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

  [ 341 votes ]   [ 23 Comments ]
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:

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

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

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

· 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 LosecR and PrilosecR - 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 (vitamin C) 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....

[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.]

* This material is reproduced with permission from Dr. Sarah Myhill’s patient-information website ( It is featured, along with additional testing info pertaining to UK residents, on pp. 63 and 64 of her free 179-page online book - "Diagnosing and Treating Chronic Fatigue Syndrome." R Sarah Myhill Limited, Registered in England and Wales: Reg. No. 4545198.

Note: This information has not been evaluated by the FDA and is not meant to prevent, diagnose, treat, or cure any illness, condition, or disease. It is essential that you make no decision about additions to or changes in your healthcare plan or health support regimen without first researching and discussing it in collaboration with your professional healthcare team.

Discuss This Article Post a Comment 

HCL supplements
Posted by: CWB
Dec 12, 2007
I tried the HCL supplements a couple of years ago, and did feel that it gave a boost (of absorption) to all of my other supplements. However, a few months later I developed interstitial cystitis, an often concomittant illness with CFIDS (my condition) or FM inwhich foods high in acids create a painful bladder syndrome. Thankfully I have been able to manage that condition with diet--though sadly having to cut out most of the great fresh fruits of summer and tomatoes. I'm one of the lucky ones, though, and have been able to eat many of the implicated foods in moderation and infrequently. Many with this condition suffer great pain and have to go on (yet another) medication or even have surgery--so it's worth avoiding! I stopped taking the HCL. While I understand that HCL is an inorganic acid and that the acids in foods are organic, I have not been able to find info on the safety of HCL for those with IC. I've posed the question to Immunesupport and Dr. Cheney via the internet, but they haven't been able to respond. I'm guessing that it's an unknown. IC, like CFIDS and FM, is not compeltely understood but appears to be another condition on the continuum of potential allergic and immune dysfucntions that we so easily slip into. I think it would be important for our community to understand how these conditions and protocols may be linked or present contraindications before trying this. Those of us with CFIDS and FM have already had to give up so much, I'd hate to see a lot of people come down with potentially incredibly restrictive IC. I hope I'm off base, and that someone professional who has studied this specifically will respond. Meanwhile, here's a link to info on IC,
Reply Reply

Interstitial Cystitis
Posted by: sfd647
Dec 19, 2007
I have had a painful bladder situation for 2 yrs now and wasn't sure what was happening to me. Other things have been ruled out like a Cystocele ( a type of herniated bladder pressing in against the walls of the vagina. The pressure is horrible but there was nothing showing. The technician doing the ultra sound told me about IC and I went online to check it out. I was amazed and feel that this is possibly what has been going on. I mention this because of this article about the lack of gastric acid in our stomachs to which Vitamin B12 is undersupplied because of certain medications. I have much of what they have been describing as to the problems associated with lack of stomach acid to break down necessary nutrients for our body to function with. GERD is one and IBS is another. I have had horrible yeast breakouts as well that will not seem to go away. I have had very serious leg infections that no one can eliminate to where my skin isn't even my skin anymore. It is horrible. I have no idea if all of this is relative or not. It is so confusing as to what is happening to me over the last 2 1/2 yrs. I have always been in need of Vitamin B12 because of anemia problems that come and go. Do you think that this could be all related. Does anything that I have been describing fit to the things you have encountered. I wish we could talk privately so I could discuss the IC with you more in detail. It is so unbearable. No one can possibly know how horrible it feels. The pressure is unbearable. I haven't found anything to take it away. Thought that Ditropan would help but hardly does anything. Perhaps I am not taking enough. Also, just lately since this summer, I have been eating strawberries, raspberries, pineapple more than average. I have had these situations even before I had started to eat in abundance of these particular fruits. I have cut out tomatoes since this past summer because of it being a nightshade vegetable/fruit that causes painful arthritis. Is there a solution to my delemma? Need to know more about IC though as well. Too many loose strings to these horrible, disabling, conditions I have going on 24/7.



