Low acid levels in stomach


Stomach acid is important for good health.

  • It is needed to digest proteins.
  • It is needed to empty the stomach correctly.
  • It is needed to kill pathogenic organisms (bacteria and yeast) ingested.
  • It is needed for the absorption of micronutrients, for example zinc, selenium, magnesium, calcium, copper, iron, etc.
  • It is needed for the absorption of vitamin B12 and essential amino-acids, etc.

Low stomach acid (hypochlorhydria).

Hypochlorhydria is when the stomach cannot produce enough stomach acid (hydrochloric acid). The popular belief is that all symptoms of heartburn, bloating, gas and epigastric pain, etc. in a patient, is due to the over-production of stomach acid. 

However, too low levels of stomach acids, can cause the same symptoms. When people, especially those over the age of 40, complain of these symptoms, you must consider hypochlorhydria. About 90% of patients over 40 years who see their doctor with these symptoms, will in fact have low stomach acid. Contrary to popular belief, acid production decreases with age, like most things.

Prescribing the wrong medications (for example proton pump inhibitor such as omeprazole, etc.) to lower the stomach acid, will make the situation even worse. Your short term symptoms will improve, but your overall health will suffer.

Low stomach acid can cause several symptoms and signs.

Low stomach acid can cause overgrowth of bacteria and yeast, which results in food being fermented in the stomach, instead of being digested. In turn, this leads to gas and wind, which causes bloating. A further consequence is changes in the intestinal flora in the rest of the gastro-intestinal system, resulting in further problems of its own. This can lead to diarrhea or constipation and mal-absorption.

The question is how low stomach acid can give you the same symptoms as high stomach acid? When the stomach acid is low, the food (especially proteins) is not digested effectively and stays in the stomach for much longer periods.  The food then starts to ferment and this process forms gas. The gas causes the bloating and discomfort, which can cause the esophageal sphincter to open, allowing food contents to push up into the esophagus.  Even though the stomach acid may be low, this food content pushing up can cause the burning sensation.

When the stomach acid is too low, you can get growth of a bacterium called H. Pylori. We know that H. Pylori causes most stomach ulcers. These bacteria are killed by strong stomach acids. (Note: Do not supplement with Betaine HCL until the stomach ulcer is cured. Discuss the treatment of H. Pylori with your doctor.)

Not all people with low stomach acid have symptoms of ‘indigestion’, heartburn or GERD (Gastroesophageal reflux disease) – however, if you have other chronic diseases and especially if you are over 40, you have nothing to lose by testing yourself.

When the stomach is not acidic enough, you get mal-absorption of vitamin B12 and other micronutrients, like zinc, selenium, magnesium, calcium, copper, iron, etc. Lower essential amino acids (isoleucine, leucine, lysine, methionine, threonine, valine, phenylalanine, and threonine) are also associated with low stomach acid. All these deficiencies can cause serious health problems over time, like diminished immune function, loss of eye sight, heart disease, weak bones and many others.

Low stomach acid can cause several diseases.

Wrong bacteria and yeast can irritate the lining of the stomach and increase your risk for stomach cancer.

Studies show an increased tendency to develop pneumonia, hip fractures, age-related macular degeneration and allergies.

Here is a list of some of the diseases associated with low stomach acid:

  • Allergic reactions
  • Chronic Candidiasis
  • Childhood asthma
  • Cardiac arrhythmias
  • Acne rosacea
  • Gallbladder disease
  • GERD
  • Eczema
  • Chronic cough
  • Chronic autoimmune hepatitis
  • Chronic laryngitis
  • Macular degeneration
  • Iron deficiency anemia
  • Muscle cramps
  • Stomach cancer
  • Rheumatoid arthritis
  • Ulcerative colitis
  • Osteoporosis
  • Multiple sclerosis
  • Hyperthyroidism
  • Lupus erythromatosis
  • Celiac disease
  • Diabetes type 1
  • Reynaud’s syndrome
  • Scleroderma
  • Polymyalgia rheumatica
  • Sjogren’s syndrome
  • Etc.

How do you test for low stomach acid?

Heidelberg Capsule test.

