Old man having a stomach pain – picture courtesy of kozzi.com

If you are among the millions of adults who suffer from uncomfortable stomach and digestive problems, such as gas, bloating, heartburn, indigestion, or hair loss, your symptoms could be caused by one of the most misunderstood and misdiagnosed medical conditions among adults, Hypochlorhydria.

Table of content:

• What Is Hypochlorhydria?
• The Scope of the Problem
• The Role of Hydrochloric Acid in the Stomach
• Common Symptoms of Hypochlorhydria
• Health Conditions Associated With Low Stomach Acid
  • Helicobacter Pylori Infections
  • Long-Term Health Effects of Low Stomach Acid
• How Diet Impacts Hypochlorhydria
• Why Is Hypochlorhydria Often Overlooked By Mainstream Medical Practitioners?
• The Dangers of Misdiagnosis
  • Antacids Make The Problem Worse
• How To Test For Hypochlorhydria At Home
  • Testing With Baking Soda is Not Reliable
  • The “Lemon Test”
  • Testing For Hypochlorhydria Using Betaine Hydrochloride (Betaine HCL)
  • Clinical Testing of Stomach Acid Levels
• How To Treat Hypochlorhydria With BH
• Supporting BH Therapy With Dietary Changes and Supplements
• For More Information

What Is Hypochlorhydria?

Hypochlorhydria, also referred to as low stomach acidity (low levels of naturally-occurring hydrochloric acid, a substance that is secreted by the lining of the stomach), is a serious medical condition that is often undiagnosed or is misdiagnosed as Hyperchlorhydria (excessive stomach acid). Mainstream medical practitioners are often unaware of the prevalence of this issue and are ill-equipped to recognize the signs and symptoms of this common digestive disorder, making it vital for consumers to educate themselves about the signs and symptoms of low stomach acidity, as well as the various home-based tests and natural treatment options that are available for people with Hypochlorhydria.

The Scope of the Problem

Because this condition is often undiagnosed or the symptoms are assumed to be caused by a different issue, the actual number of people who are affected by Hypochlorhydia is unknown. Many reports on the prevalence of low stomach acid estimate that about 30 percent of adults under the age of 40 are suffering from this condition, with that number rising to over 75 percent among adults aged 70 and over. Dr. Dorothy Hall, an Australian Naturopathic Doctor, estimated that the likelihood of having Hypochlorhydria roughly matches one’s chronological age; 50 year olds have a 50 percent chance of having the condition, 60 percent of 60 year olds and so on. In the most severe cases of Hypochlorhydria (most common among people aged 90 and over), the stomach can actually become what is referred to as “achlorhydric”, meaning it produces virtually no acid whatsoever.

The Role of Hydrochloric Acid in the Stomach

The lining of your stomach begins secreting hydrochloric acid as soon as food enters it, boosting the acidity of your stomach (lowering the pH). This acid blends with potassium chloride and sodium chloride to help create the digestive fluid in your stomach, which works to support the healthy function of digestive enzymes that are essential to the processing of foods, particularly proteins. While each element within the digestive fluid plays a role in healthy digestion, hydrochloric acid is the most important of these three compounds – without hydrochloric acid, postassium chloride and sodium chloride have minimal effect on digestion.

While hydrochloric acid is always present in trace amounts in your stomach, the levels of this acid fluctuate throughout the day depending on your food intake.

Healthy levels of hydrochloric acid in the stomach are essential to your overall health and wellness; this naturally-occurring acid works to help protect your body against illness and disease caused by microorganisms and food-borne bacteria, preventing dangerous overgrowth of pathogens that can lead to serious side effects and even death. When there is not enough acid in the stomach, infections and parasites can thrive; this is why senior citizens are at a particularly high risk of succumbing to food-borne illnesses like food poisoning and e-coli.

While acids in your stomach play a vital role in both keeping out harmful toxins and parasites, these same acids also work to help the body process and digest food into tiny pieces so that it can be absorbed and converted into fuel. Because your naturally-occurring digestive enzymes rely on a healthy level of hydrochloric acid in the stomach, if you have low stomach acid levels, your digestive enzymes simply cannot work effectively. This leads to serious digestive issues and malnourishment.