Lack of stomach acid and GERD
Posted by: ohiosue
Dec 12, 2007
I was told by a health store manager that my GERD could be from not enough acid so I bought digestive enzymes with the HCL in them and it made my acid reflux much worse. So not everyone has acid reflux caused by not enough acid- mine was from too much. Plus I have Barrett's esophagus and adding acid was not a good idea for me! Now I take a good digestive enzyme and a probiotic supplement daily that has no added acid and am doing well with my IBS now under control with no meds. I also had acid reflux surgery that helped a lot as my esophageal sphincter was not working at all. ohio sue
Reply Reply

Acid sensitive digestive enzymes and probiotics?
Posted by: michleen
Nov 13, 2012
Hello There,

I am not sure you'r going to see my replay since this is from 2007, but if you do can you tell me what kind of probiotics and digestive enzymes you used? I am trying to find some for my son that don't make his acid reflex worse and I can't see to find any. Every time I try to introduce something to help him with his food allergies and gut issues it seems to make the problem worse. I tried probiotics, digestive enzymes, slippery elm, l-glutamine...all made his situation worse.

Thank you and I hope you get this


Opened My Eyes
Posted by: born2hurt
Dec 19, 2007
I had been suffering for a long time with anemia and lack of energy. I had thought it was from being a "girl" and the "woman" thing. As I got older and it didn't go away and then I had a gastric bypass and things got worse and worse I knew something was wrong. This article clicked. Even the doctors haven't put 2 and 2 together. I am bringing this to them to show them that maybe I am not crazy or just another complainer. Now maybe they will believe me that I do not have any energy! Coupled with this bypass I had, even with the battery of vitamins I take my body just will not absorb them! No wonder I keep losing weight and look like an old hag. My bones ache fiercely too. I am really excited about reading this article. Thank you Dr. Myhill and Prohealth! I will come back and let you know how I make out with my doctors.
Reply Reply

Papaya Enzyme
Posted by: VitaD
Dec 19, 2007
I wonder if I have this. I have been diagnosed with GERD because I get pains where my gallbladder used to be. I had a roux n y stomach bypass 5 years ago, and was told to expect not to have stomach acid. I was told it would clear up the GERD I had at the time. Four years after the stomach surgery I had problems that required removal of my gallbladder; I understand that can be caused by Hypochlorhydria. That is when the pains in my chest started. I was given Protonix to help my chest, but it did not help. Then I was given a spasm medicine, which helps an attack. How could I have GERD? Wouldn't the Protonix almost ensure hypochlorhydria? Would Papaya Enzyme help my digestion if I had hypochlorhydria?
Reply Reply

Omitted Cause of Low Stomach Acid
Posted by: jmc99
Dec 28, 2007
A major cause of low stomach acid has been omitted from Dr. Myhill's article. Chronic Helicobacter pylori infections may not cause uclerations in all cases, but minimally degrade parietal cells that secrete HCl (acid) and intrinsic factor (which facilitates the absorption of vitamin B12). With inadequate acid production, pepsinogen secreted from chief cells is incompletely converted to the proteolytic enzyme pepsin to digest dietary protein. As the former manager of a small specialty medical laboratory and medical center specializing in GI infections, I can report that many cases of poor health due to low stomach acid and vitamin B12 related anemia have been resolved through proper identification of H. pylori through serology or stool antigen and proper treatment with PrevPac or Helidac (drugs) supported by appropriate nutriceuticals.
Reply Reply

Posted by: clay2
Jan 6, 2008
I've been on Protonix for many years for GERD and Barrett's. I have no doubt that the low acid from Protonix left my gut susceptible to the virus that gave me Chronic Fatigue Syndrome and chronic pain, and it undoubtedly played into my developing Lymphocytic Colitis at the same time. I can't believe modern medicine can't figure this out. I tried cutting the Protonix working with a naturopath, but the heartburn returned and with Barrett's I can't mess around. I take HCl at meals when I eat meat and hope that helps.
Reply Reply

