Hypochlorhydria involves a decrease in the production of gastric acid (HCL) in the stomach. This condition is common in people with thyroid and autoimmune thyroid conditions, and while hypothyroidism can cause hypochlorhydria, people with hyperthyroidism and Graves’ Disease can have this condition too. Either way, the decreased acid will cause problems with digestion, which of course can lead to numerous symptoms and further problems which I will discuss in this article.
So what leads to hypochlorhydria? There are numerous factors, but here are four of the more common reasons why a person might have problems producing enough gastric acid:
1. Hypothyroidism. The slowing down of the metabolism associated with hypothyroid conditions can in turn lead to a decrease in the production of gastric acid (1). As a result, some people with hypothyroidism and Hashimoto’s Thyroiditis have hypochlorhydria. Taking synthetic or natural thyroid hormone might help, although my goal of course is to try restoring the person’s thyroid health back to normal if at all possible.
2. Autoimmunity. The parietal cells are located in the stomach, and they are responsible for the secretion of gastric acid. They also produce intrinsic factor, which is required for the absorption of vitamin B12. Many people are familiar with pernicious anemia, which involves autoantibodies being produced against the intrinsic factor, which result in a reduction of vitamin B12 absorption. But antibodies can be formed which attack the parietal cells, which will lead to the decreased production of gastric acid.
Remember that people with one autoimmune condition are more likely to develop another autoimmune condition. As a result, someone with Graves’ Disease or Hashimoto’s Thyroiditis is more likely to develop antibodies against the parietal cells, thus resulting in hypochlorhydria. The reverse can be true as well, as someone can have this condition and then go on to develop an autoimmune thyroid condition. Either way the goal is to try to suppress the autoimmune component, control the inflammation, and restore the health of compromised areas of the body.
3. H. Pylori. I’ve written about H. Pylori in a separate article, as this is an infection in the stomach, which in turn can interfere with the production of hydrochloric acid (2). This infection is common in people with Graves’ Disease and Hashimoto’s Thyroiditis. And it can be difficult to eradicate, as the conventional medical treatment consists of using very potent antibiotics. And sometimes these antibiotics aren’t strong enough to get rid of this organism.
There are natural treatment methods available to eradicate H. Pylori, which I usually recommend to my patients who test positive for this. The downside is that the natural treatment protocol for H. Pylori takes time to work, and there is no guarantee they will eradicate the H. Pylori, although in most cases they do work well. Either way, anyone with digestive issues should consider getting tested for H. Pylori, although the lack of digestive symptoms doesn’t rule out the possibility of being infected by this organism.
4. Acid stopping medication. This one is obvious, although I figured I’d bring it up since many people take acid stopping medication. This medication is taken to intentionally decrease the production of gastric acid. While some people might need to take this medication, most people don’t need to take this, and most don’t realize the harm it’s causing. There are reasons why a person experiences symptoms such as heartburn and reflux, and these problems can usually be corrected over time by improving one’s diet. And so it makes me sick to see these commercials encouraging people to take this medication. Once again, I’m not suggesting that some people can’t benefit from these medications, but for most people these drugs are causing further problems with their digestive system while just masking the symptoms.
What Are The Consequences of Hypochlorhydria?
Although the overall pH of the body is supposed to be alkaline, the pH of the stomach should be between 2 and 4. However, a condition such as hypochlorhydria will reduce the gastric pH. This in turn will cause problems digesting food, can lead to gastro microbial overgrowth, and can therefore lead to a condition such as gastroenteritis, which is inflammation of the gastrointestinal tract. Over a period of time this can lead to a condition such as leaky gut, which I’ve also discussed in other articles, and in turn will cause an immune system response.
How Does Atrophic Gastritis Factor Into This?
Atrophic gastritis is associated with the chronic inflammation of the stomach. There are a number of factors which can cause this condition, but the two main factors are 1) infection with H. Pylori, and 2) it can be autoimmune in nature. We already know how H. Pylori can affect the production of gastric acid. And autoimmune atrophic gastritis can also damage the parietal cells, which as you know produce HCL. Studies also show that autoimmune thyroid conditions are more prominent in people with atrophic gastritis (3).
How Does One Correct This Problem?
As for how to treat hypochlorhydria, the goal of course should be to get to the root cause of the problem. So if this condition is caused by hypothyroidism, then the goal should be to address this condition. Taking synthetic or natural thyroid hormone may help, but if possible I of course recommend restoring the person’s thyroid health. This isn’t always possible, and so some people with hypothyroidism and Hashimoto’s Thyroiditis will need to take thyroid hormone. If H. Pylori is causing the decreased production of gastric acid then this infection needs to be eradicated.
There are cases when someone will need to supplement with betaine hydrochloride on a temporary basis, which can help compensate for the decreased production of HCL by the body. So for example, if someone has H. Pylori, while trying to eradicate this infection it might be a good idea to take betaine HCL to help digest the food you eat. If someone has antibodies against the parietal cells they also will probably need to take something to help with digestion, and hopefully at the same time will be working to suppress the autoimmune component of the condition.
