You may have low stomach acid if you suffer from one or more of the following:
- acid indigestion
- intolerance to certain foods (get gassy when eating certain foods)
- frequent belching, feeling full and feeling like the food just isn’t moving along after eating
- Gastro-Esophageal Reflux Disease (GERD)
- H. pylori infection
- frequently take antacid drugs
- fingernails crack easily
- acne rosacea
- gum inflammation and receding gums (periodontitis)
- increased risk of heart attack
Millions of people suffer from the above and many are unaware that these could have this underlying cause: too little stomach acid… yes, too little, stomach acid production! Low stomach acid alone may not be the sole cause or the major cause of these problems. However, taking appropriate measures to restore proper stomach acid often results in significant improvement. You will not only feel better, but also improve nutrient flow to the rest of your body.
Stomach acid, which is also called hydrochloric acid or HCL, is necessary for many bodily functions. Low stomach acid is the condition where the stomach produces an inadequate amount of HCL. This condition is also called hypochlorhydria. Millions of people erroneously try to suppress HCL production by taking antacids. This is a common error made by people who decide to take antacids on their own, or doctors who prescribe them to people. This error has many dangerous implications for many systems of the human body.
I’ll provide a lot of information in this article which will cover the following:
- Why HCL production in the stomach is so important
- How it affects so many seemingly unrelated symptoms
- Why restoring proper stomach acid production is an important component for preventing some major health problems (included in the list above)
I’ll use a question and answer format so you can skip to the information you’re interested in.
Who is at high risk for low stomach acid (hypochlorhydria)?
Everyone knows that as we age, our body functions don’t work as well as as when we were younger. Those over 50 years old are at high risk for low stomach acid. It is estimated that about 75% of those over 60 have low stomach acid.
Those with allergies, asthma, and gallstones are also at increased risk for low stomach acid. Most chronic illnesses result in low stomach acid. In fact, in a recent study, the hydrochloric acid levels of “healthy” college students’ were measured, before and after getting the flu and periodically thereafter. The study showed that it took an average of 2 months for their HCL levels to return to their pre-flu levels.
How is low stomach acid diagnosed or identified?
The gold standard for determining low stomach acid is the Heidelberg test. This test has the patient swallow a tiny capsule, that contains a microtransmitter that measures the baseline pH (acid/alkaline level) of the stomach. The lower the pH, the more acidic. Next, the patient drinks a baking soda solution, and the transmitter measures the drop in acidity. The pH is recorded long enough to see how soon the stomach acid recovers to high acid levels.
There are comparison studies that compared symptoms of low stomach acid and blood tests with Heidelberg test measurements. The findings showed that symptoms of low stomach acid were often more important than Heidlelberg measurements in determining the need for HCL. The symptoms are:
- loss of appetite for high protein foods
- “acid stomach” relieved by eating
- bad breath and body odor
- gas shortly after eating
- indigestion 30 minutes to an hour after eating that lasts up to 4 hours,
- frequent visible undigested food in the stools
- difficulty digesting fruits or vegetables
- acid and spicy foods cause stomach upset
Jonathan Wright, MD, a pioneer in natural health care, has tested thousands of patients with the Heidelberg test. He has noted the following additional symptoms:
- slow hair growth
- chipping or cracking fingernails
- leg cramping
- nutrient deficiencies of folic acid, B6, B12, magnesium, calcium, iron and zinc
The stomach mixes food with HCL to break up large food paticles into smaller ones. HCL also breaks up food into its components for safe delivery to the small intestine. This helps prevent food allergies and is associated with decreased allergy responses.Stomach acid is needed to cordinate signals to the nervous system for opening and closing the lower esophageal sphincter (the muscular-valve from the esophagus to the stomach). HCL is also necessary to effectively coordinate the stomach’s exit valve, the pyloric sphincter, for opening and closing for passage of food into the beginning of the small intestine. Proper coordination of these valves prevents acid reflux, and GERD.Just about all foods we eat have a small amount of foreign bacteria. Unless the bacteria are enough to cause symptoms, we often don’t even notice it because the HCL kills the foreign bacteria. Some foreign bacteria are more harmful than others. Helicobacter pylori (H. pylori) is one of those more harmful. It is the causative agent of stomach ulcers. If H. Pylori remains in the stomach for long enough, it is directly implicated as causing stomach cancer. H. Pylori also lowers stomach acid. Low stomach acid predisposes to H. Pylori infection and other GI bacterial, yeast and parasitic infections [1. Dial S, Delaney J, Barkun A, et al. Use of gastric acid-suppressive agents and the risk of community-acquired clostridium difficile-associated disease. JAMA. 2005;294:2989-2995.]. Stomach HCL also prevents pathogens from getting down farther into the small and large intestines.According to Dr. Wright, “it’s been my clinical observation that calcium, magnesium, iron, zinc, copper, chromium, selenium, manganese, vanadium, molybdenum, cobalt, and many other “micro-trace” elements are not nearly as well-absorbed in those with poor stomach acid as it is in those whose acid levels are normal.”What are the indirect functions of HCL?
The stomach also produces digestive enzymes to help break down proteins into amino acids. Pepsinogen is released in coordination with HCL, which helps change pepsinogen into the enzyme pepsin. Pepsin is the gastric digestive enzyme.
