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

  [ 367 votes ]   [ 25 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.

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Article Comments Post a Comment

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

same issue!
Posted by: toronto101
Feb 23, 2015
hi there - i realize much time has passed since your post - but i have the exact problem and wondering if you found out what the cause was and a solution? thanks!


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

Hypochiorhydria and intense lower extremity muscle pain
Posted by: dais
Oct 27, 2014
Some one help me please. I have been taking Pralosec 40 mg twice daily since Sept 9 prior to a scheduled tonsillectomy in late December. I work out every morning weights, swim, elipical etc. I started noticing additional leg and knee pain but thought that it was an old injury. Ten days ago I started feeling extreme lower extremity muscle pain and fatigue (to the point that I could barely stand). I never thought it was the meds until I read about side effects. I am off the meds now seven days and still in great deal of pain in standing, walking etc. If I have a lactic acid buildup in my muscles, how do I releave this? I also have history of drug reactions post use. Thoughts please!!!!
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