Do you often experience indigestion, heartburn, or heartburn? We often think that these are caused by too much stomach acid or gastritis. But did you know that even if there is not enough stomach acid, that is, low acid, these symptoms can also occur ? That is what we medically call hypochlorhydria. Simply put, this means that the production of hydrochloric acid (HCl), the main acid in your stomach, is reduced. So, today we will talk about this in more depth.
What is hypochlorhydria?
Simply put, hypochlorhydria is when your stomach doesn't produce enough hydrochloric acid (HCl). Hydrochloric acid is the main and strongest type of acid produced by our stomach. It is important for our digestive system as well as our immune system.
Think about it, this acid helps the food we eat, especially proteins, to be properly broken down and digested. It is also essential for the absorption of nutrients that our body needs, for example, vitamin B12 and iron. Another thing is that this acid also helps to control harmful bacteria and viruses that enter our stomach with food, and protect the stomach from infections.
So, if you have hypochlorhydria, you have difficulty digesting food properly, especially protein. Over time, this can lead to serious nutritional deficiencies . Not only that, but you are also more likely to get various infections. These infections can further damage your stomach and entire digestive system.
What is the difference between Hypochlorhydria and Hyperchlorhydria?
These two words are somewhat similar, so they can be confused. For example, "Hypo-" means "less." "Hyper-" means "more."
That means:
- Hypochlorhydria is a condition in which the stomach produces too little hydrochloric acid (HCl).
- Hyperchlorhydria is the excessive production of hydrochloric acid (HCl) in the stomach.
Many people in our country, when they experience symptoms of stomach inflammation and gastritis, think that the cause is increased stomach acid, which is called hyperchlorhydria. That is why they often use acid-reducing medications.
But surprisingly, the symptoms you sometimes experience, such as heartburn and a sour taste in your throat (acid reflux or laryngopharyngeal reflux), may be due to low stomach acid, or hypochlorhydria!
How do you know that? When the stomach acid is low, food is not digested properly. Then, this undigested food causes gas bubbles to form inside the stomach. When these gas bubbles rise, some of the stomach acid can travel up the esophagus into the throat. Then, even the small amount of acid that reaches the throat can make you feel like you have "too much acid." Do you understand?
How does hypochlorhydria affect our body?
Stomach acid is not just a byproduct. It is important to our health in many ways.
Risk of nutritional deficiencies
As we mentioned earlier, our bodies need good stomach acid to properly absorb protein, vitamin B12, and several other minerals. So, when this acid is low, the body cannot properly break down and absorb these nutrients. As a result, undigested food and nutritional deficiencies occur.
- Protein and vitamin B12 deficiency can lead to iron deficiency anemia, as well as vitamin deficiency anemia. These conditions also affect our nervous system.
- Calcium and magnesium deficiencies can lead to bone weakness, a condition called osteoporosis.
Long-term digestive system problems
In the short term, having undigested food in your digestive system can cause you a lot of stomach discomfort. In the long term, this can lead to more serious problems.
For example, undigested food can ferment in the intestines, causing an unwanted growth of bacteria in the small intestine. This is called ``Small Intestine Bacterial Overgrowth (SIBO)``.
Not only that, when stomach acid decreases, common bacteria like `H. pylori` can also grow out of control. This `(H. pylori)` bacteria is a major cause of chronic gastritis and peptic ulcer disease.
Why does hypochlorhydria occur? What are the main causes?
There are several main reasons for this situation:
Atrophic gastritis
This is the most common cause of hypochlorhydria. Atrophic gastritis is a condition in which the cells that secrete acid in the stomach gradually die and become ineffective. This occurs as a result of long-term inflammation of the stomach, known as chronic gastritis. There are many causes of chronic gastritis. Examples include bacterial infections (especially H. Pylori), excessive alcohol consumption, and some autoimmune diseases.
H. pylori infection
This is a very common bacterial infection. According to some statistics, about half of the world's population has this infection. Some people can have this bacteria in their bodies without any symptoms. But in some people, this bacteria grows rapidly in their bodies, interfering with the production of stomach acid, and over time, reducing the amount of acid. Surprisingly, the reduction in stomach acid also creates a good environment for the bacteria `(H. pylori)` to grow.
