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Overview

Hypochlorhydria

Hypochlorhydria is a de/ciency of
stomach acid. If you don’t have enough
stomach acid, you can’t digest food
properly or absorb its nutrients. This leads
to indigestion, malnutrition and sometimes
bacterial overgrowth. Fortunately,
hypochlorhydria is relatively simple to test
and treat.

Contents Overview

Symptoms and Causes Diagnosis and Tests

Management and Treatment

Outlook / Prognosis Living With

Overview
What is hypochlorhydria?
Hypochlorhydria means low stomach acid
— speci/cally, low hydrochloric acid (HCI),
which is the most powerful acid your
stomach produces. Hydrochloric acid
plays an important role in your digestion
and immunity. It helps break down protein
and absorb essential nutrients, and it
helps control viruses and bacteria that
might otherwise infect your stomach.

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If you have hypochlorhydria, you’ll have

trouble digesting food properly, especially
protein. Over time you can develop serious
nutritional de/ciencies. You’ll also be
prone to infections, which can cause
further damage to your stomach and
digestive system.

What is the difference between

hypochlorhydria and
hyperchlorhydria?
“Hypo-” means “low.” “Hyper-” means
“high.” Hypochlorhydria means your
stomach isn’t producing enough
hydrochloric acid. Hyperchlorhydria means
it produces too much. In the U.S., people
most often attribute their digestive
problems to hyperchlorhydria, and they
often use medication to suppress their
stomach acid. But in fact, symptoms of
chronic acid reWux, laryngopharyngeal
reWux or heartburn can also be caused by
hypochlorhydria. Poor digestion from the
lack of stomach acid can create gas
bubbles that rise into your esophagus and
throat, carrying stomach acid with them.
Even trace amounts of acid in your throat
can feel like too much.

How does hypochlorhydria

affect my body?
Stomach acid is necessary for digestion
and absorption of protein, vitamin B12 and
several minerals. When your body is no
longer able to break down and absorb
these nutrients, you end up with
undigested food and nutritional
de/ciencies. Protein and vitamin B12
de/ciencies lead to iron de/ciency anemia
as well as vitamin de/ciency anemia,
which affects your nervous system.
Calcium and magnesium de/ciencies lead
to osteoporosis.

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Undigested food in your GI tract causes a

range of uncomfortable GI symptoms in
the short term and leads to more serious
problems in the long term. For example,
undigested food left to ferment in your GI
tract can lead to gut bacteria overgrowth
in your small intestine (SIBO). Low
stomach acid also leaves you vulnerable
to overgrowth of other common bacteria,
including H. pylori, which is associated
with chronic gastritis and peptic ulcer
disease.

Symptoms and Causes

What causes hypochlorhydria?
The most signi/cant causes include:

Atrophic gastritis. The most common

cause is a condition called atrophic
gastritis, which is when the cells that
secrete stomach juices atrophy and
stop working. Atrophic gastritis is the
end result of chronic inWammation of
the stomach (gastritis). Chronic
gastritis can be caused by a variety of
things, including bacterial infection (H.
Pylori), alcoholism and autoimmune
disease.

H. pylori infection. This common

bacterial infection affects about half of
us in the U.S. In some people, H. pylori
causes no symptoms, but in others, it
can take over, /ghting and eventually
decreasing stomach acid. Ironically,
low stomach acid can also allow for H.
pylori to take over.

Acid-reducing medications. Chronic

use of antacids, H2 receptor blockers,
and especially proton pump inhibitors
(PPIs) can cause low stomach acid.
PPIs were originally approved only for
short-term use, but they are now
commonly overprescribed and used to
treat chronic symptoms such as GERD
and heartburn. Eventually, they can
cause the acid-secreting glands in the
stomach to stop working.

What are the symptoms of

hypochlorhydria?
Immediate symptoms involve indigestion,
including:

Abdominal pain.

Bloating.

Gas.

Diarrhea.

Constipation.

Undigested food in poop.

ReWux.

Heartburn.

Prolonged hypochlorhydria may produce

symptoms of nutritional de/ciencies,
including:

Brittle /ngernails.

Hair loss.

Paleness.

Fatigue.

Weakness.

Numbness or tingling in hands and

feet.

Memory loss.

Headaches.

Other contributing causes may include:

Advanced age. Cells age as we do, and

over time, the cells that produce
stomach acid can begin to die off.

Chronic stress. This doesn’t mean

common, everyday stress. But if you
have signi/cant stress sustained over
a long period of time, it can affect your
stomach acid production.

Stomach surgery, including gastric

bypass surgery, is known to affect
stomach acid production.

What risk factors are

associated with
hypochlorhydria?
Being over the age of 65.

Prolonged use of antacids or PPIs.

H. pylori infection.

History of gastritis or stomach ulcers.

History of stomach surgery.

Diagnosis and Tests

How can I tell if I have low
stomach acid?
The symptoms of hypochlorhydria —
symptoms of indigestion, nutritional
de/ciencies and possibly bacterial
infection — can be caused by many things.
Hypochlorhydria is only one possible
cause. If you have several of the risk
factors associated with low stomach acid,
you might suspect that is your problem.
But there’s no way to know for sure
without taking a stomach acid test.

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Healthcare providers use a variety of tests

to diagnose hypochlorhydria. There are
also some DIY tests you can try at home.
These may not be as accurate, but they
offer a relatively simple and inexpensive
way of exploring your theory. We
recommend that if you do get a positive
result from an at-home test, you follow up
with a trained healthcare provider.