In summary, hypochlorhydria is common in thyroid and autoimmune thyroid conditions. In hypothyroid conditions the decrease in metabolism will make one more susceptible to having a decreased production of gastric acid. Those people with Graves’ Disease and Hashimoto’s Thyroiditis have an increased chance of developing antibodies against the parietal cells, and are also more likely to contract an infection such as H. Pylori. And since proper digestion is so important to an optimally functioning immune system, it is important to address the cause of the hypochlorhydria for anyone who is looking to achieve optimal health.
I am having digestive and hormone issues.
I had a stool test done and found to be abnormally low in pancreatic enzymes. I was taking digestive enzyme supplements but turns out I have a small ulcer at the base of my esophagus. When I take HCL or protease containing supplements I occasionally cough up blood from the ulcer irritating supplements. PPI’s give me strange, scary heart type symptoms so I’m not taking them currently either.
Can you recommend what I might be able to do to better digest foods under these conditions? Can diet alone mend the ulcer and correct the low digestive enzyme issue? I drink vegetable juices and my stomach can now tolerate some raw foods, as well as steamed vegetables and bone broth. I don’t digest fats well at all, and protein is slow to digest as well.
Many thanks for your time and attention. Best regards to you.
Patricia
Current supplements: vitamin D 1000, vitamin B complex (100% RDA only), just began taking acidophilus 3 billion SCD approved. (SCD=Specific Carbohydrate Diet)
Hi Trish,
I would definitely continue to avoid HCL, and since you’re having problems with the protease enzymes I would avoid those for now as well. Diet alone can do wonders, and stress management is also essential. Certain herbs might be able to help enhance the mucoprotection, such as aloe vera and slippery elm. Licorice can also help, although if you have high blood pressure you will probably want to avoid taking this. Goldenseal is another great herb. I think taking the probiotics are important, and you mentioned the possibility of having a leaky gut, which isn’t necessarily associated with ulcers, although it is of course possible that you have both issues. There are numerous methods to test for a leaky gut.
Forgot to mention I had an upper endoscopy and I am negative for H.Pylori.
I do have an imbalance of bad to good bacteria per the stool test though. I realize my hormones are probably being effected by the digestive issues, leaky gut etc. but don’t know how to address next steps due to the ulcer and low enzymes issue.
Thank you
Hi Dr. Eric, I suspect my years of ongoing stress has made my candida flare up and has damaged my gut lining (leaky gut) as I have become sensitive to certain foods and sometimes it creates slight inflammation of my gums….and i do have low stomach acid….so factoring all this in, can i take slippery elm powder?? since it coats the stomach, will it decrease my stomach acid even more? i cant seem to find any certain info online. thank you.
i forgot to mention, i tried taking HCL to boost stomach acid, i think that caused inflammation more…i assume it’s coz my gut lining is being irritated….so is it safe to assume that once i coat my gut with slippery elm, then taking HCL to boost stomach acid slowly will eventually help recovery of my condition?
Hi Avis,
Slippery elm shouldn’t have a negative impact on the gastric acid production. To answer your other question, if you build up the mucosal lining of the gastrointestinal tract, you might be fine taking HCL. However, you do need to be careful, as not everyone needs to take HCL.
Dear Dr Eric,
I have had blood tests and was found to be ‘moderately’ low on thyroxine. Because I have symptoms of hypothyroidism my doctor has prescribed 50mg Levothyroxine to be taken once/day. I began taking this yesterday. However, having read information I am wondering whether this is the correct course for me? I have been a vegan for 8 years and have acid reflux so take PPI’s, both bad for Vit B12 absorption. I would like to stop taking PPI’s but fear the symptoms of heartburn, etc. Most of the time I take multivitamins with B12 and Vitamin D in mind (also supplements, oils and nuts for EFA’s). I became very run down before christmas, was not taking supplements, my hair began falling out in a patch at the right side of my center parting and has not yet grown back.
I had a night in hospital, in February, due to gastritis and duodenitis. An ultrasound scan found a polyp in my biliary duct. An endoscopy exam found I had a lump in my esophagus and I am waiting for results from biopsies. My question: am I hypo or do I have a vitamin deficiency caused by poor digestion caused by PPI’s or both!? Having read this article I now understand that being hypo may cause the acid reflux so Levothyroxine would eventually help my gastric problems. On the other hand would it safe to continue to take Levothyroxine until I can check with my doctor whether B12 / Vit D deficiency could be the problem rather than being hypo? This could take about 3 weeks. I hope this makes sense and best wishes, M, xx.
Vegan diet causes a rise in stomach acid over time due to the general alkalinity of plants. I know it’s not what you want to hear but eating grass fed meat can, over time, help balance the damage done.
Long term LPR (Laryngeal Reflux) sufferer here. 15 years of GERD meds, Hashimoto’s, Nissen fundoplication, alternate diets and truck loads of supplements, (H. Pylori test is negative), nothing helps. I feel a burning at the back of my mouth near the uvula.
I’ve tried T3 and now T4 for the Hashimoto’s but I don’t notice much difference, also have adrenal issues.
I’ve explored the low acid approach with Chris Kresser (one of the people who popularized this) but had no luck. The approach above sounds excellent and sells many books but it just hasn’t worked with me.