Hydrochloric acid (HCl) insufficiency can be complete (achlorhydria) or partial (hypochlorhydria) and intermittent. It plays an important part in the first digestive step, which if not completed properly can result in digestive problems all the way through the digestive tract. Some people with low stomach acid have no obviously related symptoms and are led to believe they are digesting properly, when they are not. An HCl trial is a safe, worthwhile, and relatively accurate way to discover if an insufficiency exists.
HCl does not digest food on its own, but creates an environment in which digestion begins. HCl is responsible for converting pepsinogen to pepsin, which begins breaking down proteins in the stomach. With limited HCl, pepsinogen isn’t converted to pepsin and protein digestion fails. A second action of HCl is to prevent infections, since most organisms that are ingested are destroyed by an adequate acid environment.
Since the long-term administration of supplemental HCl may result in reduced stomach output of acid, administration is advised for diagnostic purposes and short-term use only. Short-term use may result in a return of normal acid production.
Signs, symptoms & indicators of Hydrochloric Acid Deficiency
Undigested food in stools
Offensive stool
Must observe food combining rules or can eat poorly combined foods
Counter Indicators
Can eat poorly combined foods
Meal-related burping
Meal-related bloating
General flatulence
White spots on fingernails
Drowsiness after meals
Conditions that suggest Hydrochloric Acid Deficiency
Allergy / Intolerance to Foods (Hidden)
Consuming foods to which a person is allergic may contribute to poor stomach acid production. And, when stomach acid production is reduced or absent (either naturally or with the use of antacid medications) the chance of developing food allergies is enhanced.
Dermatitis Herpetiformis
People with Dermatitis Herpetiformis frequently have mild malabsorption associated with low stomach acid and should consider an HCL trial.
Atrophic Gastritis
The ability to produce acid, pepsin and intrinsic factor is lost altogether in patients with complete gastric atrophy.
Heartburn / GERD
Based on the clinical experience of doctors such as Dr. Jonathon Wright, MD, supplementing with hydrochloric acid sometimes relieves the symptoms of heartburn and improves digestion in individuals who have hypochlorhydria. Unexplained bloating, belching and heartburn are frequently diagnosed as symptoms of hyperacidity and sometimes wrongly treated with antacids, when in fact the underlying problem is insufficient acid production.
For those who have heartburn because of hypochlorhydria, antacids or medications which reduce acid production may bring relief of the heartburn but can lead to poor digestion and contribute to dysbiosis, leaky gut, and food allergies.
Helicobacter Pylori Infection
Infection with H. (helicobacter) pylori can impair HCL production. Low HCL production may also contribute to an overgrowth of H. pylori.
Rheumatoid Arthritis
Lack of stomach acid occurs frequently in rheumatoid arthritis patients. This is associated with changes in gastric microbial patterns.
Hives
Gastric analysis with histamine stimulation was performed on 40 patients with chronic hives (urticaria). Approximately 65% of the patients had either hypochlorhydria or achlorhydria. Of the patients with reduced acid output, 65% obtained almost complete or partial relief of symptoms with hydrochloric acid (HCl) therapy. These patients previously had been unresponsive to all other forms of treatment. The best results were obtained in the 22 patients with achlorhydria. In this group, 18 patients (82%) were almost completely relieved by HCl therapy. In another report, administration of dilute HCl altered the putrefactive flora ordinarily present in the small intestine of achlorhydric individuals.
According to the second report, therapeutic use of dilute HCl has fallen into disrepute, largely on theoretical grounds. However, many capable internists and dermatologists remain convinced, on the basis of clinical experience, that acid therapy is beneficial. [Rawls WB, Ancona VC. Chronic urticaria associated with hypochlorhydria or achlorhydria. Rev Gastroenterol 1951;18:267]
Risk factors for Hydrochloric Acid Deficiency
Alcohol-related Problems
Alcohol consumption can damage the HCL producing cells in the stomach.
Zinc Requirement
The amino acid histidine, zinc, and vitamin B1 are all needed for hydrochloric acid (HCL) production. If any of these are lacking in the diet or not absorbed properly, this can result in hypochlorhydria. Interestingly, the absorption of histidine and zinc are dependent upon the presence of adequate levels of HCL.
Vitamin B1 Requirement
Please see the link between HCL Deficiency and Zinc Deficiency.
Vitamin B6 Requirement
Vitamin B6 is necessary for the production of hydrochloric acid.
PPI antacid use
History of asthma
History of adult acne
History of eczema
Hydrochloric Acid Deficiency suggests the following may be present
Anemia, Megaloblastic
An item called “intrinsic factor” may be in short supply because it also is made by the parietal cells which produce hydrochloric acid and pepsinogen. Intrinsic factor makes the absorption of vitamin B12 possible, and without it B12 deficiency sets in. This disease is called pernicious anemia. The hypochlorhydric stomach often makes insufficient amounts of intrinsic factor so B12 levels should be checked and a series of vitamin B12 injections given if needed.
Hydrochloric Acid Deficiency can lead to
Hives
Gastric analysis with histamine stimulation was performed on 40 patients with chronic hives (urticaria). Approximately 65% of the patients had either hypochlorhydria or achlorhydria. Of the patients with reduced acid output, 65% obtained almost complete or partial relief of symptoms with hydrochloric acid (HCl) therapy. These patients previously had been unresponsive to all other forms of treatment. The best results were obtained in the 22 patients with achlorhydria. In this group, 18 patients (82%) were almost completely relieved by HCl therapy. In another report, administration of dilute HCl altered the putrefactive flora ordinarily present in the small intestine of achlorhydric individuals.
