The stomach and its acid secretion may seemingly be unrelated to bladder health but as a matter of fact, stomach acid plays an important role in overall health – as a first line of defense for our immune system, in protein digestion and nutrient absorption.
Many may think of stomach acid in relation to heartburn/GERD, which affects up to 27 % of adults  and has risen recent years. As a result, antacids are the 7th most popular personal care product in the US alone, with sales of many million dollars .
However, the symptoms for low and high stomach acid are very similar. While high stomach acid can definitely be very irritating, low stomach acid may have more far reaching consequences.
Why do we even need stomach acid?
Stomach acid, or hydrochloric acid (HCl) is one of the most vital secretions to help us digest and absorb food and also to help protect our bodies from disease.
HCl is one of the key components for efficient digestion and the body’s first line of defence against pathogenic viruses, bacteria and yeasts. Pathogens thrive in a more alkaline environment and cannot normally survive the harsh acidity of the stomach.
Low levels of HCl may cause an array of problems and may be the root cause of various seemingly unrelated disorders.
One of the key functions of HCl is to acidify the environment in the stomach. This sterilizes the food, which is important to prevent the food from putrefying and thus becoming a source of toxicity for the body.
Furthermore, HCl can kill off any pathogenic bacteria, viruses or yeasts that might be entering the body through food. It acts as a first line of defence for our immune system.
The next key function of HCl is to ‘unravel’ the chains of amino acids present in proteins in order to prepare them for digestion. Moreover, it activates the protein-digesting enzyme pepsin.
This starts the digestion of proteins that we need as building blocks to keep our bodies healthy and to produce enzymes and hormones.
We also need HCl to absorb vitamin B12 and to ‘ionize’ certain minerals, such as calcium, magnesium and zinc, which is important for their efficient absorption.
What happens if we don’t have enough stomach acid?
Because HCl has so many important functions, low levels (hydrochloridia) may lead to unwanted symptoms.
First of all, proteins are hard to break down without sufficient HCl and may start to rot and putrefy in the stomach. This could produce a lot of gas, potentially leading to bloating, indigestion and belching.
Protein could also sit undigested in the stomach, causing a feeling of fullness and sometimes nausea. Amino acids from protein may not arrive where they are needed, potentially leading to a shortness of enzymes, neurotransmitters or and hormones, which can affect the whole body.
When food leaving the stomach is not acidic enough, it may fail to trigger hormones to secrete pancreatic enzymes and bile. This could affect digestion and absorption in the intestines. The small intestine may also ‘reject’ the food and push it back up, potentially resulting in heartburn.
With low HCl, nutrient absorption may be compromised, even if they are supplemented.
The vitamins B12, B6 and folate all need HCl for absorption and are potentially deficient in people suffering from low HCl . Absorption of other nutrients such as vitamin C, iron , magnesium and calcium  could also be impaired. Chronic nutrient deficiencies in turn may have a negative impact on all aspects of health.
With age, stomach acid levels drop and with it the potential for stomach problems. This may sometimes be due to an infection with the H. pylori bacterium, which can take hold in the stomach when acid levels are low and then survive HCl even if it levels are raised subsequently [3, 6].
Without adequate stomach acid, we are more prone to a variety of infections as our first line of defence is not in place [7, 8].
The effect of Low Stomach Acid on Bladder Health
Without adequate stomach acid to kill invading microbes, pathogens such as E. coli  can enter the body through food and find their way into the bladder and cause urinary tract infections (for example from contaminated chicken).
Calcium and magnesium are needed for normal muscle function, so if they aren’t absorbed well this could have consequences for the bladder muscle potentially resulting in issues such as incontinence or an overactive muscle.
Also, materials to repair bladder cells may not be getting through.
Risks of taking Antacid Medications
Many people who suffer from indigestion and heartburn might reach for antacid medication. There are two types of these medications: antacids, which consist of alkalizing minerals that neutralize acid and Proton Pump Inhibitors (PPIs), which inhibit the secretion of stomach acid.
