Hypochlorhydria (low Stomach Acid): Causes, Symptoms, And ...

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What is hypochlorhydria?

Medically reviewed by Saurabh Sethi, M.D., MPH — Written by Jayne Leonard — Updated on July 21, 2023

Causes
Symptoms
Risk factors
Diagnosis
Treatment
Outlook

Hypochlorhydria is the medical term for a low level of stomach acid. This may cause digestive issues, nutritional deficiencies, and gastrointestinal infections.

An individual with hypochlorhydria is unable to produce enough hydrochloric acid (HCL) in the stomach.

Stomach acid, along with several enzymes, helps to break down food. Other functions of this acid include:

aiding the body in absorbing certain nutrients, such as protein and vitamin B-12
killing bacteria and other pathogens in the stomach to prevent infection

In this article, we describe the symptoms and causes of hypochlorhydria. We also explore the treatment options.

Causes

Woman with hypochlorhydria — Bloating, burping, and gas may be symptoms of hypochlorhydria.

Common causes of hypochlorhydria include:

Age

The stomach can produce less acid as a result of aging.

According to a 2013 review, hypochlorhydria is the main change in the stomach of older adults. People over the age of 65 have the highest risk.

Stress

While everyday stress may not have much effect on the production of stomach acid, chronic stress can contribute to hypochlorhydria.

Medications

Long-term use of antacids or other medications for acid reflux or heartburn may decrease the body’s production of stomach acid.

Doctors often prescribe medications called proton pump inhibitors to treat acid reflux, and these can cause hypochlorhydria.

Bacterial infection

Over 50 percent of people worldwide are infected with a bacteria called Helicobacter pylori (H. pylori). This infection can contribute to low levels of stomach acid and gastric ulcers.

Zinc deficiency

Zinc is necessary for the production of stomach acid. A lack of this mineral can contribute to hypochlorhydria.

Stomach surgery

Some surgical procedures, including gastric bypass surgery, can reduce the amount of acid the stomach produces.

Symptoms

Symptoms of hypochlorhydria can include:

bloating
burping
diarrhea
gas
hair loss
heartburn
intestinal infections
nausea while taking supplements
nutrient deficiencies, including deficiencies in iron and vitamin B-12
undigested food in the stool
upset stomach
weak fingernails

There is also a link between hypochlorhydria and several other medical issues, such as:

allergies
anemia
asthma
autoimmune disorders
skin problems, including acne and psoriasis

Risk factors

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Being 65 or older is a risk factor for developing hypochlorhydria.

Certain factors can increase the risk of developing hypochlorhydria, such as:

taking medications to reduce the production of stomach acid
being 65 or older
having high levels of stress on an ongoing basis
eating a diet that lacks zinc or having poor zinc absorption
having an H. pylori infection
having undergone stomach surgery

Diagnosis

To diagnose hypochlorhydria, a doctor will typically take a person’s medical history and perform a physical exam.

They can also test the acidity of the stomach with a small capsule that contains a transmitter. The person swallows the capsule, and the transmitter reports the amount of acid in the gastrointestinal tract.

Doctors measure acidity using the pH scale. A pH value of 3–5 suggests hypochlorhydria, while a pH level of less than 3 indicates normal levels of stomach acid.

If the pH value is greater than 5, this suggests an almost complete absence of stomach acid, which is termed achlorhydria.

If the results show hypochlorhydria or achlorhydria, the doctor may take blood tests to check for a deficiency in iron or other nutrients.

A doctor may prescribe HCL supplements to confirm a diagnosis. If a person feels better when taking the supplements, low stomach acid is likely the cause of symptoms.

Treatment

Treatment for hypochlorhydria depends on the underlying cause. Options include:

Antibiotics for H. pylori

An H. pylori infection requires antibiotic treatment.

A doctor will usually prescribe at least two antibiotics to take at the same time. Taking a combination of antibiotics prevents the bacteria from developing a resistance to one of the drugs.

The doctor may need to check whether the H. pylori bacteria are still present after 4 weeks of treatment. If they are, the doctor may prescribe a different combination of medications.

Reviewing medication use

Long-term use of antacids and proton pump inhibitors can result in hypochlorhydria. A doctor may recommend stopping the use of the drugs or switching to a different treatment.

Always speak with a doctor before changing or stopping medications.

Digestive enzymes and HCL supplements

A person may benefit from taking an HCL supplement and a pepsin enzyme to increase stomach acidity. This treatment option may be especially beneficial for older adults experiencing a natural decline in levels of stomach acid.

Natural digestive enzymes are also available in health stores and drugstores. These often contain extracts of papaya and pineapple, which can stimulate the production of stomach acid.

A variety of digestive enzyme supplements are also available to purchase online.

Consult a doctor before taking an HCL supplement.

Stress management

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Practicing yoga can help to reduce chronic stress.

Reducing chronic stress can restore digestive function. The following lifestyle changes can help:

managing and reducing sources of stress
exercising regularly
learning deep breathing and progressive muscle relaxation techniques
practicing meditation and mindfulness
practicing yoga
attending therapy

Changing eating habits

Making some dietary changes can help to improve symptoms of hypochlorhydria.

Avoid foods that are difficult to digest, such as those that are fatty and fried. Also, chew each bite thoroughly to break the food down and allow it to mix with the digestive enzymes in the mouth. Smaller food particles are more easily digested in the stomach.

It is a good idea to avoid eating for at least 3 hours before bedtime. This allows the body to fully digest before sleeping, and it can reduce the risk of nighttime heartburn.

Do not lie down immediately after a meal, and do not eat while lying down.

Addressing nutrient deficiencies

For the stomach to produce HCL, the body needs to absorb zinc from the diet. Zinc-rich foods include:

pumpkin seeds
oysters and crabs
beef and pork
fortified breakfast cereals
baked beans
cashews

A low level of stomach acid can result in other deficiencies, such as a lack of iron, vitamin B-12, and calcium. A doctor or a dietician can help. They may recommend taking supplements or increasing dietary intake of these nutrients, especially once a person regains a regular level of stomach acid.

Outlook

If left untreated, hypochlorhydria can negatively impact a person’s health and well-being. It is important for people to report associated symptoms and undergo testing.

Once a doctor determines why a person’s level of stomach acid is low, they can recommend ways to relieve or prevent symptoms. Prompt treatment also reduces the risk of complications.

Treatment options include making dietary and lifestyle changes, taking supplements, and altering the course of medications.

GastroIntestinal / Gastroenterology
Infectious Diseases / Bacteria / Viruses
Seniors / Aging

How we reviewed this article:

SourcesMedical News Today has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Britton, E., & McLaughlin, J. T. (2013, February). Ageing and the gut. Proceedings of the Nutrition Society, 72(1), 173–177https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/ageing-and-the-gut/A85D096755F5F7652C262495ABF302A0/core-reader
Franceschi, F., Tortora, A., Di Rienzo, T., D'Angelo, G., Ianiro, G., Scaldaferri, F., … Gasbarrini, A. (2014, September 28). Role of Helicobacter pylori infection on nutrition and metabolism. World Journal of Gastroenterology, 20(36), 12,809–12,817https://www.wjgnet.com/1007-9327/full/v20/i36/12809.htm
Kines, K., & Krupczak, T. (2016, August). Nutritional interventions for gastroesophageal reflux, irritable bowel syndrome, and hypochlorhydria: A case report. Integrative Medicine: A Clinician's Journal, 15(4), 49–53https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991651/

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Medically reviewed by Saurabh Sethi, M.D., MPH — Written by Jayne Leonard — Updated on July 21, 2023

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