Hypochlorhydria: Signs, symptoms, and consequences

Testing stomach pH

Hydrochloric acid (HCl) is produced in the stomach and used to initiate protein digestion, release vitamins and minerals from food, and kill off potential pathogens. The acidity of gastric secretions is essential to these functions but can cause discomfort and erosion in the esophagus if the lower esophageal sphincter pressure is reduced. Under normal conditions, gastric pH is maintained at a pH of 1-3. However, the goal of therapy for esophageal reflux is to increase the gastric pH to above 4 when reflux is most likely (Raymond 2021).

Hypochlorhydria (low stomach acid) can cause symptoms of chronic reflux and heartburn as well. This can be due to compromised digestion and subsequent fermentation of undigested food. Prolonged use of antacids or proton pump inhibitors, aging, chronic stress, H. pylori infection, and gastric surgery can increase the risk of hypochlorhydria.

The causes of hypochlorhydria should be identified and addressed. Nutrition therapy may be indicated, including supplemental micronutrients and hydrochloric acid until digestion and HCl levels improve. Signs, symptoms, and guidelines for hypochlorhydria include (Cleveland Clinic Hypochlorhydria):

Signs of maldigestion

• Abdominal pain
• Bloating
• Constipation
• Diarrhea
• Gas
• Heartburn
• Reflux
• Undigested food in feces

Signs of nutrient deficiencies

• Brittle fingernails
• Fatigue
• Hair loss
• Headaches
• Memory loss
• Numbness or tingling in hands and feet
• Paleness
• Weakness

Testing for hypochlorhydria

Baking soda test

• Test how long it takes to burp after consuming 4 ounces of cold water with a quarter teaspoon of baking soda. The combination of stomach acid and baking soda creates carbon dioxide which causes burping. If burping doesn’t occur within 3-5 minutes, it is possible that stomach acid is low (and therefore pH is increased)

Heidelberg pH test

• A small, encapsulated radio transmitter that measures pH is swallowed. Once in the stomach, it takes a baseline pH reading.
• After baseline, a baking soda solution is consumed to neutralize stomach acid.
• The capsule will then determine how much time it takes for stomach acid to return to baseline.

The SmartPill

• The SmartPill wireless transmitter measures actual gastric acid levels instead of pH.

Gastric String Test / EnteroTest

• A small capsule attached to a string is swallowed and remains in the stomach for 10 minutes. The pH of the string is then measured with pH paper. A pH of 3-5 may indicate hypochlorhydria and a reading above 5 suggests achlorhydria, a severe condition in which no hydrochloric acid is present. At the time of writing this article, the Gastric String Testor EnteroTest is not available. The next evolution of this test is the EnteroTrack but this test is not designed to evaluate stomach pH but to collect mucosal samples from the upper GI tract: "Collected samples represent a liquid biopsy of mucosal content, which can be analyzed by reference laboratories for biomarkers corresponding to disease status."
  EnteroTrack.com

Dietary guidelines for hypochlorhydria

• Consume protein at the beginning of the meal to stimulate HCl production
• Consume fluids separately, at least 30 minutes away from a meal
• Don’t lie down within 2-3 hours of a meal
• Eat smaller meals and chew all foods thoroughly to aid digestion
• Consume fermented and probiotic foods, including miso, sauerkraut, and live-culture yogurt
• Avoid highly processed foods and excess amounts of fatty foods
• Supplement vegetarian diets as needed with protein, vitamin B12, calcium, and iron

Betaine HCl Supplement Protocol

1. Start with one capsule containing 350-750 mg of betaine HCl with a protein-rich meal. If no discomfort, increase to two capsules at the next meal.
2. If discomfort occurs after increasing the dose, neutralize with 1 tsp baking soda in water or milk, and reduce the dose for the next meal.
3. Gradually increase the dose by one capsule every two days, without exceeding 3,000 mg, until discomfort occurs. Then, reduce the dose by one capsule.
4. Establish a consistent dose once the appropriate level is found, adjusting for smaller or less protein-dense meals.
5. Discontinue use and consult a healthcare professional if discomfort continues despite dose adjustments.
6. Avoid using betaine HCl if you have peptic ulcer disease and do not open capsules as HCl can damage teeth and irritate mucous membranes.
7. Ensure the meal accompanying the betaine HCl is at least 500 calories with adequate protein to avoid gastric irritation.

References

Cleveland Clinic Hypochlorhydria. https://my.clevelandclinic.org/health/diseases/23392-hypochlorhydria

Guilliams, Thomas G, and Lindsey E Drake. “Meal-Time Supplementation with Betaine HCl for Functional Hypochlorhydria: What is the Evidence?.” Integrative medicine (Encinitas, Calif.) vol. 19,1 (2020): 32-36.

Raymond, Janice L., et al. Krause and Mahan's Food & the Nutrition Care Process. Elsevier, 2021.

EnteroTrack.com