Hypochlorhydria

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

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

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:

• Serum B12
  
• Ferritin
  
• Calcium
  
• Magnesium
  
• Gastrin levels

   

Surveillance for infections like C. difficile is also important.