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Can low stomach acid cause osteoporosis?

osteoporosis x-ray

Did you know that every three seconds someone around the world experiences a fracture due to osteoporosis?1 While eating a healthy, balanced diet – with plenty of calcium and magnesium – is key to protecting yourself against the condition, how you digest those nutrients could be just as important.

In this article, we explore the link between low levels of stomach acid and osteoporosis. Are the two connected? Or is it just a theory? Here we’ll dive into the details using scientific studies, below.

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How digestion can influence osteoporosis

Hydrochloric acid – or stomach acid – helps break down or ‘dissolve’ nutrients in the gut, which makes it easier for our body to absorb them.2 But if we’re not producing enough stomach acid, those nutrients may never make it out of the gut and into our bones – this can lead to osteoporosis symptoms such as weak, brittle bones.

According to one expert, 90% of those with osteoporosis have low stomach acid.3 Research has now confirmed this theory. A 2010 study published in the Scandinavian Journal of Gastroenterology concluded that ‘malabsorption of dietary calcium is a cause of osteoporosis’.4 While in 2011, Spanish researchers found that proton pump inhibitors (PPIs), which reduce stomach acid, could increase the risk of developing the condition.5

In addition, a more recent study from 2018 also concluded that the use of PPIs is strongly associated with an increased risk of hip fracture development – especially in those who already have an elevated risk of this.6

What causes low stomach acid?

Scientists are discovering that there is in fact a link between low stomach acid levels and bone health, but why do people have low stomach acid in the first place? Well, there are a number of reasons we can start to produce less stomach acid, including:7

  • Stress 
  • Ageing 
  • Zinc and B vitamin deficiencies 
  • Gastritis and bacterial infections – especially H. pylori 
  • An underactive thyroid 
  • Medication, particularly PPIs.

Symptoms of low stomach acid

If you have low stomach acid levels, you may start to notice the following symptoms:8

  • Heartburn (acid reflux) 
  • Bloating and gassiness after meals 
  • Brittle nails 
  • Thinning hair

Having said this, these symptoms can be related to other health conditions too. So, it’s best to get the advice from a medical professional if you’re experiencing any of the signs above.

How to increase stomach acid

So, what can you do to try and increase your stomach acid? Among other things, taking a digestive enzyme that contains betaine hydrochloric acid (betaine HCI) may help to improve digestion and nutrient absorption by temporarily making your stomach more acidic.9

A study published in the journal Molecular Pharmaceutics in 2013 found that when six volunteers were given 1500mg of betaine HCI, this lowered their gastric pH – which then increases stomach acid production – for over an hour.10 Supplements often combine betaine HCl with digestive enzymes to help boost nutrient absorption.

Taking a calcium supplement could also help counter the effects of low stomach acid. An early study by Creighton University School of Medicine in 1985 discovered that 11 people with achlorhydria (no stomach acid) were able to absorb calcium normally when they took a calcium carbonate supplement with breakfast.11

Support your bone health

While genetics determine the potential size and strength of your skeleton, there are some things you can do to work towards having strong bones. Listing the most obvious first, having a healthy diet is one of the best things you can do to keep your bones in check.12 Eating calcium rich food for bones like milk, eggs, green vegetables, soya products and nuts is recommended so that you reach the required daily intake of 700mg.13

Want to know how to increase bone density? The NHS states that weight-bearing exercise and resistance-exercise are particularly effective for both improving bone density and preventing osteoporosis.14

If you’re interested in learning more about how you can look after your bones, we’ve got a whole article with 12 ways to support your bone health to help give you some ideas.

The final say

There does seem to be a link between bone health and stomach acid levels. However, there are things you can do to support both of these areas, like exercising regularly and eating the right food for strong bones and muscles.

Disclaimer

Advice is for information only and should not replace medical care. Please consult a doctor or healthcare professional before trying any remedies.

 

Sources

  1. International Osteoporosis Foundation. Facts and statistics. Available from: https://www.iofbonehealth.org/facts-statistics 
  2. https://www.ncbi.nlm.nih.gov/books/NBK279304/ 
  3. UHN staff. The Unusual Link Between Low Stomach Acid and Osteoporosis. Available from: https://universityhealthnews.com/daily/bones-joints/osteoporosis-could-low-stomach-acid-be-the-cause-of-your-bone-health-problems/ 
  4. Sipponen P, Härkönen M. Hypochlorhydric stomach: a risk condition for calcium malabsorption and osteoporosis? Available from: https://www.ncbi.nlm.nih.gov/pubmed/19958055 
  5. Martí-Cabrera M, Martí-Masanet M, Esplugues JV. Chronic use of proton pump inhibitors: is the risk of osteoporosis and fractures real? Available from: https://www.ncbi.nlm.nih.gov/pubmed/21419526
  6. https://link.springer.com/article/10.1007/s00198-018-4788-y
  7. https://www.sciencedirect.com/topics/medicine-and-dentistry/gastric-hypoacidity 
  8. https://my.clevelandclinic.org/health/diseases/23392-hypochlorhydria
  9. https://pubchem.ncbi.nlm.nih.gov/compound/Betaine-hydrochloride 
  10. Yago MR, et al. Gastric Re-acidification with Betaine HCl in Healthy Volunteers with Rabeprazole-Induced Hypochlorhydria. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23980906 
  11. Recker RR. Calcium absorption and achlorhydria. Available from: https://www.ncbi.nlm.nih.gov/pubmed/4000241 
  12. https://theros.org.uk/information-and-support/bone-health/ 
  13. https://www.nhs.uk/live-well/bone-health/food-for-strong-bones/ 
  14. https://www.nhs.uk/conditions/osteoporosis/prevention/
 

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