Hypochlorhydria – the root of your leaky gut issues
Low stomach acid (hypochlorhydria) is the most common GI condition in the US. In fact, it can be the root cause for almost ALL digestive conditions. The majority of people with IC and bladder issues and chronic UTI’s have low stomach acid. If you have autoimmune disease, bladder or digestive issues, food allergies and intolerances or gastric reflux, GERD, dyspepsia, or any other chronic condition, this blog is for you!
Why is stomach acid important?
Stomach acid is made of HCL and has many important functions. These include breaking down proteins into amino acids and other nutrients your body needs; signaling the pancreas and small intestine to make digestive enzymes and bile needed to further digest your macronutrients, kills pathogenic bacteria, parasites and yeast from food and preventing them from entering systemically (Priest, 2017). Age decreases the production of stomach acid, which can lead to digestive and autoimmune issues as you age. In fact, gut issues are often linked to brain inflammation, which is why you often hear functional practitioners use the term “heal your gut, heal your brain” (Priest, 2017). HCL is needed for protein digestion by activating pepsin, which is why many people with low levels will have maldigested stools. It can also activate intrinsic factor, which is key for B12 absorption (Jockers, n.d). It can stimulate the delivery of bile and enzymes to help with fat digestion. Fatty stools? Check HCL.
Hypochlorhydria has detrimental health effects with long-term use, including autoimmune disorders. “HCL plays a key role in many physiological processes; it triggers intestinal hormones; prepares folate and B12 for absorption; and is essential for the absorption of minerals, including calcium, magnesium, potassium, zinc, and iron. Lack or suppression of HCL has been associated with increase in osteoporosis; bone fractures; and impaired absorption of B12, iron and magnesium” (Kines & Krupczak, 2016). HCL also prevents the overgrowth of pathogens in the upper GI tract, so hypochlorhydria can be a risk factor for SIBO. HCL is also responsible for breaking down dietary proteins aiding in the prevention of food allergies associated with incomplete digestion of protein.
Does acid reflux mean you have too much stomach acid?
Many people mistakenly think that acid reflux is from too much stomach acid. This is far from the truth, since it is very rare for someone to have too much stomach acid. “It is epidemic for people to have too little stomach acid” (Priest, 2017). In fact, using medication like Prilosec, Zantac, and Pepcid can actually worsen your problem by completely eliminating stomach acid production, worsening your GI and leaky gut issues over time. In fact, these medications can contribute to osteoporosis, nutrient deficiencies and heart disease. Proton pump inhibitors (PPI’s) are the top 10 most common prescribed drugs in the world for treatment of GERD and peptic ulcers (Kines & Krupczak, 2016). “New evidence, particularly with extended use, has revealed a decrease in absorption of some key vitamins and minerals, gut dysbiosis, rebound stomach acid hypersecretion, increased reflux-like symptoms, and hypergastrinemia. Hypergastrinemia may be associated with an increased risk of stomach cancer” (Kines & Krupczak, 2016)
So, what is causing the reflux?
According to Preist 2017, it all boils down to keeping the esophageal sphincter tightly down to prevent reflux or backflow of stomach contents into the esophagus. Poor digestion of food from too little stomach acid and enzymes slows digestion and stomach emptying. Not enough stomach acid increases intra-abdominal pressure (IAP). The pressure in the stomach then pushes against the lower esophageal sphincter causing it to not be able to keep a tight seal. Even small amounts of acid moving into your esophagus cause significant pain and burning since the esophagus is not protected from the pH of stomach acid like the stomach lining. This describes the mechanism behind heartburn that occurs with meals, or shortly after eating, however over time, the sphincter can weaken causing more consistent heartburn unassociated with a meal. When untreated, long-term reflux can damage the esophagus (Priest, 2017). Despite hypochlorhydria being responsible for or contributing to almost every GI related issue, it is relatively straight forward to treat. According to Preist (2017), it often requires supplemental HCL and digestive enzymes while making important dietary changes. “This combination helps the body maintain adequate levels of HCL on its own over time, therefore requiring less and less supplemental HCL” (Priest, 2017).
