Acid Reflux, GERD: Too Much or Too Little Stomach Acid?

How many people that have been diagnosed with acid reflux, heartburn, GERD; or those experiencing  a “lazy gut”, a “heavy gut”, abdominal bloating and cramping on a regular basis, do you think have ever been told that their symptoms are possibly the result of a LACK of stomach acid, and NOT AN EXCESS of stomach acid.  In my experience, none of them have ever been informed of, or entertained this possibility.  On the advice of a television commercial and what most others (the herd) are doing for the same type of problem, these people are often taking over-the-counter antacids or prescription proton pump inhibitors (PPI’s) with the specific intent of reducing the levels of stomach acid.  The choice to purposefully reduce stomach acid, aside from being terribly misinformed, can and often does have devastating consequences to one’s overall health and to the digestive system as a whole. 


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Signs and Symptoms of Hypochlorhydria (low stomach acid):

There can be an endless list of digestive and other symptoms associated with decreased stomach acid, which include but are not limited to the following:

  • Bloating
  • Gas, especially after meals
  • “Heavy” gut even when eating small meals
  • Inability to handle/digest red meat
  • Heartburn, indigestion, reflux
  • Undigested food in stools
  • Constipation
  • Nausea
  • Intense Hunger
  • Abdominal cramping
  • Foul smelling gas and bowel movements (especially in the morning)
  • Halitosis, bad breath
  • Acne
  • Headaches
  • Rosacea
  • Depression
  • Vitamin and mineral deficiencies
  • Skin issues
  • Chronic hepatitis
  • Diabetes
  • Thyroid conditions
  • Childhood asthma
  • Autoimmune issues

Let us examine what physiology has to say about all of this.


The Importance of HCl (hydrochloric acid)

It is difficult to overstate the importance of HCl in human physiology.  HCl is secreted by the parietal cells in the stomach. It sets the stage for optimal protein digestion and sets the proper pH of the stomach for the rest of the digestive system to work properly.  The digestive system is very much a pH determined system.  When food passes into the bottom of the stomach, the parietal cells are triggered to secrete HCl.  In order for pepsin/pepsinogen, key enzymes for protein digestion, to be released, the stomach needs to have an acidic pH.   If the pH of the stomach is too high (due to a lack of HCl) protein will not be adequately broken down into the necessary, smaller peptide chains.  This leads to poor protein digestion, malabsorption, and possibly, if this goes uncorrected, putrification of the protein.  As well, the pH of chyme (stomach acid, other gastric juices, and food) that enters the first portion of the small intestine, called the duodenum, will signal the release of cholecystokinin (CCK) and secretin.  These two substances relay information to the pancreas and biliary portion of the liver about the level of undigested food (particularly fats and protein) in the chyme.  If stomach acid levels are low, CCK will not be optimally triggered.  As a result, further digestion of undigested protein, fats, and carbohydrate will not occur.  The result will be large amounts of undigested food passing into the intestines.  This will contribute to disturbing the balance of intestinal flora and create an environment that favors autointoxication (toxifying from the inside-out).  In addition to all of that, as if that was not enough, if chyme is not acidic enough it will also not “clear” the stomach in a timely manner. The longer it sits in the stomach; it can begin making its way back up the system and produce “heartburn” and “reflux” type symptoms.  Isn’t that interesting?    

Another key role of HCl is mineral absorption.  Optimal HCl levels are a necessary component for the absorption of all minerals.  Many minerals require adequate HCl to separate the mineral from the food in order to be most effectively and efficiently absorbed.  There is significant evidence to suggest that hypochlorhydria (low stomach acid) can lead to multiple mineral deficiencies. In particular, research on long-term PPI users demonstrates the presence of severe magnesium deficiency.  (The specific role of PPI’s is to wipe out large amounts of stomach acid).  Magnesium is one of the most protective and important minerals in the body, particularly when it comes to protection from the biological activity of excess estrogen.  A deficiency is clearly not good for overall health. 

In addition to its major digestive importance, HCl also has a role in immunity.  The level of stomach acidity can also serve to protect us from foreign invaders that may enter through our food supply in the form of viruses, bacteria, parasites, yeast, fungus, molds, etc. 


Potential Causes of Hypochlorhydria

In order for the stomach to produce adequate levels of stomach acid (HCL), there must be sufficient chloride, sodium, thiamine, and zinc.  Zinc deficiencies are very common because most diets are often deficient in the nutrient.  Many people are mistakenly on a “low sodium” diet for one reason or another and lose high amounts of chloride and sodium through the sweat.  As well, adequate protein intake is necessary to stimulate HCl production in the stomach.  As such, low protein diets can result in diminished HCl levels.  Of course, the regular administration of bicarbonates, acid blocking drugs and antacids are huge roadblocks for optimal HCl production. There is also research to suggest that the stomach bacteria H. Pylori appears to have an inhibitory effect upon the production of stomach acid.  Whether or not this relationship is causal has been a topic of debate amongst the scientific and functional medicine communities.  Many believe that we simply produce less HCl as we age.  I would ask, is it aging that decreases HCl production, or is it what we put into and do to our bodies as we age that leads to the decline in HCl production?  Food for though I guess. 


