Low Stomach Acid Symptoms

Most people have heard about acid reflux and heartburn, which are conditions associated with too much stomach acid and backflow of acid from the stomach into the food pipe. However, low stomach acid can also cause problems. Please continue reading to learn about low stomach acid symptoms, causes, and treatment.

Understanding stomach acid production

The stomach is a hollow organ in the body’s digestive system. It takes food from the esophagus (food pipe), starts the process of digesting the food, and passes it further into the digestive tract, i.e., into the small intestine.

The stomach produces about 3-4 liters of gastric juice daily to digest food. Gastric juice contains digestive enzymes like pepsin and hydrochloric acid (stomach acid) which help to break down food and absorb nutrients. Hydrochloric acid also keeps the stomach pH low. This keeps harmful bacteria and viruses in check that might otherwise cause GI tract infections.

Having enough stomach acid is important for gastric function. However, high stomach acid levels can cause problems like gastroesophageal reflux disease (GERD), heartburn, and stomach ulcers. On the other hand, low stomach acid production, a condition called hypochlorhydria, can lead to digestive issues and nutritional deficiencies.

What causes low stomach acid (hydrochloric acid)?

The main risk factors and causes of low stomach acid include:

Atrophic gastritis: A condition in which the cells that produce stomach acid stop working due to chronic gastritis (long-lasting inflammation of the stomach). Risk factors for atrophic gastritis include alcoholism, certain autoimmune disorders like pernicious anemia, and bacterial infections like H. pylori.
Helicobacter pylori infection: H. pylori is a common bacterial infection that affects up to 50% of the US population. In many people, it does not cause any symptoms. However, H. pylori can lead to decreased stomach acid production. Interestingly, low stomach acid is a risk factor for uncontrolled growth of H. pylori.
Medications that block stomach acid production: Long-term use of antacids, H2 blockers, and proton pump inhibitors (PPIs) for heartburn and GERD (gastro-oesophageal reflux disease) can lead to low stomach acid. These drugs can eventually cause the stomach acid-secreting cells to stop working.
Age: Advanced age can be a cause for low stomach acid levels because the cells in the stomach no longer produce enough hydrochloric acid.
Chronic stress: Significant stress for an extended period of time can lead to reduced gastric acid secretion (this only occurs with higher stress levels than the usual everyday stressors).
Stomach surgery: A stomach surgery, such as gastric bypass surgery, can lead to low levels of stomach acid.

What are the symptoms of low stomach acid?

The lack of adequate stomach acid can cause the following symptoms:

Stomach pain
Bloating
Gas
Nausea
Vomiting
Diarrhea
Constipation
Undigested food in the stool
Acid reflux and heartburn (these symptoms can be confused with excessive stomach acid)
Early satiety (feeling full quickly)
Weight loss

As mentioned, stomach acidity is important for nutrient absorption and overall gut health. Less stomach acid can lead to iron deficiency anemia and other nutrient deficiencies like calcium, vitamin D, and B12 vitamin deficiency, which in turn can cause chronic health issues. Some of the signs and symptoms of nutrient deficiencies include:

Pale skin
Skin problems
Hair loss
Brittle nails
Tiredness
Weakness
Numbness and tingling in the hands and feet
Headaches
Memory problems

Other serious complications that can develop due to low stomach acid include osteoporosis, bone fractures due to vitamin D and calcium deficiency, and leaky gut due to an imbalance between good and bad bacteria.

How can you tell if you have low stomach acid or too much?

Both too much and too little stomach acid can cause digestive problems. However, the signs and symptoms are a little different.

Excessive gastric acid secretion can occur in people with a rare condition called Zollinger-Ellison syndrome. High levels of stomach acid can cause symptoms such as stomach pain, burning or discomfort in the upper abdomen, acid reflux and heartburn, nausea, vomiting, diarrhea, bleeding in the GI tract, loss of appetite, weight loss, and gastric ulcers (ulcers in the stomach lining).

Your healthcare provider can order blood and other tests to check for high or low stomach acid production. You can also do test at home by mixing half a teaspoon of baking soda in half a glass (120 mL) of cold water and drinking it on an empty stomach. The hydrochloric acid in your stomach will combine with the baking soda to make carbon dioxide gas, making you burp. If it takes you more than 5 minutes to burp, it could indicate that you don’t have enough stomach acid.

What is the treatment for low stomach acid?

Treatment for low stomach acid consists of treating the underlying cause, for example, Helicobacter pylori infection. Your doctor may ask you to take a hydrochloric acid (HCl) supplement called betaine hydrochloride. They may also treat a vitamin deficiency with nutritional interventions. Digestive bitters can also help relieve symptoms of low stomach acid.

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