Lymphocytic Colitis
Posted by: Wend9
Mar 18, 2008
I also have been on Protonix/Prilosec for the past 6 years. Two years ago I was diagnosed with Lymphocytic Colitis and now I find I am also very anemic. How much HCI do you take? I don't have heartburn, my problem is that I constantly burp if I don't take the Prilosec. I had my esophagas stretched 6 years ago as well. Thanks for your help, Wendy


Protonix and stomach virus
Posted by: jPass
Oct 22, 2011
I am on 40 mg. twice a day, and I also have a bad stomach virus that has yet to go away after a week. My question is can the lack of stomach acid caused by the protonix prolong a stomach virus?


Stomach Issue
Posted by: rlstomach
May 2, 2008
For the past 16 months I have had this constant hunger-like gnawing/rumbling. There is never a feeling of satisfaction after a meal (hence there is the tendency to overeat). This is something that had been a problem for me 25-30 years ago, but had been "dormant" in recent years, which I attributed to diet modification (i.e. smaller more frequent meals, eliminating most sodium, eating more grains, etc.). A recent scoping of the stomach revealed nothing significant. I've just switched from 30 days of Protonix to Aciphex. I had also tried BHCL for a period, but didn't find any improvement from it. I'm not convinced that the problem is GERD. I'd appreciate hearing from anyone that has had similar symptoms.
Reply Reply

Posted by: lea
Oct 1, 2009
Just wondering if you were diagnosed with gastritis; or what was your diagnosis for the gnawing? Thanks best, Ann
Reply Reply

Posted by: flatulent
Jan 13, 2011
I have to wonder how many consider that long before most people turn to "alternative" medicine for their stomach issues, they have already been down the path of antacids, H2 blockers and PPI's. Most of the current PPI's state that they PERMENENTLY shut down those acid producing cells. So, of course if they already went through a course of PPI's, there is a decent chance they will have low stomach acid by the time they turn to Naturopathic Medicine. I don't personaly know if I have low or high stomach acid. I just know I get Gastritis at the drop of a couple of days of drinking coffee, or even taking Vitamin C as ascorbic acid. Basicaly, anything I eat or drink that would raise acid levels raises Cain. Unlike the most I am refering to here, I was already heavily involved in the natural path when I started having severe stomach issues. I tossed HCL at it like tic tacs and spent hundreds of dollars on the highest quality enzymes. I took pro-biotics at levels you would only see in Naturopathic Colleges. Nothing helped. Now, the odd thing about all of this is that I am now 53 years old, so I sort of fit into that as you get older catagory your HCL goes down. The only catch to this is the stomach symptoms I currently have are exactly identical to what I experienced for years when I was a child and being raised in a very high stress situation by a alchoholic father. I was finaly sent to the Doctor for a upper GI and they found Gastritis and a Duodenal ulcer, the only type of stomach ulcer believed to be caused by high stress and high acid levels constantly dumping. Hmmmm. One size does not fit all I hear. Nothing against the natural approuch. I am fully into it. I am so into it I would like to share something with the folks here. It is a scientificaly proven fact that low ph levels for the blood cause stress, and can cause anxiety, and even panic syndrome if the lactic acid levels or CO2 gets high enough. The primary mechanism that keep blood ph regulated are proper breathing to elimate excess CO2 and the PH buffering system, i.e. minerals in the bloodstream. Now, if people stop and think about this that suffer from serious gastric problems and lots of stress and anxiety on top of it, there is a easily explainable loop going on here. High stomach acid would tend to eat up the blood buffer and the person would become susceptable to stress, that would tend to dump more acid. This is me as a child, and it is me now.
Reply Reply

Protonix and stomach virus Please help urgent!!!
Posted by: jPass
Oct 22, 2011
I am on protonix 40 mg. Twice daily and also have had a stomach virus for over a week. My question is can the decreased acid caused by the Protonix PROLONG a stomach virus? Thank you in advance for answering.
Reply Reply

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