Low Stomach Acid: Belching, Gas, and Constipation Explained

If you’ve ever experienced belching, gas, or constipation, you know how uncomfortable and embarrassing these symptoms can be. These symptoms have several potential causes, but one commonly overlooked is low stomach acid. But what exactly is low stomach acid, and what causes it? 

In this article, we’ll explore the scientific evidence behind these symptoms and delve into the causes of low stomach acid.

What is low stomach acid?

Hypochlorhydria, or low stomach acid, occurs when the stomach doesn’t produce enough acid to break down food and absorb nutrients. 

Stomach acid aids digestion and nutrient absorption, as well as protecting the body from harmful bacteria and pathogens in food. A lack of stomach acid can cause indigestion, malnutrition, and sometimes bacterial overgrowth, as well as other digestive symptoms.

Symptoms of low stomach acid:

A person with low stomach acid may experience several symptoms, including:

• Belching/burping after meals 
• Gas after a meal
• Bad breath 
• Fullness after a meal 
• Constipation 
• Unable to digest heavy protein meals

• Belching/Burping After Meals:

It’s common to burp or belch after a meal. However, excessive belching could be a sign of low stomach acid. Researchers have found that hypochlorhydria can cause incomplete food digestion, resulting in stomach gas formation. This excess gas buildup can result in frequent belching after meals.

In one study, the researchers found that low stomach acid levels were associated with increased belching in patients with gastroesophageal reflux disease (GERD).

• Gas After a Meal:

Gas can be uncomfortable and embarrassing after a meal. Low stomach acid impairs the breakdown of carbohydrates in the stomach, contributing to gas formation. Food fermentation in the stomach can produce gas, which may result in bloating and discomfort. Furthermore, the gas can put pressure on the lower esophageal sphincter (LES), causing acid reflux. 

A study has shown that low stomach acid levels may increase the risk of functional dyspepsia, a condition characterized by upper abdominal pain, bloating, and early satiety.

• Bad Breath:

Bad breath can also be cause by low stomach acid. A fermentation process in the stomach can result in the release of foul-smelling gasses that can then be expelled through the mouth when the food ferments. Additionally, low stomach acid levels can allow bacteria to grow in the stomach, causing an overgrowth of bacteria and bad breath. 

A study found that H. pylori infections, which cause low stomach acid, were associated with bad breath among patients with functional dyspepsia.

• Fullness After a Meal:

Insufficient stomach acid can cause you to feel overly full after a meal, even if you ate only a small amount. Inadequate acid levels slow down the digestion process, leading to delayed gastric emptying. As a result of delayed emptying, food remains in the stomach for longer periods, resulting in a feeling of fullness.

A study found that low stomach acid levels led to delayed gastric emptying and excessive fullness after meals.

In my previous podcasts, I discussed low stomach acid in relation to heartburn after gastric bypass surgery and the advantages of digestive enzymes. In these podcasts, you can find valuable information.

• Constipation:

Low stomach acid can also cause constipation. If food is not properly digest in the stomach, the intestines will lack nutrients and hydration, leading to constipation. Additionally, low stomach acid levels can cause bacterial overgrowth in the small intestine, causing constipation and altered gut motility. 

A study showed that low stomach acid levels were associated with constipation in Parkinson’s patients.

Another study investigated the relationship between low stomach acid (hypochlorhydria) and bacterial overgrowth in the small intestine. The results showed that low stomach acid levels were associated with an increased risk of bacterial overgrowth in the small intestine. 

Furthermore, the study found that proton pump inhibitors (PPIs) were associated with an increased risk of bacterial overgrowth. It has been suggested that restoring normal stomach acid levels may reduce the risk and severity of bacterial overgrowth and related gastrointestinal symptoms.

• Unable to digest heavy protein meals:

Digesting protein requires adequate stomach acid.  In fact, animal proteins are the most difficult to digest.  Especially after bariatric surgery.  You see, chewing your food signals the release of hydrochloric acid(stomach acid).   

Additionally, the release of stomach acid triggers the other organs involved in digestion to release pepsin, bile, pancreatic enzymes and many digestive properties that are necessary to ensure adequate absorption of the nutrients you consumed. 

Causes of Low Stomach Acid

Several factors can cause low stomach acid. To identify and resolve the underlying issues, it is essential to understand these causes. Here are some common causes of low stomach acid:

• H. pylori Infection:

Helicobacter pylori is a bacterium that causes inflammation and damage to the cells that produce stomach acid in the stomach lining. It is a common cause of hypochlorhydria. 

Studies have shown that H. pylori cause disruption of the normal secretion of gastric acid, resulting in hypochlorhydria.

• Medications: PPI Use:

A proton pump inhibitor (PPI) is a medication often prescribe to treat conditions like gastroesophageal reflux disease (GERD) and peptic ulcers. PPIs reduce stomach acid production. However, studies have shown that prolonged use of PPIs can lead to a decrease in stomach acid levels, potentially causing hypochlorhydria. Therefore, medication should be taken under medical supervision for the prescribe amount of time.