According to the second report, therapeutic use of dilute HCl has fallen into disrepute, largely on theoretical grounds. However, many capable internists and dermatologists remain convinced, on the basis of clinical experience, that acid therapy is beneficial. [Rawls WB, Ancona VC. Chronic urticaria associated with hypochlorhydria or achlorhydria. Rev Gastroenterol 1951;18:267]
Recommendations for Hydrochloric Acid Deficiency
Herbal Combinations
Bitter herbs are thought to stimulate digestive function by increasing saliva production and promoting both stomach acid and digestive enzyme production. As a result, they are particularly used when there is low stomach acid but not in cases of heartburn or too much stomach acid.
These herbs taste bitter, thus the name. Some examples of bitter herbs include greater celandine, wormwood, and gentian. Bitters are generally taken either by mixing 1–3 ml tincture into water and sipping slowly 10–30 minutes before eating, or by making tea, which is also sipped slowly before eating. There are many combination products available from your health food store.
A more comprehensive list would include andrographis, artichoke, barberry, bitter melon, bitter orange, blessed thistle, boldo, centaury, dandelion, devil’s claw, elecampane, gentian, goldenseal, greater celandine, horehound, juniper, Oregon grape, picrorhiza, prickly ash, vervain, wormwood, yarrow and yellow dock.
Cayenne Pepper (Capsicum frutescens)
Capsaicin, the active ingredient in cayenne, is believed to assist digestion by stimulating the flow of both salvia and stomach secretions. One or two capsules of cayenne pepper taken before meals stimulates hunger also.
Therapeutic Fasting
Fasting gives the digestive system a needed break from the nearly constant effort that is required to process what we swallow. Unless we have been eating very healthfully, and sometimes even if we have, fasting will provide a period of rest to allow digestive rejuvenation to occur.
Juices / Juicing
A juice fast gives the digestive tract a rest from its heavy responsibilities, and strengthens a digestive weakness.
Vinegar
Apple cider vinegar or lemon juice taken with meals mildly stimulates hydrochloric acid production.
Digestive Enzymes / (Trial)
A trial using plant-based enzymes to enhance digestion demonstrated their additional benefit of improving hydrochloric acid production in those individuals who were hypochlorhydric.
Vitamin Folic Acid
In cases of low stomach acid (hypochlorhydria) or no stomach acid (achlorhydria), supplemental use of hydrochloric acid normalizes folate absorption.
Vitamin B1 (Thiamine)
Several B-vitamins are needed to support hydrochloric acid production. Thiamin (B1) may stimulate digestion by improving hydrochloric acid production and intestinal muscle tone.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Strongly counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
Hydrochloric Acid
(HCl): An inorganic acidic compound, excreted by the stomach, that aids in digestion.
Achlorhydria
The complete absence or failure of stomach acid secretion.
Hypochlorhydria
The condition of having low hydrochloric acid levels in the stomach, often the cause of digestive disorders.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Protein
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Antacid
Neutralizes acid in the stomach, esophagus, or first part of the duodenum.
Allergy
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Dermatitis
A general term used to refer to eruptions or rashes on the skin.
Helicobacter Pylori
H. pylori is a bacterium that is found in the stomach which, along with acid secretion, damages stomach and duodenal tissue, causing inflammation and peptic ulcers. Although most people will never have symptoms or problems related to the infection, they may include: dull, 'gnawing' pain which may occur 2-3 hours after a meal, come and go for several days or weeks, occur in the middle of the night when the stomach is empty and be relieved by eating; loss of weight; loss of appetite; bloating; burping; nausea; vomiting.
Rheumatoid Arthritis
A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).
Histamine
A chemical in the body tissues, produced by the breakdown of histidine. It is released in allergic reactions and causes widening of capillaries, decreased blood pressure, increased release of gastric juice, fluid leakage forming itchy skin and hives, and tightening of smooth muscles of the bronchial tube and uterus.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Urticaria
Commonly known as hives, urticaria is one of the most common dermatological conditions seen by allergists. Urticaria is not just an allergic disease, however. It can be caused by metabolic diseases, medications, infectious diseases, autoimmune disease, or physical sensitivity. Traditional allergies to foods or medications as well as viral illness are frequent causes of acute urticaria which usually lasts only a few hours but may last up to 6 weeks. Chronic urticaria (lasting more than 6 weeks) is more complex, given the vast number of potential triggers. Symptoms include sudden onset; initial itching; then swelling of the surface of the skin into red or skin-colored welts (wheals) with clearly defined edges; welts turn white on touching; new welts develop when the skin is scratched; usually disappear within minutes or hours. Welts enlarge, change shape, spread or join together to form large flat raised areas.
Amino Acid
An organic acid containing nitrogen chemical building blocks that aid in the production of protein in the body. Eight of the twenty-two known amino acids are considered "essential," and must be obtained from dietary sources because the body can not synthesize them.
Histidine
An amino acid. Precursor to histamine, a vasodilator and gastric juice stimulant. Has been used as a therapeutic aid for arthritis.
Zinc
An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.
Thiamine
(Vitamin B-1): A B-complex vitamin that acts as a coenzyme necessary for the conversion of carbohydrates into glucose, which is burned in the body for energy. It is essential for the functioning of the nervous system.
Vitamin B6
Influences many body functions including regulating blood glucose levels, manufacturing hemoglobin and aiding the utilization of protein, carbohydrates and fats. It also aids in the function of the nervous system.
Cobalamin
Vitamin B-12. Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Pernicious Anemia
Anemia caused by a vitamin B12 deficiency.