This blog post is all about stomach acid, more specifically when we don’t have enough, which is called hypochlorhydria (hypo=low, chlorhydria= hydrochloride, or stomach acid). Many people suffer from either too much or not enough stomach acid, which causes some undesirable side effects and symptoms. This blog answers the question, “What the heck is hypochlorhydria?” and will also tell you how to pinpoint it and combat it.
Introduction to stomach acid
It is well known that too much stomach acid or stomach acid where it doesn’t belong (in the esophagus) causes heartburn, acid reflux and/or GERD. However, the effects of too little stomach acid on the body is less well known.
The stomach likes to keep the amount of acid, called hydrochloric acid or HCL, at just the right amount. This, keeps the pH in balance, digests proteins properly, and keeps nasty bugs at bay. Sometimes the stomach is unable to produce enough stomach acid, and this throws that balance out of whack. Let’s explore why…
What are the causes of hypochlorhydria?
Having low stomach acid can be caused by a number of factors including:
- Stress –
- Having chronically high levels of stress can wreak havoc on the body. More stress causes more digestive dysfunction.
- 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. That means that the stomach’s cells, called the parietal cells, naturally produce less stomach acid.
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, necessary for vitamin B12 absorption.
- This leads 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 will likely need to receive B12 shots to combat the deficiency.
- Chronic use of antacids and Proton Pump Inhibitors (PPIs) –
- The long-term use of antacids for acid reflux are common. They act on the cells of the stomach to reduce or neutralize stomach acid,reducing symptoms of heartburn.
- Because the symptoms of too much and too little stomach acid can be similar, many people take antacids when they might already have low stomach acid, furthering the vicious cycle.
Note: Even for those that have an “overproduction” of stomach acid, using an antacid long term may be misguided. It’s more likely there is an issue with stomach acid in the wrong place (in the esophagus due to the relaxation of the LES), rather than an overproduction in the stomach.
What are the signs of hypochlorhydria?
The signs of too much stomach acid and those of too little are strikingly similar. Things like GERD, acid reflux or heartburn are classic signs of stomach acid in excess or in the esophagus, but they are also signs of having too little stomach acid. Low stomach acid increases intra-abdominal pressure (the pressure in your stomach), which can cause the stomach acid that is present to get through to the esophagus, causing heartburn.
Additionally, look for these telltale signs of low stomach acid:
- Food borne illnesses
- Low 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
Is there a way to test for low stomach acid?
There are certain tests to determine the pH of your stomach acid and whether you are producing adequate stomach acid.
Heidelberg Capsule test or SmartPill test
- Administered by your doctor, this test works by swallowing a small capsule that contains a tiny radio,transmitting the pH of your stomach to an electronic graph.
- Pros: This test is the gold standard for determining whether you have low stomach acid. It is also unbiased and the most accurate way to diagnose the condition.
- Cons: May be pricey and not covered by your insurance.
Baking Soda Home Test
- This test is performed in the comfort of your home. Under normal circumstances your stomach produces adequate amounts of hydrochloric acid. So, when you ingest baking soda (sodium bicarbonate), it combines with your stomach acid to produce carbon dioxide, causing you to burp.
- How to perform this test:
- Ingest ¼ tsp. 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 a good bet you aren’t producing enough stomach acid.
- Pros: Cost effective and very low risk.
- Cons: May not be accurate. It’s best to perform this test for a few days in a row and compare results for the best result.
- Click here to read more about the Baking Soda test
Betaine HCL Challenge
- Another simple test is the Betaine HCL supplement challenge (under the guidance of a professional)
- Take one capsule of betaine with pepsin (approx. 600 mg) with a protein containing meal. If you have adequate stomach acid, this will cause a warming sensation in the stomach, acid reflux or a feeling of heartburn.
- If you don’t experience those symptoms, or if you have to take more than one capsule to trigger them, it’s likely you have inadequate levels of stomach acid
- Pros: Cost effective and low risk
- Cons: May cause temporary discomfort and is not appropriate for someone with ulcers, gastritis, or esophagitis
Why is low stomach acid a problem?
Chronically low stomach acid could be problematic for many reasons. Stomach acid is protective from bacterial infections and needed for proper digestion, so problems can arise like:
- Higher risk for SIBO (small intestinal bacterial overgrowth), which is linked to chronic conditions like IBS and IBD.
- Bacterial or fungal infections like H. pylori (which can cause stomach ulcers) or Candida
- Poor protein digestion since HCl stimulates pepsin release, which is an enzyme that breaks down protein.
- Malabsorption of vitamins (folic acid and B12) and minerals (iron, zinc and calcium).
- Higher risk for foodborne illness and food poisoning
5 tips to improve hypochlorhydria:
Hypochlorhydria is not a permanent condition in most cases, with improvement via lifestyle and supplement modifications. Here are my top 5 tips to help improve low stomach acid:
- Yoga, deep breathing, meditation, spending time with friends and family, and being in nature can all help combat the stress of modern life and improve digestion.
Apple cider vinegar (ACV) –
- ACV is anecdotally reported to help stimulate stomach acid production. I recommend trying this before trialing a HCl supplement, as it is inexpensive and easy to do. Try 1 teaspoon of ACV mixed in an ounce or two of water before meals. If this doesn’t seem to provide relief, you can work up to doing 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 contain gentian and other components that promote the secretion of HCl in the stomach. Try taking 1-2 teaspoons before meals in water, juice or tea.
- Betaine HCl is supplemental stomach acid in capsule or 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 enzymes like pepsin (needed for protein breakdown) before meals. I recommend taking 1 cap before small meals and 2 caps before larger ones.
Bromelain and Papain –
- These are plant based protein splitting enzymes naturally found in pineapples and papayas. If you enjoy these, you can simply include them more often in your diet. Or, you can try a supplement. Try: NOW Plant Enzymes
Let’s Wrap It Up…
Symptoms of having too much stomach acid are similar to stomach acid in the wrong place, or too little stomach acid.
It’s important to rule out other causes of acid reflux and GERD (check out this post to learn more about them), and talk to your healthcare provider or doctor about testing for low stomach acid. It is important to find out if it’s necessary for you to use an antacid or PPI long term if you do not actually suffer from excess acid.
Small lifestyle changes with some key supplements make a difference in this condition. Get in touch with Erin today for your own personalized plan for combatting low stomach acid!
GUEST ARTICLE CONTRIBUTED BY: ELIZABETH HERBERT, MS CANDIDATE AT THE MARYLAND UNIVERSITY OF INTEGRATIVE HEALTH
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