H. Pylori Can Alter Stomach Acid

Q:  For an upset stomach, I have found that taking acid, not an antacid, is helpful now that I'm in my older years (I am 85). To quote an early issue of Prevention magazine, "Research has shown that we produce less and less hydrochloric acid as we age. One of the biggest downsides of this is that protein requires a lot of hydrochloric acid to be broken down, and if protein isn't broken down completely, you will have burping and gas after eating; bloating, and heartburn."

Additionally, I read that an important cause of calcium deficiency is inadequate absorption of calcium and that calcium needs acid to be absorbed.

Since older people have less stomach acid, isn't it counterproductive to take calcium-containing antacids as a calcium supplement? I take 1 teaspoon of cider vinegar after meals, and I have had great success. Why isn't this approach promoted?

A:  Dr. Benson Massey, from the Medical College of Wisconsin Department of Gastroenterology and Hepatology, concurs that many older people produce less stomach acid, but he does not think this is simply due to aging.

He explained to me that the population group that was born about 85 years ago (your peers) was nearly entirely infected with Helicobacter pylori. H. pylori is the bacteria that sometimes produces stomach ulcers, but its importance wasn't known until the 1990s. After long-standing infection with H. pylori, the stomach lining's ability to produce acid wanes.

Younger Americans are less likely to have been exposed to H. pylori and, even if infected, would have had the infection for fewer years. So, although older people generally produce less acid than younger people, older people without H. pylori infection may actually secrete more stomach acid than younger people.

But we probably don't need as much stomach acid as what's produced in a healthy person. Protein digestion does indeed start with stomach acid, but people on acid suppression therapy or after stomach surgery are still able to digest protein.

However, calcium absorption does depend on stomach acidity, and some experts recommend calcium supplements in the form of calcium citrate, instead of calcium carbonate (e.g., Tums), which is an acid buffer. But most people do well with the much cheaper calcium carbonate, particularly if you take it with meals, when the stomach is naturally producing more acid.

Dr. Massey suspects that a single teaspoon of cider vinegar would be considerably buffered by the already digested food and probably not have much effect. He has a better suggestion: salad with vinaigrette!

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices internal medicine at the Froedtert & Medical College General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.