Stomach acids work to help your body absorb essential nutrients such as zinc, calcium, magnesium and iron, along with the vitamins C, B9, B12, A and E. When your body is unable to absorb these vitamins and minerals, a host of illnesses and chronic conditions can develop.

Common Symptoms of Hypochlorhydria

Hypochlorhydria shares many signs and symptoms with high stomach acid levels (a condition known as Hyperchlorhydria), part of the reason why low stomach acid is so frequently misdiagnosed and mistreated by both patients and their medical providers. Here are the most common symptoms of low stomach acid:

• Constipation and/or diarrhea
• Undigested particles of food in bowel movements/stool samples
• A general malaise feeling following meals
• Nausea and a general feeling of abdominal discomfort
• Heartburn and pain that extends from the lower abdomen through to the throat
• Severe stomach bloating following a meal, particularly one that includes animal-based protein such as beef or poultry
• Indigestion, belching, burping and passing gas
• Rectal itching
• Halitosis (bad breath)
• Chronic yeast infections/candida
• Recurrent parasitic infections in the stomach and throughout the GI tract.

There are also a number of physical signs of this condition that are related to malnutrition or poor nutrient absorption and sluggish enzyme production including:

• Thinning hair and hair loss, particularly among women
• Brittle nails on the fingers and toes
• Rosy red cheeks that are caused by dilation of the capillaries below the eyes
• Chronic fatigue leading to depression, weight gain and sleep disturbances
• Acne, eczema and skin rashes.

As people age, their stomach acid levels often decline, leaving them vulnerable to the effects of Hypochlorydria. Unfortunately, many of the signs and symptoms of low stomach acid mimic those which are often associated with normal age-related deterioration; most people simply expect that as we age, we should expect to pass gas more often, feel tired after eating and have difficulty digesting our food. Rectal itching is frequently misdiagnosed as hemorrhoids.

Clinicians who are aware of the prevalence and risk factors for low stomach acid will often conduct both a thorough physical exam and a lengthy interview with their patients to look for the presence of other health conditions that have been associated with Hypochlorhydria.

Health Conditions Associated With Low Stomach Acid

Low stomach acid levels have been positively linked to numerous chronic diseases, such as celiac, gluten intolerance, asthma, diabetes, Addison’s and Lupus, as well as food allergies, osteoporosis, leaky gut, and eczema. This is due to the inability of the body to absorb essential antioxidant vitamins like C, A and E, along with the impaired processing of proteins that results from low stomach acid.

The connection between auto-immune disorders and Hypochlorhydria is linked to the suppressed ability to both absorb minerals (including calcium, magnesium and iron) and vitamins (particularly B12) in combination with deficiencies in naturally-occurring amino acids. These amino acids (often referred to as natural ‘building blocks’) help the body break down proteins that are essential to the formation and maintenance of muscles throughout the body.

Helicobacter Pylori Infections

There have been numerous clinical studies linking low stomach acid levels with an increased susceptibility to Helicobacter Pylori, a bacterial infection that often goes undetected and leads to the development of painful stomach ulcers. In one study by pediatric researchers at the Pontificia Universidada Catolica de Chile School of Medicine, children who suffered from Hypochlorhydria were shown to have significantly elevated rates of Helicobacter Pylori (H.pylori) infections when compared to children with normal stomach acid levels.

In addition to the increased risk of developing stomach ulcers, H.pylori has been proven to cause increased rates of stomach cancer, a highly fatal form of the disease.

Long-Term Health Effects of Low Stomach Acid

In addition to the physical discomfort caused by low stomach acid, chronic Hypochlorhydria can lead to serious health consequences as a result of the negative effect this condition has on the body’s ability to absorb vital nutrients such as minerals and vitamins. The reality is that for people with Hypochlorhydira, it is possible to eat a healthy diet filled with nutritious foods, maintain a healthy body weight and appear to be physically fit, yet still suffer from malnutrition.

