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!
Discussion (89 Comments)
Hi. I’m on week 2 of the autoimmune paleo diet and suddenly have heartburn! Why oh why would the aip diet bring this on? I’ve rarely had heartburn before and only during pregnancy, occasionally after eating bananas, and when I have an upper respiratory thing going on (relates to post nasal drip I believe). Stumbles onto this article in my research. I think I may need to add betaine HCl. I just don’t understand why this diet would have brought this up. Thank you for any insights you might have or other ways to help treat the heartburn until I can get some supplements.
I have heard of this happening in some people. One theory is that it is changing gut bacteria, and another that the change in diet affects stomach acid. Either way, I found Betaine HCL really helpful when on the autoimmune diet and at other times as well…
How do you know when to stop taking it? I don’t get any stomach discomfort, but sometimes I have to go to the bathroom immediately after eating, Would that be a sign that I don’t need it anymore or at least to start reducing the amount? Thanks!
How would a vegetarian use the betain HCL test?
There’s a vegan HCL by Quantum Nutrition Labs that’s made from beets, and the (separate) activator is made from turmeric, ginger, tomato, and non-gmo natto.
I have been taking Betaine HCL for years and don’t know what I would do without it. During a particularly stressful time it seemed that I was suddenly unable to digest my food. I had a very heavy feeling after eating even the smallest meals (like I overdid the turkey dinner). I started getting a lot of heartburn and my esophagus became very raw, I belched a lot after eating and this was much worse if I drank something with my meal, and nothing seemed to move on down the digestive tract.
After having a gastroscopy, endoscopy and CT scan my GI specialist put me on acid reducing pills (Rabeprazole and Ranitidine) with no improvement. Several weeks into this problem I started into a flare with my ulcerative colitis as even my enteric coated pills were not being properly digested. This lead to my being prescribed Imuran – a drug I was not willing to consider.
I decided I had to explore other alternatives and went to see a naturopath who without any tests but my subjective experienced was able to get to the heart of the problem, low stomach acid. She assured me that supplementing my stomach acid would not made my raw esophagus worse but would help resolve the problems I was having. She started off on a few pills increasing until I reached the right dose and my problems improved overnight, my esophagus pain resolved very quickly, my bowels started moving properly and my ulcerative colitis came under control.
Several years passed and then I started into other problems (muscle and joint pain with decreased energy) which were caused by several nutritional deficiencies (B, D, C, Iron and Zinc) despite having a great wholesome diet. Those seem to be under control now however I would love to know if they were the cause or the result of low stomach acid. And so the journey to continued health continues…
Please be careful with this.I was doing well with it,then I read it should be taken with 15 grams of protein.I took it with breakfast…15 grams of protein from Greek yogurt,plus two waffles, a few almonds and kiwi fruit.Within a couple of hours I had severe diarrhea.When I took it with meat protein…and more than 15 grams,I had no problem.I just saw a site which advises to take with 15 to 20 grams protein and in parentheses says 4 to 6 ounces of meat….which is 28 to 42 grams. I think 15 grams is too little….and I wonder if pepsin is needed to digest dairy?
I am so happy I found this info. I just love your blog. So informative. This just may have been my lifesaver. I’ve been going thru multiple things and am determined to get to bottom of it. I have removed wheat from diet and after some withdraw symptoms of about a week long I niw feel better. I still have excessive bloating right after a meal so have some betaine hcl with pepin ordered. I am working with a nature path that I just found. We are communicating long distance right now until I see her next month.
2 years ago I had a surgery that removed my lower distal stomach as well as my pylorus. This surgery I had removed the main area in stomach that produced acid. No dr. Or dietician recommended any enzymes. I
I was wondering if you can take the Betaine with Pepsin capsules and put them into water and drink them instead of taking the pills? I have a problem swallowing and sometime choke on pills, especially larger ones. With Betaine pills with Pepsin you are suppose to increase the dosage until your stomach rumbles I guess, so taking 3 to 7 pills would really be a hassle. Does anyone know if you can open the capsules and place them in water and drink them without the Pepsin burning your throat?
Katie - Wellness Mama
I haven’t tried that but I would have concern with the HCL touching teeth and the mouth.
Hi to everyone,great article.
i have question about betaine hcl,i have gerd(heartburn) and helicobacter pylori ,can i take betaine hcl or not?
I dont know PH of my gut.
thnx in advance
Helicobacter pylori causes low stomach acid!
A symptom of Helicobacter pylori infection is that it neutralizes and decreases secretion of gastric acid to aid its survival in the stomach. https://en.wikipedia.org/wiki/Achlorhydria
There are several natural remedies for getting rid of helicobacter pylori worth looking into as Drs generally prescribe very strong antibiotics to get rid of it.
Okay so what if there aren’t any holistic practioners in any medical field in my state? The closest ones I know of for me are in Canada( live in Mt). Is a practitioner absolutely necessary to take betaine? I want to try supplementation with this and all the other supplements recommended on the GAPS diet because I want to cure my acne and severe hay/pollen/dust allergies (I have never tested for allergies because we cannot afford medical visits unless necessary and like I said, there are no doctors I approve of in my area or anywhere close so I am not exactly sure what substance my allergies are from- I only know that they are really bad in all seasons but winter) without completing the GAPS diet because my family has a middle- low income and my current health changes are expensive enough. I currently eat no white foods( not sensitive to dairy just hard to find good dairy here), am going to start FCLO and omega 3s- the one you recommended, eat your recommended diet, and am doing everything I can for my gut. This includes high quality probiotics, bone broth, ghee, grassfed as I can afford(MT animals are grassfed and then moved to local hay and green fodder for their finishing- I plan on buying half of a fully grassfed beef cow very soon), and use no prescription or chemical drugs. Yet my gut is attacking my face and I get week long bouts of sinus pressure that get so bad I have trouble standing up and my mental clarity becomes really poor. Oh! I do no fish(sadly) because there isn’t a good way to get fish here, lots of elk, and some pork. Plan on getting more elk and trying some game birds. So do I assume that I have a gut problem? I could have hereditary sinus problems from father if that’s at all possible? Sorry that this comment is like a book…
I have IBS no dairy or gluten no fruits or vegetables nothing spicy. I eat rice and chickens or potatoes and meat. I also have very bad acid reflux witch I treat with Nexicium. . Diaharea spelling not right is one of my really bad symptoms. These symptoms are very difficult to live with, also pain is really bad so bad it affects all parts of my life. I am afraid of going out because I never know when my symptoms will act up. Most times I spend a lot of time on the toilet sometimes hours in pain 2 3 5 hours. I am currently taking pain pills musical relaxers I have Graves disease and take synthroud spelling I also have a spastic colon. I just started taking probiotics vit D mirapex for restless leg and valium 5 mg and vesacare for urinary leakages
I have Hashimoto’s/Hypothyroidism. I use NDT –Natural Desiccated thyroid medication. Better than Synthoid or other synthetic meds. NDT is more real and organic. Low stomach acid can influence thyroid. Hope this helps! Love this website!
It is amazing how a seemingly minor alteration in our body’s chemistry can potentially result in major and sometimes life-threatening problems. The autoimmune problems mentioned as a result of leaky gut can be quite debilitating if not corrected at an early onset. Problems include severe allergies, post nasal drip, fluid in ears and excess yeast, bacteria, viruses in the body which can be downright miserable in themselves. In addition, the person often develop a persistent body odor that can be difficult to extinguish without proper oral supplementations (HCL for starters), emotional balancing and other remedies including detoxifying baths. It is great that you noticed an issue early on and prevented all the repercussions of low HCL.