Hypochlorhydria (Low Stomach Acid)

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Latest Edit: Iva Lloyd, ND 2014-12-31 (EDT)

Hypochlorhydria refers to a deficiency of hydrochloric acid (HCl) in the stomach. This results in impaired digestion and a number of other effects on the gastrointestinal system. Achlorhydria is a severe form of hypochlorhydria where there is complete absence of stomach acid secretion. Approximately one third of individuals over 60 years-of-age have achlorhydria and a much higher number have hypochlorhydria.[1] The symptoms of hypochlorhydria and hyperchlorhydria are similar and many people are treated for high stomach acid when in reality they have low stomach acid and the treatments are often making the situation worse.

Abdominal pain.jpg

Causes Food Reactions, Stress, Infections
See Also Digestive Conditions, Constipation, Dysbiosis, GERD, Heartburn, Inflammatory Bowel Disease, Crohn's Disease, Ulcerative Colitis, Diverticulitis
Books Books on Digestive and Liver Conditions
Articles Articles on Digestive Conditions

Hydrochloric acid is responsible for two important functions:

  1. it begins the breakdown of protein by dissolving the protein in the hydrochloric acid, and
  2. in the presence of food it activates an enzyme called pepsin, which further breaks down protein.

Naturopathic Assessment

Causal Factors

In order to stimulate the innate ability of the body to heal the causes of disease must be identified and addressed. With hypochlorhydria, the causes are variable and include lifestyle and environmental factors. A detailed assessment is required to determine which factors are contributing to hypochlorhydria.


  • Drinking water with your meals can result in dilution of the natural hydrochloric acid of the stomach and is commonly associated with increased risk and the progression of hypochlorhdria.
  • Vegetarian Diets or diets that are low in protein can result in a decreased production of hydrochloric acid (HCL)
  • Nutrient deficiencies tend to be increase the risk of low stomach acid.
  • It is unclear whether food allergies and food sensitivities are a contributing factor for hypochlorhydria or whether they are a result of the condition.

Medical Interventions

  • Prescription Medications
  • Medications such as acid-blocking agents or medications taken for heartburn cause hypochlorhydria especially if taken for a long time.
  • Medical treatments
  • Gastric resection, or surgical removal of part of the stomach.


  • H. pylori infection has been identified as a cause of hypochlorhydria, since it can cause atrophic changes to the gastric mucosa.[2] Hypochlorhydria is considered a consequence of chronic helicobacter infection.[3]


  • Genetic Factors
  • Proinflammatory IL-1 polymorphisms are associated with hypochlorhydria.[4]

Diagnostic Testing

Because the symptoms of low stomach acid and high stomach acid are very similar it is important to due the appropriate diagnostic testing to ensure that the correct problem is being treated.

Here are three preliminary self tests which you can undertake at home before visiting your doctor:

  1. Take a small amount of baking soda in water first thing in the morning and if you have not belched within a few minutes, you may not be producing enough stomach acid, since hydrochloric acid reacts with baking soda to produce carbon dioxide gas.
  2. Take a dose of a Betain hydrochloride supplement before the start of a meal and if you experience any warmth, burning or indigestion associated with excess acid, it is unlikely that you are suffering from insufficient stomach acid. If this happens you should be able to obtain relief by taking a teaspoon of sodium bicarbonate in water.
  3. When you are suffering with heartburn, take one tablespoon of fresh lemon juice. If the lemon juice remedies your heartburn then this probably means you need more stomach acid but if your heartburn becomes worse, your stomach probably has too much hydrochloric acid.

Other tests to determine the presence of hypochlorhydria include:

  • Stool Analysis to assess for protein digestion
  • Imaging Studies such as an x-rays to assess for osteoporosis.

Related Conditions

Hypochlorhydria is often associated with the following conditions:[5], [1]

  • Digestive Conditions
  • Bone and Joint Conditions
  • Blood Conditions
  • Endocrine Conditions
  • Skin Conditions
  • Other Conditions


There are two types of hypochlorhydria:

  1. Type A is associated with autoimmune conditions
  2. Type B is associated with gastritis which can be due to food reactions or due to prescription medications.

