The focus of my clinical practice and work is on cardio-metabolic disorders (obesity, diabetes, cholesterol disorders, heart disease, insulin resistance, etc.), so why am I talking about acidity and digestion in this post?

As I started seeing patients with cardiometabolic disorders, I noticed that many of them happened to have problems with digestion as well.  Symptoms like acidity, bloating, gas, constipation and/or diarrhea.

I didn’t make the connection initially, but over the years I’ve noticed that as we worked towards reversing insulin resistance through natural lifestyle changes, digestive symptoms also resolved.  I now fully acknowledge the connection between the digestive system, popularly referred to as “gut health,” and overall health.

In fact, I often refer to the co-existence of gut symptoms and cardiac risk as “cardiodigestive disorders” or CDD to remind me of this intimate link. Recall how we’ve discussed multiple times how inflammation is the root cause for chronic health conditions like heart disease, cancer, Alzheimer’s disease, and autoimmunity.  Since inflammation is caused by immune system over-activation and most of our immune system resides in our gut, it’s no surprise that improper gut health is a primary trigger to inflammation-related diseases.

So even before your cholesterol or blood glucose becomes abnormal, your digestive symptoms may be an early warning sign for ongoing inflammation in the body.  Listen to your gut and don’t just treat these symptoms as an annoyance.

This is nothing new and despite an explosion in new books and research studies on gut health, ancient Eastern medical practices like Traditional Chinese Medicine and Indian Ayurvedic medicine acknowledge the key role the gut plays in human disease.   In fact, Hippocrates, the father of modern medicine said the following over 2,000 years ago:

“All disease begins in the gut.”


In today’s post we’ll discuss the basics of stomach acid and how “acidity” or “GERD” (Gastroesophageal Reflux Disease) symptoms are often misdiagnosed and mistreated as excess stomach acid, when it’s frequently due to low stomach acid. You’ll also learn about the wide range of health conditions that are associated with low stomach acid (aka hypochlorhydria) and the side effects of acid blocking medications like the popular PPIs (Proton Pump Inhibitors).  Our dietitian, Prerna Uppal, will then provide some natural remedies and lifestyle changes to help restore natural acid production.

The Role of Stomach Acid

Stomach acid, aka hydrochloric acid or HCL, plays a critical role in digestion.  It breaks down food particles into smaller pieces that are sent to the small intestine for further processing and nutrient absorption.  Stomach acid also triggers the release of digestive enzymes by the pancreas and small intestine.  If food is not properly broken down by a sufficient amount of stomach acid and the additional downstream enzymes, your body will not extract nutrients from that food.

In other words, if you are going through the effort of investing in high quality, nutrient dense foods, but have low stomach acid, you are not benefiting from the essential vitamins and minerals in those foods.  Stomach acid helps your body absorb a number of nutrients, including folate, vitamin B12, vitamin C, beta-carotene, iron, and some forms of calcium, magnesium, and zinc.

Nutrient dense foods potentially become nutrient deficient in the absence of adequate stomach acid and overall digestive function.

Stomach acid is also a critical part of our immune system function. When we produce insufficient amounts of acid, we are more susceptible to bacterial infections like H.Pylori (bacteria causing ulcers) and fungal infections like Candida to name a few.

Signs and Symptoms of Low Stomach Acid

Undigested food particles from insufficient stomach acid get digested by bacteria producing excess gas leading to symptoms like abdominal bloating, gas, nausea, cramping and acidity due to back pressure that sends acid up to the esophagus (swallowing tube).  This type of “acidity” is commonly misdiagnosed as excess acid which is then mistreated with acid-blocking medications which we’ll discuss in a moment.

I mentioned the link between digestion and immunity, so it’s no surprise that low stomach acid is linked to some of the following conditions:

  • Asthma and allergies (food and airborne)
  • Autoimmune disorders
  • Digestive symptoms (mentioned above) including bloating after meals
  • Vitamin and mineral deficiencies (B12, Iron, and those already mentioned)
  • Bacterial overgrowth
  • Intestinal hyperpermeability (aka “leaky gut”)
  • Skin conditions: eczema, hives, acne rosacea, dry skin
  • Anemia (from deficiencies in iron, B12, etc.)
  • Increased bone fractures (key minerals that are essential for bone strength, like calcium and magnesium, are often deficient with low stomach acid)
  • Hair loss (especially in women) or dry hair
  • Weak or cracked nails
  • Rectal itching

How are so many diverse conditions connected to something like low stomach acid?

