5 Things to Know About Stomach Acid, Heartburn, Acid Reflux, and GERD
Are you struggling with acid reflux, GERD, or heartburn?
What about gas, bloating, diarrhea, constipation, or abdominal pain?
If so, you’re not alone!
Nearly two-thirds of Americans deal with digestive complaints every day, and nearly one-third struggling with heartburn, acid reflux, or Gastroesophageal Reflux Disease (GERD).
As one of the first organs in your digestive system, your stomach sets up the rest of the digestive tract for success… or failure. If your stomach isn’t working well, the rest of your digestive tract will struggle to do its job. Your stomach plays many huge roles in digestion and overall health.
Today, we’re breaking down some of these roles and how exactly your stomach affects your digestion.
1) Stomach acid is essential for protein digestion.
Stomach acid, hydrochloric acid, is an extremely strong acid. The primary goal of stomach acid is to reduce the pH of the stomach (or make it acidic). The acidity of the stomach is important for many things, but the primary goal of having an acidic stomach is to allow for proper digestion of the protein you eat.
A protein is a huge chain of molecules, called amino acids. During digestion, your body breaks the protein down into these component parts, these amino acids. This protein chain changes shape depending on multiple factors, including temperature and acidity. In your body (or the body of any organism), you want and need your proteins to be folded correctly because this allows the proteins to function in the right way and at the right time; this is why your body is so tightly regulated, particularly when it comes to our temperature and pH. But when it comes to digestion, folded proteins are much harder to break down. We need those proteins to unfold. (It’s almost like dissolving salt in water. Does salt dissolve faster when it’s in a big lump or when it’s in many smaller pieces?) When protein enters your acidic stomach, it unfolds. It opens up so that you’re able to digest it easier, faster, and more completely. Your stomach acid also activates various chemicals called enzymes, which actually do the job of breaking down into smaller pieces (digesting your food). The stomach acid unfolds the protein, while the enzymes break it down.
Without this acidity, the proteins you eat stay folded up. You don’t digest them as much as you should. This can lead to issues with “food sensitivities” or IgG-related allergies because your body doesn’t like big chunks of foreign protein in it, so it sends your immune system to go fight them off. Undigested protein can also lead to other issues, including bloating, abdominal pain, gas that smells foul or like sulfur, and diarrhea. It can also play a role in the development of ulcerative colitis, an inflammatory bowel disorder causing frequent bloody diarrhea. Over the long term, lack of protein digestion can also lead to loss of muscle mass, changes in mood, fatigue, and changes in your hair, skin, and nails.
2) Stomach acid is a key player in nutrient absorption.
Beyond its primary role of protein digestion, your stomach also plays a key role in the absorption and digestion of other nutrients, though this is often more indirect. As we stated earlier, your stomach is essential for the function of the rest of your digestive system.
Directly in the stomach, the amount of stomach acid you have plays a role in the absorption of some key vitamins and minerals, most notably Vitamin B12 and iron, as well as other minerals like calcium, magnesium, and potassium. Vitamin B12 (aka cobalamin) is essential for energy production, nervous system function, methylation, and red blood cell formation, and it has many other functions as well; to absorb Vitamin B12 effectively, you need stomach acid to release it from the food you eat. Without stomach acid, the B12 will stay bound up in the food, making it difficult, if not impossible to absorb enough. As for the minerals, your stomach acid changes them into a form that’s easier to absorb and incorporate into your body. Without stomach acid, much like B12, these minerals would be extremely hard to absorb.
Indirectly, your stomach acid plays a role in the absorption of fats, carbohydrates, and other vitamins and minerals by organizing the rest of your digestive system and telling the organs when to do their jobs. When the food you eat leaves your stomach, it enters your small intestine mixed together with your stomach acid. This acid-food mix entering your small intestine tells your liver, gallbladder, and pancreas to start secreting bile and enzymes to break down proteins, carbs, and fats. When you don’t have enough stomach acid, this signal is weak and these organs don’t get a strong cue to help digest your food, so a large portion of food may not be fully digested. Like with undigested protein, undigested carbs and fats can lead to a similar set of symptoms, including bloating, gas, abdominal pain, and diarrhea.
Your stomach acid also plays a role in telling your intestines to move your food along, using wave-like contractions of your intestines called peristalsis. Without enough stomach acid, these contractions can slow down, leading to constipation, among other symptoms.
(Yes, too little stomach acid can lead to constipation AND diarrhea, which seems counter-intuitive, but which one it produces depends on you and your individual body and function. In many cases, constipation and diarrhea can occur together, or they can alternate, which occurs in the mixed type of irritable bowel syndrome.)
3) Stomach acid acts as an important defense mechanism against foreign bacteria and other bugs.
