Hypochlorhydria (Low Stomach Acid)

Could your indigestion and reflux be caused by hypochlorhydria (low stomach acid)?

By Dr. Paul Deglmann

Edited by Meghan Feir Walker

If you’ve ever experienced the displeasure of chronic acid reflux, indigestion, cramps and other problematic digestive issues, you know how hard it can seem to find a remedy. Doctors may direct you to antacids, proton pump inhibitors, and H2 receptor blockers, but this often doesn’t provide the relief you’re seeking. It also can cause unpleasant side effects and damage. 

While an overabundance of stomach acid production is usually blamed for indigestion and heartburn, could your indigestion and reflux be caused by low stomach acid (hypochlorhydria) instead? 

I’ll dig deeper into what hypochlorhydria is, what symptoms it can produce, its most common causes, and tips and potential remedies for those with the condition. Read on to learn more about this common problem and watch my video on this topic.

What is hypochlorhydria?

For your body to absorb proper nutrients from the food you eat, your digestive system needs to function correctly. When anything is slightly off, it can cause numerous problems. This includes an imbalance of stomach acid production.

Stomach secretions consist of hydrochloric acid (HCl) and enzymes. They also have a mucus coating to protect the stomach lining. When your body isn’t producing enough HCl, this is called hypochlorhydria. 

Many problems can be caused by not producing enough stomach acid because it is necessary to break down food and absorb nutrients properly. Hypochlorhydria can lead to indigestion, malnutrition, immunity issues, and even bacterial overgrowth. 

Hydrochloric acid has a big impact on not only your digestive functions but also how well your body can ward off viruses and bacteria. It helps your body break down protein, absorb nutrients and vitamins, and helps keep bacteria and viruses at safe levels in your stomach. Without enough HCl, you’re likely to get more infections, which will then cause further damage to your stomach and digestive system. 

While digesting any food can cause indigestion when stomach acid is too low, protein is especially difficult to break down without enough HCl. 

If you don’t get proper care to correct hypochlorhydria, you might cause damage to your gastrointestinal system and develop other chronic health issues. 

What is the difference between hypochlorhydria and hyperchlorhydria?

Although we’re talking about hypochlorhydria in this article, there’s also a condition called hyperchlorhydria. “Hypo” means low, while “hyper” means high. Hypochlorhydria produces too little hydrochloric acid, while hyperchlorhydria produces too much. However, they can cause similar symptoms. 

In Western medicine, doctors most often treat acid reflux problems as an issue of hyperchlorhydria, too high levels of stomach acid. This is why you see advertisements for antacids and proton pump inhibitors (PPIs) everywhere you turn. 

However, most of the time, the problem isn’t that you have too much stomach acid. Most often, it’s actually quite the opposite.

You may be wondering why you would have acid going up your esophagus if you don’t have enough stomach acid. 

When you’re having digestive issues from not producing enough stomach acid, this low level of acid can create little bubbles that rise and travel up your esophagus and throat. These little bubbles carry stomach acid, creating these disturbing symptoms. Since stomach acid is so harsh, even the smallest amount of it can feel uncomfortable when it comes up your throat. 

Another term, achlorhydria, describes people who have almost no stomach acid.

Hypochlorhydria (low stomach acid)

What are the symptoms of hypochlorhydria/low stomach acid?

As I mentioned earlier, in order for your body to be able to digest and absorb protein, vitamin B12, and many minerals, your body has to have enough stomach acid. When your stomach acid production is compromised, you’re no longer able to break down and absorb the nutrients you need to function properly. This can result in a domino effect of symptoms. 

For example, protein and vitamin B12 deficiencies can cause anemia (iron and/or vitamin deficiency anemia). This can have a huge effect on your nervous system. 

As another example, if you have a calcium or a magnesium deficiency, this can lead to osteoporosis. 

Undigested food can ferment in the GI tract, leading to small intestinal bacterial overgrowth (SIBO), which produces many unpleasant, daily symptoms. Along with the painful, frustrating symptoms, SIBO itself can also lead to malabsorption and osteoporosis. 