Hypochlorhydria affects health in a number of ways:

  • Inhibits normal functioning of the stomach
  • Stomach acidity is important to break down food molecules, especially protein
  • Results in the malabsorption of vitamin B12, folic acid, calcium, iron and trace minerals.
  • Results in malabsorption of protein
  • Predisposes a person to malnutrition which increases risk of degenerative disease
  • If foods are partially digested and gain access to the body, the immune system may be activated to target these innocuous proteins
  • Decreases the body's natural mechanism of destroying infections and pathogens in food.
  • Is associated with colon toxicity
  • Increased amounts of undigested proteins can provide food for harmful flora leading to production of toxins.
Article Small Intestine Bacterial Overgrowth, NDNR [1], 2011 March
  • Results in small intestinal bacterial overgrowth and dysbiosis
  • Results in increased intestinal permeability.

Common Symptoms

There are a wide range of symptoms associated with hypochlorydria including:

  • Digestive Symptoms
  • Abdominal bloating, especially when consuming animal protein
  • Burping
  • Flatulence or gas typically right after eating
  • Indigestion
  • Diarrhea
  • Constipation
  • Hunger even after eating or an abnormal sense of fullness
  • nausea
  • Slow digestion
  • Undigested food in stool
  • Bad breath (halitosis)
  • Big Belly or increase weight gain around the upper and mid abdomen.
  • Itchiness around the rectum
  • Loss of appetite for meat
  • Skin and Nail Symptoms
  • Rosy cheeks due to capillary dilatation in the cheeks
  • Weak, peeling or cracked fingernails that break easily
  • Acne
  • Hair loss in females

Naturopathic Treatment

The goal of naturopathic treatment is to support and work in tandem with the healing power of the body and to address the causal factors of disease with individual treatment strategies. Hypochlorhydria can easily progress to a chronic disease if not treated appropriately. The specific treatment for hypochlorhydria would vary depending on a person's age, the exact symptoms that they experience and the associated conditions.

It is always advisable to work with a naturopathic doctor before engaging in any treatment plan.


Lifestyle recommendations include:

  • Until the causes of low stomach acid are resolved, or if the hypochlorhydria is associated with advancing age it may be necessary to decrease the consumption of meat protein.
  • Ensure that the diet contains adequate amounts of fruits and vegetables, preferably raw (especially in the summer) to ensure adequate levels of natural digestive enzymes.
  • Ensure you drink adequate water, but not while while eating. Avoid cold water as it has a greater effect in lowering HCL production.
  • Eat smaller meals more regularly. Chew your food thoroughly. Remain sitting up for a least 45 minutes after eating to reduce the occurrence of acid being churned up into the esophagus and to allow gravity to play its part.

Naturopathic Therapies

The prescribing of naturopathic therapies requires the guidance of a naturopathic doctor as it depends on a number of factors including the causal factors, a person's age, prescription medications, other conditions and symptoms and overall health. It is always advisable to work with a naturopathic doctor prior to taking any natural therapies.

Naturopathic Therapies for hypochlorhydria include:

  • Bitter herbs are often indicated for hypochlorhydria.
  • Acupuncture can help restore the digestive fire required to breakdown food.


Reviewed by Iva Lloyd, BScH, RPE, ND [2]

  1. 1.0 1.1 El-Hashemy Shehab, Skowron Jared, Sorenson Linda (2011) Textbook of Naturopathic Family Medicine & Integrative Primary Care: Standards & Guidelines CCNM Press.
  2. Cater RE 2nd (1992 Dec) Helicobacter (aka Campylobacter) pylori as the major causal factor in chronic hypochlorhydria Med Hypotheses; Vol39(4):367-74 PMID: 1494326.
  3. Cater RE 2nd (1992 Dec) The clinical importance of hypochlorhydria (a consequence of chronic Helicobacter infection): its possible etiological role in mineral and amino acid malabsorption, depression, and other syndromes Med Hypotheses; 39(4):375-83 PMID: 1494327.
  4. Furuta T, El-Omar EM, Xiao F, Shirai N, Takashima M, Sugimura H (2002 Jul) Interleukin 1beta polymorphisms increase risk of hypochlorhydria and atrophic gastritis and reduce risk of duodenal ulcer recurrence in Japan Gastroenterology; Vol123(1):92-105 PMID: 12105837.
  5. Prousky Jonathan. (2008) Principles and Practices of Naturopathic Clinical Nutrition CCNM Press.
  6. 6.0 6.1 Prousky Jonathan (2008) Principles and Practices of Naturopathic Clinical Nutrition CCNM Press.