Is Heartburn Really About Too Much Stomach Acid?

By David Blyweiss, M.D., Advanced Natural Wellness

October 11, 2021

What do you do when you have heartburn?

If you’re like most people, you probably take an antacid like Nexium, Prilosec or Prevacid. That’s just what people do.

But is it the right thing to do?

These types of drugs, called proton pump inhibitors (PPIs) reduce stomach acid. But as you age, the most common cause of heartburn isn’t too much stomach acid. It’s too little!

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In fact, at least half of patients with heartburn—especially those over age 60—don’t have enough stomach acid to start with. It’s a condition called hypochlorhydria.

This is a big problem, because symptoms of low stomach acid are almost identical to having too much of it. They both generate heartburn, bile reflux, gas, bloating and abdominal discomfort. But mainstream docs rarely consider low stomach acid when reviewing these symptoms. It’s more likely they’ll just send you home with an antacid, probably in the form of a PPI, and consider their job done.

When you start taking that drug – whether prescribed or over-the-counter – it will deplete your stomach acid and digestive enzymes even further. And that’s a problem.

Without enough stomach acid, you can’t properly absorb protein, vitamins and minerals. Just as bad, because stomach acid kills potentially toxic bacteria on food, the loss of this critical digestive fluid can result in small intestinal bacterial overgrowth and create a toxic environment in your gut.

And in addition to wiping out what little stomach acid you have, PPIs are associated with malabsorption of calcium,vitamin B12 and magnesium deficiencies, kidney disease, dementia and reduced bone density.

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Confused? Take My Apple Cider Vinegar Challenge.

I have an extremely easy test you can perform right at home to find out if you have low stomach acid.

The next time heartburn strikes, take a tablespoon of apple cider vinegar in a glass of water. If the pain disappears or gets remarkably better, that’s a pretty good indication that your body isn’t producing enough hydrochloric acid.

In this case, you can boost your body’s natural production of stomach acid by taking 325 to 650 mg of betaine hydrochloride with pepsin at the beginning of each meal.  If you experience a slight burning sensation in the pit of your stomach, decrease the dosage.

You can also restore a natural acid balance in your digestive system by taking digestive enzymes. Taking a mixed blend of amylase, lipase and other digestive enzymes helps break down food in your digestive tract and reduce gastric upset. Enzyme-rich produce like parsley, kale, broccoli, apples, pears strawberries and other fruits and veggies can help, too.

I also recommend taking a high-quality probiotic. And I’m not talking about picking up some yogurt at the grocery store. These commercial products don’t have nearly enough good bacteria in them.

Instead, look for a supplement containing multiple strains of lactobacillus and bifidobacter. It should also include a “prebiotic” to help the good bacteria survive the trip to the gut and intestines. This will help restore a healthy balance of microflora to keep your digestive tract working smoothly.

When Stomach Acid Has Nothing to Do with Heartburn

It’s important to remember that heartburn isn’t always about your stomach acid. There are other things that can cause that uncomfortable feeling.

  • Being overweight can trigger it. Excess weight can also cause a backflow of acid into the esophagus. So it’s a good idea to start engaging in activities and eating habits that can help drop those excess pounds.
  • Some patients find that spicy foods, acidic foods, fried foods or fatty foods cause heartburn symptoms. If you can find which foods are triggering your symptoms, you’ll know which foods to avoid.
  • Carbonated beverages are another trigger. They place a great deal of pressure on your esophagus that promotes reflux. So it’s a good idea to steer clear of them. Opt for water, herbal teas and low-acid smoothies.
  • Overeating is probably the number one reason for gastrointestinal discomfort. So it’s best to eat small, healthy meals throughout the day. And please… skip the midnight snack. It’s nothing more than an invitation for heartburn and reflux.

If you are careful to track what you’ve consumed prior to a heartburn attack, you might find there is an obvious culprit or two that you can take control of.


Britton E, McLaughlin J. Ageing and the gut. Proceedings of the Nutrition Society. 2013; 72(1), 173-177.

Freedberg DE, Lebwohl B, Abrams JA. The impact of proton pump inhibitors on the human gastrointestinal microbiome. Clin Lab Med. 2014;34(4):771-785.

Haastrup PF, Thompson W, Søndergaard J, Jarbøl DE. Side Effects of Long-Term Proton Pump Inhibitor Use: A Review. Basic Clin Pharmacol Toxicol. 2018 Aug;123(2):114-121.

Jaynes M, Kumar AB. The risks of long-term use of proton pump inhibitors: a critical review. Ther Adv Drug Saf. 2018;10:2042098618809927.

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