September 6


4 Greatest Reasons You Actually Need More Stomach Acid

By Sunny Brigham, MS, CNS, LDN

September 6, 2021

minutes read time


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…

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
  • Fatigue
  • 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…

  • Fatigue
  • Paleness 
  • Dizziness
  • 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.

  • I suffer with acid reflux and gastritis and was given ppi’s for years. They quit working and drs couldn’t give me a good reason to be on them when I asked for help to get off of them. They just wanted me to up the dose to double. I had scope and my stomach was a little red so I wanted off them as they weren’t helping much anyways. I was upset and dr told me I needed Ativan to calm down. So I weaned myself of Oemprazole. I still take over the counter relief as I can’t get off it completely. I can’t figure out my triggers.

    • Good for you! I love when people take charge of their health! Remember…triggers can be both food and stress. How are you doing with managing stress? What about sleep? Are you overexercising? How about food…have you done a food/mood log to help ID your trigger foods?

  • My doctor has me on pepcid at lunch time and omeprazole at dinner time. I was on pepcid 2x a day,but doctor just change it in August. He said I have GERD, which was also causing my asthma to flare? I am not sure where the reflux is coming from. I know that I have been deficient in B12 back in Feb. Took B12 for about a month and a half. B12 was retested and it was back in normal range so I stopped B12 Supplements.

    • I’m sorry to hear this Addie. Stress and food are the biggest triggers. What are you doing for these? Reflux can cause asthma to flare so you definitely want to get that under control. I’d be curious to know what your “normal” B12 levels are because normal for the lab isn’t normal for Hashimoto’s.

      • Normal range of B12 was 619. Is that a good range for hashi? Just recently asked my pcp to recheck B12 because of the way I have been feeling and she refused because of that 619 range…she obviously doesn’t understand hashi!

        • That depends on what the reference range is. If it’s up to 800, then it may be good. But if it’s 1200, then not likely. Testing MMA or homocysteine are better options for getting an accurate read on your B12. A serum B12 just shows what’s in your blood but not what’s actually getting into your cells to be used. Most with Hashimoto’s are on B12 long-term due to other factors as well.

    • That’s a tough question to answer because it’s going to be different for everyone. Ideally, you want to work to reduce your triggers…food triggers and stress management. That will help with most of it before the repairing process needs to start.

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