Lara Pizzorno is the author of “Your Bones: How You Can Prevent Osteoporosis and Have Strong Bones for Life – Naturally” and a member of the American Medical Writers Association with 29 years of experience specializing in bone health.
Recently we asked Lara if she would help us provide a series of short, ongoing videos to help you (our customers and readers) stay up to date on the latest facts and science related to bone health and overcoming osteoporosis naturally.
In this latest video, Lara talks about low stomach acid and whether or not apple cider vinegar will help with your calcium absorption. Watch the video below (or read the transcript provided) and let us know what you think in the comments. 🙂
Hello, I’m Lara Pizzorno and I’m here to answer some question that were submitted by you after we ran our first series of video clips on bone health.
So this is a question I received from a woman: “I suspect I am a person with low stomach acid because of my family history. To get the most calcium absorption should I take a spoon of apple cider vinegar with my meal before the calcium supplement or do you have some other recommendations?”
Well yes, you do want to ensure that you have enough stomach acid to take your calcium supplement.
But unfortunately cider vinegar, although it has other beneficial effects for you is not an effective means for increasing your stomach acid.
Let me explain why you need stomach acid and why you may not be producing enough stomach acid for your optimal health and then I definitely have some recommendations for you to increase your stomach acid production if you need to.
It’s very important for all of us to be producing some stomach acid when we take calcium. This is the reason it’s best to take your calcium supplement with meals because you should naturally be secreting some hydrochloric acid then. It’s what our bodies are preprogrammed to do in response to consuming food.
Why do we need stomach acid?
Well, calcium is absorbed in the small intestine where normally the PH balance is alkaline and not acidic. But stomach acid is needed not to just absorb the calcium but to liberate it from its delivery partners. Whether it’s the calcium in the foods you eat or in a calcium supplement. The calcium you consume is going to be bound to a partner, it doesn’t just come to you as calcium. It’s going to be bound to something like calcium hydroxide, calcium sulphate, calcium carbonate, the calcium in hydroxyapatite in which it’s bound to phosphorus, calcium citrate, calcium chloride, I can go on and on here. There are a number of natural delivery forms of calcium that are present in calcium rich foods and in supplements including AlgaeCal. AlgaeCal contains 4 different kinds of naturally found types of plant derived calcium. Regardless of which type of calcium you consume, it has to be released from its delivery partner and this is accomplished by stomach acid, and you need it. And our ability to produce stomach acids typically falls off as we age.
In numerous studies 30%to as many as 50% of postmenopausal women have been found to be deficient in stomach acid, it’s quite common. And people with low stomach acid absorb only about 4% of an oral dose of calcium. What might cause you to have little stomach acid? It’s not just aging and there’s plenty you can do about it. Two very common possibilities are infection with a bacterium called helicobacter pylori this is the bacterium that promotes ulcers. Or you can be taking drugs, over the counter or prescribed medication, acid blocking drugs that are taken to relieve symptoms of heartburn or indigestion of gastroesophageal reflux or GERD, like the H2 blockers which is Zantac, Pepcid or proton pump inhibitors such as Nexium or Prilosec.
Let’s talk about H pylori first, at least 25% of population of the western modern world including America is infected with H pylori and those of us who are hispanic or African American heritage are at an especially high risk of H pylori infection. As many as 40% of African American and Hispanic individuals have been found in recent studies to have H pylori. In developing nations, H pylori is even more common it affects up to 80% of the population in these developing countries. And it’s very easily transmitted so it’s quite easy to pick it up if you go travelling there. And H pylori really doesn’t like stomach acid. It avoids it, it abounds coming into contact with it in two ways. First it burrows into the mucous lining of the stomach to get into the epithelial cells underneath the mucous lining of the stomach where the PH is more neutral and it damages the parietal cells which are the stomach cells that secrete hydrochloric acid for us in the process of burrowing into the epithelium so H pylori makes us less able to secrete stomach acid. And then H pylori neutralizes any stomach acid that we do manage to produce by itself producing large amounts of an enzyme called urease which breaks down the urea present in the stomach and it converts it into carbon dioxide and ammonia. Each molecule of ammonia then gets degraded into two molecules of bicarbonate which very effectively neutralizes any stomach acid that’s around.
So H pylori makes it very hard for us to absorb not just our calcium but all the nutrients in the foods we eat. Particularly vitamin B-12 which is an extremely important nutrient for bone health. But that is a complicated subject and we will talk about it in another video!
So if you’re taking any acid suppressing drugs, which are very effective in suppressing or preventing you from secreting or even producing any stomach acid, your likelihood of not having enough stomach acid around to absorb the calcium from your food or supplements is unfortunately quite high.
Another cause of low stomach acid is simply just getting older! By the time both men and women reach age 60, about half of us no longer make enough stomach acid to optimally digest our food and that includes releasing the calcium that we consume through our food and supplements through its delivery partners or the food matrix and then solubilizing it.
On the list of other causes of low stomach acid include stomach allergy, especially to wheat or dairy products, overindulgence in alcohol which may have been a factor for you when watching the Superbowl, pretty distressing I’m a Seahawks fan! And the after effects of some viral illnesses. After a bad flu or whatever your stomach acid is going to go down a bit, just for a while and then it should recover.
Fortunately it’s very easy to do something about this and correct it because it’s very potentially damaging to our bones and overall health for that matter. You need stomach acid to break down your food and absorb the nutrients in your food. Not only your calcium but everything! So what you want to do is provide your stomach with the additional stomach acid that you’re not secreting but that you need. Cider vinegar is great for you for other reasons, but it is unlikely to help you absorb your calcium. It is true that vinegar is acidic, but it is not an effective agent of increasing your production of stomach acid.
