Why You Need Stomach Acid and What Happens When You Neutralize It

The importance of stomach acid is well-documented. Your body needs stomach acid for a lot of good reasons:

  • Stomach acid plays an essential role in the immune system by killing harmful bacteria and parasites that are ingested with food
  • Stomach acid activates the enzyme pepsin needed for protein digestion
  • Stomach acid signals to the pancreas produce digestive juices and enzymes to further break down food
  • Stomach acid initiates peristalsis, the rhythmic contractions of the intestines, that crush and move the food through the GI tract
  • Stomach acid is essential for the absorption of Vitamin B12 which plays key role in the normal functioning of the brain and nervous system, and in the formation of blood.
  • Stomach acid performs an essential digestive function by reducing food clumps (bolus) into smaller particles (chyme), so that the intestines can absorb nutrients quickly and effectively.

The effect of suppressing stomach acidity with drugs is to decrease nutrient absorption to such a degree that there can be long term health consequences. In the process you are also compromising an essential part of your immune system. Stomach acid kills harmful microbes on contact but without it these intruders can flourish. The longer the duration of acid suppression the higher the risk of harmful effects.

Stomach acidity is measured by a chemistry table known as, the pH scale (shown below).

PH Levels

As you can see from the chart, an individual with a healthy, properly-functioning digestive system has esophagus with a pH: 7, a small intestines with a pH: 7, and, in between, a stomach with a pH:2.

The Connection Between Low Stomach Acid Levels and Reflux

Stomach AnatomyAnother important function of stomach acid is the effect that it has on the Lower Esophageal Sphincter (LES). The LES is the valve which allows food to enter the stomach but prohibits reflux of gastric acid into the esophagus. The autonomic nervous system activates the LES in response to increased stomach acidity. The LES has “sensors” that measure the acidity of your stomach contents. As the concentration of stomach acid (aka Hydrochloric acid or HCl for short) increases, the closing pressure of the LES increases. However, if the stomach does not reach the proper level of acidity, the LES valve remains open and stomach acid will reflux into the esophagus.

Conversely, the pyloric sphincter is the valve which holds stomach contents until they are ready to flow down to the intestines. The pyloric sphincter works in exactly the opposite way of the LES. It will not open until stomach acidity has reached a sufficiently high level. This is nature's way of ensuring that food is properly digested before it flows through the rest of the gastrointestinal system. However, if the stomach does not reach the proper level of acidity, the pyloric valve remains closed and stomach will linger resulting in indigestion, bloating and possibly forcing stomach contents to back flow into the esophagus.

As we age, our body produces less and less stomach acid. It is therefore no coincidence that reflux and GERD increases with age.

Danger of Acid Neutralizers

The conventional method of treatment for reflux is prescription or over-the-counter “acid-neutralizers”. These include proton pump inhibitors (PPI's),  H2-receptor antagonists, and antacids. The exact functionality of these differ, but the common thread is that they all reduce or eliminate stomach acid, in effect, raising the pH level of the stomach.

There is some relief from symptoms because any acid that refluxes into the esophagus will have a higher pH, lessening the damage to the esophagus. However, they do nothing to treat the underlying cause, and, in taking them, you self-inflict your stomach with a condition known as achlorhydria. Achlorhydria is a lack of sufficient stomach acid which is responsible for dozens of digestives disease through the GI tract. Some of the diseases that are directly or indirectly caused by achlorhydria or are listed below.

Achlorhydria Related Upper Gastric Tract Diseases

  • Esophagus: Candidal esophagitis (Boerhaave syndrome, Mallory-Weiss syndrome), Zenker's diverticulum, Barrett's esophagus, Esophageal motility disorder (Nutcracker esophagus, Achalasia, Diffuse esophageal spasm, GERD), Esophageal stricture, Megaesophagus
  • Stomach: Gastritis, Peptic ulcers, Dyspepsia, Pyloric stenosis, Gastroparesis, Gastroptosis, Portal hypertensive gastropathy, Gastric antral vascular ectasia, Gastric volvulus

Achlorhydria Related Intestinal Tract Diseases

  • Small intestine - Enteritis (Duodenitis, Jejunitis, Ileitis), Peptic (duodenal) ulcer, Curling's ulcer, Malabsorption: Coeliac, Tropical sprue, Blind loop syndrome, Whipple's, Short bowel syndrome, Steatorrhea, Milroy disease
  • Large intestine, appendix and colon: Appendicitis, Colitis (Pseudomembranous, Ulcerative, Ischemic, Microscopic, Collagenous, Lymphocytic), Functional colonic disease (IBS, Intestinal pseudoobstruction/Ogilvie syndrome), Megacolon/Toxic megacolon, Diverticulitis, Diverticulosis
  • Large and small intestines: Enterocolitis (Necrotizing), IBD (Crohn's disease), Vascular: Abdominal angina, Mesenteric ischemia, Angiodysplasia, Bowel obstruction: Ileus, Intussusception, Volvulus; Fecal impaction — Constipation · Diarrhea (Infectious)
  • Rectum: Proctitis (Radiation proctitis), Proctalgia fugax, Rectal prolapse
  • Anus: Anal fissure/Anal fistula, Anal abscess, Pruritus ani

Accessory Achlorhydria Related Intestinal Tract Diseases

  • Liver: Hepatitis (Viral hepatitis, Autoimmune hepatitis, Alcoholic hepatitis), Cirrhosis (PBC), Fatty liver (NASH), vascular (Hepatic veno-occlusive disease, Portal hypertension, Nutmeg liver), Alcoholic liver disease, Liver failure (Hepatic encephalopathy, Acute liver failure), Liver abscess (Pyogenic, Amoebic), Hepatorenal syndrome, Peliosis hepatis
  • Gallbladder: Cholecystitis, Gallstones / Cholecystolithiasis, Cholesterolosis, Rokitansky-Aschoff sinuses, Postcholecystectomy syndrome
  • Bile duct, biliary tree: Cholangitis (PSC, Secondary sclerosing cholangitis, Ascending), Cholestasis/Mirizzi's syndrome, Biliary fistula, Haemobilia, Gallstones / Cholelithiasis common bile duct (Choledocholithiasis, Biliary dyskinesia)
  • Pancreatic: Pancreatitis (Acute, Chronic, Hereditary), Pancreatic pseudocyst, Exocrine pancreatic insufficiency, Pancreatic fistul