Understanding Low Stomach Acid: Causes, Symptoms, Tests, and How Betaine HCl Can Help

If you’ve ever felt a burning sensation in your chest or struggled with bloating and indigestion after eating, you might think excess stomach acid is to blame. I used to believe the same, treating every bout of discomfort with antacids and hoping for relief. But what if the real issue was too little stomach acid? 

Stomach acid, primarily made up of hydrochloric acid, is essential for breaking down food, absorbing nutrients, and protecting against harmful bacteria. It turns out low stomach acid—often overlooked and misunderstood—can cause a cascade of digestive problems, from nutrient malabsorption to bloating and heartburn. 

In this article, we’ll explore low stomach acid, its causes, common symptoms, and how to test for it. I’ll also share how betaine HCl has helped many, including myself, to support proper digestion and regain balance.

What Causes Low Stomach Acid?

You may be thinking to yourself, how did I even get here? Digestion used to be so effortless and without any discomfort. Let’s take a look at some contributing factors.

Age

Studies are mixed as to whether or not stomach acid decreases simply due to aging as a factor. However, we do know that stomach acid-related conditions increase with age.

A study of 753 subjects examined the connection between age, gender, and gastric acid secretion. Researchers divided subjects into nine distinct age groups, with particular emphasis on individuals aged 65 and older. Researchers placed a pH probe in the stomach to record pH levels every four seconds over 24 hours.

Unlike earlier studies, researchers found no significant differences in average stomach acid levels (mean gastric pH), baseline acidity, or acidity levels during the day, night, or after eating, regardless of age or gender.

So, what could be the factors contributing to lower stomach acidity that seems to become oh-so-common as we get older? Researchers noticed a few factors. Let’s take a look. 

H. pylori

One factor recognized by research contributing to low stomach acid is H. pylori infections. 

H. pylori is a type of bacteria that can infect the stomach. Over time, this infection can cause long-lasting irritation due to an enzyme called urease that the bacteria make and damage to the stomach lining.

This irritation can harm the cells and tissues responsible for producing stomach acid, often referred to as atrophic gastritis. As the infection persists, the number of cells that create stomach acid may gradually decrease, leading to lower acid levels.

This ongoing irritation can also prompt the release of certain immune system chemicals, known as cytokines, which interfere with the cells that usually produce stomach acid (parietal cells), causing them to become less effective.

In addition to the digestive impact, stomach acid plays an essential protective role in the body by helping eliminate harmful microorganisms entering the gastrointestinal tract. Hydrochloric acid (HCl) creates an acidic environment that destroys various bacteria, viruses, and parasites that might otherwise threaten health. 

When stomach acid levels are low, this weakens the protective barrier, potentially increasing the risk of infections and making them more severe.

H. pylori infections affect around 50% of the US population. Worldwide, H. pylori infections tend to become more common with age. In older adults, rates can reach 40%-60% for those without symptoms and over 70% for elderly patients with stomach or intestinal issues.

It’s still unclear whether the prevalence of H. pylori infections increases with age, potentially because stomach acid naturally declines for some people as they age. Further studies are needed to clarify this connection.

H. pylori requires medical attention. Note that it can be a particularly hard infection to correctly diagnose and treat. If you have H. pylori, a more acidic stomach makes the bacteria more resistant to antibiotics. In this case, it might be beneficial to temporarily block stomach acid as you’re taking antibiotics and avoid taking betaine HCl supplements. You should see your doctor for proper diagnosis and treatment.

Medications

A second factor contributing to low stomach acid involves the use of certain medications that can reduce or interfere with acid production in the stomach:

• Proton pump inhibitors (PPIs) like omeprazole and esomeprazole work by blocking the enzyme in the stomach lining responsible for producing acid, effectively lowering the overall acid level.
• H2-receptor antagonists such as ranitidine and famotidine reduce acid by blocking histamine, which signals the stomach to produce more acid.
• Anticholinergics and tricyclic antidepressants (like amitriptyline) reduce acid by blocking certain nerve signals that stimulate its production.
• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin can indirectly impact acid levels by reducing substances that protect the stomach lining, potentially leading to irritation and damage.

And, of course, there are the obvious antacids that some people pop like candy. These over-the-counter chewable tablets or liquids, often made from calcium carbonate, magnesium hydroxide, or aluminum hydroxide, work by neutralizing existing stomach acid on contact. While they provide quick relief for heartburn or indigestion, frequent overuse may disrupt the balance of stomach acid and lead to digestive issues over time.

