Hydrochloric acid (HCl), stomach acid, is critical for healthy digestion.

When stomach acid is low (hypochlorhydria), you may have symptoms like:

  • Bloating, belching, burning, and lots of gas right after meals

  • Feeling full, even when eating small meals

  • Indigestion, diarrhea, or constipation

  • Food reactions

  • Weak, peeling, and cracked fingernails

  • Rosacea, acne, eczema, and other skin problems

  • Iron deficiency

  • Chronic intestinal parasites and dysbiosis

  • Undigested food in your stool

  • Chronic yeast infections

Low stomach acid can cause a variety of health problems, including:

  • Depression and anxiety

  • Stomach cancer

  • Gallbladder disease

  • Osteoporosis

  • Autoimmune disease

  • Faster aging

There are lots of reasons why stomach acid can be low. Some common ones are:

  • Age - stomach acid production decreases naturally with age

  • Stress

  • Vitamin/mineral deficiency

  • Use of acid-blocking medications

  • Chronic bacterial infections (like H pylori)

  • Autoimmune gastritis - stomach inflammation

There are a variety of tests you can use to check your stomach acid levels, including more invasive ones, like those from your doctor:

  • Gastric acid secretion test - used to measure the amount of acid in the stomach and the level of acidity in stomach contents. The test is done on an empty stomach so that all that’s left in there is fluid. The fluid is removed through a tube that’s inserted through your mouth and down your esophagus, and the contents are analyzed. Gastrin might be injected during the procedure, which helps test the ability of the cells in your stomach to release acid.

  • Heidelberg Stomach Acid Test - considered the gold standard for identifying low stomach acid. Your doctor will have you swallow a small capsule with a radio transmitter, which measures the acidity level in your stomach while you drink a baking soda solution. Baking soda lowers stomach acid levels, so if your levels don’t return to normal, it’s a sign of low acid.

There are tests you can try on your own. They are not diagnostic but can give you a sense of what your stomach acid levels are like.

*These tests are not appropriate for children.*

  • Baking Soda Challenge

    • First thing in the morning, on an empty stomach, mix 1/4 teaspoon of baking soda in water (about 6 ounces)

    • Drink it quickly

    • Start a 5-minute timer

      • If your stomach acid levels are high enough, you should belch within 2-3 minutes

      • If you belch quickly and repeatedly, you may have high stomach acid, but you might have also swallowed air when drinking the baking soda solution

      • The bicarbonate in the baking soda is converted to carbon dioxide gas in the stomach and should cause belching in less than 5 minutes

      • If you’ve hit the 5-minute mark and haven’t belched, your stomach acid levels may be low

    • Repeat this test 3 times for a more accurate result

  • Betaine HCl Challenge (*Do not try this if you have peptic ulcers, and if you aren’t sure, ask your doctor.)

    • Buy a Betaine HCl with pepsin supplement

    • Eat at least 6 ounces of meat with a meal

    • Take 1 Betaine HCl with pepsin in the middle of the meal

    • See what happens!

      • No symptoms mean you may have low stomach acid

      • Indigestion, burning, heat, or heaviness in your chest means your stomach acid levels are probably ok

    • Repeat this test 3 times to be more accurate. This is important because you can have a false-positive result if you:

      • Didn’t eat enough protein

      • Took the supplement before the meal instead of in the middle of it, which can cause indigestion

      • You have a hiatal hernia, or your esophageal sphincter tone is low - if you suspect these, talk to your doctor

If you take acid-blocking or acid-reducing medications, your test results might be falsely low. It takes these medications about 2-3 days to clear your system for a more accurate test result. *If you are on prescribed medications, consult your doctor before stopping or changing your medications.

If you have low stomach acid (hypochlorhydria), these strategies can help:

  • Eat slowly and chew thoroughly. Digestion begins in the mouth.

  • Remove processed junk foods from your diet

  • Eat fermented, probiotic foods like unsweetened yogurt, kefir, sauerkraut, kimchi, and other fermented vegetables

  • Dilute a tablespoon of apple cider vinegar or lemon juice in a glass of water and drink it with meals

  • Take a digestive bitters supplement just before each meal

  • Eat ginger

  • Take a betaine HCl supplement (*not appropriate for children)