Stomach Acid – Why it’s Important to Your Health

Low stomach acid is known medically as hypochlorhydria. Excess acid is Hyperchlorhydria. It’s also possible to have complete loss of stomach acid, we call this achlorhydria.

Low stomach acid is when the stomach does not produce enough hydrochloric acid (HCl). The most common causes are:

1. Reflux medications
2. H pylori infection
3. Hypothyroidism
4. Autoimmune gastritis

Reflux medications like omeprazole, esomeprazole and famotidine block the pumps in the stomach that produce HCl. Some people need these medications to help manage troublesome reflux. But many people have heartburn once and end up on them for a long time.

H pylori can survive in the stomach by producing an enzyme called urease, which neutralises stomach acid. The bacteria also cause the stomach to become inflamed (gastritis), which reduces stomach acid production.

Hypothyroidism may be the cause low stomach acid and many other digestive issues, such as small intestinal bacterial overgrowth (SIBO). Hashimoto’s thyroiditis, an autoimmune condition, is also linked to autoimmune gastritis.

Autoimmune gastritis is when the immune system attacks cells in the stomach called parietal cells, which are responsible for stomach acid production. The parietal cells also produce intrinsic factor, which is needed for B12 absorption. So this can also lead to B12 deficiency or pernicious anaemia!

Zollinger-Ellison syndrome

Zollinger-Ellison syndrome is a rare condition that causes excess stomach acid. The excess acid can damage the stomach lining leading to ulcers and troublesome symptoms like heartburn and abdominal pain.

Excess stomach acid in Zollinger-Ellison syndrome is caused by overproduction of the hormone gastrin. Gastrin stimulates the release of stomach acid, but the main cause of gastrin in people with Zollinger-Ellison is a tumour called a gastrinoma.

Testing for low stomach acid

Why do we not recommend the bicarbonate soda test for low stomach acid? Because it has never been shown to work. The theory is the bicarbonate (baking) soda, an alkaline, reacts with HCl in the stomach, and acid, to give off carbon dioxide gas. This would cause you to burp. So, low stomach acid means no burp.

The only way to test for stomach acid levels is with a gastric acid output test. It involves swallowing a capsule or tube that measures pH, then having a meal. By timing how long it takes for your stomach to re-acidify after the meal can be used to determine how much acid your stomach produces.

This test can also be combined with a reflux test to measure how much acid is entering your oesophagus. This is very important for people with troublesome reflux symptoms. Also, if you take reflux medications, which cause low stomach acid, a reflux test can tell you whether you really need the medications or whether there may be some better alternatives that don’t affect your digestion.

Treatment of low stomach acid

Apple cider vinegar and lemon juice are very acidic with a pH of around 2. However, unless you were drinking large amounts of them (which we do not recommend) then they will unlikely affect the pH of your stomach. In fact, one study found that apple cider vinegar may have side-effects, like delaying gastric emptying (how long it takes for your stomach to empty food), which can worsen symptoms of reflux.

Another treatment for low stomach acid is thought to be betaine HCl. HCl is naturally produced by the stomach, so theoretically, this could help. One study in healthy volunteers showed that taking a betaine HCl was able to decrease pH levels in the stomach (make it more acidic).  However, this wasn’t in people with digestive issues so whether it helps digestion is unsure. Our Tummy MOT experts urge you to be cautious of betaine HCL supplements as too much HCl could potentially damage the stomach and oesophagus.

The best way to treat low stomach acid is by to find the underlying cause and treat that. Helicobacter pylori is treated with antibiotics. Thyroid issues with medications. If you take reflux medications but aren’t sure whether you need to stay on them, ask your doctor about getting tested for reflux.

Verdict?

Low stomach acid is a real condition, but it’s much rarer than online claims would have you believe. There are many other conditions that are more common than low stomach acid, which could be causing similar symptoms. You can find out more if you want to speak to a gut health specialist about your symptoms.