By Dr. Shawna Darou, ND
These issues may appear to be unrelated, but what anxiety, hair loss and poor protein breakdown have in common is a lack of sufficient stomach acid. For most of us, this is not the first thing that comes to mind for a list of complaints that seem unrelated. Here’s how it works: Your stomach produces an acid called hydrochloric acid that breaks down your proteins, aids in mineral absorption, activates intrinsic factor to absorb B12, and is also the first line of defense against bacteria and parasites in your food. Therefore, when you have low stomach acid, it affects how you digest your food (especially proteins) causing digestive discomfort, can cause deficiencies of nutrients like vitamin B12 and iron, and also imbalances in your gut microbiome.
The link with anxiety, is three-fold: first of all without proper protein absorption, you will be deficient in amino acids like tryptophan which is a core building block in serotonin. Secondly, an imbalance in the gut microbiome can also cause mood disorders like anxiety and depression. And thirdly, very low levels of either vitamin B12 or iron are also associated with anxiety.
It’s all about pattern recognition – looking for the link between body symptoms. Another scenario could be very low iron levels that are not coming up, difficulty putting on muscle with exercise, and chronic bloating.
Here is a list of many of the symptoms of low stomach acid:
- You don’t feel well when you eat meat
- Burping or bloating after eating (within 15 minutes or so)
- Indigestion, nausea or heartburn
- Muscle atrophy
- A growing list of food sensitivities
- Dry skin
- Hair thinning
- Iron or vitamin B12 deficiency
- Peeling nails
- Osteopenia / osteoporosis
- SIBO (small intestine bacteria overgrowth)
- Intestinal dysbiosis (overgrowth of pathogenic bacteria or parasites)
What are causes of low HCl?
Given that the symptoms listed above are very common, let’s look at what can cause low stomach acid. We’re always looking to get to the root of the issue.
- Chronic high stress
- H. pylori infection in the stomach
- Gastric surgery
- Aging (HCl production decreases with age)
- Chewing lots of gum (more bicarbonate from the mouth dilutes stomach acid)
- Zinc deficiency
- Taking acid blocking medications, especially PPI’s (proton pump inhibitors)
If we suspect that low stomach acid may be the cause of some of your symptoms, there are several ways to assess.
1. The Heidelberg Test:
This test involves swallowing an electronic capsule that measures stomach acid in a fasting state. You then drink a solution with sodium bicarbonate (baking soda) to neutralize the natural acid, and the electronic pill measures the amount of time it takes for your stomach acid to return to acidity. This test is considered the ‘gold standard’, but is not easily accessible.
2. Betaine Hydrochloride challenge:
This simple test involves taking a supplement containing Betaine HCl with pepsin with a high protein meal, and seeing if you have an effect. If your own stomach acid is sufficient, you will feel warmth or mild heartburn after taking the capsule. If you feel nothing, the dose is increased the next day, again with a high-protein meal. The need for a higher dose of Betaine HCl with a high-protein meal suggests that you are not making enough stomach acid. Caution with this test if you have any significant or serious digestive symptoms, this test should be done with supervision.
3) The Burp Test
This test is probably the safest test to try on your own. First thing in the morning, before eating, drinking or brushing your teeth, drink a mixture of 1/8 teaspoon of baking soda (sodium bicarbonate) in 100 mL of slightly warm water. This mixture should cause you to burp as the bicarbonate combines with stomach acid to create carbon dioxide! The optimal time for a burp is between 1-2 minutes. Less than this can indicate too much stomach acid, and anything over 3 minutes suggests low stomach acid production.
The most important part of treatment is to determine what the cause of low stomach acid is and address it. Testing for H. Pylori is top on the list, and addressing stress levels comes next.
We may temporarily add a supplement with Betaine Hydrochloride with Pepsin with high protein meals to support digestion and absorption of nutrients, while we’re working on the underlying causes. Some people also respond well to apple cider vinegar before meals to encourage stomach acid production.
If you suspect that you may have low stomach acid from the list of symptoms above, or tried the ‘burp test’ and didn’t get a burp, we can certainly assess more thoroughly and put together a plan to optimally restore digestive health. Health starts in the gut, and very simple things like improving stomach acid production can make a huge difference in all aspects of your health.
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