Hashimoto’s comes with a whole host of not-so-fun side effects. Fatigue is one of the most common symptoms that I hear about most. But fatigue is a complex issue. There are a ton of reasons that someone with Hashimoto’s will experience fatigue. But the one we’re going to discuss in this blog is nutrient absorption.
Nutrient absorption, or lack thereof, can make or break someone’s health but also how they feel. We need nutrients to run our bodies. It’s how we create energy, build new cells, and keep our muscles pumping. Nutrients are important!
After reading this blog, you’ll understand why using acid suppressors creates more symptoms of Hashimoto’s by preventing nutrient absorption from happening.
Purpose of Stomach Acid
We're going to get into a little bit of anatomy here. Bear with me because this will all make sense in a moment.
Hydrochloric acid, also called stomach acid or gastric acid, is found in the stomach pouch. It’s released by cells in the stomach lining called parietal cells. These cells are important because we actually need stomach acid.
Stomach acid has several purposes to include…
- Acting as your first line of defense against critters on your food
- Activating intrinsic factor so you can absorb vitamin B12
- Breaks down proteins from long strands into individual amino acids
- Vital for absorption of minerals like iron and calcium
When you have low stomach acid, you’re going to have poor nutrient absorption. You’ll develop things like…
- chronic anemia, or low iron
- symptoms of reflux
- fatigue from low B12 absorption
- calcium depletion from the bones
Often people think that reflux is a sign of too much stomach acid. In reality, it’s just displaced stomach acid. I talked a lot about signs of reflux here and how it’s mistaken for high acid. When people believe they have too much acid, they’ll take an acid suppressing medication.
In taking these types of medications, you’re turning off your body’s ability to absorb the very nutrients your body needs for energy, healthy bones, and a good functioning thyroid. I’m not saying there isn’t a need for these medications. I believe there’s a time and place for everything.
But they should be used while fixing the foundation. Not long-term.
B12 and Hashimoto’s
It’s pretty common to be low in B12 when you have Hashimoto’s. This is for a few reasons.
First, with Hashimoto’s it’s common to also have something called parietal cell antibodies. This means your body is attacking those parietal cells that release stomach acid. Without stomach acid, you’re not going to absorb B12 on your own well.
Secondly, if you’re taking acid suppressing medications to help control reflux, you’re also stopping B12 absorption in your body. Remember, you need stomach acid to absorb B12 on your own. If you’re stopping the release of stomach acid or suppressing it, you’re not going to absorb B12.
Pernicious anemia is also prevalent amongst those with Hashimoto’s. Pernicious anemia is an autoimmune condition as well. This one is slightly different in that it has antibodies against intrinsic factor. Intrinsic factor is what’s needed to absorb B12. Its activated by stomach acid.
No stomach acid = no activation of intrinsic factor = poor or no B12 absorption.
The last common thing that can affect B12 absorption in Hashimoto’s is digestive inflammation. This is very common amongst a lot of people, not just those with Hashimoto’s. Digestive inflammation, aka leaky gut, is going to prevent absorption of a lot of nutrients, not just B12. Getting your gut under control will also help increase your B12 absorption.
Why is this important?
Vitamin B12 is a vital nutrient for…
- Proper function of your nervous system
- Energy production (hellooooo fatigue!)
- Creation of new blood cells - important for combating anemia
- Building new DNA in your body
It’s not the most vital nutrient, but it is a very important one. It’s also a common deficiency as well.
Common signs of deficiency include…
- Tingles in your hands and feet
- Troubles swallowing
- Problems recovering from anemia
- Difficulty finding words at times
There are others but these are the most common.
As an aside, you can have “normal” B12 labs and still be low in B12. This is because a serum B12 test looks at the B12 in your blood but not what’s actually getting inside the cells and being used.
Iron and Hashimoto’s
This is another vital nutrient for your body but also a common deficiency in Hashimoto’s. Fun fact - iron is required in large amounts for proper T4 to T3 conversion in your liver. So, being low in iron is going to cause your thyroid to not function as well as it could.
Iron is vital for…
- Converting T4 to T3 in the liver
- Creating new red blood cells to carry oxygen around your body
Stomach acid is vital to absorption of iron in the body. Stomach acid is pretty acidic...hence the name. The acidic environment is needed to absorb a lot of minerals, iron included. When we’re suppressing that stomach acid, the intestines aren’t acidic enough to allow absorption.
There are many symptoms of low iron, but the most common that those with Hashimoto’s will experience are…
- Shortness of breath
- Restless legs
- Hair loss or brittle hair
If you’re suppressing your stomach acid, you’re likely struggling with low iron or feelings of low iron.
This would be the same if you have parietal cell antibodies. Without the parietal cells, there is no stomach acid. And without stomach acid, iron absorption is going to be very low.
Managing Stomach Acid
I know I talked a little about other things that can cause low stomach acid aside from medications, but we’re really focusing on medications here. Why? Because they’re widely prescribed and used.
My husband was prescribed one for his gastritis but was never told of the downsides of taking them. I assume many others were likely not told of the side effects either. I see many clients that are on acid blockers, so we work to ditch them.
If you’ve been prescribed an acid blocker (Prilosec/ Omeprazole is the most common), you DO NOT want to stop taking this old turkey or without the consent of your physician. Certain classes of acid blockers called proton pump inhibitors (PPIs) need to be stepped down slowly so you don’t have rebound reflux.
Think of your body as a house. If your foundation is cracked, the walls are going to be cracked as well. You can repair those cracks but they’ll continue to come back. But if you fix that foundation and the cracks, the house is solid again.
In this analogy, the walls are the acid blocker and the foundation is the reason you have reflux.
The goal of being on an acid blocker should be to control your symptoms while you discover the source of your reflux. As I stated here, the two primary causes that I see most often are food intolerances causing bloating and stress.
Getting to that foundation (food and stress) will help reduce the reflux so that you can maintain a good amount of stomach acid to absorb your nutrients and combat fatigue.
Where do you think your reflux is coming from? In the comments, let me know which nutrient you think you’re struggling to absorb.