Hypochlorhydria - lack of stomach acid - can cause lots of problems
Hypochlorhydria arises when the stomach is unable to produce hydrochloric acid. It is a greatly overlooked cause of problems.
Acid environment in the stomach
The stomach requires an acid environment for several reasons.
- acid is required for the digestion of protein,
- acid is required for the stomach to empty correctly and failure to do so results in gastro-oesophageal reflux disease (see Heartburn),
- acid is required to sterilise 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.
Problems arising from hypochlorhydria
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 sterilise 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 defences 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.
- Allergy to gut microbes. The idea here is that gut microbes are miniscule compared with human cells and all too easily spill over into the bloodstream with the potential to cause allergic or inflammatory reactions at distal sites. Irritable bladder or interstitial cystitis is an obvious case. But I suspect many other pathologies such as arthritis, venous ulcers, rosacea, "intrinsic" asthma, mesenteric adenitis, rheumatic fever, polymyalgia rheumatica and other such can be explained by this mechanism.
- Fermenting brain. Nishihara has shown that fermenting gut may result in fermenting brain - low levels of microbes in the brain may ferment neurotransmitters into LSD and amphetamine like substances (to cause hyperactivity, psychosis and other such) or ferment out serotonin, acetylcholine, GABA to cause low mood and depression. If this is correct then this explains a whole range of psychiatric conditions and establishes the mechanism of the widely observed food-mood connection. See Nishihara's work at []
- 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 vitamin 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, 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.
- Risk factor for cancer. I suspect many bowel tumours are driven by microbes in the upper fermenting gut. Indeed we know that helicobacter pylori infection is a risk factor for stomach cancer. In Japan, where hypochlorhydria is very common, stomach cancer is a major killer.
Symptoms of hypochlorhydria
When any of the above problems go wrong, it can result in symptoms.
- 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-oesophageal reflux disease
- Iron deficiency Anaemia
- B12 deficiency
- A tendency to candida dysbiosis or bacterial dysbiosis.
Cause of hypochlorhydria
The stomach is lined with cells that are proton pumps - that is to say they pump hydrogen ions from the blood stream into the lumen of the stomach. Stomach acid is simply concentrated hydrogen ions. There is a natural tendency for these hydrogen ions to diffuse back from where they came but this is prevented by very tight junctions between stomach wall cells. However, if the gut becomes inflamed for whatever reason, there is leaky gut and hydrogen ions leak back out. A common cause of inflammation and leaky gut is allergy. See Allergy to Foods, Inhalants & Chemicals - signs and symptoms of
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 at mealtimes. Indeed, my standard recommendations for nutritional supplements suggest combining my Mineral Mix with ascorbic acid to be taken at mealtimes. Ascorbic acid, combined with the minerals, most of which are in the chloride form, reacts to form a combination of mineral ascorbates and hydrochloric acid. This is the perfect mixture to optimise absorption because it mildly acidifies the stomach and puts the minerals into the best available form to be absorbed, i.e. the ascorbate, and, of course, an acid environment.
The third approach is to take betaine hydrochloride. 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 glycaemic index, low allergy potential, smaller meals), getting rid of helicobacter pylori, and 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 food, of course, are dairy products.
A test for hypochlorhydria - Salivary VEGF
Dr John McLaren-Howard has again come up with a brilliant suggestion for a simple test to identify hypochlorhydria. The idea here is that it is very difficult for the stomach to produce stomach acid. The normal acidity of blood is about pH7, but the acidity of stomach acid can be as low as pH1 - that means that hydrogen ions (which create acidity) are a million times more concentrated in the stomach than in the bloodstream. So the stomach wall has a very difficult job to do. The gastric parietal cells need quite a bit of energy from ATP to pump hydrogen ions from the inside of the parietal cell into the lumen of the stomach. The difficult bit is stopping these hydrogen ions leaking back again. This is achieved because the gastric parietal cells form a protective barrier between each other at the cell membrane tight junction to stop hydrogen ions leaking back. Because this is extremely hard work and the body does not want to waste energy, the main regulator for the cell membrane tight junction is vascular endothelial growth factor (VEGF).
What this means is that the more stomach acid is produced, the more VEGF is necessary to keep the glue going between gastric parietal cells. Therefore, one would expect salivary VEGF levels to be proportionate to the amount of stomach acid. And indeed this is the case. There is a huge amount of research that has been done with respect to VEGF, most of which is to do with high levels. However, the reverse is also true and low levels of VEGF would be a pointer towards hypochlorhydria.
This test would be invalidated by taking proton pump inhibitors and possibly other acid blockers, so for the best chance of an accurate result, really these drugs need to be stopped for four days prior to doing the test.
VEGF test - the practicalities
Saliva for VEGF tests should be unstimulated. That is: a sample is given at least one hour after a meal and at least 15 minutes after drinking soft drinks, tea or coffee. A break of 24 hours after alcohol ingestion is needed AND a similar break after any proton-pump-inhibitor drugs are used and ideally any drug that interferes with stomach acidity. Put 1-2ml of saliva into the blue topped trace element free tube supplied and post to Acumen to arrive on a working day.
Bicarbonate burp test
This may give a rough guide - the idea here is that sodium bicarbonate, when swallowed, reacts with stomach acid to make carbon dioxide which is subsequently burped up. The timing of the burp gives a clue as to how acid the stomach is. It is at least cheap and DIY. See [[]]
Hydrochloric acid production This is an interesting animation showing how hydrochloric acid is produced in the stomach.
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