Continued use of acid-reducing medications
Long-term use of medications such as antacids, H2 receptor blockers, and especially proton pump inhibitors (PPIs) is also a major cause of decreased stomach acid.
Imagine, you have a constant heartburn. So you go to the pharmacy and take a medicine for gastritis (maybe PPIs). After a while, the inflammation subsides. But if you keep taking these medicines for years without medical advice, the glands in your stomach that naturally produce acid can gradually become less active. That's when you start to develop hypochlorhydria. In fact, drugs like PPIs were originally approved for short-term use only. But now they are widely prescribed for chronic conditions like GERD (gastroesophageal reflux disease) and heartburn, sometimes unnecessarily.
Other reasons
In addition to these main reasons, several other factors may be involved:
- Aging: As we age, the cells in our body also age. Over time, the cells that produce stomach acid can also start to die off.
- Chronic stress: This isn't just about the minor stresses we face every day. But if you have chronic, high levels of stress, it can also affect stomach acid production.
- Stomach surgery: It is known that some stomach surgeries, such as gastric bypass surgery, can affect stomach acid production.
What are the symptoms of hypochlorhydria?
The symptoms of this condition can be divided into two parts.
Sudden digestive problems
These are the first symptoms to appear:
- Stomach pain
- Stomach bloating, flatulence
- Gas formation
- Diarrhea (vomiting)
- Constipation
- Passing undigested food through feces
- Reflux, Heartburn
Long-term nutritional deficiency symptoms
If hypochlorhydria persists, nutritional deficiencies may also cause symptoms such as:
- Nails break easily, become weak
- Hair loss
- Pale skin
- Frequent fatigue, tiredness
- Body weakness
- Numbness, tingling sensation in the limbs
- Memory loss
- Headache
What are the risk factors for hypochlorhydria?
Who is more likely to have this condition?
- For those over 65 years of age
- People who take acid-reducing medications such as antacids or PPIs for a long time
- For those with `H. pylori` infection
- For those who have previously had gastritis or stomach ulcers
- For those who have undergone stomach surgery
How do I know if I have low stomach acid?
The symptoms of hypochlorhydria – that is, digestive problems, nutritional deficiencies, and even bacterial infections – can be symptoms of a number of other conditions. Therefore, having these symptoms alone does not mean that you have hypochlorhydria. This is only one possible cause. However, if you have several of the risk factors mentioned earlier, you may suspect that you have this problem.
However, there is no way to know for sure whether this condition exists or not without a stomach acid test.
A simple test you can do at home - the baking soda test
This is a simple method that you can try at home. The theory behind this is that when baking soda (sodium bicarbonate) combines with stomach acid, it produces carbon dioxide (`CO2`) gas. This gas makes you want to go to the bathroom quickly.
How to do it:
1. It should be done on an empty stomach (without eating).
2. Mix a teaspoon of baking soda in half a glass of water (about 4 ounces), stir well, and drink. The colder the water, the better.
3. Then see how long it takes you to get to Gudus.
The theory is: If you don't pass stool within three to five minutes, it means you don't have enough acid in your stomach.
Important: This is not a 100% accurate test. But it can give you some idea. If you get a positive result from a home test like this, it is best to definitely see a qualified doctor for advice.
Tests performed by doctors
Your doctor will listen to your symptoms, medical history, and perform a physical exam. If he or she suspects hypochlorhydria, he or she may recommend one of several tests to check your stomach acid levels.
These are some of the main tests used:
- Heidelberg pH test: In this test, you swallow a small capsule containing a radio transmitter. It measures the pH of your stomach. After measuring your normal pH, you are given a baking soda solution to drink to neutralize your stomach acid. Then, the doctor measures how long it takes for your stomach to return to its normal acid level. This allows your doctor to see how well your stomach is producing and secreting acid.
- The SmartPill test: The SmartPill is also a wireless transmitter that you swallow. Instead of measuring pH like the Heidelberg test, it directly measures the acid levels in your stomach.