Over time, chronic malnutrition can lead to a host of physical and mental problems including chronic fatigue syndrome and severe depression. Associated illnesses include those which are related to the body’s ability to both absorb nutrients and eliminate waste, such as arthritis, colon cancer and muscle wasting.

How Diet Impacts Hypochlorhydria

Because Hypochlorhydria negatively affects a person’s ability to digest proteins, the vast majority of people with this condition have difficulty digesting red meat products such as steak, roast beef and hamburgers. Other protein-rich foods like cheese and fish can also be irritating to those who are suffering from low levels of stomach acid. Unfortunately, avoiding protein-rich foods only masks the problem of Hypochlorhydria; many people fail to make the connection between their intolerance for high-protein foods and a deficiency of stomach acid.

Some people with Hypochlorhydria have also found that their symptoms are minimized by avoiding foods and beverages which can cause spasms in the esophageal sphincter such as caffeine (coffee, tea and colas), peppermint, spearmint, and spicy foods, such as hot peppers and cured meats. Modifying dietary habits to include more high-fiber, plant-based proteins may provide some relief from post-meal symptoms of gas, bloating and constipation.

Why Is Hypochlorhydria Often Overlooked By Mainstream Medical Practitioners?

There are many theories about why so few mainstream medical practitioners accurately diagnose low stomach acid among their patients in spite of how common this disorder is. Unfortunately, medical schools are renowned for providing little in the way of nutritional training for their students, rarely considering the fact that people living in a first-world country could suffer from malnutrition.

Some M.D.’s, including Dr. Johathan Wright, suggest that the massive pharmaceutical industry is partly to blame for the lack of awareness about Hypochlorhydria among both patients and professionals.

Antacids are aggressively marketed through social media campaigns, sports sponsorships and celebrity endorsements for two reasons: symptoms of excessive stomach acid are common among adults (and mirror the symptoms of low stomach acid) and antacid sales represent a major profit line for the drug companies.

According to the World Health Organization, “the global pharmaceuticals market is worth US$300 billion a year” and is expected to grow to “US $400 billion within three years”. Six of the ten top-grossing pharmaceutical companies are based in the United States, where they have average sales of “US$10 billion a year and profit margins of about 30%”.

The demand for both over-the-counter and prescription antacid products has helped fuel the remarkable growth and profit margins for the pharmaceutical companies; a June, 2011 article in the Drug Store News (a publication catering to pharmacy operators) boasts that between April 2010 and April 2011, a number of sales records for antacids were shattered – the sales of just 3 types of OTC antacids totaled over $118 million dollars, while the top-selling OTC antacid earned more than $150 million in sales for pharmaceutical giant Procter & Gamble. Annual sales are also up by nearly 199% for the antacid Tums to $51.7 million in the U.S. alone.

Many industry-watchers, alternative medical practitioners and patients believe that since antacids generate a tremendous amount of money for the pharmaceutical companies, consumers are being misinformed about the prevalence of low stomach acid. Ironically, there are no OTC products currently offered by any of the major pharmaceutical companies which are specifically designed to combat Hypochlorhydria.

The Dangers of Misdiagnosis

According to Dr. Jonathan Wright, MD, the common practice of treating indigestion and stomach problems with antacids is having a widespread, negative effect on the health and wellness of our population, particularly among people who are aged 40 and older.

Dr. Wright explains that when stomach acid levels are insufficient (due to either aging or suppression through the use of OTC and prescription antacids), people run the risk of suffering serious health problems related to malnutrition, irregardless of how healthy their diet is. He asserts that when people suffer from indigestion, heartburn, gas, belching and bloating, it is:

almost always, and I really do mean 99 percent of the time, it is, not enough acid in our tummies.

These low acid levels reduce the body’s ability to process minerals and nutrients from food, leading to symptoms of fatigue which are often misdiagnosed as being part of the natural aging process.

Antacids Make The Problem Worse

Because many of the signs and symptoms of Hypochlorhydria are similar to those which people with Hyperchlorhydria (high stomach acid levels) have, both patients and medical providers frequently treat undiagnosed low stomach acid with antacids. This can be a dangerous practice; not only does it leave the root cause of the symptoms undiagnosed, resulting in the continuation of the malnutrition and uncomfortable side effects of low stomach acid, but the use of antacids actually also serves to further suppress the level of acid in the stomach, making the problem of Hypochlorhydia even worse over time.

