Gastric acid, gastric juice or stomach acid, is a digestive fluid formed in the stomach and is composed of hydrochloric acid (HCl), potassium chloride (KCl) and sodium chloride (NaCl). The acid plays a key role in digestion of proteins, by activating digestive enzymes, and making ingested proteins unravel so that digestive enzymes break down the long chains of amino acids. Gastric acid is produced by cells in the lining of the stomach, which are coupled in feedback systems to increase acid production when needed. Other cells in the stomach produce bicarbonate, a base, to buffer the fluid, ensuring that it does not become too acidic. These cells also produce mucus, which forms a viscous physical barrier to prevent gastric acid from damaging the stomach. The pancreas further produces large amounts of bicarbonate and secretes bicarbonate through the pancreatic duct to the duodenum to completely neutralize any gastric acid that passes further down into the digestive tract.
The main constituent of gastric acid is hydrochloric acid which is produced by parietal cells (also called oxyntic cells) in the gastric glands in the stomach. Its secretion is a complex and relatively energetically expensive process. Parietal cells contain an extensive secretory network (called canaliculi) from which the hydrochloric acid is secreted into the lumen of the stomach. The pH of gastric acid is 1.5 to 3.5 in the human stomach lumen, the acidity being maintained by the proton pump H+/K+ ATPase. The parietal cell releases bicarbonate into the bloodstream in the process, which causes a temporary rise of pH in the blood, known as an alkaline tide. (1)
The highly acidic environment in the stomach lumen causes proteins from food to lose their characteristic folded structure (or denature). This exposes the protein’s peptide bonds. The gastric chief cells of the stomach secrete enzymes for protein breakdown (inactive pepsinogen, and in infancy rennin). Hydrochloric acid activates pepsinogen into the enzyme pepsin, which then helps digestion by breaking the bonds linking amino acids, a process known as proteolysis. In addition, many microorganisms have their growth inhibited by such an acidic environment, which is helpful to prevent infection.
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(1). Marieb EN, Hoehn K (2010). Human anatomy & physiology. San Francisco: Benjamin Cummings. ISBN 0-8053-9591-1.
The Heartburn Connection
As mentioned earlier, hypochlorhydria and heartburn (reflux/GERD) have a complicated relationship that is often misunderstood. If you go to the doctor for heartburn, your treatment will be a band aid for the symptoms at best, and at worst (and most common), the start of new and worsening issues. It is often assumed that heartburn is this volcanic-like overflow of too much stomach acid erupting up through the esophagus causing the painful and/or burning sensation of heartburn. It is true that stomach acid in the esophagus is what causes the discomfort, but it is not from a bubbling over, it is actually from small amounts of stomach acid getting into the esophagus due to changes in pressure associated with low levels of stomach acid. It is very, very rare for someone to have too much stomach acid. It is epidemic for people to have too little stomach acid.
When acid reflux medication like Prilosec, Nexium, Zantec, Pepsid, etc are used, they actually lessen or completely eliminate stomach acid. This makes you incredibly vulnerable to worsening GI issues. A recent cohort study concluded that those who took PPI’s (proton pump inhibitors) for more than 1 year had an associated 25% increased risk of death. These medication were not designed to be used for more than 6-8 weeks but are often taken for years. While these medications do provide welcomed relief, they can lead to osteoporosis, nutrition deficiencies and heart disease, each of which can contribute to higher risk of death.
So what is causing the reflux? It all comes down to keeping the esophageal sphincter tightly down to prevent reflux or backflow of stomach contents into the esophagus. Poor digestion of food from too little stomach acid and enzymes slows digestion and stomach emptying. Not enough stomach acid increases intra-abdominal pressure (IAP). The pressure in the stomach then pushes against the lower esophageal sphincter causing it to not be able to keep a tight seal. Even small amounts of acid moving into your esophagus cause significant pain and burning since the esophagus is not protected from the pH of stomach acid like the stomach lining. This describes the mechanism behind heartburn that occurs with meals, or shortly after eating, however over time, the sphincter can weaken causing more consistent heartburn unassociated with a meal. When untreated, long-term reflux can damage the esophagus.
