Your stomach acid

FloridaLady

Lack of Stomach Acid - Hypochlorhydria - Can Cause Lots of Problems

by Dr. Sarah Myhill, MD*
December 10, 2007

Dr. Sarah Myhill, MD, is a UK-based ME/CFS/FM specialist focused on nutrition, preventive medicine, and patient education.

Hypochlorhydria arises when the stomach is unable to produce hydrochloric acid (stomach acid). It is a greatly overlooked cause of problems - to the extent that in the UK at least nobody is testing or looking for it. It is especially common in those with ME/CFS/FM, and is known to be associated with childhood asthma.

The stomach requires an acid environment for several reasons:

n First, acid is required for the digestion of protein.

n Second, acid is required for the stomach to empty correctly, and failure to do so results in gastro-esophageal reflux disease (GERD).

n Acid is required to sterilize the stomach and kill bacteria and yeast that may be ingested.

n And an acid environment is required for the absorption of certain micronutrients, in particular divalent and trivalent cat-ions such as calcium, magnesium, zinc, copper, iron, selenium, boron and so on.

As we age, our ability to produce stomach acid declines, but some people are simply not very good at producing stomach acid; sometimes because of pathology in the stomach (such as an allergic gastritis secondary to food intolerance), but sometimes for reasons unknown.

Possible Problems with Low Stomach Acid
There are many possible problems that could arise from hypochlorhydria:

Failure to digest foods properly. This will result in a general malabsorption of proteins. Indeed hypochlorhydria - as induced by antacids and H2 blockers and protein pump inhibitors - substantially increases one's risk of osteoporosis because the body simply does not have the raw material to replace bone. Many degenerative conditions will be associated therefore with hypochlorhydria.

Failure to absorb trace elements. Trace elements are essential for normal body functioning, if these are not present then the biochemistry of the body will go slow, organs will go slow, and this will accelerate the ageing process. Therefore, one would expect to see people getting diseases such as cancer, heart disease, and neuro-degenerative conditions before their time.

Failure to sterilize the stomach contents. This will make individuals more susceptible to gut infections such as gastro-enteritis and possibly enteroviruses such as Epstein-Barr virus, Coxsackie virus, Echovirus, and so on.

Gastric acid is an essential part of normal defenses against disease. Gastric acid is also essential for getting rid of undesirable bacteria and yeast that appear in the diet. Particularly virulent strains, of course, may cause simple food poisoning. However, if there is an overgrowth of bacteria and yeast in the stomach, then foods will get fermented instead of being digested. This produces wind and gas resulting in bloating and alcohols which may or may not be useful to the body.

Increased risk of stomach cancer. Having the wrong bacteria and yeast in the stomach will irritate the lining of the stomach and increase one's risk of stomach cancer.

Malabsorption of B12. It is well known that the stomach must be acid in order to absorb B12. Indeed, using a proton pump inhibitor such as omeprazole [a drug used to reduce stomach acid production - trade names Losec^R and Prilosec^R - often prescribed for patients with heartburn (gastroesophageal reflux disease or GERD)] will reduce absorption of vitamin B12 to less than 1% of expected. Many people already suffer from borderline B12 deficiency - this is a difficult vitamin for the body to assimilate, but essential for normal biochemistry.

Symptoms of Hypochlorhydria

When any of the above problems go wrong, it can result in symptoms of:

Accelerated ageing because of malabsorption. Wind, gas and bloating as foods are fermented instead of being digested, i.e. irritable bowel syndrome. A tendency to allergies. The reason for this is that if foods are poorly digested then large antigenically interesting molecules get into the lower gut, where if the immune system reacts against them, that can switch on allergy. Gastro-esophageal reflux disease (GERD). [See also "Acid Stomach - or Not Enough Stomach Acid? The Symptoms are Similar, but For CFS and FMS Patients It's Often the Latter."] Iron deficiency (anemia). B12 deficiency. A tendency to Candida dysbiosis or bacterial dysbiosis [imbalance in the natural flora of the gut].

Treatment of Hypochlorhydria

The treatment in the short term is to take acid supplements. Indeed, this may explain why cider vinegar is such a popular treatment for many problems - the vinegar acidifies the stomach and improves the digestion of food. Clearly, this has the potential to affect a wide range of conditions. The problem with cider vinegar is that it contains yeast and would therefore not be tolerated by many people.

A second possibility is to take high dose ascorbic acid at mealtimes. Indeed, my standard recommendations for nutritional supplements suggest combining [minerals] with ascorbic acid to be taken at mealtimes...This...mildly acidifies the stomach and [promotes absorption].

The third approach is to take Betaine Hydrochloride (Betaine HCL), a naturally occurring substance derived from beets. This is available in capsules which need to be taken with food, and the dose adjusted according to the response. I suggest that people start off with one capsule initially and build up to maybe four or five capsules depending on the size of the meal and the response to treatment. Often in the longer term with the correct diet (low glycemic index, low allergy, smaller meals, get rid of Helicobacter pylori, correct gut flora) this cures the chronic gastritis, and the stomach is again able to produce acid normally.

