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.
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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* This material is reproduced with permission from Dr. Sarah Myhill’s patient-information website (http://www.Drmyhill.co.uk). 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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