Identifying HCl Deficiency

The most effective and definitive way to assess HCl status is through the Heidelberg pH capsule test. This particular test is a bit invasive, which is why so few have it done.  Basically, after swallowing a radio transmitter capsule that is about the size of the average B-complex vitamin, it measures the resting pH of the stomach.  The physician will then introduce a baking soda challenge (which is very alkaline).  By observing how quickly and efficiently the stomach returns to an acidic state following the baking soda challenge, the physician can determine whether or not the individual in question is producing adequate amounts of HCl.  Like I said, it is a little invasive.

There are practitioners of various types who recommend an HCl Challenge Test to assess HCl status.  This is a misguided effort in my experience.  That particular assessment does not actually assess HCl status.  Rather, it would be a reflection of the integrity of the mucosal barrier of the stomach, which is great to know, but offers little information about HCl production status.      

If one is experiencing reflux type symptoms during and after meals, consider trying the following:  take a teaspoon of lemon juice (preferably organic and freshly squeezed but, hey, do the best with what you have) about 5 minutes before, in the middle of, and immediately following your meal.  If your reflux symptoms improve to any degree, there is a good likelihood that your symptoms are the result of hypochlorhydria (low stomach HCl) and not due to too much stomach acid!

Hypochlorhydria can also be assessed indirectly through a correlation of symptoms and through a simple blood chemistry and/or Hair Tissue Mineral Analysis (HTMA).  Lab values of interest would be sodium, chloride, carbon dioxide, BUN, anion gap, ALP, gastrin, MCH, MCV, globulin, total protein, phosphorus, and others.    


“Fixing” Hypochlorhydria

There are many individuals that use supplemental HCl to help restore optimal levels.  While this is a potentially effective short-term solution and may bring about some positive results, a far better strategy in my opinion is to support the overall physiology of the individual in question.  Remember, digestion is one of the first things the body will begin to sacrifice health wise in order to ensure short-term survival.  So, if one is “stuck” in a chronic stress response at the cellular level – coming out of that with a sound nutritional strategy to support cellular oxidative metabolism will allow the body to up-regulate digestive capacity on its own.  I have seen individuals receive no relief at all from HCl supplements and others do quite well on them for a while.  Long-term, however, supplementation has its limitations and drawbacks.   

There are things that can be included in the diet that may help to improve HCl production.  Salt is one of those things.  Salt is a potent HCl stimulator.  Drinking a glass of luke-warm or room temperature water with some white, sea salt or Morton’s Pickling salt in it about 15-20 minutes prior to a meal can prove to be beneficial for HCl production and digestion as a whole.  How much salt depends on the individual in question, how much s/he typically salts their food, what the salt intake has been like over the past few months to a year, overall water metabolism, etc.  I have seen some individuals do well on ¼-1/2 teaspoon of salt prior to meals in this fashion.  Every BODY is different. 

One could have his/her zinc status assessed with laboratory assessment, HTMA, or with a zinc challenge test.  If zinc levels are sub-par, restore zinc levels as soon as possible and that will significantly improve HCl production.

It should be obvious that low HCl, hypochlorhydria, has negative health effects that far exceed the digestive system.  Supporting overall physiology with digestible foods, eaten in the proper ratios and at the right frequency is a great strategy for helping the body upregulate HCl production and overall digestion.

Thanks for reading!

 Recommended Reading and Study:

  1. Digestive Wellness by Elizabeth Lipski, PhD., C.C.N
  2. Restoring Your Digestive Health by Jordan Rubin, N.M.D.
  3. Textbook of Functional Medicine (2010) written by many very smart people
  4. Blood Chemistry and CBC Analysis by Dicken Weatherby, N.D. and Scott Ferguson, N.D.
  5. Clinical Ecology by Lawrence Dickey, M.D.


Author’s Note:  This post/article, and any other for that matter, is not intended to replace proper medical advice.  If you suspect an issue, speak with the appropriate licensed medical professional. 


Disclaimer:  I am a C.H.E.K. Practitioner and Holistic Health Practitioner, not a medical doctor.  Services are rendered to engaged members and clients only.   I do not diagnose, prescribe for, treat or claim to prevent, mitigate or cure any human diseases. I do not provide diagnosis, care, or treatment of individuals.  I do not prescribe prescription drugs nor do I recommend you to discontinue them. I provide my opinion on how to use food and movement to foster health and wellness to support optimal physiology and to nourish and support normal function and structure of the human body-mind.  I allow what I feel ‘Creative Energy’ to flow through me.  If you suspect any disease, please consult your physician.

Statements have not been evaluated by the Food and Drug Administration. They are not intended to diagnose, prescribe for, treat or claim to prevent, mitigate, or cure any human illness or disease. They are intended for holistic health education only. The FTC requires that you be informed that the results in case notes and testimonials given are not typical, however, they do show what some individuals have been able to achieve.

Individuals vary, which is why it is important to always consider the whole person when recommending any course of action.  If you suspect a medical condition, you should consult a physician.  No attempt should be made to use any information provided as a form of treatment for any specific condition without the approval and guidance of a physician. Anyone with any health complaint should seek the care and consultation of an appropriate licensed healthcare physician and/or practitioner.




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