Stomach acid is a key part of your immune system and the regulation of the bacteria and other microbes in your GI tract. As we mentioned before, proteins tend to lose their shape and don’t function well when things get too acidic. So, when you eat food and it has bacteria or other “bugs” on it (which most of your food will), your stomach acid protects you by unfolding essential proteins and killing off many of those uninvited guests. If you don’t have enough stomach acid, your stomach will be less acidic, allowing some of these bugs through.
In addition to bugs coming in through your mouth, your intestines are also filled with bacteria, viruses, parasites, and fungi (collectively called microbes or microorganisms). These make up your microbiome or your gut flora, mostly living in your large intestine. This sounds like a health hazard, but these microbes are essential for you to survive and thrive. They help you produce essential nutrients like Vitamin K and butyrate and are highly connected to your brain and overall mood and cognitive function. Recent research tells us that your microbiome impacts almost every aspect of your health and wellness, including your weight. You need your gut to be filled with these little bugs!
However, if you have the wrong mix of microbes (not enough helpful microbes or too many harmful microbes) or microbes in the wrong places (in your stomach or small intestines), you can experience problems. They can affect many aspects of your health, including digestive function, hormonal balance, autoimmunity, and brain health. Your stomach acid plays a critical role in managing the amount of these bugs, particularly in your small intestine.
Just like how many bugs are killed by entering the stomach, stomach acid helps to clean out the small intestine of bacteria and other organisms. Small Intestinal Bacterial Overgrown (SIBO) is a condition where you get too many bugs growing in your small intestine; they steal and digest your nutrients while secreting harmful byproducts, creating symptoms like gas, bloating, and abdominal pain.
4) Heartburn, acid reflux, and GERD are often related to having too little stomach acid, not too much.
31% of Americans are consistently dealing with heartburn, acid reflux, and GERD. It’s incredibly common, but these symptoms are not at all normal.
Commonly, these conditions are treated using antacids like Tums, proton-pump inhibitors (PPIs) like omeprazole/prilosec, or H2-blockers like pepcid/famotidine. The goal of all of these medications is to reduce the acidity of your stomach. Logically, it seems like these should be great treatment options. After all, these conditions are due to stomach acid entering your esophagus or throat; the acid is essentially “burning” these areas, creating that feeling of heartburn.
However, these conditions are actually often related to a LACK of stomach acid, not too much stomach acid. So, instead of making the problem better, these medications often exacerbate the symptoms and aren’t treating the real cause of the condition. How does this work?
Between your esophagus and your stomach is this ring of muscle called your lower esophageal sphincter (the LES). This sphincter opens when you swallow, allowing food to enter your stomach, then closes again to prevent food and stomach acid from coming back up. There are a number of factors that control how and when this ring of muscle opens and closes, and one of those factors is how acidic your stomach is. If your stomach isn’t acidic enough, the LES doesn’t get a strong enough signal to remain closed, so it can reopen, allowing acid to slosh back up into the esophagus and creating the symptoms of heartburn and acid reflux.
5) Low stomach acid can be related to many chronic health issues.
Your gut health is incredibly important to your overall health and well-being. Recent research has related the health of your digestive system to nearly every chronic illness, including eczema, cancer, autoimmune disorders, asthma, heart and cardiovascular disease, diabetes, and even many mental health disorders. As one of the first organs in your digestive tract, your stomach sets the tone for the rest of your digestive system. An unhealthy stomach will often lead to dysfunction in other organs, including the liver, gallbladder, pancreas, and intestines.
As we discussed above, if you’re not digesting your food well, this can create a variety of issues, from food sensitivities to bloating to abdominal pain. Poor digestion also creates inflammation in the digestive system as your immune system responds to the imbalanced microbiome, undigested foods, and foods that you are sensitive or allergic to. Inflammation in the digestive system can allow certain pathogens, toxins, and foreign material into your system, increasing inflammation all over your body. This is where the connection to other illnesses comes in - excess inflammation in your body is related to just about every chronic illness we see today, from heart disease and diabetes to eczema and autoimmunity. For most people, the digestive system and the food that we eat are key contributors to this systemic inflammation and the development of various conditions and diseases.
Closing Thoughts
Understanding how your body works is an essential part of understanding your health problems and how they happen. It’s also an essential part of understanding how you go about improving your health and well-being.
Restoring proper stomach function is one of the biggest factors when it comes to treating almost any digestive complaint, as the stomach helps the rest of the digestive system do its job. If your stomach isn’t functioning well, you’re setting your digestive system up for significant problems.
If you’re dealing with a digestive complaint or another health issue, we’re here to help. Whether it’s decreasing the symptoms or getting back to something you love, we’ll help you get there. Call us at 763-373-9710 or click here to set up your appointment and get back on the right track!
Wishing you the best,
Dr. Nicholas Carlson
Northbound Chiropractic
Serving Delano, MN, Maple Plain, and the rest of Wright and West Hennepin Counties