A Functional Medicine Approach to Low Stomach Acid
The conventional approach to reflux, one of the main symptoms of hypochlorhydria has been addressed above regarding heartburn medications. There is actually no conventional treatment directly for low stomach acid. The mainstream medical community does not recognize it as a condition to be treated, but only the symptoms which is creates. Those symptoms are treated with medications such as PPI’s for reflux, steroids, biologics, and anti inflammatory meds for IBD and various antiemetic and antidiarrheal meds for IBS and IBD. Or in the case of gallbladder issues, surgery is the option. And yes, hypochlorhydria can be part of your gallbladder issues. None of these options solve the issue at hand. The GI tract is much more comprehensive than matching a medication to a symptom. You deserve better. Despite hypochlorhydria being responsible for or contributing to almost every GI related issue, it is relatively straight forward to treat. It generally requires supplemental HCL and digestive enzymes while making diet changes. This combination helps the body maintain adequate levels of HCL on its own over time, therefore requiring less and less supplemental HCL.
Dig Dis Sci. 1984 Mar;29(3):202-6.
Effect of tea on gastric acid secretion.
Dubey P, Sundram KR, Nundy S.
The gastric acid response to a 200-ml cup of tea was measured by in situ titration in 36 patients with duodenal ulcer (DU) and 56 without duodenal ulcer (controls). Tea resulted in an acid secretory response which was almost equal to that after a maximal dose (0.04 mg/kg) of histamine. The effect of tea was mainly due to its local chemical action on gastric mucosa. Tea without milk and sugar resulted in an acid response higher than that evoked by a maximal dose of histamine. The concentration of tea brew that had the greatest effect on gastric acid secretion was 15 g/200 ml, which was three times as much as that in a palatable cup of tea. Tea is a potent stimulant of gastric acid, and this can be reduced by adding milk and sugar.
10 WAYS TO INCREASE STOMACH ACID PRODUCTION
THE IMPORTANCE OF HCL (STOMACH ACID)
Having enough HCL (hydrochloric acid or stomach acid) is critical for good digestion and immune health. Without adequate HCL food is incompletely digested and failure of assimilation occurs. If this happens, we become vitamin and mineral deficient. When a person starts to eat, the stomach is stimulated to start producing HCL. The HCL activates the chief cells in the middle portion of the stomach to start secreting a protein-digesting enzyme known as pepsinogen. Pepsinogen requires the presence of hydrochloric acid in order to begin digesting protein. The major role of HCL is to activate pepsinogen (not digest food), which now becomes known as pepsin.
Stomach acid gradually increases during a meal. When the stomach acid amount is elevated, which normally takes about 20-30 minutes after eating, it neutralizes enzymes from the mouth, helps to kill bacteria, parasites, viruses that enter with the food, carbohydrate digestion is reduced, and protein digestion starts. There are many consequences when HCL production is not adequate. See “Do You Have Enough Stomach Acid?”
CAUSES OF LOW HYDROCHLORIC ACID (LOW STOMACH ACID)
• Eating when upset. Hydrochloric acid secretion may be completely inhibited by stress, emotion, or worry. It is the low-grade, long-term, emotionally-oriented life stress that is more the culprit here. NOTE: Intense stress caused by high stress situations or desire for high achievement is associated more with HCL over (hyper) secretion and peptic ulcer disease (at least initially). As the stress continues, the body is exhausted and HCL production is no longer adequate.
• Eating a nutritionally-deficient diet of processed and fast foods.
• Lack of sufficient minerals in the daily diet.
• Excess carbohydrate consumption and poor food combining.
• Zinc deficiency.
• B vitamin deficiency especially thiamine deficiency.
• Refined sugar, which depletes minerals. Replace mineral-depleting refined sugar and sweeteners with maple syrup, honey, or stevia.
• Chronic illness.
• Drinking ice water with meals.
• Age – as you get older, stomach acid production tends to decrease especially if there is any chronic illness.
• Antacid use.
• Taking prescription and over the counter drugs that suppress HCL production either directly or indirectly.
WAYS TO INCREASE STOMACH ACID PRODUCTION
1. RELAX AT MEALTIMES
Make sure that when you eat, you are relaxed and at peace. Avoid eating when upset as stress and emotional upset can stop the production of HCL. Try doing The Relaxation Response twice a day, if possible before breakfast and dinner. This technique helps counter stress and will prepare you for a calm meal.
2. ADD FERMENTED VEGGIES TO YOUR DIET
Eat unpasteurized, unheated, salt-free sauerkraut and other fermented vegetables like kimchi. Fermented vegetables help to raise stomach acid “if” it is too low, and lower stomach acid “if” it is too high. Eating 1/4 to 1/2 cup of sauerkraut with meals is very helpful to the digestive system. I recommend making your own or buying Rejuvenative Foods. As awareness of these important vegetables has grown, you can find great fermented vegetable options near you. Look for fermented veggies at your grocery store or local farmer’s market.