  • It is a state-of-the-art diagnostic tool for measuring pH levels in the stomach.
  • What is the protocol for this test?
    • No acid suppressing drugs for at least 4 days.
    • Fast for 12 hours beforehand.
    • Swallow a small pill sized capsule.
    • Drink a solution of sodium bicarbonate.
    • It tests continuously the pH in your stomach as long as needed.
    • Finally you will have a graph showing your stomach response.
    • From this test you can determine if you have too much, too low or no stomach acid.
  • Self tests.
  • Apple cider vinegar test.
    • This test is safe, cheap and easy to do.
    • Take one tablespoon of apple cider vinegar when experiencing symptoms like heartburn, bloating, gas and/or epigastric pain, etc.
    • If your symptoms improved when taking apple cider vinegar, you most probably do not have enough stomach acid.
    • This test is only an indicator to do further tests.
  • Baking soda test.
    • This test is safe, cheap and easy to do.
    • By drinking baking soda, it creates a chemical reaction with the stomach acid in your stomach and forms carbon dioxide gas that causes burping.
    • There could be a lot of variables and therefore it is recommended to do this test at least for 3 consecutive mornings to find an average.
    • You must perform this test first thing in the morning on an empty stomach.
    • How to perform this test:
      • Mix a teaspoon of baking soda in 120 to 180mls (4-6 ounces) of cold water.
      • Drink it.
      • Now time how long it takes for you to belch. If you do not belch within 5 minutes you can stop timing.
      • If your stomach produces enough stomach acid, you will likely belch within 2 to 3 minutes. Early and repeated belching may be due to too much stomach acid (do not confuse it with small burps from swallowing air when drinking the baking soda solution). Belching after 3 minutes may indicates low stomach acid.
      • This test is only a good indicator to do more tests. This test is also not accurate enough to rule out low stomach acid.
  • Betaine Hydrochloride (Betaine HCL) test.
    • Always discuss self testing of stomach acidity and management with your professional healthcare provider (medical doctor).
    • Do not do this test while having an active gastric ulcer!
      • Caution: NSAID (non-steroid anti-inflammatory drugs, like ibuprofen, Diclofenac, etc.) and corticosteroids together with Betaine HCL increase your risk of gastritis.
    • How to perform this test: (under the supervision of your doctor)
      • Get Betaine Hydrochloride (Betaine HCL 650mg) with pepsin tablets.
      • Eat a high protein meal of at least 170g (6 ounces) of meat or more.
      • In the middle of your meal take one Betaine HCL tablet.
      • Continue with your meal and pay attention to any symptoms.
        • If you do not notice any symptoms, it is likely that you have low stomach acid.
        • If you start having any stomach discomfort, like burning or heaviness, this may mean that you do not have low stomach acid. This should pass quickly or take an anti-acid tablet or baking soda.
      • Repeat this test and if you have 2 positive tests you can start thinking of supplementing with Betaine HCL tablets.
  • How do you treat low stomach acid?
    • You may take apple cider vinegar with meals – it acidifies the stomach and thereby improves digestion.
    • Betaine HCL supplementation.
          • Short term to medium term:
      • By supplementing with Betaine HCL, you help the digestive process to work better.
      • When you established that your stomach acid is low, take the following steps (always discuss it with your medical doctor):
      • Day 1: After arising and +/- 30 minutes before breakfast, take one Betaine HCL capsule (650mg) on an empty stomach. If you experience any abdominal discomfort, burning or nausea – discontinue the taking of Betaine HCL and discuss it with your medical doctor.
      • Day 2: Do the same as on day 1.
      • Day 3: Do the same as on day 1, but increase the amount of Betaine HCL capsule by one capsule.
      • Day 4: Do the same as on day 3.
      • Increase the dosage by one capsule every second day, until you experience symptoms of abdominal discomfort, nausea and/or burning. This will mean that the correct dose for you to take before every meal will be one capsule less than when experiencing the symptoms. Most people will need 3 to 5 capsules or even more before each meal.
      • It is important to find the correct dosage for you as an individual. If you need 3 Betaine HCl capsules per meal, it will not help to only take 1 capsule to try and save money!
      • If your correct dosage is 3 capsules per meal, I will recommend to take 1 capsule Betaine HCl with pepsin and 2 capsules of only Betaine HCl.
          • Long-term:
      • Find the cause and taper down the Betaine HCL.
      • Treating H.Pylori.
        • Remember not to continue with medications which lower your stomach acid secretion after treating the H.Pylori bacteria and healing of the stomach ulcer. (After all, the cause of the growth of the H. Pylori bacteria is due to low stomach acid.)
      • Correct the intestinal flora – taking fermented food.
      • Improve the health of the gastro-intestinal system by:
        • Whole food (food which is not processed)
        • No processed food and preservatives (or minimum)
        • Fermented food/drinks, like Kefir.
          • Etc.
        • By following the above you improve the health of your gastro-intestinal system, which will reduce the quantity of Betaine HC1 capsules need over time.