Do you have low stomach acid?

How do you know…test and not guess?

The CBC and CMP:

A skilled clinician can diagnose low stomach acid levels off of routine complete blood counts (CBC) and comprehensive metabolic panels (CMP) if they know what they are looking for. Patient history should always be a big factor with this, but here are the major signs on these tests.

Optimal Ranges:

Chloride 101-106

Serum Protein 6.9-7.4

Serum Globulin 2.4-2.8

Phosphorus

BUN

MCV

MCH

MCHC

Vitamin D

Thyroid

The nice thing about the CBC and CMP is that they are routine tests for medical doctors and are nearly always covered by insurance if you go through your primary care medical provider. Here are the indications that I look for:

Low Chloride Levels: One of the main components of hydrochloric acid is chloride. When we see low chloride levels in the blood under 100 (101–106 is functionally normal), then it is a sign of low HCL.

Abnormal Serum Protein and Serum Globulin Levels: Since HCL is needed for protein digestion, when these levels are abnormal such as a serum protein under 6.9 or over 7.4 g/dL and globulin level under 2.4 or over 2.8 g/dL then it could be a sign of low HCL. Especially if liver enzymes are relatively normal.

Low Phosphorus Levels: If phosphorus levels are low, with a vitamin D deficiency and/or hyperparathyroidism then it may be a sign of low HCL production.

High BUN Levels: A lack of stomach acid may result in a high amount of nitrogenic waste (from poor protein digestion) in the bloodstream. This can be seen as a BUN (blood urea nitrogen) level of 20 or more.

Abnormal MCV/MCH/MCHC: This has to do with the size of the red blood cell (RBC). Methylation with B12 is a critical part of the RBC maturation process in the bone marrow. Inadequate B12 will result in immature RBC’s that will be larger and less effective at carrying oxygen to cells.

HCL is also necessary for iron absorption, so if these numbers are below normal along with low Hct, Hbg, etc. it could be an iron deficiency related to low HCL.

Normal MCV should be between 85–92

Normal MCH should be between 27.7–32%

Normal MCHC should be between 32–36%

Additional Lab Testing:

High Homocysteine Levels: Stomach acid is critical for B12 absorption (4). B12 is one of the key components of methylation which keeps homocysteine levels between 5–8 umol/L. If B12 levels are low, then homocysteine will be elevated.

Low B12 Levels: Intrinsic factor is a glycoprotein in the stomach that is necessary for B12 absorption. With inadequate HCL production, intrinsic factor will be unable to work effectively and the individual will develop a B12 deficiency (5).

When a patient history indicates symptoms of low stomach acid levels and 2 or more of these findings are on lab work then it is a good clinical assumption that the individual needs to focus on strategies to improve HCL production.

Maybe take “The Betaine HCL Challenge Test”:

This is a very reliable test you can perform if you have the symptoms above and failed the Baking soda test. It will cost you a bottle of Betaine HCL, which you will probably need anyways if to help you restore HCL levels if they truly are low.

To Perform the Test do the Following:

Buy some Betaine HCL with pepsin (we use Acid Prozyme or Super Digest HCL)
Eat a high protein meal of at least 6 ounces of meat (you can have veggies too)
In the middle of the meal (never in the beginning) take 1 Betaine HCL pill
Finish the meal and observe what you notice.

Possible Outcomes:

You Don’t Notice Anything: If you do not notice any difference it is most likely that you have low stomach acid levels.
You Notice Indigestion: If you notice a burning, hotness or heaviness in your chest then these are signs you have adequate stomach acid levels.

It is best to do this test 2-3 times in order to make sure you aren’t getting a false positive. There are 3 main reasons for someone getting a possible false positive.

Didn’t Consume Enough Protein: If it is a relatively low protein meal, you won’t need much HCL and therefore the supplement can cause too much of an increase.
Took the Capsule Before the Meal: This will almost always cause indigestion as your body isn’t ready for the supplement.
Have Esophageal Sphincter Dysfunction: For some individuals, they may have a hiatal hernia or poor contractile activity of the esophageal sphincter that can cause an increase in indigestion like symptoms. It is always good to get a medical exam to rule these things out before doing the test if possible.

After getting 2-3 positive tests in a row, begin using the HCL supplement with the protocol I give at the bottom of this article along with the 10 ways to improve your stomach acid levels.

What is the role of the stomach (organ)?