What a number of recent scientific investigations have documented is that vinegar ingestion:
- Reduces the glucose response which is the rise in blood sugar that follows the consumption of carbohydrates, both in healthy adults and in individuals with diabetes so it’s quite helpful for us.
- And cider vinegar has also been shown to lower the glycemic index of starchy foods, so it makes them less likely to cause a spike in blood sugar levels.
- There’s also some evidence that vinegar increases the short term feeling of satiety or feeling of fullness so we eat a bit less when vinegar is part of our meal.
All great reasons to include cider vinegar in what you consume. But vinegar does not help you increase stomach acid production nor is it going to help you digest your food. For that you need stomach acid.
And the best way to do that is to supplement. You can get a supplement of hydrochloric acid with betaine. And this will be much more effective for you.
Hydrochloric acid with betaine is very inexpensive it can be found at any health food store or online and this is how take it:
- You begin by taking just one tablet or capsule containing 600 mg of hydrochloric acid at your next meal.
- If this does not aggravate your symptoms then at every subsequent meal of the same size as the first one, you take one more tablet or capsule. One at the next meal, two at the next meal after that and 3 at the next meal and so on. *When you take several tablets or capsules, don’t take them all at once, space them out throughout your meal. Just as your body would normally be producing the hydrochloric acid for you throughout your meal you want to space out your supplemental hydrochloric acid.
- You can continue to increase the dose until you reach 7 tablets or you experience a feeling of warmth in your stomach, whichever occurs first. A warm feeling in your stomach means you’ve taken too many tablets for that meal and you need to take one less tablet for a meal that size. It’s a good idea however to try the larger dose again at another meal just to make sure that the hydrochloric acid was what caused the warmth and not something else. After you’ve found the largest dose you can take at your large meals without feeling any stomach warmth, then you want to maintain a dose of the similar size and you’ll need to take less at smaller meals.
As your stomach’s parietal cells heal, these are your cells in the lining of our stomachs that secrete hydrochloric acid for us and they will begin to regain the ability to produce hydrochloric acid you need to properly digest your food, you will probably notice that warm feeling again and you can cut down on how much hydrochloric acid you’re taking with a meal. Eventually you may find that you may not need any supplemental hydrochloric acid but it may continue to be helpful for you especially with a larger meal. Since I mentioned our ability to secrete hydrochloric acid does decrease a bit as we age.
I hope this has been helpful information for you and I hope you will tune in next time, thanks!
Allen LH. Calcium bioavailability and absorption: a review. Am J Clin Nutr. 1982 Apr;35(4):783-808.PMID: 7041607
Sipponen P, Härkönen M. Hypochlorhydric stomach: a risk condition for calcium malabsorption and osteoporosis? Scand J Gastroenterol. 2010;45(2):133-8. doi: 10.3109/00365520903434117. PMID: 19958055
Saltzman JR, Russell RM. The aging gut. Nutritional issues. Gastroenterol Clin North Am. 1998 Jun;27(2):309-24. PMID: 9650019
Pounder RE, Ng D. The prevalence of Helicobacter pylori infection in different countries. Aliment Pharmacol Ther. 1995;9 Suppl 2:33-9. PMID: 8547526.
Malaty HM. Epidemiology of Helicobacter pylori infection. Best Pract Res Clin Gastroenterol. 2007;21(2):205-14. PMID: 17382273
Johnston CS, Gaas CA. Vinegar: medicinal uses and antiglycemic effect. MedGenMed. 2006 May 30;8(2):61. PMID: 16926800
Christiansen PM. The incidence of achlorhydria and hypochlorhydria in healthy subjects and patients with gastrointestinal diseases. Scand J Gastroenterol. 1968;3(5):497-508. PMID: 5706664
Russell RM. Gastric hypochlorhydria and achlorhydria in older adults.JAMA. 1997 Nov 26;278(20):1659-60. PMID: 9388081
Radebold, Klaus. “Achlorhydria.” eMedicine. Eds. David Greenwald, et al. 11 Jul. 2002. Medscape. 20 Dec. 2004 <http://emedicine.com/med/topic18.htm>.
Corley DA, Kubo A, Zhao W, et al. Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients. Gastroenterology. 2010 Jul;139(1):93-101. doi: 10.1053/j.gastro.2010.03.055. Epub 2010 Mar 27. PMID: 20353792
Eom CS, Park SM, Myung SK, et al. Use of acid-suppressive drugs and risk of fracture: a meta-analysis of observational studies. Ann Fam Med. 2011 May-Jun;9(3):257-67. doi: 10.1370/afm.1243. PMID: 21555754
Kwok CS, Yeong JK, Loke YK. Meta-analysis: risk of fractures with acid-suppressing medication Bone. 2011 Apr 1;48(4):768-76. doi: 10.1016/j.bone.2010.12.015. Epub 2010 Dec 23. PMID: 21185417
Vestergaard P, Rejnmark L, Mosekilde L. Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. Calcif Tissue Int. 2006 Aug;79(2):76-83. Epub 2006 Aug 15. PMID: 16927047
Kann PH, Hadji P, Bergmann RS. [Pharmacogenic osteoporosis beyond cortisone : Proton pump inhibitors, glitazones and diuretics.][Article in German] Z Rheumatol. 2014 Apr 13. [Epub ahead of print] PMID: 24728601