Hypochlorhydria is the medical term for a low level of stomach acid. People with hypochlorhydria may experience digestive issues, nutritional deficiencies, and gastrointestinal infections, but prompt treatment can prevent serious complications.
An individual with hypochlorhydria is unable to produce enough hydrochloric acid (HCL) in the stomach.
Stomach acid, along with several enzymes, helps to break down food. Other functions of this acid include:
- aiding the body in absorbing certain nutrients, such as protein and vitamin B-12
- killing bacteria and other pathogens in the stomach to prevent infection
In this article, we describe the symptoms and causes of hypochlorhydria. We also explore the treatment options.
Common causes of hypochlorhydria include:
The stomach can produce less acid as a result of aging.
According to a 2013 review, hypochlorhydria is the main change in the stomach of older adults. People over the age of 65 have the highest risk.
While everyday stress may not have much effect on the production of stomach acid, chronic stress can contribute to hypochlorhydria.
Doctors often prescribe medications called proton pump inhibitors to treat acid reflux, and these can cause hypochlorhydria.
Over 50 percent of people worldwide are infected with a bacteria called Helicobacter pylori (H. pylori). This infection can contribute to low levels of stomach acid and gastric ulcers.
Zinc is necessary for the production of stomach acid. A lack of this mineral can contribute to hypochlorhydria.
Some surgical procedures, including gastric bypass surgery, can reduce the amount of acid the stomach produces.
Symptoms of hypochlorhydria can include:
- hair loss
- intestinal infections
- nausea while taking supplements
- nutrient deficiencies, including deficiencies in iron and vitamin B-12
- undigested food in the stool
- upset stomach
- weak fingernails
There is also a link between hypochlorhydria and several other medical issues, such as:
Certain factors can increase the risk of developing hypochlorhydria, such as:
- taking medications to reduce the production of stomach acid
- being 65 or older
- having high levels of stress on an ongoing basis
- eating a diet that lacks zinc or having poor zinc absorption
- having an H. pylori infection
- having undergone stomach surgery
To diagnose hypochlorhydria, a doctor will typically take a person's medical history and perform a physical exam.
They can also test the acidity of the stomach with a small capsule that contains a transmitter. The person swallows the capsule, and the transmitter reports the amount of acid in the gastrointestinal tract.
Doctors measure acidity using the pH scale. A pH value of 3–5 suggests hypochlorhydria, while a pH level of less than 3 indicates normal levels of stomach acid.
If the pH value is greater than 5, this suggests an almost complete absence of stomach acid, which is termed achlorhydria.
If the results show hypochlorhydria or achlorhydria, the doctor may take blood tests to check for a deficiency in iron or other nutrients.
A doctor may prescribe HCL supplements to confirm a diagnosis. If a person feels better when taking the supplements, low stomach acid is likely the cause of symptoms.
Treatment for hypochlorhydria depends on the underlying cause. Options include:
Antibiotics for H. pylori
An H. pylori infection requires antibiotic treatment.
A doctor will usually prescribe at least two antibiotics to take at the same time. Taking a combination of antibiotics prevents the bacteria from developing a resistance to one of the drugs.
The doctor may need to check whether the H. pylori bacteria are still present after 4 weeks of treatment. If they are, the doctor may prescribe a different combination of medications.
Reviewing medication use
Long-term use of antacids and proton pump inhibitors can result in hypochlorhydria. A doctor may recommend stopping the use of the drugs or switching to a different treatment.
Always speak with a doctor before changing or stopping medications.
Digestive enzymes and HCL supplements
A person may benefit from taking an HCL supplement and a pepsin enzyme to increase stomach acidity. This treatment option may be especially beneficial for older adults experiencing a natural decline in levels of stomach acid.
Natural digestive enzymes are also available in health stores and drugstores. These often contain extracts of papaya and pineapple, which can stimulate the production of stomach acid.
A variety of digestive enzyme supplements are also available to purchase online.
Consult a doctor before taking an HCL supplement.
Reducing chronic stress can restore digestive function. The following lifestyle changes can help:
- managing and reducing sources of stress
- exercising regularly
- learning deep breathing and progressive muscle relaxation techniques
- practicing meditation and mindfulness
- practicing yoga
- attending therapy
Changing eating habits
Making some dietary changes can help to improve symptoms of hypochlorhydria.
Avoid foods that are difficult to digest, such as those that are fatty and fried. Also, chew each bite thoroughly to break the food down and allow it to mix with the digestive enzymes in the mouth. Smaller food particles are more easily digested in the stomach.
It is a good idea to avoid eating for at least 3 hours before bedtime. This allows the body to fully digest before sleeping, and it can reduce the risk of nighttime heartburn.
Do not lie down immediately after a meal, and do not eat while lying down.
Addressing nutrient deficiencies
For the stomach to produce HCL, the body needs to absorb zinc from the diet. Zinc-rich foods include:
A low level of stomach acid can result in other deficiencies, such as a lack of iron, vitamin B-12, and calcium. A doctor or a dietician can help. They may recommend taking supplements or increasing dietary intake of these nutrients, especially once a person regains a regular level of stomach acid.
If left untreated, hypochlorhydria can negatively impact a person's health and well-being. It is important for people to report associated symptoms and undergo testing.
Once a doctor determines why a person's level of stomach acid is low, they can recommend ways to relieve or prevent symptoms. Prompt treatment also reduces the risk of complications.
Treatment options include making dietary and lifestyle changes, taking supplements, and altering the course of medications.