Symptoms of hypochlorhydria can include:

  • Acid reflux/heartburn (yes, that’s right. Most cases of acid reflux are caused by too little stomach acid and not too much)
  • Getting full quickly
  • Abdominal pain
  • Undigested food in stools
  • Feeling like there’s a brick in your stomach or feeling like the food is stuck and won’t go down
  • Belching, especially around eating food
  • Bad breath
  • Gas
  • Bloating
  • Constipation/diarrhea
  • Upset stomach/nausea
  • Desire to eat when not hungry
  • Fatigue
  • GI infections
  • Anemia, including iron and vitamin deficiency anemias
  • Deficiencies, such as vitamin B-12, calcium, magnesium and other vitamins and minerals
  • Protein deficiency

Prolonged nutritional deficiencies caused by hypochlorhydria can also lead to these additional problems: 

  • Brittle fingernails
  • Hair loss
  • Paleness
  • Ongoing fatigue
  • Weakness
  • Neurological issues, such as numbness, tingling and vision changes
  • Memory loss
  • Headaches
Hypochlorhydria (low stomach acid)

Causes of hypochlorhydria or low stomach acid?

Hypochlorhydria can have many causes. The most common risk factors include:

  • Gastritis or stomach ulcers
    • Gastritis describes chronic inflammation of the stomach
    • Chronic gastritis can be caused by many things, but the most common causes are H. pylori, alcoholism, and autoimmune diseases
    • After having gastritis for a prolonged period, you may develop atrophic gastritis, which is when the cells that produce stomach juices stop working
  • H. pylori infection
    • H. pylori is a gram-negative bacteria that loves to hang out in the stomach and upper GI tract
    • This infection negatively affects the parietal cells in the stomach and commonly causes low stomach acid
  • Food sensitivities

  • Medications
    • Using medications that reduce stomach acid, such as antacids, H2 receptor blockers, and PPIs, can put you at a high risk 
    • PPIs were originally intended to be used for short amounts of time, not for years
    • These types of medications are overprescribed and used to treat GERD and heartburn symptoms, but they can cause the stomach glands that secrete acid to stop working
  • Chronic stress
    • Normal levels of stress are expected, but prolonged, significant stress can affect your stomach acid production
  • Vitamin deficiencies
    • Particularly zinc and B vitamin deficiencies 
  • Toxins

  • Other chronic infections

  • Age
    • As we age, stomach acid production naturally declines
  • Stomach surgery
    • This can include gastric bypass and other types of stomach surgeries
Hypochlorhydria (low stomach acid)

Do you have low stomach acid? How is hypochlorhydria diagnosed?

To diagnose hypochlorhydria, your doctor should assess your symptoms, health history and lifestyle, along with conducting a physical examination. If they think you may have hypochlorhydria, they may test your stomach acid levels. Unfortunately, these tests are unreliable and invasive. 

Functional doctors will, instead, diagnose hypochlorhydria based on your symptoms and history, along with noticing patterns on stool tests (low elastase, high steatocrit, or fat in the stool). 

If you are diagnosed with hypochlorhydria, your doctor will likely order additional tests to check on nutritional deficiencies or bacterial infections.

You can also try this simple test at home. Keep in mind that this baking soda test isn’t 100% accurate, but it can give you an idea of your stomach acid production. 

The baking soda test

When baking soda is paired with stomach acid, carbon dioxide (C02) is produced. The result? You’ll burp. 

The baking soda test involves drinking 4 ounces of cold water combined with a quarter teaspoon of baking soda on an empty stomach. With a stopwatch, time how long it takes you to burp. 

If it takes you longer than 3 to 5 minutes to burp, you probably don’t have enough stomach acid.  

If the at-home baking soda test is positive and/or symptoms persist, please follow up with a practitioner. 

What can you do to help with low stomach acid?

Along with looking at your history and symptoms, a good doctor will check for possible underlying causes.

Other proactive things you can do include: 

  • Addressing a possible H. pylori infection
    • This can be tested in many ways, but we prefer a high-quality stool test
  • Removing any sensitive food triggers
    • The best way to do this is by getting tested for food sensitivities
    • Common food triggers are grains and dairy
  • Improving or developing stress-management strategies
    • Deep breathing, meditation, limbic retraining, doing things you enjoy doing (as long as they are healthy), etc.
  • Taking proper supplementation

Additional tips if you have low stomach acid

Many health issues may require medical assistance, but some symptoms and their causes can be altered by making different choices and tweaking lifestyle habits. 