- The gastric string test: In this test, a capsule attached to a string is swallowed and then removed after 10 minutes by holding it by the string. The string is then tested with pH paper. Normally, a healthy stomach has a pH of 1 to 2. This means it is very acidic (a pH of 0 is the most acidic). If you have hypochlorhydria, your stomach acid may have a pH of 3 to 5. If the pH is higher than 5, it is a serious condition. This is called achlorhydria . This means that your stomach has almost no hydrochloric acid (HCl).
If your tests confirm that you have hypochlorhydria, your doctor may also order additional tests to check for nutritional deficiencies or bacterial infections. All of this information will be used to create a treatment plan that is right for you.
How is hypochlorhydria treated?
When treating this, three main aspects are taken into account:
1. Treating the underlying cause
If your doctor can pinpoint the cause of your hypochlorhydria, the first step is to treat that cause. This may involve changing your medications, treating an underlying condition, or treating a bacterial infection with antibiotics.
2. Hydrochloric acid (HCl) supplementation
To treat hydrochloric acid deficiency, your doctor may recommend an HCl supplement to take with meals. For example, a supplement called Betaine hydrochloride. These HCl supplements often come with an enzyme called Pepsin. These supplements help your digestion process. Sometimes, when you use these, your stomach acid production gradually returns to normal, and you can stop taking these supplements. Although these are available over the counter, they are not suitable for everyone. So don't try them on your own without talking to a doctor.
3. Providing supplements for nutritional deficiencies
If your low stomach acid has caused other nutritional deficiencies, such as iron, calcium, or vitamin B12, your doctor may recommend supplements to help replenish those nutrients.
Can hypochlorhydria be cured?
In many cases, this condition can be reversed or successfully treated with HCl supplements. However, it is important to address the underlying cause. If you have an infection, illness, or inflammatory condition, it can continue to cause problems – not only hypochlorhydria, but also other problems. Therefore, it is essential to undergo a complete medical examination before starting treatment with HCl supplements. Your doctor can help you properly treat the cause of hypochlorhydria and its effects, such as specific nutritional deficiencies.
What is a diet suitable for people with low stomach acid?
Diet alone cannot restore your stomach acid levels. However, these tips can help make your digestion easier when living with hypochlorhydria:
- Eat protein first at meals: Eating protein-rich foods (such as fish, meat, eggs, lentils) at the start of a meal helps stimulate stomach acid production.
- Delay drinking water: Avoid drinking water or other beverages for at least 30 minutes after eating. This gives your stomach more time to produce acid and digest protein.
- Eat foods containing probiotics: Eating probiotic foods like yogurt, miso, and sauerkraut can help increase the amount of good bacteria in your gut and control bad bacteria.
- Avoid high-fat and processed foods: These foods are difficult to digest and contain little nutrition.
- Be especially careful about your diet if you are a vegetarian: Many of the nutritional deficiencies (protein, iron, calcium, vitamin B12) associated with low stomach acid are found in animal products (meat, fish, dairy products). If you are a vegetarian, make sure to get these nutrients from supplements or other appropriate foods. A good quality health shake blend may be an easy way to do this.
- Eat small meals and chew them well: To give your digestive system the best chance to break down and digest food properly, eat small meals rather than large meals at once. Also, chew and swallow your food well.
- Eat your last meal two to three hours before bedtime: Give your body enough time to digest food before you go to bed.
Finally, the most important thing to remember!
Hypochlorhydria, or low stomach acid, is a more common but under-recognized condition than we think. Symptoms such as heartburn and heartburn that are often mistaken for hyperchlorhydria may actually be due to low stomach acid.
Medications used to increase stomach acid can contribute to a decrease in stomach acid and worsen digestive problems.
Therefore, careful diagnosis and testing are essential for successful treatment. Medical tests can identify whether you have low or high stomach acid, as well as other important factors that may be affecting your symptoms. With the right information, your doctor can help you develop a good treatment plan for the causes and effects of hypochlorhydria. Therefore, if you have these symptoms, be sure to seek medical advice.
` Hypochlorhydria, stomach acid, hydrochloric acid, digestion, nutritional deficiencies, stomach inflammation, gastritis, SIBO, H. pylori, PPIs
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