It is not uncommon for patients with Hypochlorhydria to spend years looking for a correct diagnosis for their digestive disorders, leaving them vulnerable to both the negative effects of malnutrition and the increased risk of parasitic infections of the stomach and the gut. Unfortunately, the widespread availability of antacids and the misinfomation about the symptoms of high and low stomach acid levels has led to rampant overuse and misuse of both OTC and prescription antacids among adults in America and the rest of the world.

How To Test For Hypochlorhydria At Home

There are a variety of simple at-home tests available that can help patients self-diagnose Hypochlorhydria, as well as advanced diagnostic procedures that are performed by a licensed medical practitioner. Here are the two most commonly-used home tests for low stomach acid:

Testing With Baking Soda is Not Reliable

Some sites recommend to mix baking soda with water and drink this first thing after waking up in the morning. They say that if you have enough stomach acid then you will burp within 5 minutes.

Testing for low stomach acid with this method is not accurate at all.

The theory behind this idea is that the baking soda + the stomach acid will release some carbon dioxide gas, making you burp. But when you wake up, your acid level is at its lowest. The stomach will not start producing acid until after you start swallowing something, and this process will take roughly 15 minutes to complete. Something else to consider is the fact that the amount of acid produced by your stomach will depend on what you eat.

The “Lemon Test”

One of the simplest ways to test for low stomach acid in the comfort of your own home is known as the “lemon test.” When you are suffering from stomach discomfort, simply place a teaspoon of lemon juice in 2-4 ounces of water and drink the mixture. If there is not enough acid in your stomach, the addition of the acid-filled lemon juice mixture will provide you with relief from your symptoms. In people with too much stomach acid, drinking acidic beverages like lemon water will make digestive discomfort worse.

Testing For Hypochlorhydria Using Betaine Hydrochloride (Betaine HCL)

According to Dr. Natasha Turner, a Toronto, Canada-based Naturopathic Doctor, best-selling author and regular guest of the Dr. Oz Show, the following is a simple test that can be used at home to test for low stomach acid”

Note: People who have ulcers should NOT attempt this test:

Prepare for the test by purchasing Betaine Hydrochloride from Amazon (disclosure: I may earn commissions if you purchase from this link), also known as BH, HCL or Betaine HCL capsules. Look for BH which has been produced by a reputable supplement company and be sure not to confuse BH with Betaine Anhydrous, a product used to treat some rare genetic disorders. Betaine Hydrochloride (BH) is an over-the-counter supplement that contains hydrochloric acid; it is sold in most pharmacies, health stores and online supplement retailers.

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Prior to eating your largest meal of the day which includes a portion of protein, take one capsule or tablet of BH. Shortly afterwards, you should feel a warm, slightly burning sensation throughout your stomach. This indicates that the BH has activated the existing acid in your stomach, letting you know that your naturally-occurring levels of stomach acid are sufficient. (Burning, stomach pain, acid stomach, nauseousness/queasiness, constipation, loose stool, burning stool or rectum, acid reflux can all be symptoms of taking too much HCL.)

Patients who feel no effects whatsoever after taking a single dose of BH should repeat the above process the following day prior to their largest meal, however, the dose should now be increased to two tablets or capsules of BH. Once again, pay attention to any warming or burning sensations in the stomach or digestive tract.

If you feel a warm sensation in your stomach after taking two BH tablets, repeat the procedure the next day before your main meal, reducing the dose back down to one tablet or capsule.

Dr. Turner advises that patients continue this course of treatment (taking one tablet of BH prior to the largest meal each day) until a feeling of warmth or burning occurs after taking the supplement. This warming sensation indicates that there is enough acid in the stomach to support healthy functions without the need for supplementation with BH. She advises that patients should then begin taking a digestive enzyme product prior to each meal to help maintain a healthy digestive system.

