Low stomach acid, or hypochlorhydria, occurs when the the parietal cells lining the stomach are unable to produce enough acid (HCl) for whatever reason.
Low stomach acid can be a significant problem since sufficient amounts are required for a number of purposes. Firstly stomach acid is required for the digestion of proteins. High acidity breaks down the bonds between protein fibres allowing proteolytic (protein digesting) enzymes to go to work to further digest protein in the small intestine. Secondly, stomach acid is needed to liberate essential minerals from food so they are present in their unbound ionic forms which can then be absorbed. This is true for important nutrient minerals including calcium, magnesium, zinc, copper, iron and selenium. Stomach acid is also required to liberate vitamin B12 from meat, its main dietary source. Finally, acid acts to sterilise the stomach, killing bacteria, yeast and parasites that may be ingested.
The symptoms of low stomach acid can mimic those of too much stomach acid so it is important to test your stomach acid production to determine whether you have too much or too little. You don't want to be taking antacids if you have too little or taking HCl supplements when you already have too much acid.
The symptoms of low stomach acid include:
- Bloating, belching, burning or flatulence shortly after eating
- Rectal itching
- Smelly gas (putrefaction)
- Skin rashes (psoriasis, acne, eczema, rosacea)
- Weak nails ( due to poor mineral absorption)
- Higher risk of food poisoning
- Bacterial overgrowth of the small intestine - Chronic Candida infection
- Mineral deficiencies
- B12 deficiency
- Food Sensitivities
Many readers suffering from unexplained chronic illnesses or who have been diagnosed with irritable bowel syndrome (IBS), chronic fatigue syndrome (ME/CFS) and the like, will recognise these symptoms, I feel it it important to describe the various methods of testing available to detect low stomach acid.
This is the most basic test for low stomach acid production. It is certainly not the most accurate but it is cheap and easy and can be performed in the comfort of your own home. The test is conducted as follows:
1. Day 1: take 1 capsule of Betaine HCl (usually 600mg) with each meal
2. Day 2: take 2 capsules with each meal
3. Continue increasing by 1 capsule per day until you feel a sensation of warmth in your stomach or until you reach seven capsules per meal
4. Reduce the ‘warm stomach' dose by 1 capsule per meal
5. Discomfort may develop later, as your body begins producing more HCl -
reduce dose by 1 capsule at a time.
The more capsules it takes to produce the sensation of warmth in your stomach, the lower your stomach's own production of acid is assumed to be. Betaine HCl capsules are widely available from health stores and are relatively inexpensive.
N.B. This test should not be performed if there is evidence of stomach ulcers or gastritis.
Home Testing with Samples Sent to a Lab
Salivary Vascular Epidermal Growth Factor Test
The basis of this test is that vasuclar epidermal growth factor (VEGF) is required to help hold the parietal cells of the stomach lining closely together so that hydrogen ions that form stomach acid do not leak back through the stomach lining. Research has shown that the more stomach acid that is produced the more VEGF is also produced. Levels of VEGF in the saliva seem to correlate well with the amount of stomach acid being produced. The test procedure is as follows:
1. A saliva sample is produced at least one hour after a meal and at least 15 minutes after drinking soft drinks, tea or coffee. A break of 24 hours after alcohol ingestion is needed. (24 hours also needed after any proton-pump-inhibitor drugs are used and ideally any drug that interferes with stomach acidity) 2. Put 1-2ml of saliva into the test tube supplied 3. Post to the lab and wait for the results
This test was developed by Dr. John McLaren Howard, is produced by Acumen and the only place I can currently find it available from is Dr. Sarah Myhill's website (http://www.drmyhill.co.uk/test.cfm?id=96).
Heidelberg Stomach Acid Test (pH Gastrogram)
This test requires you to visit a clinic or lab. It is likely to be the most accurate measure of stomach acid production but the most time consuming and expensive. The test was developed at the University of Heidelberg in the city of Heidelberg, Germany. The Heidelberg test involves swallowing a pH monitoring device that transmits information about the level of acidity in your stomach back to a computer that a clinician can review. The pH monitoring device is similar in size to the average nutritional supplement capsule so is easy to swallow and nothing to worry about. The test procedure is as follows:
1. Fast overnight (at least 8 hours)
2. Arrive at the clinic/lab and swallow the pH monitoring capsule
3. A small electrode will be placed on your stomach to pick up signals from the capsule
4. You will be asked to recline on a bed for 30-40 minutes
5. The capsule can be removed by pulling it back out of your mouth using a small string attached to it or you can simply pass it in your next bowel movement.
6. A doctor will print a graph of the capsules pH readings as it sat in your stomach and discuss the result with you.
So as you can see having adequate stomach acid levels are vital to digestive and systemic health and there are a number of approaches to testing. The approach you take may well depend on cost and whether you can attend a clinic/lab. The HCl challenege is a good initial screen but if you are unable to resolve your symptoms by following the instructions and using betaine HCl supplements you should consult a doctor of nutrition professional for further advice and perhaps testing.