7 Major Functions of Stomach Acid

Sterilizes the Food: Whenever we consume food, bacteria and other microorganisms come in with the food (even if it was cooked or pasteurized). The stomach acid helps to neutralize the bad invaders we don’t want in our system (1, 2).
Protein Digestion: Stomach acid is necessary to begin the process of breaking down protein. Have you ever marinated meat in vinegar? Vinegar is not nearly as acidic as what your stomach acid should be, yet, over time it degrades the meat. This is what your stomach acid should be doing in a much quicker fashion.
Activating Pepsin: Pepsin is a proteolytic enzyme that is necessary for our body to effectively metabolize protein. Stomach acid activates pepsin from its inactive form called pepsinogen.
Activating Intrinsic Factor: Stomach acid helps to activate intrinsic factor which is a glycoprotein produced in the stomach that is necessary for vitamin B12 absorption.
Stimulating the Delivery of Bile and Enzymes: Stomach acid helps to stimulate the release of bile from the liver and gall bladder and digestive enzymes from the pancreas.
Closing the Esophageal Sphincter: Stomach acid is an important trigger for the contraction of the esophageal sphincter (just above the stomach) to protect the soft, delicate tissue of the esophagus from the harsh acids in the stomach.
Opening the Pyloric Sphincter: Stomach acid helps to active the pyloric sphincter which allows food to move from the stomach to the small intestine.

12 Signs that You Have Low Stomach Acid:

The condition of low HCL causes poor digestive motility and sphincter activity. This allows food contents to sit in the stomach and be metabolized by bacteria that are able to survive due to lack of stomach acid. The result of this bacterial fermentation is gas which can cause bloating, cramping, belching, etc.

Here are the most common signs and symptoms that you have low stomach acid production.

1) Gas and Belching: With low HCL, this usually comes on shortly after a meal, within 60 minutes.

2) Acid Reflux: This is most commonly caused by low acid (not too much acid) as explained in this article.

3) Bloating and Cramping: The gas production from the bacterial fermentation in the stomach produces this. Again, it typically comes on within an hour of eating.

4) Chronic Bad Breath: This is due to the toxic metabolites produced through bacterial fermentation in the stomach.

5) Bad Body Odor: Poor stomach acid production leads to an overall microbial overgrowth throughout the body. More microbes produce more stinky toxins.

6) Undigested Food in Stools: This is obvious, you are not able to completely metabolize the food you are consuming.

7) Aversion to Meat: Many people with low stomach acid desire to avoid meat and have digestive problems (as described above) when they eat it. Especially red meat which is usually tougher and depends upon more HCL than whiter meats for digestion.

8) Tired After Meals: If the digestive process has to work twice as hard, it will cost us a lot of energy, leaving us tired.

9) Feeling Full But Still Hungry: You are full because food isn’t leaving your stomach, but you are hungry because you are not absorbing nutrients effectively.

10) Chronic Anemia: You aren’t having excessive bleeding, you are consuming enough iron in your diet (or even in supplements), yet you still have a non-responsive anemia (9).

11) Weak Fingernails: If your fingernails break, chip or peel easily it is a classic sign of nutrient deficiencies, especially protein, minerals and B12.

12) Frequent Nausea: Because your stomach gets full quickly, it can often trigger a nausea reflex.

Additionally, you may be more prone to food poisoning because the less stomach acid you are producing, the less able you will be to sterilize the food stuffs in the stomach. Have you ever wondered why 2 people can eat the same dish, one gets sick and the other doesn’t. It may have had to do with stomach acid production.\

Maybe the “The Baking Soda Stomach Acid Test”

Ingesting baking soda has been a natural remedy used for many years to help settle an upset stomach.

Baking soda contains sodium bicarbonate which has hydroxide (OH-) ions that reduce acidity.

Since reducing acidity can create more comfort in someone with acid reflux, baking soda developed this reputation.

There is a simple test you can do at your home in order to see if you have enough stomach acid.

This involves drinking baking soda in order to create a unique chemical reaction within your stomach.

This reaction happens when the (OH-) ions of the baking soda (sodium bicarbonate) and the hydrogen (H+) ions within the hydrochloric (stomach) acid (HCL).

This should naturally result in carbon dioxide gas production and a resulting burping effect.

This test is virtually free (excluding the cost of a ¼ tsp of baking soda) so there is nothing to lose.

I recommend doing this test because it is safe and has no cost and it can be done very easily.

However, the test isn’t without its flaws. There are many variables that go uncontrolled for in this experiment.

To minimize extraneous variables, I recommend performing the test on 3 consecutive mornings in order to find an overall average.

With this method, you are looking for a pattern of results instead of a one-time “yes” or “no.”

Also, to improve the accuracy it is important to do the test first thing in the morning before eating or drinking anything else.

There are no scientific studies that discuss this method as either reliable or unreliable.

The results of the test can vary widely depending upon the individual, so it is up to your interpretation from what you are experiencing with this.

The infographic below goes over how to do the test properly.

Early and repeated belching may be due to excessive stomach acid (but don’t confuse these with small little burps from swallowing air when drinking the solution).

Any belching after 3 minutes is an indication of low stomach acid production.