating red meat as I would burp a lot after eating red meat and some foods.
How do I get my stomach acid to be balanced? This is really affecting me and my sinuses.
I have started to use some some prebiotics. Does alkalinising my diet help in this regard? It becomes so painful on my chest especially that I so need to use sinus sprays.
Hi There.
You could definitely try the ACV in water before a meal with a large amount of protein and see if that helps or not. If there is any irritation after trying this then you should discontinue. Another option would be a digestive enzyme with HCL in it but that is only recommended if you no longer have a diagnosis of GERD.
Aside from potential low stomach acid, make sure you are chewing your food adequately as digestion starts in the mouth. Also, slow down your pace of eating to support the body’s natural digestive processes if you can. Over time, stomach acid level should restore themselves.
can low stomach acid cause itchy skin? I was told i had dyspepsia a few years ago. stomach problems for over a year. was put on ppi which i have come off of . seems like my medication does not work so well sometimes during the month. seems to be associated with the taking of my ppi. also , can low stomach acid affect the absorption of my medication? (Inderal) thank you for any insight you may have.
Because there is not a large amount of research done on low stomach acid, there is no clear cut answer to your questions. Itchy skin a lot of the time can be related to some sort of immune response, either environmental or food. For example, itchy skin or rashes have been implicated in (but not limited to) food allergies or hypersensitivities.
In regard to your medication question, it would depend on if a medication requires stomach acid for absorption and if there is a known medication interaction. Interestingly, some medications can actually weaken the muscle that controls the contents going into your stomach, beta-blockers are one of them. Therefore worsening reflux. However, any medication recommended by your physician should be continued as instructed.
I have a history of disordered eating (anorexia, and binge eating.) Though I am now recovered, I have nearly constant sensation of something in my throat for years now (which any tests show everything is fine.) I find myself clearing my throat a lot, only for it to persist. I have NO heart burn or anything, only this constant feeling of something in my throat. I have poor digestion (regular constipation, which I take magnesium to help.) My doctor wants to prescribe me antacids, while I don’t believe it is too much acid, rather low stomach acid. Would ACV and/or HCL acid help in this matter?
Hi Jen,
It is possible that you could be suffering from something called silent reflux. I have seen clients with similar complaints of something stuck in their throat but no classical reflux symptoms. ACV may not make a difference in this case as your symptoms are not located in the stomach. It could also irritate your throat more due to the acidity level of it. It may be worth a shot to try the antacids and if it doesn’t help, further testing may be necessary such as an endoscopy.
Hi there! I am trying to figure out what is wrong-I think it might be silent reflux. It’s strange though because I don’t seem to have indigestion and I have pretty good bowel movements but my throat is well the main issue. During the winter, they thought I had strep (probably was just a carrier, no fever but I had at least 4 rounds of antibiotics) which probably made things worse. I may have babesia/bartonella so I am taking supplements for that but the throat issue- is red, inflamed, sometimes mucus- post nasal white drip in the back, swallowing, dehydration, white on back of tongue, and losing weight! And I cannot sleep without a humidifier. I haven’t been able to swallow normally since March! I am really underweight, like 5,8′ and 104 lbs and don’t know what foods to eat to gain weight but not irritate throat although I have been using coconut oil. Does this sound like LPR? I am going to try digestive bitters next I think.
LPR symptoms can vary greatly so an endoscopy can usually confirm it which is done by a gastroenterologist. It may be smart to schedule an appointment with one of our dietitians to discuss strategies to gain weight and not worsen your symptoms. An elaborate health history would be required to make recommendations that are specific to you.