November 7, 2013

Digestion for (not-so) Dummies: The Stomach, Pt.2

MOAR acid!
Since so much can happen in the stomach—or not happen, as we’re starting to see—our digestive train is still sitting here at the nice, cozy stomach station. The café at the small intestine station is waiting for us with hot coffee and fresh-baked cookies, but we’ve got business to finish here first. In the previous post, we uncovered the surprising truth that acid reflux/heartburn is usually the result of too little stomach acid, rather than too much. I left off saying that in this next part, we would talk about ways to naturally increase stomach acid. And we will. But first, let’s look at some other, more serious consequences of insufficient stomach acid, because after that, we’ll all be in agreement that we are not kidding around about this, and we really do want to make sure we have strong stomach acid, and lots of it. (To quote the stupendous Dave Barry, “I am not making this up.”)

Is it any wonder we don’t feel well 
after we hurry through a meal?
First, let’s get our parameters straight. A meal here and there when you’re hurried and stressed out isn’t going to hurt you. It might make you uncomfortable for a couple of hours, but it’s not going to do any long-term damage. The thing is, in our modern, go-go-go world, with ever-increasing demands on our time and attention, there are people who spend YEARS in sympathetic nervous system dominance. (With fight-or-flight ruling their lives, instead of rest-and-digest.) There are people who take prescription acid blockers for years, sometimes decades. And there are people who, by nature or nurture, eat extremely fast, barely chew, and wash their food down with gigantic gulps of water, soda, iced tea, or some other ice-cold beverage. Holy bad digestive juju, Batman!

So far, we’ve covered a lot of ground for how to create good digestive juju. In part 1,we talked about the role of the brain in digestion, and the importance of slowing down and being calm at mealtimes. In part 2 we discussed the mouth and all the good things that come from chewing thoroughly. In part 3, we dropped the truth bomb about stomach acid. In this installment, we’ll get to ways to naturally increase stomach acid production, because it’s pretty much the single best thing you can do to ensure smooth digestion along the entire rest of your GI tract.

Before we go there, let’s take a brief but important detour to the effects of low stomach acid beyond a little indigestion. Gas, bloating, reflux, and general discomfort are bad enough. But what about anemia, osteoporosis, poor immune function, depression, anxiety, infertility, and memory loss? These are only a few of the potential outcomes of long-term stomach acid insufficiency. They’re especially insidious because they don’t happen overnight. If you eat peanuts, say, and go into anaphylactic shock right afterward, you can easily and logically connect A to B. But these other conditions can take a long time to develop, so it’s harder to connect the dietary and digestive dots. As the authors of Why Stomach Acid is Good for You explain:

“Many of the adverse effects associated with long-term suppression of stomach acid may take years or even decades to develop. At the same time, clinical trials of most drugs, which might expose these problems, generally last only a few months. Regrettably, many of the potential accompaniments of long-term acid suppression, including asthma, allergies, skin disorders, rheumatoid arthritis, insomnia, osteoporosis, gastrointestinal infection, depression, and many, many others, can take [a very long time] to develop. They would seem to have nothing to do with stomach acid and, therefore, would rarely, if ever, be reported.”

So while it might be hard to connect the dots, it’s easy to explain things. And while the conditions listed above might seem to have nothing to do with stomach acid, they most definitely are connected. (Just like saturated fat might seem to be harmful for health, as we've been led to believe for the past sixty-plus years, but just because something seems true doesn't mean it is. Hehheh. You know me...I couldn't resist an opportunity to pass along yet more information on the vindication of yummy, delicious, HEART HEALTHY saturated fat. *Just one note about that first link--the author's list of saturated fat sources at the end of the article contains a couple of foods that are actually higher in monounsaturated fat than saturated. Other than that, it's cool.) 

