Low stomach acidity: how to determine, nutrition and diet

Everyone knows that high stomach acidity is bad, but do you know how dangerous low stomach acidity is?

For the digestion process in the stomach to proceed normally, a certain amount of hydrochloric acid is required, which is produced by its mucous membrane, and low stomach acidity causes many health problems.

So why does hypochlorhydria occur and how can you differentiate between increased and decreased stomach acidity?

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Epidemiology

Nobody knows the real number of people with insufficient stomach acidity. However, according to some reports from practicing European and American gastroenterologists, almost 28% of adults have this problem by the age of forty, and almost 40-45% have a chance of encountering it at the age of 50. And among people 70 years and older, this number increases to more than 75%.

So it is important to keep in mind that the older a person is, the less hydrochloric acid the stomach produces, which can lead to a condition called achlorhydria.

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Causes low stomach acidity

In the list of the main causes of low stomach acidity, only one point can be mentioned, and this is a reduction in the production of hydrochloric acid - a product of the parietal exocrine cells (parietal cells) of special intragastric glands - fundic, located deep in the mucous membrane of the bottom of the stomach (fundus ventricul).

But gastroenterologists associate the reasons for the decrease in the secretion of hydrochloric acid (HCl) with the following factors:

• infection of the stomach with the bacterium Helicobacter Pylori (to ensure its survival, it neutralizes stomach acid with hydrogen nitride);
• atrophy of the gastric mucosa;
• slowing down of metabolism caused by hypothyroidism (decreased thyroid function);
• hypochloremic metabolic alkalosis (develops in diseases accompanied by frequent vomiting or diarrhea);
• stomach cancer and/or radiation therapy that has affected this organ;
• tumors of the islet cells (islets of Langerhans) of the pancreas;
• somatotropic adenoma of the pituitary gland (in which the synthesis of the hormone somatostatin increases);
• autoimmune damage to the parietal cells of the stomach (immune gastritis) in Sjogren's syndrome;
• zinc deficiency in the body;
• deficiency of thiamine (vitamin B1) and niacin (nicotinic acid or vitamin PP).

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Risk factors

Experts also name the following risk factors for decreased stomach acidity:

• poor nutrition and highly restrictive diets;
• excess carbohydrate consumption;
• inflammatory bowel diseases that have a general inhibitory effect on HCl secretion;
• stress and chronic depressive state (contributing to the development of functional achylia);
• celiac disease (intolerance to gluten in cereals);
• old age.

In addition, long-term use of sodium bicarbonate (soda) and heartburn-relieving antacids neutralizes the action of gastric acids. Antihistamines (blocking H2-histamine receptors) and antiulcer drugs of the proton pump inhibitor group suppress the functions of the parietal cells of the stomach and the production of HCl. But acetylcholine receptor antagonists (m-anticholinergics) lead to a decrease in the secretion of gastric juice by reducing the influence of the vagus nerve.

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Pathogenesis

Most often, the pathogenesis of disorders of hydrochloric acid secretion is seen in problems of nervous, paracrine and endocrine control of the multi-stage process of its production.

For example, there may be insufficient activity of the G-cells of the gastric antrum mucosa (from Latin antrum – cavity), which produce gastrin and function only at a certain pH level, as well as partial dysfunction of the ECL cells – the source of gastric histamine.

Impaired acid production may be due to inadequately receiving signals from receptors of the neurotransmitter acetylcholine, the release of which in the stomach (after food enters it) should stimulate its production.

^{Disturbances in the transfer of hydrogen protons (H +} ) necessary for the formation of hydrochloric acid from the cytoplasm to the plasma membrane of parietal cells cannot be ruled out. This process is ensured by a transport enzyme - hydrogen-potassium adenosine triphosphatase (H ⁺ /K ⁺ -ATP) or a proton pump, and here, due to insufficient strength of cell membranes, there may be losses of H ⁺. And the density of membranes and their compounds in parietal cells, as it turned out, is regulated by the glycoprotein cytokine VEGF (vascular endothelial factor), which may be lacking under certain conditions, in particular, with prolonged oxygen starvation of tissues, the presence of foci of chronic inflammation or the constant presence of mycotoxins of mold and other fungi in the body.

