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Hypochlorhydria

Hypochlorhydria: Understanding Low Stomach Acid and Its Functional Impacts

Authored by Chris McDermott, APRN, practicing with autonomous authority in Florida | Intercoastal Health, Florida

What Is Hypochlorhydria?

Hydrochloric acid (HCl) is secreted by the parietal cells of the stomach and plays a critical role in initiating the breakdown of proteins, activating enzymes such as pepsin, and maintaining a sterile environment in the upper GI tract. It also supports the absorption of essential nutrients such as vitamin B12,iron,calcium, and magnesium.

Hypochlorhydria refers to insufficient production of stomach acid. Without adequate HCl levels, the body struggles to break down food, absorb nutrients, and protect against harmful bacteria and fungi. This can result in a wide range of digestive and systemic symptoms, many of which are mistakenly attributed to other causes.

Clinical Symptoms of Low Stomach Acid

Symptoms associated with hypochlorhydria often mimic those of high stomach acid or general indigestion, leading to underdiagnosis or inappropriate treatment with acid-suppressing medications.

Common Symptoms Include:

Bloating, belching, or gas shortly after eating
Early satiety (feeling full quickly)
Indigestion or reflux, especially after protein-rich meals
Constipation or diarrhea
Undigested food in the stool
Nausea after taking supplements
Fatigue and weakness related to iron deficiency anemia
Joint aches and muscle weakness
Peeling, brittle, or soft fingernails
Post-adolescent acne or rosacea
Dilated capillaries in the cheeks and nose

When prolonged, hypochlorhydria may also contribute to osteoporosis, neurocognitive decline, and chronic nutrient depletion.

Functional Testing for Hypochlorhydria

Key Diagnostic Tools:

Heidelberg pH test: Monitors stomach pH via a swallowed capsule.
Gastrin blood test: Elevated levels can indicate compensation for low stomach acid.
Betaine HCl challenge: Clinical trial with acid supplementation.
Comprehensive nutritional panel: Evaluates B12, ferritin, magnesium, calcium, and zinc levels.

Causes and Contributing Factors

Aging: Natural decline in acid production after age 60.
Medications: Long-term use of proton pump inhibitors (PPIs) and H2 blockers.
H. pylori Infection: Impairs parietal cell function.
Autoimmune Gastritis: Autoimmune attack on parietal cells.
Chronic Stress: Suppresses digestive secretions.
Dietary Deficiencies: Lack of zinc, B vitamins, and chloride.

Clinical Implications of Hypochlorhydria

Nutrient Deficiencies: Malabsorption of iron, B12, calcium, magnesium.
Gastrointestinal Infections: Increased risk for SIBO and candida.
Reflux and GERD: Poor acid tone can worsen reflux symptoms.
Skin and Autoimmune Disorders: Associated with conditions like psoriasis and autoimmune gastritis.
Gallbladder Dysfunction: Poor bile stimulation, leading to gallstones or biliary insufficiency.

Conditions Linked to Hypochlorhydria

Condition	Possible Connection
Iron deficiency anemia	Impaired iron absorption
Osteoporosis	Calcium and magnesium malabsorption
SIBO	Reduced gastric defense
Candida overgrowth	Disrupted gut flora balance
GERD	Lower esophageal sphincter dysfunction
Chronic atrophic gastritis	Parietal cell loss and achlorhydria
Autoimmune diseases	Gut permeability and nutrient deficits
Cognitive decline	Due to long-term B12 and iron deficiencies

Functional Medicine Approach at Intercoastal Health

1. Remove Underlying Triggers

Gradual discontinuation of acid-suppressing medications
Eradication of H. pylori if present
Diet modification to remove inflammatory foods

2. Rebuild Acid Production and Gastric Tone

Betaine HCl with pepsin supplementation
Digestive bitters, apple cider vinegar before meals
Zinc, B6, and chloride repletion

3. Replenish Nutrient Deficiencies

Restore B12, iron, calcium, magnesium, and fat-soluble vitamins

4. Repair and Support the Gut Lining

Use of L-glutamine, aloe vera, and DGL (deglycyrrhizinated licorice)

5. Rebalance the Gut Microbiome

Targeted probiotics and prebiotics
Minimize unnecessary antibiotics

Monitoring and Long-Term Considerations

Patients with chronic hypochlorhydria should have regular monitoring of:

Surveillance for infections like C. difficile is also important.

Conclusion

Hypochlorhydria is a significant but frequently unrecognized factor contributing to digestive, nutritional, and immune dysfunction. Through comprehensive testing, personalized interventions, and root-cause analysis, Intercoastal Health helps patients restore healthy stomach function, enhance nutrient absorption, and support systemic resilience.

Opekun, A. R., Opekun, J. L., & Saeed, S. A. (2013). Gastric re-acidification with betaine hydrochloride in healthy volunteers with pharmacologically induced hypochlorhydria. PLoS ONE, 8(9), e72646. https://pmc.ncbi.nlm.nih.gov/articles/PMC3946491/
Wilkinson, J. M., & Cavanagh, H. M. (2004). Management of experimental hypochlorhydria with iron deficiency anemia using plant extracts: An animal model. Evidence-Based Complementary and Alternative Medicine, 1(2), 151-156. https://pmc.ncbi.nlm.nih.gov/articles/PMC4121923/
Wright, H. N., & Taylor, J. (2020). Meal-time supplementation with betaine HCl for functional hypochlorhydria: A practical protocol. Integrative Medicine: A Clinician’s Journal, 19(1), 12-16. https://pmc.ncbi.nlm.nih.gov/articles/PMC7238915/
Schiller, L. R., & Fordtran, J. S. (2023). Achlorhydria and hypochlorhydria: Clinical features and management. In StatPearls. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507793/

In conclusion, a comprehensive evaluation by a functional medicine nurse practitioner in Florida facilitates identification of cellular-level and molecular imbalances driving cardiometabolic dysfunction. By integrating evidence-based therapies with Longevity Medicine and Regenerative Medicine medical care services—where cardiovascular health is often impacted—we offer patients a regenerative, preventive framework to rebuild resilience and optimize wellness. Call (904) 799‑2531 or schedule online to request your personalized GI and metabolic health assessment.

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