The combination of a disrupted immune system from improperly digested food particles and the potential for multiple nutrient (vitamin, mineral, etc.) deficiencies stemming from low stomach acid are sufficient to trigger all types of seemingly unrelated health conditions.  

The reason food allergies are more prevalent with low stomach acid is because the undigested proteins from food are recognized as foreign invaders, which then trigger an immune system response by allergy-specific antibodies called “IgE” antibodies. Dr.Evan Untersmayr is an authority on this topic and found that study subjects with lower stomach acid from acid-blocking medication had a 300 percent increase in production of the allergy-specific IgE antibodies and were over 10 times more likely to develop food and airborne allergies.

Fatigue is also a very common symptom of low stomach acid since the energizing nutrients in foods cannot get absorbed by undigested foods.

Natural remedies for treating low stomach acid 

There are multiple natural strategies for treating low stomach acid, many of which are rooted in the ancient science of Ayurveda.  Ayurveda refers to our digestive energy as “agni” (fire) and stomach acid is a key contributor to agni.  For those of you who might be skeptical of these approaches, keep in mind that many of these interventions like the use of apple cider vinegar are only now becoming validated by research studies.  Our ancient ancestors had an innate wisdom about digestion and overall health that today’s scientist can’t match.  We’ve had this validated through our clinical experience. I’ve listed some of the natural remedies below but as Dr.Ron mentioned, you may need assistance from a dietitian, naturopathic doctor, or functional medicine practitioner familiar with effective treatment for low stomach acid.

    1. Organic, raw apple cider vinegar: 1 tablespoon organic, raw apple cider vinegar (a popular brand is Bragg’s) mixed with 4 oz water can be taken first thing in the morning and 30 minutes before meals.  The acetic acid in the vinegar helps restore the pH balance of the stomach.
    2. Lemon Juice: Similar to apple cider vinegar but less potent, Ayurveda recommends you squeeze the juice of half a lemon in 8 oz of warm water and drink on an empty stomach first thing in the morning.  Lemon juice can also be incorporated into marinades.
    3. Hydration:  The protective bicarbonate layer lining the stomach is made up of water so when we are dehydrated, the stomach lowers acid production to protect the stomach, so hydration is necessary to maintain normal acid release by the stomach.  Warm water is preferred and it’s best not to drink water with meals since it can dilute the effects of stomach acid.  Instead drink water between meals.
    4. Eat Clean Foods:  Eating unprocessed, natural, mostly plant-based foods while controlling sugar and excess carb intake will promote the optimal balance of bacteria in our digestive system which facilitates acid production.
    5. Mindfulness:  Stress, especially stress during eating, impairs acid production.   It is a well-known belief in ayurveda that your state of mind when you eat, determines the nutritional fate of your meal.  The same meal will be well assimilated if you are feeling happy and positive. Alternatively, it will be poorly digested if you are emotionally stressed.Eat slowly and chew your bites thoroughly.  
    6. Ginger: Chewing a small piece of ginger or drinking ginger tea between meals can help stimulate acid production.   Ayurveda suggests chewing on a piece of fresh ginger with “kaala namak” or black salt.
    7. Protein timing:  Since protein triggers acid production, eat protein first followed by vegetables and other non-protein foods.
    8. Fermented Foods: Fermented foods like sauerkraut, kimchi, pickled foods, yogurt, kefir, etc. contain organic acids, enzymes and beneficial bacteria that can improve acid release.  Eating these foods with your heavier protein meals can facilitate digestion.
    9. Manuka Honey has antibacterial properties which kill harmful bacteria in your stomach that interfere with acid production.  Use in moderation since any form of honey can raise blood sugar.
    10. Dandelion Tea is another great way to increase stomach acid production.
Dr.Ronesh Sinha is author of the best-selling book, The South Asian Health Solution. His work with Asian Indians and diverse populations in Silicon Valley to reverse diabetes and chronic health conditions has been featured on the cover of Fortune Magazine and the LA Times. He blogs at where he offers cutting edge content and online wellness programs to help readers achieve their health goals.

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