See, some nutrients—especially certain minerals—are absorbed best in an acidic environment. They need to be “liberated” from the foods they’re bound to in order for us to get at them, and acid is what does the liberating. Calcium, for example, requires acid to be separated from the food it’s in and absorbed by the body. (This is how chronic, long-term low stomach acid can lead to osteoporosis.) Same with iron (anemia, anyone?), folate, zinc, and B6. So you can see how long-term low stomach acid—whether due to natural reasons or acid-suppressing drugs—can lead to some pretty serious conditions.

Osteoporotic or anemic? We should evaluate our digestive function before we start popping 
calcium and iron supplements. Maybe we do need more of those minerals, 
but maybe what we need even more is stronger stomach acid!

On a different but related note, there’s a severe form of anemia, called pernicious anemia, and it’s unrelated to iron absorption. It’s a B12 deficiency, and it is serious, serious business. In addition to stomach acid, specialized cells in the stomach secrete something called intrinsic factor. We need both intrinsic factor and good stomach acid to absorb B12. Our bodies store B12 for a while, so it takes a long time before our stockpile runs out and we start noticing deficiency symptoms. But deficiency symptoms are many, and they’re often misdiagnosed—sometimes with catastrophic consequences for quality of life, not to mention medical expenses. B12 deficiency is a big, big deal

Is it Alzheimer’s, or acid?
B12 deficiency is common in older folks. One reason why is because stomach acid production naturally decreases as we age. Plus, older people are less likely to consume B12-rich foods, like red meat, since they’re typically more complicated to prepare than foods that contain no natural B12, like boiling pasta for dinner, or having a pastry for breakfast instead of eggs and sausage. (Show me an 80-year old living alone who’s going to go to the bother of grilling a steak for dinner instead of having macaroni, or even a bagel!)  And the real kicker here is that one of the most insidious signs of B12 deficiency is memory loss. So, how many elderly people have the misfortune to walk out of the doctor’s office with a (MIS)diagnosis of Alzheimer’s disease—which, in our current medical environment basically amounts to a death sentence because there is no effective treatment—rather than the simple advice to take a good quality B12 supplement and/or work on increasing their stomach acid production and eating more B12-rich foods? Alzheimer’s isn’t the only thing B12 deficiency gets mistaken for. Other conditions that might benefit from B12 supplementation (or just better digestion!) are fatigue, asthma, heart disease, and depression.

Let’s take a quick look at that last one—depression. Have you ever heard of serotonin? It’s the “feel good” neurotransmitter many doctors think is lacking in depression. (Research seems to indicate that people who get the winter blues [aka “seasonal affective disorder”] are low in serotonin, in addition to the obvious vitamin D they’re not getting from sunshine that time of year.) Well, neurotransmitters are chemical messengers that get made in various organs and glands and travel to the brain, where they influence mood and behavior: feeling happy, calming down, amping up, feeling groovy, etc. Some neurotransmitters pump us up, others calm us down. Some help us deal with stress and difficult situations. Having the right balance of neurotransmitters allows appropriate expression of emotions so that we can make our way through the world effectively and not be terrified to walk out the front door and interact with whatever might be on the other side. They help keep us from turning into simpering messes when—shockingly—not every single thing in life goes our way.

Okay, great. What does any of that have to do with digestion? Simple. Neurotransmitters are made from amino acids—the single building blocks that string together to make proteins. Ah! Now we’re getting somewhere. If you’ve got insufficient stomach acid, you won’t digest your proteins properly. Poor protein digestion --> insufficient amino acids available to make serotonin, dopamine, epinephrine, and all those other cool neurotransmitters. You can follow this same train of thought and arrive at why poor protein breakdown could potentially bring on anxiety, panic attacks, and other effects on mood stability. (These are also likely linked to carbohydrate intolerance and having a lifetime free pass to ride the blood sugar rollercoaster, but let’s address one topic at a time, shall we?)

Depressed? Anxious? Excessively worried? Yes, some of it’s in your mind, but a lot of it is in 
your digestive tract, too! And the good news is, the GI side of things is easy to fix!