Quite often, the pathogenesis of low acidity lies in the imbalance of substances that can inhibit the secretion of gastric juice: enterogastrone (intestinal gastroinhibitory hormone), secretin (especially its variety - vasoactive intestinal peptide), the hormone somatostatin (produced by D-cells of the gastric mucosa and regulating the release of gastrin).

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Symptoms low stomach acidity

The first signs of high pH of gastric juice appear after eating - in the form of belching and a feeling of discomfort in the stomach area. Moreover, belching (with the taste of the food consumed) can occur several hours after eating. This symptom is evidence that the food is still in the stomach, while with normal acidity it should already be in the small intestine. Therefore, a feeling of discomfort in the stomach can be accompanied by nausea with low acidity of the stomach.

Other symptoms of low stomach acidity include flatulence (bloating); intestinal disorders (diarrhea or constipation); halitosis (bad breath), and there may be a white coating on the tongue; the presence of undigested food fragments in the stool; weight loss; itching in the rectum; chronic fatigue.

Pain from low stomach acidity is rare and usually extends from the stomach to the throat, appearing after heartburn.

By the way, heartburn with low stomach acidity is a common occurrence, as well as with high acidity: the difference lies in the cause of gastroesophageal reflux. The fact is that insufficient gastric acid leads to an increase in intra-abdominal pressure, under the influence of which the lower esophageal sphincter, which separates the esophagus and stomach, opens. And even a microscopic amount of acid that gets on the mucous membrane of the esophagus is quite enough to cause heartburn.

A long-term decrease in the level of hydrochloric acid in the gastric juice and the associated deficiency of certain substances (mentioned above) may be indicated by:

• chronic fungal infections and recurrent intestinal invasions;
• food allergies and chemical poisoning;
• irritable bowel syndrome;
• weakness of the limbs, paresthesia (numbness and tingling in the limbs);
• acne, eczema and skin rashes;
• increased dryness of the skin, brittle nails, thinning and loss of hair;
• depression, sleep and memory disorders.

What is the danger of low stomach acidity?

The answer to this question can be very short: sufficient acidity in the stomach and gastric juice is crucial for good digestion and the state of the immune system.

Complications and consequences

Listing the specific consequences and complications of high stomach pH, experts emphasize the primary importance of acid for protein digestion: HCl activates the transformation of the proenzyme pepsinogen II into the enzyme pepsin, which ensures the process of breaking the amino acid bonds of protein foods through proteolysis.

Acid is necessary for the proper functioning of the stomach sphincters and the further movement of its contents (chyme); for the neutralization of pathogenic bacteria and yeast fungi entering the gastrointestinal tract; for the production of pancreatic juices by the pancreas. Finally, only in an acidic environment can the body absorb calcium, magnesium, iron, zinc, copper, selenium, etc.

Thus, the consequences and complications of low acidity can be expressed in increased susceptibility of the body to intestinal infections and enteroviruses; protein deficiency due to their malabsorption; iron deficiency anemia; deficiency of vitamins C, A, E, B12 and folic acid; reduced secretion of bile and pancreatic enzymes.

All this can lead to the development of a wide range of pathologies. Thus, toxins of intestinal microbes, getting into the bloodstream, cause allergic or inflammatory reactions in distal areas, for example, interstitial cystitis. There is a tendency to the development of intestinal dysbacteriosis.

Undigested proteins acidify the blood (causing the bones to lose strength) and increase the blood urea nitrogen level many times over, which increases the load on the liver and kidneys. A deficiency of cyanocobalamin (vitamin B12) and folic acid in the body leads to the development of Addison-Biermer disease (megablastic anemia) with numerous neurological manifestations.