To learn more about gastric surgery, PPIs, and low stomach acid, you may find the following blogs helpful:

• “3 causes of digestive issues after WLS”
• “Gastric Surgery & Heartburn Considerations”

• Autoimmune Reaction Against Parietal Cells:

In some instances, the stomach lining’s parietal cells are mistakenly target and attacked by the immune system. These cells produce hydrochloric acid. Due to the immune system’s attack on these cells, they are unable to produce adequate amounts of stomach acid, which results in low stomach acid levels. This condition is known as autoimmune atrophic gastritis.

• Chronic Stress:

There are several health problems that can result from stress, including a decrease in stomach acid production. During periods of stress, the body’s sympathetic nervous system becomes more active, which can interfere with proper digestion. 

Studies have shown that psychological stress significantly decreases the amount of gastric acid secreted in the stomach. Stress management techniques and lifestyle modifications can support healthy digestion.

• Hypothyroidism:

An underactive thyroid gland, known as hypothyroidism, can contribute to low stomach acid levels. In addition to regulating the metabolism of various tissues, thyroid hormones also affect the gastrointestinal tract. 

Research suggests that hypothyroidism can impair gastric acid secretion, leading to hypochlorhydria. It is important to address this underlying cause with proper thyroid management and treatment.

• Decreased Vagal Activity:

The vagus nerve regulates gastric acid secretion as part of the autonomic nervous system. A reduction in vagal activity can result in a decrease in stomach acid production. 

Surgical procedures that involve vagotomy, which is the cutting or severing of the vagus nerve, have been found to decrease gastric acid output significantly. Age and certain health conditions can reduce vagal activity.

• Aging:

The production of stomach acid naturally declines with age. A decrease in acid levels with age can be attribute to several factors, including changes in gastric physiology and reduced function of acid-secreting cells. Aging-related hypochlorhydria may contribute to digestive issues and nutrient deficiencies in older adults.

It’s important to note that the low stomach acid causes vary among individuals, and multiple factors can contribute simultaneously. For proper evaluation, diagnosis, and treatment of low stomach acid, it’s recommend to consult a healthcare professional.

Low Stomach Acid Solutions: Restoring Optimal Digestion

Various approaches can be taken to address hypochlorhydria or low stomach acid. Here are some potential solutions for low stomach acid:

• Apple Cider Vinegar:

The natural remedy, apple cider vinegar (ACV), is believe to increase stomach acid levels. Despite the lack of scientific research specific to apple cider vinegar’s effects on stomach acid levels, a study concluded that vinegar, including apple cider vinegar, may enhance stomach acid production.

Take one tablespoon of ACV in a glass of water before meals. ACV’s acidic nature may stimulate acid production and aid digestion. However, before using this method, consult a healthcare professional, especially if you have a history of acid reflux or stomach ulcers.

• Betaine HCl:

Supplementing with betaine hydrochloride (HCl) capsules can help boost stomach acid levels. Betaine HCl supports digestion by providing more hydrochloric acid. In order to ensure proper dosage and use of betaine HCl supplements, you should consult with a healthcare professional.

• Digestive Enzyme Supplements:

Supplementing with digestive enzymes can improve digestion, especially if low stomach acid interferes with protein digestion. 

A study investigated the use of digestive enzyme supplements in patients with hypochlorhydria. Researchers found that supplementation with digestive enzymes, including proteases, can improve symptoms associated with low stomach acid and enhance protein digestion.

Look for a high-quality digestive enzyme supplement that includes proteases, which help break down proteins, as well as other enzymes, such as amylases and lipases.

• Probiotics:

Taking probiotic supplements or eating probiotic-rich foods can help promote healthy gut bacteria. Probiotics support optimal digestion by maintaining a balanced microbiome. It has been shown that strains such as Lactobacillus and Bifidobacterium enhance digestion and enhance gut health.

Incorporating probiotics through fermented foods or supplements may contribute to overall digestive health.

• Lifestyle Modifications:

Additionally, lifestyle changes can help restore stomach acid levels and promote healthy digestion. These include:

• Eating Mindfully: For proper digestion, you need to chew your food thoroughly and eat in a relaxed environment.
• Managing Stress: Engage in stress-reduction practices such as meditation, deep breathing exercises, or hobbies to minimize chronic stress’s impact.
• Avoiding Trigger Foods: Identify and avoid foods that may exacerbate digestive symptoms, such as spicy or greasy foods, caffeine, and alcohol.
• Eating Smaller, Frequent Meals: Rather than consuming large, heavy meals throughout the day, you should eat smaller, frequent meals.It’s important to note that these solutions may not be suitable for everyone, and individual responses may vary. To ensure safe and effective management of low stomach acid, it is essential to work with a healthcare professional.

• Seek Professional Guidance:

It is truly necessary to seek medical advice and guidance if you suspect you have low stomach acid. In addition to identifying the underlying causes, they can provide you with specific recommendations tailored to your situation, as well as monitor your progress over time.

Final words

Belching, gas, and constipation are unwanted guests at the digestion table that reveal a sneaky culprit: low stomach acid. You can regain digestive harmony by understanding the causes and implementing simple solutions. Don’t ignore your gut instinct, seek professional guidance, and let discomfort go. You’ll be happier and healthier soon!