This blog post is all about stomach acid, more specifically when we don’t have enough of it, a condition called hypochlorhydria (hypo=low, chlorhydria= hydrochloride, or stomach acid).
This blog answers the question, “What the heck is hypochlorhydria?” and will also tell you how to identify and manage it.
Stomach Acid 101
Stomach acid, also called hydrochloric acid (HCl) is released from stomach cells to help breakdown our food.
The acid is meant to stay in the stomach and not escape upwards into the esophagus and/or throat. A muscle called the esophageal sphincter acts like a door that typically protects stomach contents from leaving.
Stomach acid is responsible for keeping the stomach at a low pH level (aka acidic), which is required to digest proteins properly, absorb certain nutrients, and keeps nasty bugs at bay.
Sometimes the stomach is unable to produce enough stomach acid, and this throws the initial stages of digestion out of whack.
What are the signs of hypochlorhydria?
Signs of hypochlorhydria may sound similar to those diagnosed with GERD or heartburn.
That’s because low stomach acid can increase the pressure in your stomach. This can cause the stomach acid that is present to rise through to the esophagus, causing heartburn. Ouch.
Additionally, these are some key signs of low stomach acid levels:
- Poor appetite in the morning
- Feeling of excess fullness after meals
- Bloating, belching and gas
- Chronic yeast or candida infections
- Weak or cracked fingernails
- Nausea after taking supplements
- Undigested food in the stool
- Multiple food allergies
What causes hypochlorhydria?
Low stomach acid may be due to numerous factors including:
- Stress –
- Having chronically high levels of stress can wreak havoc on the body. More stress causes more digestive issues.
- In periods of stress, the parasympathetic nervous system, known as the “rest and digest” system, does not work properly. That means less stomach acid is produced in the face of a stressful situation.
- Aging –
- As we age, our cells age, too. Parietal cells, or cells in the stomach that produce acid, decline over time.
- Autoimmune Metaplastic Atrophic Gastritis (AMAG) –
- This autoimmune condition attacks the parietal cells of the stomach, suppressing them from making stomach acid and a protein called intrinsic factor. Intrinsic factor is required for vitamin B12 absorptions
- Eventually, this can lead to hypochlorhydria as well as a condition called pernicious anemia (severe B12 deficiency caused by a lack of intrinsic factor).
- AMAG is an inherited disorder, and is diagnosed through endoscopic biopsy. Additionally, those with AMAG likely need B12 shots to correct the deficiency.
- Helicobacter pylori (H. pylori) infection-
- Those with H. pylori infections in the stomach sometimes experience hypochlorhydria. The bacteria are able to reduce stomach acid production as a way to help it survive in the harsh stomach environment.
- It’s important to get properly diagnosed and treated for H. pylori. Hypochlorhydria typically resolves thereafter.
- Chronic use of Proton Pump Inhibitors (PPIs) –
- The long-term use of acid-blocking drugs for acid reflux are common. They act on the cells of the stomach to reduce stomach acid production, essentially resulting in drug-induced hypochlorhydria.
Is there a way to test for low stomach acid?
There are certain tests to check for hypochlorhydria including:
Direct Acid Aspiration
- While this may be considered the gold standard, this test is quite invasive and uncomfortable. A tube goes down your throat and into the stomach to collect contents and measure the pH level directly.
Heidelberg Capsule test
- This test works by swallowing a small capsule that contains a tiny radio, transmitting the pH of your stomach to an electronic graph. While pH levels are easily assessed, the amount of stomach acid is not measured.
- This is also a high-tech pill (a bit larger than the Heidelberg capsule) that is able to wirelessly measure the amount of stomach acid you produce, pH, as well as motility throughout the digestive tract.
Baking Soda- At-Home Test
- Perform this test at home with some baking soda (sodium bicarbonate). While this is not a validated test, it’s fairly low risk, low cost and easy to perform.
- When baking soda combines with stomach acid, you get produce carbon dioxide (CO2), causing you to burp.
