Got stomach acid? The answer is yes, quite a bit of it, and it’s one of those things that you never want to have to worry about. The stuff is acidic enough to burn your skin (main ingredient, hydrochloric acid) and, fun fact, our bodies produce 4 liters of it every day. But because our stomach wall is lined with a coat of protective mucus, we usually don’t feel the burn as our gastric juices go about their essential digestive and immunity duties. But every so often we are aware of it, when, say after a too-spicy meal, a small amount of acid travels back up from the stomach into the tube that connects the stomach to the throat, the esophagus. As the esophagus has no protective lining, we experience the uncomfortable feeling of heartburn, or more technically, gastric reflux. However, for about 20% of the population, the condition is chronic, labelled GERD (or gastroesophageal reflux disease), and the older we are, the more likely we are to suffer from it. The real disaster here is the common treatment for GERD – over-the-counter or prescription proton pump inhibitors (PPIs) drugs like Nexium and Prilosec – which come laden with side-effects and are based on a fundamental misunderstanding of what’s actually causing the problem. These drugs depress the body’s production of stomach acid even though usually the real culprit is that the body isn’t making enough! Here’s what you need to know about how stomach acid really works, why you need to have plenty of it and how to avoid occasional heartburn or chronic GERD without resorting to drugs:

The stomach acid story in a nutshell. 

The story begins in the mouth. No, check that. It begins with your eyes that take in an appetizing meal and your nose which savors the food aromas, and then the taste receptors in your mouth which come alive when you take a bite. All that sensory information triggers the stomach’s production of acid in the stomach, about 1/3 of its total output, before the food ever makes it to the stomach. Its chief job is to activate the enzyme pepsin which, along with the stomach acid itself, breaks down dietary protein in the stomach, so it can be turned into human proteins, that is, the ‘building blocks’ of the human body. (The small intestine, the next stop on the digestive train, handles most of the carbs and fats.) 

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But that’s not the whole story. The stomach acid also helps the body extract essential nutrients, like vitamin B12 and the mineral magnesium. As well, it’s responsible for maintaining the proper acidic environment in the stomach that helps stop most bacteria, viruses and fungi in their tracks. (If the pathogens are too toxic though, the gut’s immune system will have to come to the rescue.) 

Dropping acid (levels).

Stomach acid is like most things the body produces. Less gets produced as we pass through middle age into our elder years. The result? We become more prone to gut infections. We get less good at absorbing B12, which the body needs to make the stomach acid in the first place, a kind of vicious circle that results in many seniors becoming B12 deficient. (Unless they supplement -- a good multi vitamin-for-seniors will usually do – they may suffer symptoms like low energy and mental confusion.) 

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Now we come to GERD. Healthy acidity levels in the stomach help prompt a ring-shaped esophageal sphincter muscle, situated between the esophagus and the stomach, to tighten up after food has passed into the stomach, preventing any stomach contents from flowing back up. Less stomach acid increases the risk of backflow, directly, via a too-relaxed sphincter muscle, or indirectly, when insufficiently digested food ferments in the gut, and the gas produced presses up against the sphincter. Whatever the cause, GERD symptoms aren’t pleasant. They include a burning sensation in the chest, a sour taste in the mouth, difficulty swallowing, or hoarseness. Long-term risks include ulcers and a pre-cancerous condition known as ‘Barrett’s esophagus’. Dr. Jonathan Wright, author of Why Stomach Acid is Good for You, estimates that 90% of people over 40 with GERD suffer from low levels of stomach acid. 

The PPI “solution” that’s hardly a solution at all.

The antacid drugs -- Nexium, Prilosec, and Prevacid -- are a Big Pharma cash cow, and a textbook case of treating symptoms while ignoring the root cause of the problem, in this case, by lowering stomach acid levels, often making it worse. A 2020 review by a group of Weill Cornell physicians linked regular PPI use with dementia (quite possibly because of a B12 deficiency), kidney disease and an increased risk of contracting COVID. A Mayo Clinic study correlated PPI use with less microbial diversity in the gut, which puts regular users at greater risk for gut infections, vitamin deficiencies and bone fractures. I’ll rest my case with two more pieces of evidence. In a study that reviewed the medical records of hundreds of thousands of VA hospital patients, patients on the PPIs had a 25% higher risk of death. And finally, according to drugwatch.com, as of Sept. 24, there are 12,308 active PPI lawsuits pending in U.S. federal courts. PPIs? Thanks, I’ll pass and I would suggest you consider doing the same. If you’re you are taking PPIs regularly and ready to kick the stuff, taper off slowly with the help of a physician, to monitor your progress and help you avoid a “rebound effect” of higher-than-normal stomach acid levels. 

The art of how to eat for your stomach acid. 

For most of us, the way to make stomach acid your friend is to observe some smart lifestyle basics, which apply not only to what you eat but how you eat. In the “how” department, the key is to eat mindfully. That is, you want to savor your food calmly. Chew slowly and take a pause between bites. That will prime your system to start pumping stomach acid even before the food hits your stomach. The less stress you feel, the better your digestive system will work – you want to be in “rest and digest” mode (the parasympathetic nervous system is running the show), not in the all fired up “fight or flight” mode (the sympathetic nervous system). 

The art of what to eat for your stomach acid.

No surprise, a healthy and diverse microbiome is the best way to protect your gut’s ability to extract nutrients from food and to maintain its immune defenses even as stomach acid levels fall with age. Think prebiotic foods, especially non-starchy veggies like leafy greens, which feed your good bacteria, and probiotic foods which introduce friendly strains. Consider a good probiotic supplement.  You’ll also want to practice these five stomach acid pro tips: 

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1. Begin a meal with something bitter, for instance bitter greens like kale, arugula and dandelion or Swedish Bitters, a traditional herbal tonic that’s easily available. Doing either will prime the stomach acid pump. 
2. Begin a meal with a protein to rev up the stomach acid-producing machinery. 
3. Limit how much fluid you drink at a meal, no more than a half-pint, so as not to over-dilute the stomach acid in your system. 
4. Avoid coffee or tea at mealtimes which can interfere with digestion. 
5. Explore supplements like HCI Betaine or digestive enzymes with a knowledgeable integrative health care practitioner.