What It Means If You Feel Nothing After Taking Two Pills of Betaine Hydrochloride

Dr. Turner advises that people who have relatively sufficient levels of naturally-occurring stomach acid will feel a warm, mildly burning sensation in their stomach after taking one or two doses of BH. However, people who suffer from low stomach acid will require larger doses of BH to activate their stomach acid, a definitive sign of low stomach acidity.

If you follow the above BH/meal protocol and do not feel these sensations, take one additional pill of BH prior to your largest meal each day until you do feel a warm, burning sensation in your abdomen, up to a maximum of 10 BH pills per day. According to Dr. Turner, the amount of BH supplementation it takes to elicit a symptomatic response (warmth and burning in the digestive tract) is relative to the severity of the patients’ Hypochlorhydria – the lower the levels of naturally-occurring stomach acid are, the greater the dose of BH needs to be to activate the heartburn symptoms.

Simply put, if you test yourself for low stomach acid by taking one, then two, tablets of BH prior to eating a meal and you do not feel any sort of warming or burning sensation in your stomach or digestive tract, you can be relatively certain that you are suffering from Hypochlorhydria (low stomach acid).

Dr. Turner further discusses that effectively treating low stomach acidity requires strict adherence to a regiment of BH supplementation for an extended period of time:

Correcting a hydrochloric acid deficiency may take a few weeks or even months

Clinical Testing of Stomach Acid Levels

Medical providers can measure stomach acid levels through a diagnostic test that is typically performed in a hospital or outpatient clinic under local anesthetic. Known as a Gastric Acid Analysis, this test involves the insertion of a small tube through the nose, passing through the esophagus into the stomach. A tiny meter located at the end of the tube measures the level of acid within the stomach.

Another option for testing stomach acid levels involves the use of Heidelburg capsules, which are tiny capsule-shaped electronic devices that are ingested by the patient. Once these capsules reach the stomach, they transmit information to the medical technicians such as the level of stomach acid and the thickness of the mucus on the lining of the stomach. After a period of time, the patient passes the Heidelburg capsules through their colon in their stool.

How To Treat Hypochlorhydria With BH

If you have tested positive for low stomach acid, you may want to begin treating your condition with BH, following the protocol outlined by Dr. Turner, N.D. Dr. Turner outlines how pre-meal supplementation with BH can help to restore adequate levels of hydrochloric acid in the stomach which in turn will lead to a reduction in symptoms related to malnourishment such as fatigue, indigestion and hormonal disruptions.

According to Dr. Turner, patients may need to follow a BH protocol for a number of weeks (or even months) before they detect any significant changes to their health, while long-term use of a low therapeutic dose of BH will likely be needed for most people to prevent relapses.

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Supporting BH Therapy With Dietary Changes and Supplements

In order to maximize the benefits of BH therapy, you can work to include foods in your diet that are naturally rich in betaine, such as dark leafy greens like spinach, kale and beet greens. You can also increase your consumption of foods that have high levels of naturally-occurring acid, such as lemon, kefir yoghurt, pineapples, sauerkraut and rice vinegar, as these foods will help boost the acid levels in your stomach.

Many nutritionists and natural health practitioners also recommend the use of probiotic supplementation to encourage the fight against dangerous bacteria in the gut and repair cellular damage to the lower intestine; probiotics can be taken in capsules or by eating homemade fermented foods.

The use of digestive enzyme supplements is also popular among people who are taking BH to resolve low stomach acid issues because low stomach acid and low digestive enzymes usually are concurrent problems. Many people have found that taking digestive enzyme supplements helps them digest their food better, leading to greater absorption of nutrients and reducing the risk of malnutrition.

For More Information

Contrary to popular belief, growing older does not mean that you need to suffer from digestive problems like bloating, excess gas and bad breath, however, it does mean that your stomach acid levels are decreasing each year. If you believe you may be suffering from low stomach acid, speak with your medical provider or contact a Naturopathic Doctor in your area. Hypochlorhydria is a common, treatable condition that when left undiagnosed, can cause a host of serious, long-term health problems.

As mentioned previously, many people are finding relief when using Betaine HCL Pepsin.

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