The baking soda test

The theory behind this at-home is that

baking soda combined with stomach acid
produces carbon dioxide (C02), which will
cause you to burp. For the test, you’ll drink
half a glass (4 ounces) of cold water
combined with a quarter teaspoon of
baking soda, on an empty stomach. Then
time how long it takes you to burp. If it
takes longer than three to /ve minutes, the
theory goes, you don’t have enough
stomach acid.

How is hypochlorhydria
diagnosed?
Your healthcare provider will conduct a
physical exam and listen to your
symptoms and health history. If they
suspect hypochlorhydria, they will suggest
one of several stomach acid tests.

Medical tests to diagnose stomach acid

include:

The Heidelberg pH test. For this test,

you’ll swallow a small capsule with a
radio transmitter that measures the pH
levels in your stomach. After taking a
baseline measurement, you’ll drink a
baking soda solution to neutralize your
stomach acid. Then the test measures
how long it takes your stomach to
return to baseline acid levels. This tells
healthcare providers how well your
stomach produces and secretes acid.

The SmartPill test. The SmartPill is

another wireless transmitter that you
swallow. Unlike the Heidelberg test,
which measures pH levels, the
SmartPill measures gastric acid levels.

The gastric string test. This test

involves swallowing a capsule
attached to a string, then pulling it out
by the string after 10 minutes. The
string is tested with pH paper. Normal
stomach acid has a pH level of one to
two, which is highly acidic, with zero
being the most acidic level on the
scale. If you have hypochlorhydria,
your stomach acid might be more in
the range of three to /ve. Above /ve is
a severe condition called achlorhydria,
which means you have virtually no
hydrochloric acid.

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If you test positive for hypochlorhydria,

your healthcare provider may want to
follow up with additional tests to detect
nutritional de/ciencies or bacterial
infections. They’ll use all of this
information to design your treatment plan.

Management and
Treatment
How is hypochlorhydria
treated?
Treating hypochlorhydria is a three-
pronged process.

Address underlying causes. If your

healthcare provider has been able to
identify the cause of your
hypochlorhydria, the /rst step will be to
address that. This might mean
adjusting your medication
prescriptions, treating an underlying
health condition, or /ghting a bacterial
infection with antibiotics.

Supplement hydrochloric acid. To

treat the hydrochloric acid de/ciency
itself, your healthcare provider may
prescribe an HCI supplement (betaine
hydrochloride) to take with meals. HCI
supplements are often combined with
the enzyme pepsin. These
supplements can help your digestion.
Sometimes, they help your stomach
acid gradually return to normal levels,
and you can discontinue taking them.
They are available over the counter, but
they are not for everyone, so you
should talk to your healthcare provider
/rst before self-prescribing.

Supplement nutritional de>ciencies. If

your low stomach acid caused other
de/ciencies, such as iron, calcium or
vitamin B12, your healthcare provider
may recommend supplements to help
replace those nutrients.

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Outlook / Prognosis
What is the prognosis for
hypochlorhydria?
This condition can often be reversed, or at
least successfully treated, with HCI
supplements. It’s important to address the
underlying causes, however. If you have an
infection, disorder or inWammatory
condition, these will continue to cause
problems, including hypochlorhydria and
others. Make sure to get a thorough
medical screening before treating with HCI
supplements. Your healthcare provider can
help ensure you’re treating the causes and
effects of hypochlorhydria, including
speci/c nutritional de/ciencies.

Living With
What’s a good diet for low
stomach acid?
Diet alone won’t restore your stomach
acid, but these guidelines may help
improve your digestion while living with
hypochlorhydria:

Eat protein >rst. Protein at the

beginning of your meal helps to
stimulate acid production.

Drink Buids later. Save drinks until at

least 30 minutes after you’ve /nished
your meal. This gives your stomach
more time to produce acid and
metabolize proteins.

Eat probiotic foods, including yogurt,

miso and sauerkraut, to help boost
your good gut bacteria and keep
harmful bacteria in check.

Avoid overly fatty and processed

foods, which are harder to digest and
 offer little nutrition.

Fortify your vegetarian diet. Many of

the de/ciencies associated with low
stomach acid, including protein, iron,
calcium and vitamin B12, are most
abundant in animal-sourced foods,
such as meat, /sh and dairy products.
If you’re a vegetarian, make sure you’re
supplementing these nutrients. This
might be easiest with a quality health
shake blend.

Eat smaller meals and chew

thoroughly to give your digestive
system its best chance to break the
food down.

Finish your last meal two to three

hours before bedtime. Give your body
time to digest before lying down.

A note from Cleveland Clinic

Hypochlorhydria, or low stomach acid, is a

relatively underdiagnosed condition that
may be more common than we know.
Symptoms commonly associated with
hyperchlorhydria, or high stomach acid,
including heartburn and reWux, may
actually stem from hypochlorhydria.
Medications to treat high stomach acid
can contribute to low stomach acid,
making digestive problems worse.
Successful treatment requires careful
diagnosis and testing. Medical tests can
identify high or low stomach acid as well
as other important factors that may be
contributing to your symptoms. With the
right information, your healthcare provider
can help you make a plan to treat the
causes and effects of hypochlorhydria.

Medically Reviewed

Last reviewed on 06/27/2022.

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