The Problem of Low Stomach Acid

I’ve written before that I am taking Betaine HCL with Pepsin as a digestive support supplement to address low stomach acid. This was recommended to me by my functional medicine doctor, as well as suggested in Aglaee Jacob’s book Digestive Health with Real Food.  I believe this supplement is making a real difference in my IBS-D symptoms.  I started taking it shortly after starting the elimination diet, and have noticed real improvement over the last couple of weeks.

I want to talk more about the problem that this supplement is meant to address — low stomach acid — and refer you to some good resources to help you decide if trying this supplement is right for you.

Why is stomach acid important?

The stomach needs to be acidic to do it’s job of beginning the process of digesting your food, particularly harder to digest proteins (e.g., red meat).  The acidity of the stomach contents also triggers the release of critical digestive enzymes when the contents move into the small intestines.  Think of it as a chain of dominos as your food moves along your digestive tract.  If that first domino isn’t knocked over, the ones that follow won’t fall either.

Proper stomach acidity also is critical to the proper absorption of certain vitamins and minerals (B12 in particular).  It also protects you against bacteria and parasites you may ingest, so it’s plays a critical immune function that helps prevent you from getting ill.

What causes low stomach acid?

Low stomach acid, or hypochlorhydria, is the condition that occurs when your stomach is not able to produce sufficient amounts of hydrochloric acid.  You can get low stomach acid because you take proton pump inhibitors (PPIs), such as Prilosec.  Ironically, many people take PPIs because they are having symptoms that suggest they have low stomach acid, but because these drugs are so well known, people (and sometimes their doctors) assume their stomach acid is too high and start taking PPIs.  If you have low stomach acid, taking PPIs is exactly the wrong thing to do.  It’s not clear why others have low stomach acid.  Some theorize that it naturally declines as you age, but I have read others who challenge that view.  Some say when the digestive system is compromised in some way — by inflammation for example — it can interfere with the processes that maintain the proper acidity level during digestion.

What are the symptoms of low stomach acid? 

The symptoms of low stomach acid are described very well in this article at SCD Lifestyle, but I will summarize them here.  Acid reflux / heartburn after you eat is one.  (So don’t automatically assume you need acid reducing medicines if you have this symptom.)  Feeling like you don’t digest meat well, particularly red meat, is another.  The last is burping, bloating and gas after you eat.  (For me, bloating was the big clue that I was having low stomach acid.  A few hours after I ate, I looked like I was passing a bowling ball through my gut.)

Is there a test for low stomach acid?

I did not take a test.  I just decided to try Betaine HCL and see if it works.  But I have read about three other tests.  The most expensive and apparently most reliable is the Heidelberg Stomach Acid Test.  You will need to have a doctor administer this, if you can find one willing.  Another is called the Salivary VEGF test.  And finally there’s a DIY test involving ingesting baking soda and timing your burps.

How do I increase stomach acidity?

There are several ways to approach this.  Some people use digestive bitters, which are supposed to stimulate the secretion of stomach acids.  Others take apple cider vinegar or lemon juice (diluted to prevent burning your throat) before eating.  I decided to take Betaine HCL with Pepsin.  This contains the hydrochloric acid (HCL) your stomach would normally produce, along with pepsin which is a digestive substance your stomach also normally produces.  The two are linked so a stomach that isn’t producing enough HCL is probably not producing enough pepsin, according to what I’ve read.  It took me a while to find a brand that didn’t have additives that I couldn’t eat (one actually had dairy in it – go figure!), but I did finally find the Solaray brand and that’s what I take.

What is the protocol for taking Betaine HCL?

First, if you have any type of stomach lining problems, like an ulcer, or you take any medicines that could cause damage to the stomach lining (e.g., NSAIDs like Advil), you really must talk to your doctor before trying this supplement.  The stomach lining could be further damaged if you don’t.

Second, it is very important to take this with food already in your stomach – and some of that food must be protein.  If you are having an all carbohydrate meal or snack, don’t take it.  Take the pills mid-meal – this is to protect your stomach lining and to make sure they work effectively.

You have to ramp up on this supplement.  You start with one pill per meal, and then after two days you add another.  So every two days you go up a pill (two per meal, three per meal, etc.) until you reach five pills per meal.  Don’t go beyond that.  Your optimal dose may be less than five.  How will you know?  Your body will tell you when you’ve had too much.  You will get mild burning (like heartburn) or other discomfort after you eat.  Once that happens, you will know you’re on a dose that’s one pill higher than you should be.  Drop back down to the lower dose on the next meal and you should be fine.  If you feel adverse affects after starting the Betaine HCL at one pill per meal, your stomach acid levels are probably normal and this supplement isn’t for you.

Be sure to check out this article at SCD Lifestyle for a more in-depth guide on how to use Betaine HCL.

Will I have to take Betaine HCL forever?

I’m not sure.  I can tell you my experience.  I ramped up on the Betaine HCL to five pills per meal.  I was on that dose for about two weeks.  Then one day I noticed a mild burning sensation after I ate.  Now I’ve dropped down to four per meal with no ill effects.  So something changed.  I’m not sure why – but my stomach now produces at least a little more acid naturally.  This is a good thing so I am hoping eventually to be off the pills or on a lower dose.

Does it work?

I think so.  With my experience with IBS-D, it is somewhat harder to make a clear-cut case of cause and effect with the Betaine HCL.  I started the pills the same time I started my elimination diet.  So maybe I would have had the same experience without the pills – impossible to know.  I could stop the pills altogether and see if I regress, but I really don’t want to regress.

My boyfriend’s situation is somewhat more persuasive.  He had chronic constipation for years.  After reading the section on constipation in Digestive Health with Real Food, I told him to try the Betaine HCL as the book suggested.  He had dramatic improvement in a very short period of time (days).  He takes them with each meal and is very regular now.  This was after trying other methods, like high-fiber diets, magnesium supplements, and stool softeners.  He is very happy.

I hope this overview was useful to you.  I would love to hear any feedback on your experiences with low stomach acid or the Betaine HCL supplement.

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