low stomach acid

Low Stomach Acid – Does This Cause Acid Reflux?

This may sound completely counter intuitive, but there is a significant body of opinion, and some hard research, which states that one of the causes of acid reflux is too little stomach acid, not too much. Read on below…

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The Importance of Stomach Acid

Stomach acid is vitally important to us, not only for proper digestion of our food but also for a wide range of body processes which keep us healthy.

Low stomach acid – technically called hypochlorhydria – has been shown to increase with age, and is thought to affect over half of over 65 year olds.

I recommend a highly rated book all about the importance of stomach acid, and how to deal with it in relation to acid reflux, written by Dr Jonathan Wright. Details can be found here (US) and here (UK)

Here’s a video explaining the phenomenon:

YouTube Preview Image

Low Stomach Acid – Does This Cause Acid Reflux?

According to the theory (see reference 1 below), low stomach acid causes acid reflux in 4 ways:

  1. by allowing bacteria to grow, and
  2. by food, particularly carbohydrates, not being properly broken down.
  3. by the lower esophageal sphincter remaining open because the acid in the stomach is too weak to trigger its closure.
  4. By the valve at the bottom of the stomach, the pyloric sphincter, remaining closed, thereby preventing food from moving from the stomach to the duodenum.

As a result, the gases produced by bacteria in the gut leads to higher pressure in the stomach, and with a weaker Lower Esophogeal Sphincter (LES) acid is released into the esophagus.

I’ve covered the problems an overgrowth of bacteria can cause – particularly for reflux symptoms – in another article.

If this is true – ie acid reflux is caused by low stomach acid – it means that the drugs which turn down the production of stomach acid – lanzaprozole, omeprazole, prilosec and other acid suppressing drugs – are in fact making the problem worse.

There is a small number of clinical trials backing up both parts of the theory, and there is support from the evidence showing that stomach acid production declines with age.

My reading of it suggests to me that, yes, this could apply to certain individuals, but does that include me? What are the low stomach acid symptoms, and is there a low stomach acid test?

Low Stomach Acid Symptoms

The most common documented low stomach acid symptoms are:

  • Heartburn.
  • Indigestion, diarrhea, or constipation.
  • Bloating, belching, and flatulence immediately after meals.
  • Acne.
  • Rectal itching.
  • Chronic Candida.

Low Stomach Acid Test

Well. there seem to be a number of tests, some easy and straightforward, some more complicated. I suggest you start with an easy, home based test first. If this provides an indication of low stomach acid, go to your doctor and discuss it with him / her.

Home Based Low Stomach Acid Test

  1. Mix 1/4 teaspoon of baking soda ((US) (UK)  in 4-6 ounces of cold water first thing in the morning before eating or drinking anything, and drink.
  2. Time how long it takes you to belch. This should be no longer than 5 minutes.

If your stomach has sufficient stomach acid you’ll belch within two to three minutes. Any belching after 3 minutes indicates a low acid level.

I emphasise this is a rough and ready low stomach acid test, but may give you an indication. If it’s positive, I suggest you discuss the next steps with your doctor, which may include the Heidelberg Low Stomach Acid Test, below.

If you do get positive results, you may wish to consider the following test. However, be very careful if you have a history of ulcers or gastritis, and you may wish to discuss this with your doctor first.

Betaine HCL Test for Low Stomach Acid

This involves taking a supplement containing hydrochloric acid (which is essentially stomach acid) and the enzyme pepsin which works with acid to breakdown food, particularly protein.

The idea is that you take sufficient supplement to improve your symptoms, but without causing any discomfort. This involves gradually increasing the dose of supplement until a warm sensation is felt in the stomach.

In the book mentioned above, Dr Jonathan Wright recommends starting with a dose of 650 mg, taken during a meal containing some protein. If this produces a warm sensation in the stomach, then it is likely that low stomach acid is not a problem.

If there is no apparent reaction, you can  increase the dose at the next meal to see the effect. At the same time, note if the reflux symptoms improve. It may take some days for the effects to be detected.

