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!
FODMAP and IBS – A Scientific Solution
I was prescribed Betaine HCl many years ago by my naturopath, which I have taken intermittently. My concern is that it is from a porcine source (pigs). I’m concerned about the quality of the source and the treatment of the animals. Katie, do you know anything about the quality and treatment of the animas in the brand that you linked to? I looked up a few brands but none claimed to be from pastured, humanely treated animals. Thanks.
Premier Reasearch Lab’s HCL activator and HCL are animal free!!
I’ve been using Premiere Lab’s HCL activator and HCL for the last 6 weeks while on a very strict AIP diet. My energy level went up once I used the activator during a high protein meal and the HCL right after. This is a wonderful benefit for me, because this lifestyle can be exhausting at times. I ordered on Amazon after my supply from my practitioner was gone. Not pricey and I believe that the activator really helps!!
Thanks for mentioning your experience with the Activator! I have been taking Premier Research Lab’s HCl for years, and I depend on it. I have never tried it with HCL Activator, and I’d like to try it now.
For those who do experience the slight burning, drink lots of water!
Are you talking about Dr Bob Marshall’s products?
I’m taking 9 hcl pills per protein meal and no burning still. I’m on a meat only diet right now bc anything else causes extreme bloating…..is this an excessive amount to take?
I’m confused with the test. It states early burping indicates low stomach acid. Stop testing after 5 minutes. Any burping after 5 minutes indicates low stomach acid. Am I looking for early or late burping…or maybe it’s any burping?
If you burp within the first 3 minutes of the test, your stomach acid is not low. If you burp after the first 3 minutes, your stomach acid is low. If you haven’t burped within 5 minutes, stop counting, since it’s pretty clear your stomach acid is low.
I keep rereading this and I see if I burp I’m low if I dont burp I’m low…I’m missing something.
I just got it. The 1st 3 minutes if I burp its good. Anything other than that I’m low. I never burped so I guess I’m low.
i burbed (belch like) at 2 minutes and ALSO at about 7/8 min. So what does that mean?
It means you are fine and don’ t have low acid.
I know people do not realize that they need more stomach acid, they think it is the opposite when they have heartburn. Thanks for the information. I will be sharing this very informative.
I think that it is more related to sphincter function, intestinal motility and constipation with gas production.
It is the gas that usually pushes the stomach acid up through the esophagus. It does not matter if it is too much acid or too little, most adult people produce enough stomach acid to cause a heartburn but that doesnt mean they produce enough to digest food properly.
Here is some data http://www.psoriasisdietplan.com/2014/05/gerdacid-refluxheartburn-low-stomach-acid-or-too-much-stomach-acid/ on stomach acid and Betaine HCL supplementation.
Very interesting article. I’m glad I read it & will use the natural remedies rather than taking the supplements. I was surprised I already did the acv in water without knowing it was good for stomach acid.
I have hypothyroid and Hashis and I am on Betaine HCL. I initially felt so sick to my stomach taking it. My chiropractor/ nutritionist NEVER told me to take with protein only to make sure to take with food. Since I read your post I am happy to say I can ” stomach” ( pun intended) it now that I always take after eating protein. Thanks Katie!!!
I have taken betain with pepsin before. It seemed to cause acid reflux, but I never felt any warmth in my belly. I was not too serious about it but should try it again.
I also wondered if you know of any women who are over 40 who have successfully managed to lose weight after changing their diets, etc. I’m feeling rather discouraged :/
Totally love your site btw 🙂
I’m in my 50’s and lost weight doing an allergy elimination diet. I didn’t restrict eating, just changed my choices and I lost 10 pounds without trying. It’s hard to follow through as it takes time, but is worth it in the long run because you find out what’s ticking off your body.
A colleague of mine follows Joel Fuhrman’s “Eat to Live”. She lost 35 pounds switching to a vegan 50% raw diet.