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Diagnostics low stomach acidity

With a certain symptomatic similarity to increased acidity, the diagnosis of decreased stomach acidity often leads to an erroneous diagnosis. According to some data, this occurs in 10-15% of cases in patients under 40-50 years old and in at least half of cases in patients over 60-65.

To detect pathology, blood tests are required: biochemical, for antibodies to Helicobacter Pylori, for PgII (pepsinogen level) and serum gastrin, for residual urea nitrogen. To confirm Helicobacter infection, air testing is performed - the composition of the air exhaled by the patient is examined for the presence of ammonia.

The composition of gastric juice is necessarily examined with determination of its pH. The traditional method – aspiration (probing) is still used, but it gives a significant error in the results. Also read – Study of gastric contents

Instrumental diagnostics in the form of intragastric pH-metry, carried out using an acidogastrometer, allows one to simultaneously determine the acidity of all sections of the stomach.

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Differential diagnosis

Differential diagnostics is especially important in gastroenterology, since many diseases do not have specific symptoms. For example, in elderly patients with low stomach acidity, fatigue after eating is attributed to old age, and rectal itching is often diagnosed as hemorrhoids.

How to distinguish between increased and decreased stomach acidity?

Let's start with the fact that pure water is taken as the neutral pH indicator - hydrogen index (the level of H ⁺ in the solution): pH - 7.0. By the way, the pH of human blood plasma is normally 7.35-7.45.

The higher the pH numbers, the lower the acidity level and vice versa.

When measuring the pH on an empty stomach in the lumen of its body and on the mucous membranes of this localization, the physiological norm of acidity is below 2.0. And the pH for gastric juice is normally 1.0-2.0. And these are the most favorable "working conditions" for the gastric enzyme pepsin.

If the hydrogen index exceeds 4-4.5, that is, pH>4-4.5, the acidity of the stomach is considered low.

It should be noted that all medical textbooks indicate the acidity norm of the antral part of the stomach in a very wide range: from pH 1.3 to pH 7.4. The theoretically possible minimum acidity of the stomach is 8.3. And the maximum level is considered to be a pH of about 0.9.

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Treatment low stomach acidity

The medical community's understanding of the wider prevalence of increased stomach acidity and diagnostic errors lead to patients being prescribed certain medications that cannot be used with low acidity.

Thus, treatment of low stomach acidity excludes the use of such drugs as Almagel (Alumag, Maalox, Gastal and other trade names) - this is an antacid that neutralizes the hydrochloric acid of gastric juice. All antacids only aggravate the problem, but they are actively promoted on the market as universal remedies for heartburn.

It is contraindicated to treat low acidity with antisecretory drugs Omez (Omeprazole, Omitox, Gastrozol, etc.), as well as with Controlok drugs (Pantoprazole, Sanpraz, Nolpaza), which are proton pump inhibitors (see earlier about the proton pump - in the section Pathogenesis of low stomach acidity).

Antiulcer drugs containing bismuth – De-Nol (Gastro-norm) and Bismofalk – are not a means of drug therapy for this pathology.

Is it possible to increase the secretion of hydrochloric acid and how to increase low stomach acidity? Given the complexity of the process and the polyetiology of its disorders, gastroenterology uses the simplest way to solve the problem - it is recommended to take HCl preparations and enzyme medications that replenish the lack of endogenous digestive enzymes.

So, hydrochloric acid – a solution of hydrochloric acid – is taken during meals in a dosage determined by the doctor based on the examination results. Natural canned gastric juice (of animal origin) is also taken during meals – a tablespoon up to three times a day. Pepsin (powder for dissolution in water) or liquid Pepcidil should be taken in the same way and in the same dosage.

The enzyme preparation Oraza (in the form of granules) helps digestion. It is recommended to take it during or immediately after meals three times a day – one teaspoon. The treatment can be carried out for a month. When using this remedy, diarrhea may become more severe.