While your diet does affect stomach acid production, that alone won’t restore your stomach acid to healthy levels. However, the following tips can help you on your journey toward healing from hypochlorhydria. 

  • Eat protein at the beginning of your meal to stimulate acid production.
  • If you can, wait to drink beverages until after your meal. The recommended time to wait to drink fluids is 30 minutes post-meal.
  • Eat probiotic foods, like kimchi or sauerkraut. This can provide a variety of good gut bacteria, which protects you against bad bacteria from taking over. 
  • Stop eating (or at least limit) processed, sugary foods.
  • Eat animal-based foods. Many of the deficiencies associated with low stomach acid include protein, iron, calcium and vitamin B12, all of which are abundant in foods like meat, fish and eggs.
  • Eat smaller meals and chew thoroughly.
  • Finish eating supper two to three hours before bedtime to give your body a chance to digest your food.

What supplement can I take to help improve stomach acid? 

Super HCL Pro is the supplement we suggest for addressing low stomach acid. 

This product provides two essential components of healthy digestion: hydrochloric acid (HCl) and the digestive enzyme, pepsin. 

Hypochlorhydria (low stomach acid)

Hydrochloric acid is vital for the proper digestion of protein and the absorption of vitamins and minerals (especially vitamin B12, calcium, magnesium, copper and zinc). HCl also plays an important role in signaling the pancreas to release digestive enzymes. 

Pepsin is one of the first enzymes to initiate protein digestion and works in synergy with HCl to provide complete protein digestive support. 

Benefits of Super HCL Pro:

  • Provides hydrochloric acid to help maintain gastric pH
  • Promotes healthy digestion, especially of dietary protein
  • Supports overall nutrient absorption

WARNING: Do not use any HCL product like Super HCL Pro if you have a history of ulcers and/or gastritis or are taking any acid-reducing medication.

Summary

Are you concerned you may have hypochlorhydria? Speak with your doctor about tests and treatments.

What we talked about today: 

  • When your body isn’t producing enough HCl, this is called hypochlorhydria.

  • When your stomach acid production is compromised, you’re no longer able to break down and absorb the nutrients you need to function properly.

  • Various symptoms and problems can be caused by hypochlorhydria, including acid reflux/heartburn, abdominal pain, indigestion, bad breath, gas/bloating, constipation/diarrhea, nausea, GI infections, anemia, and many protein, vitamin and mineral deficiencies.

  • Hypochlorhydria can have many causes. The most common risk factors include gastritis or stomach ulcers, an H. pylori infection, food sensitivities, medications, chronic stress, vitamin deficiencies (particularly zinc and B vitamins), toxins, other chronic infections, age, and past stomach surgeries.

  • Using medications that reduce stomach acid, such as antacids, H2 receptor blockers, and PPIs, can put you at a high risk of developing hypochlorhydria.

  • To diagnose hypochlorhydria, your doctor should assess your symptoms, health history and lifestyle, along with conducting a physical examination.

  • If they think you may have hypochlorhydria, they will want to test your stomach acid levels. 

  • If you test positive for hypochlorhydria, your doctor will likely take additional tests to check on nutritional deficiencies or bacterial infections.

  • You can also try the baking soda test at home to get a rough idea of your stomach acid production. 

  • Proactive things you can do include addressing an H. pylori infection, removing any sensitive food triggers, improving or developing stress management strategies, and taking proper supplementation.

  • Take a look at our tips list for more help in addressing hypochlorhydria.

  • Super HCL Pro is the supplement we suggest for addressing low stomach acid. Please don’t use this product if you have a history of gastritis and/or stomach ulcers or if you’re using acid-reducing medications.

I hope this article will help you on your journey toward healing from acid reflux, indigestion, and other digestive-related problems. You can also watch our video here. If you found this article helpful, please share it with friends and family, and don’t forget to follow us on Instagram and Facebook for more helpful health information.