How about poor immune function? Again, easy-peasy to connect the dots. Antibodies (the things that recognize and attack invading pathogens) are made from—you guessed it—protein. We already know about poor protein digestion, but don’t forget zinc. Zinc is fairly well recognized as supporting the immune system, and we need good stomach acid to liberate zinc from our food. Ineffective protein digestion + low zinc levels = you catching every little bug that goes around. Might want to buy stock in Kleenex and Ny-Quil if you suffer from chronic indigestion.

As you can see, the list of conditions stemming from long-term disruption of good digestion ranges from the mildly annoying (bloating, gas) to the downright debilitating (depression, osteoporosis). And they don’t end there. Infertility is another biggie, but the most likely culprit there is fatty acid deficiency (i.e. women on long-term low-fat and low-calorie diets), so we’ll table that discussion until we get to fat digestion. For now, I can tell you that for couples having trouble conceiving due to male infertility, zinc deficiency in the man should be looked into. Zinc is crucial for healthy sperm production. (Fun factoid about severe zinc deficiency: You start to lose your sense of taste. So unless you’re a long-time smoker or have a bad cold, if your food doesn’t seem as flavorful as it used to, you might need some Zn.)

Wow. That “brief detour” was longer than I planned. (Show of hands: who’s surprised?) I guess I’ll devote a separate post to increasing stomach acid naturally. But I’m pretty sure we can agree now that we want to do that. Low stomach acid is no joke, and popping antacids like they’re candy shouldn’t be our go-to strategy for indigestion, because it does nothing to correct the underlying cause.

Next time, we’ll look at a few things that will correct the underlying cause and keep our digestive train rolling smoothly on down the track. (Or should I say tract, as in GI tract?)

In the meantime, for more information on what we talked about this week, check out this post by a registered nurse on PrimalDocs: The Truth About Stomach Acid: Why low stomach acid is jeopardizing your health.

And here's a bit more on just how many different body systems & health issues are related to B12. I'm telling you, overt and sub-clinical B12 insufficiencies are rampant these days.

Remember: Amy Berger, M.S., NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition.


  1. Okay!!! Anemia, osteoporosis, poor immune function, depression, anxiety, infertility, and memory loss are only a few of the potential outcomes of long-term stomach acid insufficiency.

    Kopi Luwak

  2. I hate it when after you eat you feel like bloated stomach.

  3. Hi, Amy! First-time poster here, as I just ran across your blog. Pretty timely, too, since I was just diagnosed with a hiatal hernia (during a trip to the ER and subsequent 4-day stay for severe diverticulitis, just short of rupturing).

    I get the part about needing more stomach acid. I began taking prebiotics and probiotics (and digestive enzymes) about 3 months ago after having a comprehensive nutritional test done that showed I'm not absorbing amino acids, B vitamins, and other stuff well at all. My NP had me on more than 20 supplements daily. After 3 months of not feeling any better (and my wallet starting to scream for relief), I decided to ditch all the supplements and instead take just the basic pre/probiotics and digestive enzymes.

    I figured if I'm not absorbing my nutrients as well as I could, throwing more nutrients at the problem was not going to fix it. I needed to work on the absorption part, where it begins.

    So, I'm reading your whole series on digestive health and got to this post about the stomach and the importance of stomach acid. I thought you just might cover hiatal hernias here, but you didn't. I'm hoping the answer I'm looking for will be found in the next posts in the series. But, short of surgery to fix the hernia, what should I be doing (other than the great advice you've given in this series)? The acid is irritating my esophagus and making me cough terribly. If I take a Pepcid (or a Benedryl), the coughing stops. I don't want to take either, and yet I don't want to cough all the time, either.

    Any recommendations for treating a hiatal hernia ... meaning, curing it?


    PS: I didn't want to post this as "Anonymous," but I'm having trouble with my Wordpress account. It says I don't exist. Sigh.

    PPS: I usually post as "Kathy from Maine."