You’ve heard it before. You are what you eat. But in the pursuit of healthy aging no amount of whole, local or organic food is going to do you much good if you are not able to adequately digest and assimilate it. Digestion must happen before assimilation and the main player in our stomachs is hydrochloric acid - it is a trigger for all aspects of the digestive process. The problem is that stomach acid declines with age, sometimes considerably. It is estimated that half of healthy people over the age of sixty have hypochlorhydria (low stomach acid) and by age eighty-five, that number rises to 80 percent. Common symptoms of low stomach acid include bloating and belching especially after eating, fullness and heaviness after meals, intestinal gas, indigestion, bad breath, diarrhea or constipation, acid reflux and undigested food in the stool.

Our entire digestive process depends on food being doused with hydrochloric acid (HCl) when it enters the stomach. HCl denatures proteins so they can be broken down by a powerful protein-digesting enzyme, pepsin, which, interestingly enough, is not converted to its active form without sufficient HCl. Next to water, protein is the most plentiful substance in the body and a main constituent of every cell. It is used to build, maintain and repair our tissues, meaning that incomplete protein digestion because of low stomach acid could lead to long term deficiencies and an increase in the effects of aging. If HCl is low and proteins enter the intestine only partially digested, tremendous stress is put on the pancreas to continue the job. Also, incomplete digestion of complex proteins is a major factor in the onset of food allergies, which in turn can also compromise digestion and result in symptoms of gastric discomfort.

Vitamin B12 is essential for blood formation, energy, growth, and proper cell division and function. But it needs help. The same cells that produce HCl in the stomach also produce something called intrinsic factor which binds the B12 from food so it can be properly absorbed in the small intestine.  Just as HCl output declines with age, so too does that of intrinsic factor, resulting in B12 deficiencies and increased signs of ageing. Common symptoms of low B12 levels include fatigue, paleness, high homocysteine levels (which can contribute to heart disease), muscle weakness and ultimately pernicious anemia. Lack of B12 can also damage nerve cells and can cause mental changes including memory loss, confusion and depression.

Minerals act as co-factors for the enzymatic reactions that essentially govern the functioning of our bodies. Without adequate stomach acid, we cannot properly absorb many minerals including iron, calcium and zinc. This in turn can compromise energy levels, bone density and immunity. Paradoxically, at the same time that HCl helps us absorb critical nutrients for health, it helps keep some things we don’t want out of the body – namely disease-causing microbes. Strong stomach acid is one of the first lines of defence against pathogens that enter the digestive track from the mouth or on the food we eat. It will kill organisms that would otherwise set up shop somewhere in the intestines causing imbalances or dysbiosis or worse, infections.

Contrary to what some ads on television might indicate, low stomach acid can actually cause indigestion and reflux.  Here’s how it works: primarily we have protein digestion in the stomach but if there is low stomach acid, this digestion slows down allowing fermentation to take place. This fermentation can weaken the cardiac sphincter at the top of the stomach and allow stomach acid and fermentation gases to push up into the esophagus causing pain and inflammation. Excess stomach acid actually occurs very infrequently, and what feels like too much acid is usually not enough. But when we turn to antacids and acid blockers, we can actually make the condition worse by either neutralizing the remaining acid or preventing its secretion altogether. A further reduction in stomach acid encourages more fermentation and we have the start of a vicious cycle. Proton pump inhibitors are among the top selling drugs in use and unfortunately a testament to the extent of digestive problems people experience. While they work like a charm, they don’t address the actual problem and merely suppress the symptoms. Eliminating ninety-nine per cent of all stomach acid production presents a fundamental disruption of the digestive process and new evidence indicates that some side effects of long term use may include an increase in the risk of hip fractures in adults over 50 as well as an increased risk of contracting Clostridium difficile, a type of infectious diarrhea.

Proper digestion is paramount to the pursuit of health and ‘zwellness’ and we want to take the steps necessary to ensure this process works optimally. The following are tips to help create the optimal conditions for digestion and therefore health.

• Eat smaller meals. This allows the stomach acid that is present to digest the smaller amount of food eaten instead of a larger amount staying the stomach for a prolonged time and leading to fermentation.
• Eat slowly, chew your food until it is a paste and stop eating before you are full. Your mother was right; digestion does start in the mouth.
• Avoid eating when angry, anxious or upset. When we are in “fight or flight” mode it is much more difficult for the body to support the mechanisms needed for the “rest and digest” process.
• Cut down on simple carbohydrates such as bread, pasta and rice. These tend to bring on more fermentation in the stomach which can result in increased acid reflux.
• Watch for trigger foods for acid reflux including chocolate, fried foods, alcohol, tomatoes, coffee and refined grains.
• Loosen you belt when you eat. Tight clothing can cause upwards pressure on the stomach and force acid into the esophagus.
• Loose belly fat for the same reason (among others).
• Eat as least 2-3 hours before bed. This allows for the food to be moving out of the stomach and into the small intestine by the time you lie down, thereby decreasing the risk of acid reflux during the night. Raising the head of the bed a couple of inches will help too.
• Don’t drink large amounts of liquids during meals as this can dilute the stomach acid and slow down digestion. But do ensure you are hydrated between meals.
• Try 1 Tbsp of apple cider vinegar in 2-3 ounces of water at the beginning of the meal to increase stomach acidity and aid protein digestion. Do not do this if you have ulcers.
• Speak to your health care practitioner about the appropriate use of digestive enzymes.

Jill Hillhouse, BPHE, CNP is a holistic nutritionist at Clear Medicine Wellness Boutique in Toronto.