Low or High Stomach Acid: How to Differentiate Between Them?

Why Symptoms Overlap?

Low stomach acid paradoxically mimics high stomach acid because undigested food in the stomach can ferment, releasing gas. This gas increases pressure in the stomach and forces stomach contents upward, irritating the oesophagus, and causing symptoms like heartburn or regurgitation. In high stomach acid, the symptoms result from direct irritation due to excess acid production. In both cases, the burning sensation in the chest may feel identical, complicating self-diagnosis.

This overlap of symptoms often makes it challenging to identify the underlying issue, leading many to rely on trial-and-error treatments. Missteps in addressing these conditions can worsen symptoms or delay proper care. That’s why it’s essential to recognize the nuanced differences between the two. By closely examining when and how symptoms arise, you can gain insights into whether low or high stomach acid is the culprit.

Key Indicators of Low vs. High Stomach Acid

1. Timing of Symptoms

• Low Stomach Acid: Symptoms like bloating and indigestion often occur after eating large meals or foods requiring more digestive effort (e.g., protein-rich meals). You may also experience prolonged fullness due to slow digestion.
• High Stomach Acid: Heartburn and acid reflux can occur soon after eating acidic or spicy foods or even on an empty stomach. High acid levels can irritate the oesophagus immediately.

2. Food Intolerance

• Low Stomach Acid: Difficulty digesting protein-heavy foods like meat or beans is a hallmark of low acid levels. Inadequate stomach acid fails to break down these foods effectively, causing discomfort, belching, or bad breath.
• High Stomach Acid: Certain acidic foods (e.g., citrus fruits, tomatoes) may worsen symptoms, as they contribute to existing acidity.

3. Bloating and Gas

Both conditions can cause bloating, but low stomach acid tends to produce excessive gas due to fermentation of undigested food.

4. Other Symptoms

• Low Stomach Acid: Chronic issues like nutrient deficiencies, particularly in B12, magnesium, and iron, are often linked to hypochlorhydria. You may also notice dry skin, brittle nails, or hair thinning.
• High Stomach Acid: Symptoms often include a burning sensation in the throat (acid regurgitation) and possible ulcer formation due to overexposure of the stomach lining to acid.

Diagnostic Tools to Determine Stomach Acid Levels

If you're unsure whether you have low or high stomach acid, there are several ways to determine the cause:

1. Professional Medical Testing

• A doctor may perform a gastric pH test using a small device to measure acidity levels directly within the stomach.
• Another diagnostic tool is an endoscopy, which allows a doctor to observe inflammation or damage in the oesophagus or stomach lining.

2. The Baking Soda Test (At-Home Method)

Mix a teaspoon of baking soda in water and drink it on an empty stomach. If you burp within 2-3 minutes, it suggests you have adequate stomach acid. Delayed or absent burping could indicate low acid levels. While simple, this test is not a substitute for professional diagnosis.

3. Betaine HCl Challenge Test

Under professional guidance, you can take a betaine HCl supplement with a meal. A burning sensation suggests adequate or high stomach acid, while no sensation might indicate low acid levels. This should be done cautiously and under supervision to avoid irritation.

Managing Low vs. High Stomach Acid

1. For Low Stomach Acid:

• Dietary Adjustments: Incorporate bitter foods, probiotic and fermented foods, foods rich in fibre and healthy fats, and also foods that are gentle to the stomach lining (see detailed list here). In addition to these foods, certain spices (like turmeric, ginger, cumin, black pepper, cayenne pepper, mustard seeds, ajwain or asafoetida) can also encourage stomach acid production. Avoid drinking too much water with meals to prevent diluting stomach acid. Eat smaller, more frequent meals and chew food thoroughly to aid digestion.
• Supplements: Digestive enzymes or betaine HCl may support digestion but should be used under medical supervision. For those with persistent low gastric juice production, consider using warming spices, that stimulate your digestive fire, or  food-supplements with similar effect on a daily basis. If the symptoms persist, seek advice from your medical provider.

2. For High Stomach Acid:

• Dietary Avoidance: Limit spicy, fatty, or acidic foods that exacerbate symptoms.
• Medications: Antacids or proton-pump inhibitors (PPIs) can temporarily reduce acid levels but are not ideal for long-term use without guidance. Instead, try to avoid foods and spices that exacerbate symptoms. You can also use certain herbs (chamomile, liquorice root, fennel, mint, or slippery elm) and probiotic food supplements to help reduce your acidity.
• Lifestyle: Avoid lying down immediately after meals, and elevate your upper body during sleep to reduce reflux.

Although the symptoms of low and high stomach acid overlap, understanding their subtle differences can lead us to the solution and an effective management. If in doubt, professional medical advice is essential for accurate diagnosis. Remember: if left untreated, both conditions can lead to complications, such as nutrient deficiencies in low stomach acid or ulcers in high stomach acid. Proper management of your stomach acid levels can not only improve digestion but also enhance overall health and quality of life!