Hypochlorhydria (Low Stomach Acid): Causes, Treatment, And More

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HealthlineSubscribeWhat Is Hypochlorhydria (Low Stomach Acid)?

Medically reviewed by Qin Rao, MD — Written by Megan Dix, RN, BSN and The Healthline Editorial Team — Updated on May 29, 2024

Signs and symptoms
Causes and risk factors
Diagnosis
Treatment
Takeaway

Key takeaways

Hypochlorhydria, or low stomach acid, can impede nutrient absorption and increase susceptibility to infections, potentially leading to symptoms such as bloating, hair loss, and deficiencies in iron, vitamin B12, calcium, and magnesium.
The risk of developing hypochlorhydria increases with age, chronic stress, long-term use of antacids, H. pylori infection, and stomach surgeries, necessitating a discussion with a doctor for those experiencing symptoms or with related risk factors.
Diagnosis involves physical exams, health history reviews, and stomach pH tests, with treatment options ranging from dietary changes and supplements, such as betaine hydrochloride, to antibiotics for H. pylori infections or management of underlying conditions.

Stomach secretions are made up of hydrochloric acid, several enzymes, and a mucus coating that protects the lining of your stomach.

Hydrochloric acid helps your body break down, digest, and absorb nutrients, such as protein. It also gets rid of bacteria and viruses in the stomach, protecting your body from infection.

Low levels of hydrochloric acid, called hypochlorhydria, can have a major effect on your body’s ability to properly digest and absorb nutrients.

Left untreated, hypochlorhydria can damage your gastrointestinal (GI) system. It can also cause infections and a number of other chronic health issues.

This article reviews the symptoms, causes, diagnosis, and treatment of hypochlorhydria.

What are the signs and symptoms of hypochlorhydria (low stomach acid)?

Signs and symptoms of low stomach acid are related to impaired digestion, increased susceptibility to infection, and reduced absorption of nutrients from food. These may include:

bloating
burping
upset stomach
nausea when taking vitamins and supplements
diarrhea
gas
indigestion
hair loss
undigested food in stool
weak, brittle fingernails
fatigue
GI infections
iron deficiency anemia
deficiencies of other minerals, such as vitamin B12, calcium, and magnesium
protein deficiency
neurological issues, such as numbness, tingling, and vision changes

Health conditions associated with hypochlorhydria

A number of chronic health conditions have been associated with low levels of stomach acid. These include:

lupus
asthma
thyroid issues
acne
psoriasis
eczema
gastritis
chronic autoimmune disorders
osteoporosis
pernicious anemia

What causes hypochlorhydria (low stomach acid) and who is at risk?

Some of the most common causes of low stomach acid include:

Age: Hypochlorhydria is much more common as you get older. People over age 65 years are most likely to have low levels of hydrochloric acid.
Stress: Chronic stress may decrease the production of stomach acid.
Medications: Taking antacids or medications prescribed to treat ulcers and acid reflux, such as PPIs, for a long period of time may also lead to hypochlorhydria. If you take these medications and are concerned that you have symptoms of low stomach acid, speak with your doctor before making changes to your medications.
H. Pylori: Infection with H. Pylori is a common cause of gastric ulcers. If left untreated, it can result in decreased stomach acid.
Surgery: Surgeries of the stomach, such as gastric bypass surgery, can reduce the production of stomach acid.

If you have questions or concerns about your symptoms or risk factors of low stomach acid production, talk with a doctor. They can determine what’s causing your low levels of stomach acid and develop a treatment plan that’s best for you.

How do doctors diagnose hypochlorhydria (low stomach acid)?

To determine whether you have hypochlorhydria, a doctor will complete a physical exam and take a history of your health and symptoms. Based on this information, they may test the pH of your stomach.

Stomach secretions usually have a very low pH (1 to 2), which means they are highly acidic.

Your stomach pH may indicate the following:

Stomach pH	Diagnosis
less than 3	normal
3 to 5	hypochlorhydria
greater than 5	achlorhydria

People with achlorhydria have almost no stomach acid. Older adults and premature infants often have much higher stomach pH levels than average.

A doctor may also perform blood tests to look for iron deficiency anemia or other nutrient deficiencies. A doctor can also do an endoscopy to look for atrophic gastritis.

Healthcare professionals can diagnose H. pylori by a breath or stool test.

Depending upon their evaluation and the severity of your symptoms, the doctor may choose to refer you to a gastroenterologist (a doctor who specializes in the digestive or gastrointestinal system).

How is hypochlorhydria (low stomach acid) treated?

Treatment for hypochlorhydria depends on the cause and severity of symptoms.

Some doctors recommend an approach that is mostly based on dietary modifications and supplements. An HCl supplement (betaine hydrochloride), often taken in conjunction with an enzyme called pepsin, may help increase the acidity of the stomach.

Your doctor may also recommend HCI supplements to help diagnose hypochlorhydria if the diagnosis is unclear. An improvement in symptoms while on this supplement may help your doctor diagnose this condition.

If an H. pylori infection is the cause of your symptoms, your doctor can prescribe a course of antibiotics can be prescribed by your doctor.

If an underlying medical condition is the cause of low stomach acid, your doctor can help you manage the condition and its symptoms.

Your doctor can also help you manage your medications and choose the best course of treatment if medications such as proton pump inhibitors are causing symptoms of low stomach acid.

Takeaway

Hypochlorhydria can cause very serious health problems if left untreated.

If you have digestive changes or symptoms that concern you, contact a doctor as soon as possible. They can help determine whether you have hypochlorhydria and develop a treatment plan that’s right for you.

How we reviewed this article:

SourcesHistoryHealthline 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.

Fatima R, et al. (2023). Achlorhydria. https://pubmed.ncbi.nlm.nih.gov/29939570/
Guilliams TG, et al. (2020). Meal-time supplementation with betaine HCl for functional hypochlorhydria: What is the evidence? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238915/
Hodges P, et al. (2021). Helicobacter pylori infection and hypochlorhydria in Zambian adults and children: A secondary data analysis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396721/
Kines K, et al. (2016). Nutritional interventions for gastroesophageal reflux, irritable bowelsyndrome, and hypochlorhydria: A case report.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991651/
Martinsen TC, et al. (2019). The phylogeny and biological function of gastric juice—Microbiological consequences of removing gastric acid.https://www.mdpi.com/1422-0067/20/23/6031

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Medically reviewed by Qin Rao, MD — Written by Megan Dix, RN, BSN and The Healthline Editorial Team — Updated on May 29, 2024

Hypochlorhydria (Low Stomach Acid): Causes, Treatment, And More

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Key takeaways

What are the signs and symptoms of hypochlorhydria (low stomach acid)?

Health conditions associated with hypochlorhydria

What causes hypochlorhydria (low stomach acid) and who is at risk?

How do doctors diagnose hypochlorhydria (low stomach acid)?

How is hypochlorhydria (low stomach acid) treated?

Takeaway

How we reviewed this article:

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