Michele, I am 72 and have been over weight all of my life. Plus had knee pain. My Chiropractor, who is a health advocate, suggested that I try eating Gluten free for a while and see how I felt, telling me the undigested gluten can cause inflammation. So I thought, what the heck may as well give it a try. She gave some really good recipes, which is how I found this web-site, I had tried so many diets, with no avail, and had totally given up on loosing weight, but after eating gluten free, my weight has slowly come off. I started in August, and now I am 30 lbs lower that I was. My energy level has never been better, the pain in my knees is about 90% better (still have a small amount of discomfort going up or down the stairs) I wish I had known about this many years ago. I don’t count calories, but have given up all processed foods, and vegetable oils except Olive Oil. I also use Coconut Oil and Raw Butter. It has helped me so much! You may want to consider giving it a try.
Read about resistant starch and weight loss at freetheanimal.com they have had great success with losing weight while increasing resistant starch to feed your gut bacteria. Extremely interesting and worth the read.
I am not a woman but I lost 35 pounds in 6 weeks doing the GAPS diet. My wife has lost 15 pounds just because she eats less carbos these days. We did not expect this, but it was a pleasant by-product of my GAPS diet.
Interesting. Though the test sounds painful, just the idea of waiting for a burp. Anything that would make me burp just makes me sick, I get that pressure build up but just can’t release it. Makes my chest hurt. Wonder if that’s a problem all of it’s own.
Wow… Thank you sooooo much for posting this. I am 22 and I have always drank with my meals, since no one told me otherwise. I also eat all night because I have raging hunger then. Recently my adult acne has gotten worse and I figured it was just stress related since any little amount sends me over the deep end. A while back, my cortisol was through the roof and I was having PMDD symptoms full swing. After supplementing with adrenal support vitamins, my energy level increased and I was able to go to bed and wake up on time. I guess my adrenals were shot, and I’m pretty sure this is why. Wellness mama, you’re the best!
I have Hypothyroidism; low stomach acid is just one of the myriad of symptoms experienced by those suffering this disorder.
Hydrochloric acid or HCL is made by the parietal cells (part of the stomach physiology,) alongside HCL something called Intrinsic Factor (IF), is also manufactured. Where you find HCL you also find IF. IF is essential for the absorption of Vitamin B12. So if there is low HCL there is low IF and therefore, the body fails to absorb B12; B12 deficiency is another common symptom of Hypothyroidism.
Vitamin B12 deficiency is known as Pernicious Anaemia, a very serious disorder. Oral supplements of B12 will not be properly absorbed therefore, sublingual supplements or better still intramuscular injections are recommended.
Commonly those with low levels of HCL will be diagnosed as having too much HCL and given or take ‘antacids’. Taking additional HCL will enable the body to absorb more nutrients from a healthy diet and ensure the levels of Vitamin B12 are not deficient.
Thank you for the additional information. I had been diagnosed with Hypothyroidism then Hashimoto’s. I have been taking thyroid medication for years. Now I am working with functional medicine practitioner (I am feeling better and my blood work is getting better). He suggested I take 2 different B Vitamins (I don’t have them with me now, at work so I don’t recall which B Vitamins). And I am taking 2 different B Vitamins on my own. It helps to know that some of the issues you mentioned above could be due to the Hypothyroidism.
I’m taking 20 650 mg pills and feel nothing. I’m so concerned. I’m 26 and have had some dry skin, keratosis pilaris and acne, now mild due to diet changes, since puberty. It would make sense that I have low stomach acid and even low bile due to antibiotics and phytate consumption, but jeeze. I can’t believe it’s this low to need so many pills?
Hi! I’m trying to make sense of this too. I take about 18 453 mg of HCL and I don’t feel anything. Have you figured out your situation? Any advice would be great. Thanks
Hi there! So, I was up to about 20 or 18 pills, but felt fearful that I could damage my gut and that I shouldn’t be taking that much. So, I just reduced it to ten. My thinking was that, even though I wasn’t necessarily feeling the burning sensation, there was still acid that I was adding and it was digesting something. I also added ox bile to my meals with fat and after about a month or two, I feel that my digestion improved. I can’t remember exactly what happened, but I think I eventually was feeling the burning at 10 and then less and less pills. I think I was just then taking a maintenance dose of 4 pills with each meal. More is not better. I hated when I would get an acid burp feeling in my chest and throat, like heartburn. I started to get that at even low doses of pills. So, I knew I then had good enough acid. I think dandelion tea helped me too. It’s tasty and worth a shot. Good luck ~ Crystal