Low Stomach Acid, or Hypochlorhydria, is arguably the most common GI condition in the US. It may seem small and inconsequential. It may seem silly to even put a name to it. But, it hides. It lurks, and it worsens. It is far too often ignored and disregarded. But it is the source, the cause, the reason for almost ALL digestive related issues. Low stomach acid at epidemic proportions in America. It is so common, that it is extremely rare to find anyone who doesn’t benefit from support around this issue.
You can bet your bottom dollar you have hypochlorhydria if you are on or have ever taken medication for reflux/GERD. Reflux, the medications used to treat it, and hypochlorhydria have an “it’s complicated” type relationship that we will get into in a minute. But first, how do you know if you have hypochlorhydria? This is just a few of the issues that arise from low stomach acid:
Symptoms of Low Stomach Acid
What Is HCL and Why Is It Important?
Now you ask, why is stomach acid, or hydrochloric acid (HCL) so important? Or more importantly, why is low stomach acid such a big deal? The stomach needs a relatively high pH level to break down foods, promote adequate levels of other digestive enzymes, kill foodborne pathogens and more…
Aging also decreases the production of stomach acid, so add on a nutrient poor diet and you have a recipe for digestive and immune issues each year you age. This is not an issue only for older adults however. Low stomach acid issues are rampant among children and likely one of the first offenders when it comes to mood, skin, developmental, neurological and behavior issues. If you’ve ever heard the adage “heal the gut; heal the brain.” This is a big part of that picture. A healthy gut is the precursor to a healthy brain in both children and adults and hypochlorhydria is a major offender when it comes to poor gut health. Let’s take a closer look.
The Heartburn Connection
As mentioned earlier, hypochlorhydria and heartburn (reflux/GERD) have a complicated relationship that is often misunderstood. If you go to the doctor for heartburn, your treatment will be a band aid for the symptoms at best, and at worst (and most common), the start of new and worsening issues. It is often assumed that heartburn is this volcanic-like overflow of too much stomach acid erupting up through the esophagus causing the painful and/or burning sensation of heartburn. It is true that stomach acid in the esophagus is what causes the discomfort, but it is not from a bubbling over, it is actually from small amounts of stomach acid getting into the esophagus due to changes in pressure associated with low levels of stomach acid. It is very, very rare for someone to have too much stomach acid. It is epidemic for people to have too little stomach acid.
When acid reflux medication like Prilosec, Nexium, Zantec, Pepsid, etc are used, they actually lessen or completely eliminate stomach acid. This makes you incredibly vulnerable to worsening GI issues. A recent cohort study concluded that those who took PPI’s (proton pump inhibitors) for more than 1 year had an associated 25% increased risk of death. These medication were not designed to be used for more than 6-8 weeks but are often taken for years. While these medications do provide welcomed relief, they can lead to osteoporosis, nutrition deficiencies and heart disease, each of which can contribute to higher risk of death.
So what is causing the reflux? It all comes down to keeping the esophageal sphincter tightly down to prevent reflux or backflow of stomach contents into the esophagus. Poor digestion of food from too little stomach acid and enzymes slows digestion and stomach emptying. Not enough stomach acid increases intra-abdominal pressure (IAP). The pressure in the stomach then pushes against the lower esophageal sphincter causing it to not be able to keep a tight seal. Even small amounts of acid moving into your esophagus cause significant pain and burning since the esophagus is not protected from the pH of stomach acid like the stomach lining. This describes the mechanism behind heartburn that occurs with meals, or shortly after eating, however over time, the sphincter can weaken causing more consistent heartburn unassociated with a meal. When untreated, long-term reflux can damage the esophagus.
A Functional Medicine Approach to Low Stomach Acid
The conventional approach to reflux, one of the main symptoms of hypochlorhydria has been addressed above regarding heartburn medications. There is actually no conventional treatment directly for low stomach acid. The mainstream medical community does not recognize it as a condition to be treated, but only the symptoms which is creates. Those symptoms are treated with medications such as PPI’s for reflux, steroids, biologics, and anti inflammatory meds for IBD and various antiemetic and antidiarrheal meds for IBS and IBD. Or in the case of gallbladder issues, surgery is the option. And yes, hypochlorhydria can be part of your gallbladder issues. None of these options solve the issue at hand. The GI tract is much more comprehensive than matching a medication to a symptom. You deserve better. Despite hypochlorhydria being responsible for or contributing to almost every GI related issue, it is relatively straight forward to treat. It generally requires supplemental HCL and digestive enzymes while making diet changes. This combination helps the body maintain adequate levels of HCL on its own over time, therefore requiring less and less supplemental HCL.