- How to perform this test:
- Ingest ¼ teaspoon of baking soda in 4 oz. of cold water first thing in the morning, before eating or drinking anything.
- Time how long it takes for you to burp. If it takes longer than 3 minutes, it’s likely you aren’t producing enough stomach acid.
Betaine HCl Challenge
- Another simple, at-home test is the Betaine HCl Challenge. This is essentially a supplement that has stomach acid, betaine (a byproduct from beets), and pepsin (a protein-digesting enzyme).
- Start with one capsule (~600mg) with a normal-size meal. Notice if you feel a warming sensation in the stomach, acid reflux or heartburn.
- Continue to increase the dose (up to 7 capsules) until you feel those sensations, indicating the dose was a bit too much. Then, drop back by one capsule and use that amount to achieve “normal” stomach acid levels. This challenge may help you deduce hypochlorhydria is present.
- This therapy is NOT appropriate for someone with ulcers, gastritis, or esophagitis.
Why is hypochlorhydria a problem?
Chronically low stomach acid is problematic for several reasons.
Stomach acid is protective from bacterial infections and necessary for proper digestion.
Without enough of it, problems can arise like:
- Higher risk for SIBO (small intestinal bacterial overgrowth), which is linked to chronic conditions like IBS.
- Bacterial or fungal infections like H. pylori (which can cause stomach ulcers) or Candida
- Poor protein digestion since HCl stimulates pepsin release, an enzyme that digests protein
- Higher risk for foodborne illness and food poisoning
Achlorhydria (no stomach acid) can result over time from untreated atrophic gastritis. This can eventually lead to B12 deficiency (pernicious anemia) and increased risk of stomach cancer. Stomach cancer is very aggressive and has a poor survival rate.
Five tips to improve hypochlorhydria
Hypochlorhydria is not necessarily a permanent condition. Identifying and treating the root cause and then making changes to your lifestyle and using some supplements can help improve it.
Here are my top 5 tips to improve hypochlorhydria:
- Try out some of my favorite stress-busters: yoga, deep breathing, meditation, spending time with friends and family, being in nature, playing with your pet.
- It is well established that lower stress levels directly improve digestion.
Apple cider vinegar (ACV) –
- ACV is anecdotally reported to help stimulate stomach acid production.
- It is inexpensive and easy to do. Try 1 teaspoon of ACV mixed in 8-ounces of water before meals. If this doesn’t seem to provide relief, you can work up to 1 tablespoon of ACV.
- **A note of caution: Don’t take shots of AVC as the vinegar is harmful to your tooth enamel.
Swedish Bitters –
- Bitter herbs like Swedish Bitters contain gentian and other compounds that promote the release of HCl.
- Try taking 1-2 teaspoons before meals in 8-ounces of water.
- Try: Nature Works Swedish Bitters
- Betaine HCl is supplemental stomach acid in tablet form. It’s important to make sure you consult with a healthcare professional before taking this since it can cause gastritis (painful inflammation of the stomach lining) in certain individuals.
- If you’ve determined that you have low stomach acid through testing, you may benefit from Betaine HCl and other digestive aids like pepsin (needed for protein breakdown) before meals.
- Start with 1 tablet before small meals and then slowly increase the dose as tolerated.
Bromelain and Papain –
- These are plant-based enzymes naturally found in pineapples and papayas that help to breakdown proteins.
- Try: NOW Plant Enzymes
Symptoms of hypochlorhydria are similar to that of GERD and include bloating, upset stomach, acid reflux, and heartburn.
Talk to your healthcare provider about testing options for low stomach acid before treating. It is important to find out why you may have hypochlorhydria so that a proper treatment protocol can be designed.
Small lifestyle changes to reduce stress levels and some key supplements can make a difference in this condition.
Get in touch with Erin today for your own personalized plan for managing hypochlorhydria.
GUEST ARTICLE CONTRIBUTED BY: ELIZABETH HERBERT, MS CANDIDATE AT THE MARYLAND UNIVERSITY OF INTEGRATIVE HEALTH
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