A highly rated source of HCL with Betaine can be found here (US) or here (UK)

The Heidelberg Low Stomach Acid Test

This test is administered by a health professional. It involves swallowing a pill sized acid monitor which transmits the level of stomach acid over time. If the home tests yield results which indicate a low level of stomach acid, it may well be fruitful to discuss this test with your doctor to get a definitive diagnosis.

Apple Cider Vinegar

A simple way to check for low stomach acid is to take apple cider vinegar. A tablespoon in a glass of water before a meal boosts the acidity of the stomach.

A cursory search for home remedies for heartburn and acid reflux reveals that many people gain relief from Apple cider vinegar.

Highly recommended brands: for the US –  here, for the UK – here.

I’ve written more about this seemingly miracle product here. Not only does it have a great taste of very appely cider, it appears to have a beneficial effect on reflux – studies have not shown why, but it could be as a result of supplementing low stomach acid, or assisting the LES to close.

Unfortunately it doesn’t seem to work for me; I tried on several occasions, but to no avail.

For a more detailed explanation of the problems with low stomach acid, go read Chris Kresser, ref 1 below.

Have you taken acid supplements for your gerd? Give me your feedback, or let me have your comments below.

References: 1


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3 thoughts on “Low Stomach Acid – Does This Cause Acid Reflux?

  1. Pingback: > Heartburn & Gerd / Gord News Roundup - Causes of Acid Reflux, Salt & Heartburn, New Surgical Technique - How To Get Rid of Acid Reflux

  2. Barbara

    My compliments on your website — well written, concise and concepts clearly yet simply explained!

    Over the past 3 years I have developed Ileocecal Valve Syndrome, then SIBO, IBS-C (methane tested very high on breath test), functional dyspepsia (which seems to be a milder version of full-blown gastroparesis) and most recently LPR (no more lemonade and kombucha tea for me ;-|).
    I’m modifying diet per Koufman / Aviv / Robillard.

    I am in the camp that believes low stomach (among other factors) causes LES to open when not supposed to, and is likely a contributing factor to stomach contents emptying too slowly through pyloric valve into small intestines.

    Digestively, I’m the perfect candidate to trial Betaine Hcl with Pepsin, BUT am afraid to take it, because I have [1] eosinophilic esophagitis and [2] two benign congenital esophageal strictures that narrow to 1/4 inch . One at very top of esophagus, the other at very bottom (picture a long thin balloon with knots at each end). I cannot swallow tabs or caps whole and mostly eat soft / pureed food. With capsule supplements, I pull apart and mix powder with food or drink.

    Having LPR with dietary acid being one of my worst triggers, I obviously dare not mix betaine Hcl with Pepsin with food! I take either DGL or digestive bitters before meals, chewable digestive enzymes (no pepsin) with meals, and Iberogast (herbal prokinetic to gently encourage faster stomach emptying) at the end of meals. In between meals I use ginger tea, alkaline water, Manuka honey (10+ or 15+).

    After a lot of searching, I have found a product that is Betaine Hcl WITHOUT Pepsin, but have not yet ordered it. Further research on Wikipedia shows Betaine Hcl / TMG has pH of 1.84, so I would clearly have to mix with quite a bit of food to avoid the direct acid hit.

    I have made such good progress the last 2 months healing LPR with low acid / lower fat diet and avoiding other dietary triggers that I don’t want to do anything to reactivate the pepsin.

    I understand the Betaine Hcl protocol and have my functional medicine practitioner’s blessing to try it.
    Any thoughts or insight on safely taking Betaine Hcl / TMG without triggering LPR symptoms would be kindly appreciated!

    1. rfjamieson1@gmail.com Post author

      Hi Barbara
      Many thanks for your comments. I’m sorry to hear about your conditions. Unfortunately I’m unable to advise on specific situations. I suppose I’m lucky enough not to suffer from LPR, so I can’t even comment from my own point of view. Perhaps you could post a query on the Facebook and / or forum sites which abound. I suspect, though, that given the amount of research you’ve already undertaken, you’re already aware of these and have already tried that route?


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