3. EAT WHOLESOME, REAL FOODS AND REAL SALT
Himalayan Pink Salt Lamps to Purify the Air
Eating wholesome, real foods is a great way to increase your stomach acid production. Eliminate processed foods, genetically modified (GMO) foods, fast foods, additives, dyes, and artificial flavorings, all of which are devoid of nutrition. You should also eliminate white flour, refined sugars, and artificial sweeteners and avoid overeating (even healthy, nutrient foods). Use good quality sea salt, which stimulates stomach acid production. Our favorite is pink himalayan sea salt, which provides a good dose of important minerals for your health, like magnesium.
4. INCREASE ZINC INTAKE
Zinc is critical for the production of HCL. You can increase your zinc intake through whole foods. Pumpkin seeds are the most concentrated, non-meat food source of zinc. Most foods that are high in zinc are animal foods such as beef, lamb, crabmeat, turkey, chicken, lobster, clams and salmon. Zinc food sources aside from meats are dairy products such as yogurt, kefir, cheese, nutritional yeast, peanuts, beans, wholegrain cereals, brown rice, whole wheat bread, and potatoes. Vitamin C, E, B6, and minerals such as magnesium can increase zinc absorption in the body. So adding whole food supplements will also help assimilation.
5. CHOOSE A WHOLE FOOD MULTIVITAMIN
Take a whole food, superfood multi-vitamin to help restore the vitamins and minerals that are needed for HCL production. B vitamins are especially important. Look for niacin, thiamine, and pyridoxal-5-phosphate (the active form of vitamin B6).
6. USE FOOD COMBINING TECHNIQUES FOR PROPER DIGESTION
Proper food combining takes pressure off your digestive system. Do not eat proteins and carbohydrates/starches together. Carbohydrates reduce the production of HCL and protein requires HCL to be digested. Instead, pair proteins with low-starch vegetables. To aid the body in digesting animal protein, soak meats in acidic mediums such as lemon or lime juice, tomato juice, apple cider vinegar, etc. Marinating meats is a good way to pre-digest or pre-cook them. Always eat good fats when you eat proteins. Protein stimulates stomach acid production, and protein and fats stimulate the gall bladder to dump bile into the small intestines. Good fats also are needed by the liver in order to produce bile.
Eat starches/carbohydrates with vegetables, but eat fruit alone – not with meals. When possible, eat dandelion greens with meals in soups or as greens to increase production of HCL. You should also consider the spices you use in cooking, which can stimulate stomach acid production and appetite.
7. CHEW THOROUGHLY
Did you know digestion starts in the mouth? Chew foods thoroughly to stimulate digestive enzymes in the mouth and to break up foods into the smallest particles possible for better digestion.
8. STOP EATING BEFORE BEDTIME
Try to eat three to four hours before bedtime. If you eat too late, the body struggles to complete the digestive process during the time it is naturally trying to rest. Don’t lie down immediately after eating. If you must lie down, prop yourself up with pillows so that head and upper torso are raised to aid the digestion. Avoid snacking in between meals in order to allow time for your body to digest foods properly.
9. DRINK HOT TEA WITH YOUR MEAL – NOT COLD WATER
Is Dandelion Root the New Kale?
Never drink ice water with meals as it inhibits production of stomach acid and slows down digestion. If you would like a drink with your meal, try adding warm ginger tea, which increases the production of HCL. You can also drink dandelion root tea to increase production of HCL.
If you don’t prefer tea, make a warm lemon water (use the juice of 1/2 lemon) at the beginning of your meal. You can even drink 4 ounces of freshly juiced cabbage juice to help with digestion and stomach acid production.
10. USE A LIVE-SOURCE HYDROCHLORIC ACID SUPPLEMENT
Another way to boost HCL is to take a live-source hydrochloric acid supplement after your meals. The goal is to restore the body’s ability to produce its own HCL, but until this occurs take Betaine HCL. See “Do You Have Enough Stomach Acid?” NOTE: If you are taking medications, consult with your physician to make sure that Betaine hydrochloride supplements will not cause adverse reactions in tandem with certain medications.
In more ways than one, a glass of wine may aid digestion.
ANAHAD O’CONNOR firstname.lastname@example.orgGut. 1997 Jan;40(1):49-56.
Alcoholic beverages produced by alcoholic fermentation but not by distillation are powerful stimulants of gastric acid secretion in humans.
Teyssen S1, Lenzing T, González-Calero G, Korn A, Riepl RL, Singer MV.
The effect of commonly ingested alcoholic beverages on gastric acid output and release of gastrin in humans is unknown.