Studies have shown that the use of PPIs to suppress HCl production raises the risk of catching serious infections, including the antibiotic resistant C. Difficile bug, which can lead to severe diarrhoea that can be fatal , and pneumonia  amongst others [7, 8].
Moreover, people using PPIs may develop SIBO (small intestinal bacterial overgrowth) [11, 12] or SIFO (small intestinal fungal overgrowth) . Changes of pH in the stomach due to low levels of HCl can also change the pH in the remainder of the digestive tract which can allow bacteria to live in places they would not normally be present.
So we can see that low levels of stomach acid has the potential of creating an array of problems and symptoms.
How to know if you have low stomach acid?
The most obvious symptoms could include (note that they are very similar to high stomach acid symptoms):
- digestive discomfort shortly after eating a meal
- inability to eat large portions
- acid reflux
- feeling of fullness
- GERD or GORD
Many other chronic ailments may also be indirectly linked to low levels of stomach acid (however, they are non-specific and could have a different cause). These can include (but are not limited to):
- Hair loss
- Brittle nails
- Nutrient deficiencies
- Calcium deposits
- C. Diff
- H. Pylori
- Hormonal imbalances
- Neurotransmitter imbalances
How to test for stomach acid levels?
The gold-standard functional test for HCl levels is the Heidelberg Capsule Test. A small radio transmitter capsule is swallowed and measures resting HCl levels, alternating with an alkaline bicarbonate challenge. The physician then checks how well the stomach returns to an acid condition, which determines whether or not adequate levels of HCl are produced. As far as I know there is no private lab in the UK offering this test and I don’t know if it is available in NHS hospitals.
The VEGF Test is a lab test that measures ‘vascular endothelial growth factor’ (VEGF) in the saliva, which is proportionate to the amount of HCl produced in the stomach. This non-invasive test is available privately in the UK and costs around £80.
The Bicarbonate Challenge Test is an easy and cheap test that can be done at home. It is based on the idea that an alkaline bicarbonate solution would react with the acidic HCl in the stomach, causing burping. As all DIY tests, it is probably not 100% accurate. In the morning a solution of ¼ tsp bicarbonate plus 250 ml of water is consumed on an empty stomach. Belching should occur if HCl is present. The time it takes until belching occurs is then measured:
- 1-2 minutes: normal HCL
- 2-3 minutes: normal to slightly low HCl
- 3-5 minutes: low HCl
- 5+ minutes: potentially no HCl
What to do about low stomach acid
Eat enough protein: Without sufficient protein in the diet the production of HCl and pepsin may be very low. Long-term vegetarians and vegans (including me) often develop low levels as production of HCl diminishes with the lack of protein in the diet.
Chew well: The first stage of digestion is chewing. Chewing and tasting food triggers HCl to be produced in the stomach.
Don’t eat when stressed: When the body is stressed, the sympathetic side of the nervous system favours the functioning of vital organs that would be needed in a ‘fight or flight’ situation and lowers secretions of the digestive system, including HCl.
Don’t drink with your meals: Consuming too many liquids with food can dilute stomach acid, no more than a small glass would be recommended. Try to leave at least 30 mins on either side.
Apple cider vinegar: A tsp of ACV mixed into an equal amount of water taken right before a meal may help to acidify stomach contents (it does not stimulate HCl production however)
Betaine HCL: This is a supplemental form of stomach acid. You should consult a health practitioner before taking these supplements.
Bitters: Herbal bitters may help to stimulate digestive secretions and have been used traditionally.
Do you think you have problems with low stomach acid? Have you been taking antacids? Let me know in the comments!
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- Statista Sales growth of leading brands of antacid tablets in the United States in 2016 (change to prior sales year) 2017 https://www.statista.com/statistics/194547/us-sales-growth-of-antacid-tablet-brands-in-2013/
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- Digestive Wellness Elizabeth Lipski. Published by KEATS. ISBN 0879836792 1996