Stress

Well, here we are. Add stomach acid to the long list of things that stress can mess up. Stress can lower stomach acid through a complex interplay of physiological mechanisms involving the nervous system and neurotransmitters. 

The primary pathway is the release of nitric oxide (NO) in the brain, which inhibits gastric acid secretion as a protective reflex to prevent damage to the stomach lining during stress. Stress triggers NO release in the dorsal motor nucleus of the vagus nerve, a key area in regulating stomach acid production.

Researchers discovered the role of nitric oxide (NO) in stomach acid regulation through experiments that involved blocking its production. When researchers inhibited NO, the stress-induced reduction in stomach acid was reversed, demonstrating that NO plays a crucial role in this process.

While this response is meant to be protective, modern life’s constant stressors—work, relationships, financial worries, and even information overload—can lead to a persistent cycle of low stomach acid. This can have long-term effects on digestion and gut health.

Signs and Symptoms of Low Stomach Acid

Your body gives more than one clue that you might be low in the stomach acid department. Low stomach acid disrupts digestion, affecting food breakdown and nutrient absorption. 

Digestive Symptoms

Let’s start with the obvious: the things you can feel. Stomach acid plays a key role in breaking down food and absorbing nutrients. When stomach acid levels are insufficient, various digestive symptoms can arise, many of which resemble other common digestive issues. This similarity can make it challenging to identify the exact cause without careful assessment. 

Common symptoms include:

• Post-meal discomfort: This may manifest as a persistent feeling of fullness or bloating after eating, leaving you feeling overly stuffed and heavy.
• Nausea and belching: Insufficient stomach acid can make it difficult for the stomach to digest food effectively, leading to nausea and the release of excess gas as the stomach works harder than usual.
• Heartburn and reflux: Though typically associated with excess acid, these symptoms can also result from low stomach acid. Inadequate acid levels may prevent the lower esophageal sphincter from closing fully, causing stomach contents to move back up into the esophagus.
• Suboptimal stomach emptying: Low stomach acid can slow the process of moving food from the stomach into the intestines, resulting in a sensation of heaviness or prolonged fullness. When food remains in the stomach for too long, digestion slows down, leading to longer discomfort.

If you are experiencing these or similar symptoms, it’s important to consult with a healthcare practitioner. They can provide a thorough evaluation, rule out other potential factors, and help develop a tailored plan to support your digestive health effectively.

Nutritional Deficiencies and Malabsorption

Low stomach acid can have subtle but significant effects on your health, such as nutrient deficiencies and malabsorption. It’s not just about the food you eat—it’s about how effectively your body can break it down and absorb essential nutrients. When stomach acid levels are too low, this crucial process is compromised, leading to potential deficiencies.

A review of studies explored micronutrient deficiencies that occur with low stomach acid. This is what they highlighted:

Vitamin B12

Stomach acid plays a key role in vitamin B12 absorption by first helping to release the vitamin from food. After that, stomach acid helps vitamin B12 bind to intrinsic factor, a protein in saliva. This process is important because intrinsic factor is essential for vitamin B12 absorption in the intestine. 

Iron

To absorb ferric iron, the most common form of iron in Western diets, your body needs stomach acid. Stomach acid helps keep the iron in a form that can be easily absorbed, preventing it from solidifying and getting stuck. It also helps vitamin C, which is important for boosting iron absorption, by helping change the iron into a form your body can use.

Vitamin C

Stomach acid also helps maintain vitamin C in its active form, called ascorbic acid. Without enough acid, vitamin C becomes a less effective form called dehydroascorbic acid. Since vitamin C helps your body absorb iron, having less of the active form can make it harder for your body to absorb iron properly.

Calcium

Calcium absorption starts when stomach acid helps dissolve calcium salts into a form that can be absorbed in the small intestine. People with low stomach acid absorb less calcium. 

Magnesium

Like calcium, stomach acid helps dissolve magnesium into a form that the intestines can absorb. 

These deficiencies highlight the importance of monitoring nutrient levels, especially if you have low stomach acid or take acid-reducing medications long-term. Consulting a healthcare professional can help ensure proper nutrient intake to correct any deficiencies.

It’s important to note that low stomach acid is not the only factor that can affect nutrient absorption. Other conditions, such as digestive disorders, medications, and certain lifestyle habits, can also impact your ability to absorb nutrients effectively. Always consult a healthcare professional to identify the root cause of any nutrient imbalances and receive personalized advice.