AIM AND METHODS:
In 16 healthy humans the effect of some commonly ingested alcoholic beverages produced by fermentation plus distillation (for example, whisky, cognac, calvados, armagnac, and rum) or by alcoholic fermentation (beer, wine, champagne, martini, and sherry) on gastric acid output and release of gastrin was studied. Gastric acid output was determined by the method of intragastric titration. Plasma gastrin was measured using a specific radioimmunoassay.
None of the alcoholic beverages produced by fermentation plus distillation had any significant effect on gastric acid output and release of gastrin compared with control (isotonic glucose and distilled water). Alcoholic beverages produced only by fermentation significantly (p < 0.05) increased the gastric acid output by 57% to 95% of maximal acid output (MAO) and release of gastrin up to 5.1-fold compared with control. If beer, wine, and sherry were distilled, only their remaining parts increased gastric acid output by 53% to 76% of MAO and increased release of gastrin up to 4.3-fold compared with control.
(1) Alcoholic beverages produced by fermentation but not by distillation are powerful stimulants of gastric acid output and release of gastrin; (2) the alcoholic beverage constituents that stimulate gastric acid output and release of gastrin are most probably produced during the process of fermentation and removed during the following process of distillation.
PMID: 9155575 PMCID: PMC1027007
[Indexed for MEDLINE] Free PMC Article
J Clin Invest. 1999 Mar;103(5):707-13.
Maleic acid and succinic acid in fermented alcoholic beverages are the stimulants of gastric acid secretion.
Teyssen S1, González-Calero G, Schimiczek M, Singer MV.
Alcoholic beverages produced by fermentation (e.g., beer and wine) are powerful stimulants of gastric acid output and gastrin release in humans. The aim of this study was to separate and specify the gastric acid stimulatory ingredients in alcoholic beverages produced by fermentation. Yeast-fermented glucose was used as a simple model of fermented alcoholic beverages; it was stepwise separated by different methods of liquid chromatography, and each separated solution was tested in human volunteers for its stimulatory action on gastric acid output and gastrin release. Five substances were detected by high-performance liquid chromatography and were analyzed by mass spectrometry and 1H-13C nuclear magnetic resonance spectroscopy. At the end of the separation process of the five identified substances, only the two dicarboxylic acids, maleic acid and succinic acid, had a significant (P < 0.05) stimulatory action on gastric acid output (76% and 70% of fermented glucose, respectively), but not on gastrin release. When given together, they increased gastric acid output by 100% of fermented glucose and by 95% of maximal acid output. We therefore conclude that maleic acid and succinic acid are the powerful stimulants of gastric acid output in fermented glucose and alcoholic beverages produced by fermentation, and that gastrin is not their mediator of action.
PMID: 10074488 PMCID: PMC408116 DOI: 10.1172/JCI3620
[Indexed for MEDLINE] Free P
A novel function of red wine polyphenols in humans: prevention of absorption of cytotoxic lipid peroxidation products
Shlomit Gorelik, Moshe Ligumsky, Ron Kohen, and Joseph Kanner
Published Online: 21 Aug 2007 https://doi.org/10.1096/fj.07-9041com
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Current evidence supports a contribution of polyphenols to the prevention of cardiovascular disease, but their mechanisms of action are not understood. We investigated the impact of red wine polyphenols on postprandial cytotoxic lipid peroxidation products (MDA) levels in humans. In a randomized, crossover study, the effect of red wine polyphenols on postprandial levels of plasma and urine MDA was investigated. Three meals of 250 g turkey cutlets supplemented by water (A); soaked in red wine after heating plus 200 ml of red wine (B); or soaked in red wine prior to heating plus 200 ml of red wine (C) were administered to 10 healthy volunteers. Subject baseline plasma levels of MDA were 50 ± 20 nM. After a meal of turkey meat cutlets, plasma MDA levels increased by 160 nM (P<0.0001); after (B) there was a 75% reduction in the absorption of MDA (P<0.0001). However, after (C), the elevation of plasma MDA was completely prevented (P<0.0001). Similar results were obtained for MDA accumulation in urine. Our study suggests that red wine polyphenols exert a beneficial effect by the novel new function, absorption inhibition of the lipotoxin MDA. These findings explain the potentially harmful effects of oxidized fats found in foods and the important benefit of dietary polyphenols in the meal.—Gorelik, S., Ligumsky, M., Kohen, R., Kanner, J. A novel function of red wine polyphenols in humans: prevention of absorption of cytotoxic lipid peroxidation products.