Heartburn’s Evil Twin: Hypochlorhydria

Those of us who have experienced the relentless burn of acid shooting up the throat, most often after eating chocolate cupcakes or a big greasy burger, know that the term “heartburn” is woefully accurate. The most common medical explanation says that heartburn comes from an excess of stomach acid. In some cases, however, your heartburn and other tummy troubles could actually stem from the opposite: too little stomach acid.

Hypochlorhydria is when the stomach does not produce enough hydrochloric acid to complete basic digestive functions. If you have issues with constipation, digestion, bloating, or gas, you may be experiencing side effects of hypochlorhydria.

Functions of gastric acid

  1. Digests proteins from food. Your body will not function properly if you cannot utilize the essential proteins from food.
  2. Absorbs crucial micronutrients. This includes trace elements such as magnesium, calcium, boron, copper, iron, and selenium. Vitamin B12 absorption also requires an adequate level of gastric acid.
  3. Empties the stomach. When the stomach does not empty correctly, a common side effect is heartburn or acid reflux.
  4. Sterilizes stomach contents. We often ingest harmful bacteria and yeast when we eat, and gastric acid is the body’s primary defense mechanism against these microbes. Without sterilization we are more susceptible to infection. Sterilization also prevents microbes from growing in the stomach. Gas and bloating can be caused by food fermenting in the stomach due to an overgrowth of bacteria and yeast.

Symptoms of hypochlorhydria

There are several problems that hypochlorhydria can contribute to. Remember to take this information with a grain of salt—many common maladies are much more complicated than checking off a symptoms list. You may have low stomach acid by itself, you may have low stomach acid in addition to other dysfunctions, or you may have something else entirely.

  • Irritable bowel syndrome. This is catch-all term that doctors apply to anyone with a poorly functioning digestive system.
  • Asthma. A correlative link has been documented between childhood asthma and hypochlorhydria [1].
  • Gas and bloating. When gastric acid is low, food may ferment in the stomach which causes excess gas.
  • Iron deficiency anemia. Iron from food cannot be properly utilized when gastric acid is low.
  • Low levels of B12. Adequate gastric acid is required for absorption of the critical vitamin B12.
  • Yeast infections. Some practitioners claim that hypochlorhydriacs are prone to yeast overgrowth not only in the stomach but in other parts of the body.
  • Allergies. Poorly digested food may mean that ingested allergens make their way into the lower gut where an allergic reaction can occur.
  • Acne. Skin dysfunction may occur either due to malabsorption of required nutrients or chronic microbe overgrowth that manifests in the skin.

Diagnosis of hypochlorhydria

Hypochlorhydria is not something that your typical MD will diagnose or even know much about. If you really want an official diagnosis, you would need to find a gastroenterologist willing to administer the costly and invasive Heidelberg test. As there is not a prescription treatment for hypochlorhydria, even an official medical diagnosis will not exactly pave the way to recovery. This is why many people self-treat the condition using their symptoms and overall well-being as a guide.

Treatment of hypochlorhydria

The basic treatment of hypochlorhydria is to acidify the stomach environment and to add other elements that help the stomach and intestines properly digest food.

Gentian bitters. Gentian bitters stimulate the production of gastric acid and digestive enzymes. This can be used on its own or to supplement Betaine HCl. Mix a few drops of Nature’s Answer Gentian Root in water after each meal.

Pepsin. Works in conjunction with stomach acid to digest protein. Should only be taken in a combined formula with Betaine HCl.

Betaine HCl. This is most direct way to support the stomach’s digestive capacity. You will have to figure out how much to take with each meal, though you should never take more than 3500mg in one sitting. A general rule of thumb: you have taken too much if you experience a burning sensation or acid reflux. I personally do well on roughly 1000mg with each meal. Start out with one or two capsules per meal of NOW Foods Betaine HCl with Pepsin. If you still experience gas and bloating after a week or two, increase your dose.

Digestive enzymes. These are great for people who are not getting the results they want from Betaine HCl alone. Your body may not be naturally producing these enzymes that help completely digest your food. My favorite is Source Naturals Daily Essential Enzymes which contains a broad spectrum of enzymes.

If you want to combine these methods in one shot there are a couple combination formulations that I recommend. An easy one to start out with is Doctor’s Best HCl Formula which combines Betaine HCl, pepsin and gentian bitters. Another great choice is NOW Foods Super Enzymes which contains Betaine HCL with pepsin and digestive enzymes.


[1] Bray GW. The hypochlorhydria of asthma in childhood. Q J Med 1931; J Nutr Med 1990; 1:347–60.

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