How to Test for Low Stomach Acid (Including DIY and Medical Options)

At this point, you may be wondering if you have low stomach acid. While recognizing the symptoms is an important first step, diagnosing low stomach acid typically requires testing. To help you understand how it’s assessed, here’s a breakdown of stomach acid levels and their potential implications:

Stomach Acid Level (pH)	Description	Implications
1.0 – 2.0	Normal	Healthy stomach acid levels for proper digestion and nutrient absorption.
3.0 – 5.0	Low	Decreased acid production can lead to poor digestion, nutrient deficiencies, and suboptimal gut health.
Above 5.0	Serious – Virtually No Acid	Severe lack of stomach acid, leading to significant digestive problems, including malabsorption and a higher risk of infections.

Medical Tests and Professional Assessments

There are a few possible tests if you’re looking for a professional assessment. 

One of the most commonly used tools is the Heidelberg pH capsule. After being ingested, the capsule travels through the gastrointestinal tract, wirelessly transmitting real-time data about gastric acid levels.

Another test, the SmartPill™, is a swallowable device that can track your gastrointestinal function, offering additional data on your stomach acid levels, motility, and other digestive processes. Though more commonly used to assess overall digestive health, it can provide helpful information about stomach acid production.

Finally, though it may be less appealing, the gold standard for testing stomach acid levels is an invasive procedure called the gastric aspiration test. In this test, a healthcare provider inserts a thin tube through the nose or mouth and into the stomach. The tube is used to collect small samples of stomach contents, which are then analyzed to measure their acidity.

DIY Testing Methods 

While professional tests can provide a detailed assessment of your stomach acid levels, you might prefer to try at-home methods first. These DIY tests can offer a quick and easy way to understand your stomach’s acidity, though they are not as precise as clinical evaluations. Let’s look at a couple of at-home tests you can try.

Baking Soda Test

This simple at-home test involves drinking a small amount of baking soda dissolved in water and timing how long it takes for you to burp. The theory is that if your stomach acid is low, it will take longer for the baking soda to react, as stomach acid is necessary to neutralize it and produce carbon dioxide. A delayed burping response could indicate low stomach acid. 

Here’s a step-by-step guide on how to do the baking soda test for stomach acid:

Materials:

• 1/4 teaspoon baking soda
• 4 ounces (120 ml) of cold water
• Timer

Instructions:

1. Empty Stomach: Perform the test on an empty stomach first thing in the morning.
2. Mix Solution: Dissolve the 1/4 teaspoon of baking soda in the 4 ounces of cold water.
3. Drink Solution: Drink the solution quickly.
4. Start Timer: Immediately after drinking the solution, start the timer.
5. Observe Burping: Wait for a burp to occur.
6. Record Time: Note the time it takes for the burp to happen.

Interpreting Results:

• Burp within 3-5 minutes: Typically indicates normal stomach acid levels.
• No burp within 5 minutes: This may suggest low stomach acid levels 

Betaine HCL Test

The Betaine HCl test is an at-home method some use to check their stomach acid levels. This test involves taking Betaine Hydrochloride (Betaine HCl) supplements and observing how your body reacts. 

Here’s a step-by-step guide on how to perform the Betaine HCl test:

Step 1: Preparation

1. Fast for a few hours: Take the Betaine HCl test on an empty stomach for the most accurate test to avoid interference from food. 
2. Get Betaine HCl supplements: Purchase Betaine HCl supplements, like HCL Breakthrough, typically available in capsules or tablets. These may contain additional enzymes to aid digestion. Start with a low dose (around 500-600mg – usually one capsule).

Step 2: Take the First Dose

Take one capsule of Betaine HCl with a meal, preferably one that contains protein (like chicken, beef, or fish). The presence of protein helps stimulate stomach acid production.

Step 3: Monitor for Symptoms

1. Observe your body’s reaction: Pay close attention to how you feel after taking the Betaine HCl capsule. The goal is to notice any warmth, discomfort, or burning in your stomach.

• If you experience heartburn, a burning sensation, or discomfort, it may indicate that your stomach acid levels are adequate.
• If you don’t feel any discomfort, it suggests your stomach acid may be low, as the Betaine HCl isn’t causing any irritation.

If you discover low stomach acid through testing, it’s essential to understand the root cause. Infections like H. pylori can contribute to low acid levels and should be treated by a healthcare provider. 

Additionally, if you’re on medications that reduce stomach acid, such as PPIs or H2 blockers, consult your doctor before making any changes. Identifying the cause can help ensure the right approach to managing low stomach acid. Always consult a healthcare professional before trying new strategies.

How to Support Healthy Stomach Acid with Betaine HCL

In cases where serious causes and infections are ruled out, betaine HCL and digestive enzymes can help promote optimal stomach acidity and digestion. 