Here are some common symptoms of low stomach acid:
- Heart burn
- Lack of hunger upon waking
- Burping after meals
- Bloating after meals
- Chronic constipation
- Kidney stones
- Weak nails
- Thyroid issues
- Undigested food in your stool
- Red urine after eating beets
- Chronically acidic urine pH even when eating alkaline diet
- Foul breath
- Acid reflux
- Hiccups after meals
- B12 deficiency
- Elevated homocysteine levels
- Fatigue after meals
- Feeling full but still hungry after meals
- Bad body odor
- Rectal itching
- Hair loss
- Dry skin or dandruff
Some blood work associated with hypochlorhydria include (Jockers, n.d.)
- Low chloride levels on blood work
- Abnormal serum protein (under 6.9 or over 7.4 g/dl) and serum globulin levels (under 2.4 or over 2.8g/dL)
- Low phosphorus levels along with vitamin D deficiency
- High BUN of 20 or higher
- Abnormal MCV/MCH/MCHC
- Low serum iron levels
- Low serum or RBC B12 levels
Conditions associated with low stomach acid:
- Chronic UTI’s
- Chronic Candida
- Chronic pain
- Adrenal dysfunction
- Multiple food sensitivities
- Leaky gut
- SIBO and poor vagal nerve function
- Gallbladder issues
And the list can go on……….
Here is a simple and inexpensive test to see if you have low stomach acid. Keep in mind this test is not 100% accurate, but it can give you some feedback.
SIMPLE AT HOME BAKING SODA TEST
Mix ¼ tsp of baking soda in 4-6oz cold water firsts thing in the morning before eating or drinking anything.
Drink the baking soda solution
Time how long it takes for you to do a big juicy burp. If you have not burped in 2 minutes you have relatively low stomach acid. If at 5 minutes you have not burped, you definitely have low stomach acid.
LAB TESTING FOR LOW STOMACH ACID
A Heidelberg stomach acid test can be performed by a medical doctor, but it can be expensive and invasive. But just wanted to mention you can always take that route if you wanted. However, there are other less expensive methods. Also, if you have any of the conditions listed above, you can just assume you have low stomach acid!
HCL TESTING for LOW STOMACH ACID
The HCL challenge test is a great way to determine if your stomach acid is low and has the huge benefit of actually treating the low stomach acid, while obtaining information from the challenge. I strongly recommend doing this with a practitioner as there are times it is not appropriate to do and you need to be able to dialogue with an experienced person regarding your experience. The challenge consists of starting with 1 capsule of Betaine HCL (usually with Pepsin) at a meal and noticing if you feel anything after the meal such as a different type of burning sensation than heartburn, a heaviness in your stomach or chest, or even nausea. If after 1 capsule you do not feel anything, you likely have low stomach acid. The treatment begins by increasing the dose by 1 capsule at each meal until symptoms are experienced. Again, this increase needs to be done with a practitioner to make sure that you have some clinical direction. Most people will have to repeat this test 2-3 times in order to ensure you are not getting a false positive. Many people will need a significant amount of supplemental HCL for a short amount of time to replete low levels.
So, you think you have low stomach acid. What can you do? Here are some suggestions.
- Drink Celery Juice every morning. Start each day with 1 head organic celery, 1 organic lemon (chopped and seeded), 1-inch cube fresh ginger root (chopped). This combination has many benefits, such as stimulating gastric acid, eradicating Candida, and also will help with making your bones stronger.
Here is a great link that explains the benefits of stomach acid (Wittwer, 2018)
- HCL with pepsin taken with meals-Once you figure out the amount of HCL that gives you the warm symptoms, burning, hotness, or heaviness, you should back off dose by 25% and that is your dose to take with meals. If you start getting that warm feeling on that dose, back off another 25%. That is a good sign of restoring HCL in your gut. You can eventually back off until you may no longer need them. “Supplemental HCL is used in a progression until symptoms indicating sufficient levels of stomach acid occur” (Priest, 2017).
