We're back on Day 5 of this 7 day challenge to explain exactly which conditions have a firm link in literature to low stomach acid.

Let's just start with the list. These are just some of the conditions that are linked to low levels of stomach acid or upper gastric malfunction - as you can see the list is quite long!

Autoimmune conditions make up roughly half of this list. This is no coincidence, and it really sort of galvanizes some of the information that we covered in the Gut Primer course about how leaky gut is basically considered to be a precondition for the development of auotimmunity to begin with, and the close relationship between leaky gut and low stomach acid.

So If you suffer from autoimmunity but don't see your condition explicitly listed here, just because there's an absence of a specific study on your condition, doesn't mean the same principles wouldn't apply to you. These principles are universal.

There is more and more research about hypochlorhydria coming out all the time. I suggest you simply google the words "hypochlorhydria" with whatever condition or symptom you're dealing with and just see what pops up.

Not the most exacting way to examine a relationship, but hopefully it will serve to illustrate that this is an incredibly hot topic these days. What's not so hot are the lack of safe available methods to address the issue, which we'll get into tomorrow.

Before we talk more about an important autoimmune related condition and hypochlorhydria, let's talk about some "mild" symptoms to look out for.

Perhaps the most common symptoms experienced, are the 3 Bs: Burping, bad breath, and bloating.

All of these symptoms are related to gas being present inside of the body that needs to be expelled somehow. We've really normalized these symptoms in America - characters in shows and movies belch and fart for comedic effect, these things are presented to us as normal body functions that, while not the most polite, are things that we all do.

So I want to challenge this a little bit. And I'll preface this by acknowledging that of course everyone on the earth has burped, and probably experienced some bloating and bad breath.

However, it is not normal to burp excessively, more than a few times after you've finished a meal. It is not normal to have persistent bad breath that merits brushing your teeth more than twice a day, and it is not normal to see a distended stomach, so that you can't sit in your pants comfortably, after most meals.

While microbial presence is normal and necessary in the intestines, the stomach is meant to be a virtually sterile environment. This is ensured by the presence of the acid barrier, which works to kill all microbes that enter, and which makes the stomach environment inhospitable for colonization. However, when we have low levels of acid, those microbes actually can and do take up residence in the stomach itself, and those microbes feast on the food being consumed and produce gas end-products.

Where does the gas go? It bubbles up our esophagus when we burp, and smells terrible, giving us bad breath no matter how many times we brush, and it also expands into the stomach causing bloating.

So a healthy response to your meal should not involve burping, at least not much, and your tummy should not bulge out over your pants after a meal, and breath shouldn't be outlandishly bad smelling.

If this is you, your stomach acid is in need of repair.

The other incredibly common symptom that we see for people with low stomach acid is this complaint about a feeling of warmth and increased acidity in the stomach. People will say it feels inflamed and irritated.

Most people will reach for the TUMs when they feel this, thinking they need to neutralize their acid, but actually, this almost always means you have too little acid.

Basically, your food is not moving through the GI tract fast enough due to low stomach acid, so this is resulting in too much contact with your tissue and eroding your protective mucosa. We need to build up your mucosa, but then, increase your acid to speed up transit time through the GI tract.

I'll link to my digestive dysfunction deep dive series that explains this symptom in great detail.

Now that we've gotten the more "mild" symptoms out of the way, let's focus on a major immnune driver.

Small intestinal bacterial overgrowth or ‘SIBO‘ has recently been found to be linked to upper gastric health, rather than linked to the large intestine as was previously hypothesized.

SIBO is a form of dysbiosis in the small intestine and is incredibly common in those with IBS, it's been linked to rheumatoid arthritis, MS, Fibromyalgia, Crohn's, Parkinson's, anxiety disorders among many other conditions.

It's strong association with autoimmunity has meant that many practitioners have embraced SIBO testing and interventions as a tool to relieve symptoms. It's unclear whether or not the presence of SIBO is causal or a result of a slow GI system subject to attacks from an overactive immune system, as has been demonstrated to be so common in those with any autoimmune condition. However, for many, eradicating a SIBO presence can result in significant symptom alleviation.

Previously, the prevailing theory on the onset of SIBO was that slow transit time in the colon would result in a sort of traffic jam that would back up to the ilocecal valve, which separates the small intestine from the large intestine. This ilocecal valve was thought to jam open from the waste build up, resulting in microbes from the large intestine colonizing the small intestine and causing trouble.

However, recent work has shown that the composition of microbes found in the small intestine for SIBO positive individuals was consistent more with the oral microbiome and very different than the large intestine's - this implies that these microbes were able to survive their trek downward - likely due to low acid in the stomach. So if you've been diagnosed with SIBO or suspect that you have it, stomach acid is a really important leverage point to focus on, and the mechanism for that is via the acid barrier that we've discussed previously.

So while these are some of the most common ways that compromised stomach acid can present itself, there are many many ways that this can manifest, and so I'd like you to hit pause for a moment to see if any of these symptoms sound familiar.

A word on food sensitivities. we know that food sensitivities tend to happen when you have a leaky gut, and poorly digested food slips through the gut and into the bloodstream. One of the reasons I prefer people to focus on rebuilding their stomach acid before they embark on an elimination diet, it that fixing their digestive secretions can actually move the bar on which foods they react to, and can reduce the number of foods they need to eliminate to get meaningful results.

If people suddenly possess the acid necessary to properly break down those larger proteins that were slipping out into the blood stream, then those proteins can actually get digested and absorbed before they can elicit an immune response. So often, we can see movement on food sensitivities with the proper upper digestive support.

One other note about the no taste for meat symptom. Usually we'll see this for vegetarians and vegans, but this is likely because the individual doesn't possess the secretion power to properly digest the meat - as we discussed earlier, protein requires an especially acidic stomach to be safe food and not immunostimulating.

So often people's appetites can really kick into gear once we address the acid levels. If you're struggling to gain weight or have appetite issues, this is definitely a relevant consideration for you.

Tomorrow we're really getting into the exciting stuff... we're talking more about which tool I suggest you use to go about fixing your stomach acid.

Talk to you tomorrow!