Lab Testing for Hypochlorhydria
This is an area, unlike with SIBO, if it looks like a duck and quacks like a duck… it is probably a duck. A Heidelburg Stomach Acid test can be done by your medical doctor, but it is a bit cumbersome and does not reveal much more information than would be gleaned by the more common method of testing while treating with HCL. Sometimes the patient is a better “lab test” than the sophisticated labs available. The HCL challenge test is a great way to determine if your stomach acid is low and has the huge benefit of actually treating the low stomach acid, while gleaning information from the challenge. We strongly recommend doing this with a practitioner as there are times it is not appropriate to do and you need to be able to dialogue with an experienced person regarding your experience. The challenge consists of starting with 1 capsule of Betaine HCL (usually with Pepsin) at a meal and noticing if you feel anything after the meal such as a different type of burning sensation than heartburn, a heaviness in your stomach or chest, or even nausea. If after 1 capsule you do not feel anything, you likely have low stomach acid. The treatment begins by increasing the dose by 1 capsule at each meal until symptoms are experienced. Again, this increase needs to be done with a practitioner as it can be somewhat nuanced and you need to be able to resource their clinical judgement. Many people will need a significant amount of supplemental HCL for a short amount of time to replete low levels.
Nutritional Supplementation for Hypochlorhydria
An individualized plan developed with a functional medicine practitioner is always the best approach to improving low stomach acid. Most practitioners will use a combination of supplemental HCL, digestive enzymes, probiotics, and gut healing amino acids/herbs. However, there are times when the GI tract is simply too irritated to begin increasing HCL with supplements and a period of gut healing must occur in order to tolerate the supplements needed to correct the underlying deficiencies. Your experienced practitioner will determine when and if supplemental HCL is right for you. Supplemental HCL is used in a progression until symptoms indicating sufficient levels of stomach acid occur. One of the most effective and easy to implement options for improving hypochlorhydria is probiotics. It is one of the most useful tools in addressing reflux in children. It is not that taking a probiotic directly makes more stomach acid in the stomach, but rather the increase in beneficial gut bacteria aid in the body’s ability to produce more of it’s own digestive enzymes and HCL. This improves overall digestion and takes the pressure off (pun intended) the esophageal sphincter where it can maintain a good seal. Although improving diversity and increasing good gut bacteria is crucial, it is not a silver bullet and is part of a more comprehensive functional medicine approach. No one element of HCL, probiotics, gut healing herbs/amino acids will likely do the job fully. Your practitioner will determine the right combination of healing supplements for you.
Treating Hypochlorhydria in Children
Since finding each individual’s unique dosing of supplemental HCL requires feedback from the patient based on what occurs during the slow increase of HCL dose, it is not an appropriate strategy for children. The most effective treatment in children is working behind the scenes to find offending food sensitivities, improve overall gut health, and provide therapeutic levels of probiotics, and fermented foods to support the body’s innate ability to make HCL on its own. There are times when a practitioner may use digestive enzymes in children, but we advise to use digestive enzymes with the help of a functional medicine practitioner or dietitian as they need to be initiated low and slow to prevent further irritation and discomfort.
6 Strategies for Supporting the Gut with Food
The foods you eat can go a long way to improve and prevent hypochlorhydria. Here are tried and true ways to improve digestion which will require less supplementation in the long run. You cannot maintain adequate stomach acid levels on a diet high in processed foods, sugar, and chemicals.
Hypochlorhydria, or low stomach acid, is occurring in epidemic proportions in America as our food sources have become less fresh, more processed, and further refined. The level of sugar and refined seed oils increases as the levels of chemically laden produce consumed decreases. This alone is a recipe for poor digestion and low stomach acid and does not even take into account genetic vulnerabilities, effects of medications on gut health or the detrimental effects of chronic stress on digestion. Hypochlorhydria should be detected and addressed as part of the root cause of any and all GI related issues. This includes: IBS, Crohn’s disease, Ulcerative Colitis, mood disorders (anxiety and depression), Autism, ADD/ADHD, SIBO, stubborn weight despite appropriate caloric intake and exercise, skin issues (acne, psoriasis, eczema). Although hypochlorhydria is a bigger issue than people realize, it is also pretty easy to correct which means your GI issues may be easier to resolve than you realize! Sufficient levels of stomach acid can result in clearer thinking, improved mood, better bowel movements, and increased energy. Don’t wait to optimize your GI health. Your health depends on it. Get started now by improving starting the 6 strategies for improving gut health with food. Then, we recommend you work with an experienced functional medicine practitioner to guide you in supplementation, treatment, and lab testing for any of your GI related issues.
LifeWorks Integrative Health is your home for Functional Medicine, Chiropractic care, Regenerative Stem Cell therapy, and Muscle Rehab. With two locations to serve the Kansas City area located in Overland Park and Shawnee, KS. Our experienced team is committed to exceptional care to give you the health you need for the life you want.