Stomach acid has gotten a bad rap in recent decades as the growing antacid industry marketed products to reduce acid and provide relief.
Estimates suggest that half to 3/4 of Americans struggle with having too little stomach acid and continually taking things to reduce stomach acid can make the problem worse.
Low Stomach Acid Problems
Stomach acid is important for digestion and nutrient assimilation. Having too little stomach acid can cause just as many problems (if not more) than having too much:
- Symptoms like constipation, diarrhea, undigested food in stool, acid reflux, gas, bloating, indigestion, belching, skin problems or acne, and chronic nutrient deficiencies can be related to Hypochlorhydria (low stomach acid).
- In more extreme cases, symptoms like hair loss, brittle nails, dry skin, adrenal fatigue and even autoimmune disease can occur. (1) Of course, these symptoms can stem from other problems as well, but often they can point to low stomach acid.
Risk factors for low stomach acid include: stress, consumption of processed foods, candida, aging, antibiotic or prescription drug use, drinking ice water with meals and mineral deficiencies.(2)
Why we need stomach acid
Stomach acid (HCL) is a necessary part of the digestive system:
- Stomach acid is a vital part of our digestive and immune systems. It helps break down food, but also maintains the acidic environment in the digestive system that kills bacteria, parasites and pathogens that we may ingest with food.
- HCL is also important for stimulating the pancreas and intestines to produce bile and enzymes needed to break down foods.
- Low HCL makes it difficult to break down foods, especially protein, into vital amino acids (which the body needs for hormone support, neurotransmitters and healthy skin, hair and nails).
- Nutrient deficiencies and undigested food in the body can also raise cortisol levels and deplete the adrenals since they don’t have the needed nutrients to function properly.
- Over time, this can create an imbalance in the gut that can make problems like Candida and SIBO worse since pathogenic bacteria that would normally be killed by stomach acid are able to thrive in the gut.
- Leaky Gut and autoimmune disease– There is some evidence that the undigested food in the gut can lead to leaky gut syndrome. At this point, small particles of proteins from undigested foods can enter the bloodstream, which may create autoimmune diseases.
Can Low Stomach Acid Lead to Heartburn & Indigestion?
Stomach acid signals something called the Lower Esophageal Sphincter (which separates the stomach and esophagus) to close tightly when the body has enough acid to digest the food that was consumed. When there is not adequate stomach acid to digest a food, the Lower Esophageal Sphincter will not receive this signal and will not close tightly, letting acid and undigested food creep up into the esophagus leading to heartburn and indigestion.
Additionally, if food is not properly digested, signaling to the small intestine will also be delayed. Food can sit in the stomach longer, leaving more time for acid to reach the esophagus.
How Betaine HCL (with Pepsin) Can Help
In a perfect world, our bodies would naturally create enough (and just enough) HCL to digest our food properly. In reality as many of us encounter risk factors like excess stress, less than optimal diet, and other underlying health issues daily, our bodies may not always produce HCL properly.
In these cases, supplemental HCL can be beneficial when used correctly:
- HCL can be a life-changing supplement for some people, but it should be used with caution and under the supervision of a medical practitioner.
- Those on paid medications,corticosteroids, anti-inflammatories or other medication should not use HCL.
- Those with ulcers should not use HCL.
- HCL should only be taken with meals containing proteins as not as much stomach acid is needed for digesting vegetables and fruits.
- It is important to figure out the correct dose of HCL needed as too much or too little can be problematic.
My Experience with HCL
I had many of the risk factors for low stomach acid and wondered if this could be part of the reason for my remaining nutrient deficiencies.
Under the guidance of a functional medicine practitioner, I started supplementing with HCL with Pepsin and noticed an almost immediate improvement in energy levels and digestion.
I slowly worked up the dose to find my optimal dose and now use HCL as needed to support my digestion. I’ve also found that my body seems to be producing HCL more easily now after several months of using supplements and I’m slowly able to wean down my dose.
Tests for Low HCL
There are lab tests (Gastrin level can be check by your doctor) that measure stomach acid levels but SCD Lifestyle has instructions for some simple tests that can be done at home, including the baking soda test:
- Mix 1/4 teaspoon of baking soda in 4-6 ounces of cold water first thing in the morning before eating or drinking anything.
- Drink the baking soda solution.
- Time how long it takes you to belch. Time up to five minutes.
If you have not belched within five minutes stop timing.
In theory, if your stomach is producing adequate amounts of stomach acid you’ll likely belch within two to three minutes. Early and repeated belching may be due to excessive stomach acid (but don’t confuse these burps with small little burps from swallowing air when drinking the solution). Any belching after 3 minutes indicates a low acid level.
Apple cider vinegar is another way to help determine if a person has low stomach acid. ACV is often recommended as a natural remedy for indigestion, heartburn or other temporary digestive problems. Since it is a natural source of acid, it contributes to the acidic environment in the stomach. It isn’t a perfect test, but if taking 1 tsp of ACV in water helps alleviate heartburn, it may be a sign of inadequate HCL production.
The Betaine HCL Challenge Test
The at-home test that was recommended by my functional medicine practitioner involved using Betaine HCL capsules with Pepsin to test my body’s response:
- In the middle of a meal containing at least 20 grams of protein, I took one Betaine HCL capsule.
- I carefully monitored my body’s response for the next hour to see if it affected me.
- A burning sensation in the stomach can indicate adequate HCL levels. No reaction can indicate low HCL.
This is one of the few tests where a reaction is actually a good thing. I didn’t notice a difference from taking the capsule, which meant I had low stomach acid. A person with adequate stomach acid would notice a burning or heavy feeling in the stomach after taking unnecessary HCL.
From here, I took one additional capsule with each protein containing meal until I felt a slight burning sensation and then backed down to just under that dose for my maintenance dose.
My digestion has been dramatically better since implementing this, and a recent stool test revealed no unwanted visitors or infections in my digestive system (TMI?).
I highly recommend this article about how to supplement with Betaine HCL correctly.
Other Ways to Boost HCL Production Naturally
Supplementing with Betaine HCL with Pepsin should only be done under the care of a qualified practitioner, but there are other natural ways to help increase stomach acid production:
- Do not eat when stressed or upset, as stress can lower HCL levels
- Consume a teaspoon of apple cider vinegar in water about 30 minutes before meals.
- Consume high quality proteins and vegetables and avoid processed foods, added sugars and additives.
- Use a high quality salt to taste.
- Chew foods thoroughly to make them easier to digest.
- Don’t drink with meals.
- Add 1/4 cup of homemade or unpasteurized sauerkraut to each meal
- Drink ginger tea or chew a small piece of ginger between meals to stimulate stomach acid production
- Do not eat within a few hours of bedtime to allow adequate time for digestion
Having low stomach acid can affect the body in many ways. If you think you may suffer from this, find a qualified practitioner to work with to correct this problem as soon as possible.
This article was medically reviewed by Dr. Jennifer Pfleghaar, D.O., FACEP, ABOIM. Dr Jennifer is a double board certified physician and is now working in Emergency Medicine and has an office in Ohio practicing Integrative Medicine. As always, this is not personal medical advice and we recommend that you talk with your doctor.
Have you ever taken Betaine HCL? Ever struggle with low stomach acid? Share below!