WARNING- If you have H pylori or gastritis, you will have to eradicate the bug down to non-detectable levels and heal the intestinal lining before using HCL because it could irritate it more. If that is the case, add in healing things such as cabbage juice, bone broth, L-glutamine, slippery elm bark, DGL, pure aloe vera (Wittwer, 2018). I love the pure aloe vera by Stockton aloe, it has been transformational for the healing the GI tract of my clients. For more information, check out the links below.
Check out this YouTube video interview: https://www.youtube.com/watch?v=dQaWBAwGVHE&t=366s
Here is a link where you can order a 2 – pack and get a free bottle of cream
- Other digestive support
Digestive enzymes with meals are the best strategy to ensure your food breaks down to its particles so it can be absorbed. I like Trienza by Houston Enzymes. It is a broad-spectrum enzyme that supports digestion of gluten, casein, soy, proteins, carbs, fats and polyphenols. It also includes DPP IV to support the digestion of gluteomorphin from gluten and casomorphin from casein. It also includes all the enzymes for protein digestion from AFP Peptizyme. It also includes enzymes for carbohydrates, starches, proteins, and fats. Includes some xylanase for fruits and vegetables high in polyphenols.
Here is the link for this enzyme: https://amzn.to/2RaY0aY
Digestive bitters- These are great for gas and bloating, by taking them before you eat to ignite the digestive fire, support the production of hydrochloric acid, pancreatic enzymes and bile, and help ensure normal bowel habits. And the bitter roots such as dandelion help keep the valve at the bottom of your throat closed tight, so occasional heartburn becomes a thing of the past.
Here is the link for the bitters: https://amzn.to/2BCYL2N
Probiotics– One of the most effective way to improve HCL production is probiotics. Probiotics do not directly make more stomach acid, but they can increase the numbers of beneficial bacteria to aid in the body’s ability to produce ore of its own gastric acid and enzymes. This can improve overall digestion and takes the pressure off of the esophageal sphincter to keep it shut. Also improving the diversity and increasing good bacteria is crucial (Priest, 2017).
Hands down the probiotic I recommend is Megaspore spore forming and antioxidant combination. My clients have had great success with this ranging from decrease in food allergies and intolerances, improved immunity, less digestive troubles, and overall improved digestion. You can order this here https://naturalhealthachiever.com/blog/store/?model_number=Megaspore-Probiotic-
- Other strategies to improve stomach acid. Jockers summarizes this nicely, so I want to list out his suggestions here to save time from you scanning another blog.
- Try to juice your nutrition or juice througout the day
- Use ginger. My anti-inflammatory drink is a hit- I juice fresh ginger, turmeric and manuka honey in a dairy alternative like pea milk or coconut milk. It quenches inflammation fast. Ginger is also great in veggie stir fry dishes with coconut aminos
- Drink water all day
- Do not drink much water with meals that contain meat
- Do not drink water after a meal
- Use lemon and apple cider vinegar. You can add them in your celery juice
- Eat protein at the beginning of the meal so it hits your stomach first for digestion
- Use fermented veggies or drinks
- Eat ONLY when you are relaxed
As my friend Rebekah says, “Nothing will work right if your stomach doesn’t. It all begins there. Fixing it is imperative to health and well-being” (Wittwer, 2018).
Jockers, (n.d.) 5 Ways to Test Your Stomach Acid Levels. Retrieved (2018, December 22nd) from https://drjockers.com/5-ways-test-stomach-acid-levels/
Jockers, (n.d.) 10 Ways to Improve Stomach Aicd Levels. Retrieved (2018, December 22nd) from https://drjockers.com/10-ways-improve-stomach-acid-levels/
Kines, K., & Krupczak, T. (2016). Nutritional Interventions for Gastroesophageal Reflux, Irritable Bowel Syndrome, and Hypochlorhydria: A Case Report. Integr Med (Encinitas), 15(4), 49-53.
Preist, C. (2017). A Functional Medicine Approach to Low Stomach Acid. Retrieved (2018, December 22) from https://www.lifeworkskc.com/low-stomach-acid/
Wittwer, R. (2018). The Mother of All Problems. Retrieved (2018, December 22) from http://pantrypharmacy.com/2018/12/18/the-mother-of-all-problems/