Special cells in the stomach working properly are also necessary for vitamin B12 absorption. These special cells require HCL to work properly. Low vitamin B12 is associated with elevated blood cholesterol and homocysteine levels.
Gastrin is a hormone produced in the stomach that stimulates movement of food through the stomach. Chronic antacid use hinders both HCL and gastrin secretion, predisposing to low tissue amino acids. Since immunoglobulins are made from amino acids, low tissue amino acids impairs the immune system. Low tissue amino acids also causes muscle wasting, often seen in the aged or physically debilitated.
What is the connection between inadequate HCL production, receding gums and heart attacks?
Low stomach acid is associated with the development and progression of systemic inflammation and receeding gums, called periodontitis [2. Liu C, Hou L, Wong M, et al. Relationships between clinical parameters, Interleukin 1B and histopathologic findings of gingival tissue in periodontitis patients. Cytokine. 1996;8:161-7.]. Periodontitis is associated with increased incidence of heart attacks due to systemic inflammation [3. Kornman, K. Interleukin 1 genetics, inflammatory mechanisms and neutragenetic opportunities to modulate diseases of aging. Amer J Clin Nutrit. 2006;83:475S-83S.] [4. Bokhari S, Khan A, Tatakis D, et al. Non-Surgical Periodontal Therapy Lowers Serum Inflammatory Markers: A Pilot Study. J Periodontology Online. 2009;80:1574-80.].
What are antacids for? How long should I use them?
Antacids were only developed for, and are only supposed to be used for 8 weeks or less in most cases and 6 months at the maximum. The actual recommendation from the drug prescription instructions from the Physicians Desk Reference (PDR) for a common gastric medication:
Prilosec (Omeprazole) is prescribed for the short-term treatment of stomach ulcer, duodenal ulcer, erosive esophagitis (inflammation of the esophagus), heartburn, and other symptoms of gastroesophageal reflux disease (GERD).
Longer term use predisposes to multiple vitamin and nutrient deficiencies [5. Marcuard S, Albernaz L, Khazanie P. Omeprazole therapy causes malabsorption of cyanocobalamin (vitamin B12). Ann Intern Med. 1994;120:211-215.] [6. Ivanovich P, Fellows H, Rich C.The absorption of calcium carbonate. Ann Intern Med. 1967;66:917-923.].
The usual dose for people with symptoms of GERD is 20 mg daily for up to 4 weeks. For erosive esophagitis accompanied by GERD symptoms, the usual dose is 20 mg day for 4 to 8 weeks. The dose may be continued to maintain healing.
Long-term use of Prilosec may cause severe stomach inflammation. Prilosec may mask the signs of stomach cancer.
Low stomach acid due to chronic acid suppression stimulates the chronic release of gastrin in the attempt to restore normal gastric acidity. This subsequently leads to chronically high gastrin levels that have been shown to induce cancerous tumors [7. Waldum H, Gustafsson B, Fossmark R, et al. Antiulcer drugs and gastric cancer. Dig Dis Sci. 2005;50 Suppl 1:S39-44.].
Prilosec OTC, an over-the-counter product, is approved only for frequent heartburn (occurring 2 or more days a week).
Note that the second recommendation contains the statement: “The dose may be continued to maintain healing”. Is a deficiency of Prilosec the cause of GERD? Not! Some may be led to believe that the drug maintains healing. In fact, it does not heal GERD in the first place. It only decreases the local conditions where the esophagus is no longer being irritated by stomach acid backing up into the lower espophagus which irritates the esophageal lining. This is a distinction that must be understood.
To heal erosive esophagitis, it would better to do so without decreasing HCL produced by the stomach. The details of how this is done using a Functional Medicine approach would require a whole article, so we’ll not go into that here. I plan to write and post a separate article about healing erosive esophagitis and the stomach lining here in my blog.
If you have low stomach acid and are prescribed supplemental HCL, how long do I have to take it? Can your stomach HCL production return to normal?
Betaine hydrochloride (Betaine HCL) is an acidic form of betaine, a vitamin-like substance found in grains and some foods. Betaine HCL with pepsin is used to increase the level of hydrochloric acid in the stomach. When taking Betaine HCL it should always be taken at the beginning or middle of a meal containing some protein. Often times, in patients in their 30’s and 40’s, taking supplemental betaine HCL can “jump-start” their stomach towards producing adequate HCL. Thus, they only have to use it for a short time. This can even occur in some of those over 50, if they tend to eat a good diet, exercise regularly, manage stress well, get adequate rest, etc. However, most don’t, so those over 50, often find great benefit in long term consistent use of supplemental betaine HCL with pepsin. The proper dose and correct timing in taking it with a meal make all the difference as to getting the most benefit without experiencing problems! This should be done under the guidance of a Functional Medicine doctor and Certified Clinical Nutritionist professional who is familiar with Betaine HCL for GERD, digestive problems and disorders associated with low stomach acid.
Dr Husbands is a Chiropractor, a Certified Clinical Nutritionist, an Anti-Aging Healthcare Practitioner and a Functional Medicine Doctor. For more information, visit http://www.holistichealthbayarea.com. Contact us if you have any questions about low stomach acid or other health issues.