Betaine HCl contains betaine, a compound derived from beet sugar, combined with hydrochloric acid to mimic the stomach’s natural acid production. 

A pilot study tested the effect of betaine HCl on stomach acid levels. In an experimental setting, six participants with normal stomach acid levels took acid-reducing medication to lower their stomach acid for four days. After confirming a gastric pH > 4 on the fifth day, they took 1500 mg of betaine HCl with water.

Taking betaine HCl quickly reduced gastric pH from 5.2 to 0.6 within 30 minutes, with a rapid onset, reaching pH < 3 in 6.3 minutes. The effects lasted about 73 minutes with pH < 3 and about 77 minutes with pH < 4. Betaine HCl was well tolerated by all subjects.

Guidelines and Tips for Safe Use

A review of betaine HCl’s use for low stomach acid found that it can quickly restore stomach pH to optimal levels when taken with meals. The researchers suggested the following guidelines for safe and effective use:

1. Start with 350-750 mg of Betaine HCl with a Protein-Containing Meal

This helps you gauge your body’s tolerance. If you don’t experience discomfort, you can increase the dosage at subsequent large meals but do so gradually. Increase by one capsule at each meal until you either experience a warm sensation in your stomach or reach a maximum of 7 capsules per meal.

2. Adjust Dosage According to Meal Size

Take smaller amounts of betaine HCl with smaller meals. For meals that are snacks or lower in protein and fat, reduce the dosage accordingly. 

3. Look for a Warm Sensation

If you feel a warm sensation in your stomach, this is a sign that you have taken slightly more than your body needs for that meal. At your next meal of similar size, reduce the dosage by one capsule. Re-test the higher dosage at a different meal to ensure the HCl was causing the sensation and not another factor.

4. Signs of Intolerance as a Positive Indicator 

If the warm sensation reappears or you notice signs of intolerance, it often indicates that your stomach is starting to produce adequate stomach acid levels naturally. Gradually lower your dosage as this occurs to avoid taking more betaine HCl than needed.

5. Other Considerations

• Avoid Dissolving in Drinks: This can cause tissue and teeth irritation.  
• Not for Those with Peptic Ulcers: betaine HCl has the potential to aggravate peptic ulcers and should be avoided.  

Other Ways to Support Healthy Stomach Acidity

While supplements like betaine HCl can help optimize stomach acid, you can incorporate several other strategies into your routine to support healthy stomach acid levels and overall digestion. Here are some alternative approaches:

Manage Stress

To help battle the daily stressors that can lead to low stomach acid levels, consider incorporating these science-backed methods to manage occasional stress:

• Mindfulness-based strategies like meditation, yoga, and progressive relaxation
• Exercise
• Biofeedback
• EFT (“tapping”)
• Nutrients like complex carbohydrates, protein, vitamin C, B vitamins, magnesium, and selenium

Learn more about nutrition for stress in this article. 

Take Probiotics and Prebiotics

Probiotics and prebiotics are important in maintaining gut health and supporting digestive function. Probiotics are beneficial bacteria that help balance your gut microbiome and support overall digestion. Prebiotics, on the other hand, are non-digestible fibers that feed and nourish these good bacteria. 

You can find a great source of probiotics with prebiotics in our P3-OM. 

Also, consider incorporating fermented foods like yogurt and sauerkraut to increase probiotics consumption and vegetables, fruits, and whole grains as prebiotics sources. 

Digestive Bitters or ACV

Digestive bitters and apple cider vinegar (ACV) are traditional remedies that support healthy stomach acid levels. 

Bitter compounds can boost stomach acid production by triggering special receptors on stomach cells. When activated, these receptors cause a chain reaction inside the cells, increasing calcium. This change allows sodium to enter the cells, releasing acid from the stomach’s parietal cells.

The result? More stomach acid to aid digestion. Here are some commonly used ones for digestive support:

• Gentian
• Dandelion root
• Wormwood
• Burdock root
• Artichoke leaf
• Bitter melon

Bitters are generally taken about 10 minutes before a meal to stimulate acid production. 

ACV helps to increase stomach acid by directly introducing acid into your stomach. To try this out, dilute a small amount (start with one teaspoon) in water and drink it before your meal. 

Conclusion

Low stomach acid is often overlooked but can lead to various digestive problems, including bloating and nutrient deficiencies. If you suspect you’re dealing with low stomach acid, it’s essential to assess your symptoms and consult a healthcare professional for a more comprehensive diagnosis.