Some Interesting Clinical Observations

It has been well known now for many decades that childhood asthma is associated with hypochlorhydria.

Asthma in children tends to be caused by allergy to foods. If these foods are poorly digested then they will be very much more antigenic and therefore very much more likely to switch on allergies and therefore asthma. Indeed, a study done in the 1930s showed that 80% of children with asthma also have hypochlorhydria.

The two conditions are undoubtedly related. As the child's stomach matures and acid eventually is produced, then the asthma disappears. What often occurs with hypochlorhydric children is that they malabsorb their food and therefore tend to be underweight. So clinically it is unusual to see overweight kids with asthma, almost invariably they are thin children who wheeze.

The treatment is as above, as well as trying to identify provoking foods. The commonest allergy foods, of course, are dairy products. [Ed Note: As with all health issues you should discuss stomach acidity, testing, and management with your professional healthcare team. But a simple preliminary test of stomach acidity is to drink a small amount of baking soda in water first thing in the morning. If you have not belched within a few minutes, you may not be producing enough stomach acid, since hydrochloric acid reacts with baking soda to produce carbon dioxide gas. See "Stomach Acid Assessment" by Dr. Joseph A. Debe.]

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FloridaLady

Role of hydrochloric acid in digestion

Hydrochloric acid enables the body to

• break down proteins
• break don and absorb carbohydrates ad fats
• absorb vitamins and minerals
• activate important enzymes and hormones, and
• protect against bacterial overgrowth in the gut.

HCL deficiency

HCL deficiency occurs with increasing age and sometimes due to other medical conditions. Achlorhydria is the complete absence of stomach acid while hypochlorhydria is presence of low stomach acid. These are common digestive problems whose symptoms include

• Heartburn
• Soreness and burning of the mouth
• Desire to eat when not hungry
• Flatulence
• Constipation
• Diarrhea
• Indigestion and
• Bloating
• Correlated chronic health conditions such as allergies, asthma and gallstones

Link between hydrochloric acid deficiency and heartburn

Heartburn is the burning sensation felt in the middle of the chest as a result of stomach acids that flow backward into the esophagus. These stomach acids irritate the lining of the esophagus causing discomfort and pain. The stomach's main job is to receive chewed food and to coat it all with HCL. As a result of HCL deficiency, the stomach has a more difficult job in coating all its contents. The stomach therefore flips and churns the food in order to coat it all with HCL.  In this process some of the HCL hits against the valve that leads to the esophagus and spills onto the esophagus. This results in burning the esophagus lining and causing heartburn

FloridaLady

http://www.ahha.org/AntacidsArticle.htm

FloridaLady

Raw veggies and fruit help to rebuild this acid and the enzymes needed to keep the stomach working. (mostly your greens) As we age we loose more and more of this valuable acid. I do wonder how well are stomach works while on chemo if this enzymes and acid are so disrupted? In natural medicine the stomach very important part of their treatment.  I watch Dr Oz special and he said the stomach is like a 2nd brain.  It has a really important job along with the pancreas.

Flalady

Lili46

This is so interesting. I have been on Nexium for several years for reflux. I hate having to take it every day because there is a reason for that stomach acid. I was diagnosed with celiac disease about a year ago and have been on a gluten free diet since then. I also gave up dairy after going through chemo this Fall. I figured that since I have changed my diet drastically why not try stopping the Nexium. I stopped taking it 3 weeks ago and so far no problems. I told my Gi doctor. He was okay with it but commented that it would only be a matter of time before I have symptoms again. We'll see. I'd like to prove him wrong. I've also been taking probiotics for the past 6 months. I feel great! This article helps me feel better about my decision.

althea

Thank you flalady.  This information is of particular interest to me.  I became especially sick after my mast/recon and again at my second recon surgery.  They took some extra steps the second time to minimize my nausea and one thing they discovered was food in my stomach even though I followed the instructions regarding food and liquid.  I was told to get thee to a gastroenterologist.  Instead, I've been trying my own ways of improving the rate of food moving through my system.  ...mainly I just don't want to go to a gastroenterologist! 

As for the B12 absorption mentioned in the article, I'll say again here what I've said elsewhere -- look for sublingual B12.  You hold it under your tongue for 30 seconds and your body absorbs this vitally important nutrient through the two large veins under your tongue.   Older people especially may need to supplement B12 in this way as the digestive tract weakens with age.  Vegans also should supplement B12 in this way.  

Also, I was plagued with nausea for 3 years post-chemo.  I'd be ok as long as I didn't do much.  Every single time I'd try to ramp up my activity, I'd feel ill to my stomach.  Finally, I tried a product called superfood, which is completely plant-based, mostly green, single celled plants.  My nausea finally went away and stayed away.