Pangrol (analogues - Pancitrate, Festal, Creon, Mezim) based on the digestive enzyme pancreatin is taken one or two capsules before meals. The drug can cause nausea and intestinal disorders, but long-term use is fraught with an increase in uric acid in the blood and urine.

There are few remedies that increase stomach acidity. For example, bitters are used to activate the secretion of gastric juice - tincture of wormwood (15-20 drops 20 minutes before meals). Aristochol drops can be prescribed (20-25 drops three times a day, after meals).

Cytoflavin (succinic acid + vitamins) is recommended to be taken 30 minutes before meals - one or two tablets twice a day. If there are no problems with kidney stones, you can use the vitamin and mineral complex Calcemin - one tablet once a day. It is also advisable to take vitamins B1, B9, B12, PP.

How to increase low stomach acidity?

Pay attention to foods that increase stomach acidity. Nutritionists include the following among them: all vegetables and fruits with a high content of ascorbic acid (vitamin C); ginger root (in the form of warm ginger tea, which also helps reduce bloating in the intestines); fermented vegetables (sauerkraut - as an appetizer, 100 g before the main course is enough); all fermented milk products.

You can increase your intake of zinc, which is necessary for the production of HCl in the stomach, by eating pumpkin seeds, potatoes, beans, peanuts, cheeses, whole grain cereals and bread, and brown rice. And to improve the absorption of zinc, take vitamins C, E, B6, and magnesium.

What can folk remedies for low stomach acidity offer? Apple cider vinegar (a tablespoon per glass of water, taken half an hour before meals); freshly squeezed white cabbage juice (half with water) - 100 ml twice a day; rosehip decoction (no more than 300 ml per day)), as well as drinking water with lemon juice before meals.

But oat broth, as well as flaxseed, despite the presence of omega acids, are not used in the treatment of low acidity. And to provide the body with omega-3 fatty acids, it is better to take fish oil capsules (1 capsule once a day).

Herbal treatment practiced in folk medicine to reduce the level of hydrochloric acid in gastric juice is carried out using fresh dandelion and plantain leaves, which are recommended to be added to food (without subjecting them to heat treatment).

The herbal mixture for this pathology includes the same plantain leaves, coriander fruits; trifoli leaves, gentian, silver cinquefoil, avens, and also chamomile (flowers). The mixture for preparing the decoction should contain the same amount of all ingredients, for example, three tablespoons each. For the decoction, take a tablespoon of the mixture per 0.5 liters of water, boil for 15 minutes, then infuse, filter and add boiled water to the original volume. It is recommended to use between meals throughout the day - 100-150 ml. After a three-week course, you need to take a break for a week.

You can also drink a decoction of dandelion roots, which are dug up in early autumn, cleaned, finely chopped and dried. Brew at the rate of a teaspoon per glass of boiling water, drink several times a day.

Prevention

Today, hypochlorhydria prevention consists of reducing animal proteins in the diet (which are poorly digested with low acidity) and replacing them with plant proteins from legumes, as well as reducing or eliminating sugar. There should be enough fiber.

Nutritionists' recommendations for proper digestion boil down to refusing food containing preservatives and other additives and switching to separate meals. That is, carbohydrates should not be consumed together with proteins (it is better to eat meat with vegetables that do not contain starches), and fruits should be consumed separately, and not during the main meal.

Doctors also recommend increasing the consumption of probiotic products, which will help balance the microflora of the stomach and intestines. In case of pronounced symptoms of atrophic condition of the gastric mucosa, it is recommended to follow a diet for atrophic gastritis.

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Forecast

It is difficult to predict what low stomach acidity will lead to. However, some experts consider it a risk factor for cancer. This opinion is based on the research-established involvement of Helicobacter Pylori in malignant gastroenterological diseases. It is also known that low stomach acidity is very common among the Japanese, and the main cause of their death is stomach cancer.

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