The Heartburn Connection
As mentioned earlier, hypochlorhydria and heartburn (acid reflux/GERD) have a complicated relationship that is often misunderstood.
It is often assumed that heartburn is this volcanic-like overflow of too much stomach acid erupting up through the esophagus causing the painful and/or burning sensation of heartburn. It is true that stomach acid in the esophagus is what causes the discomfort, but it is not from a bubbling over of stomach acid. It is actually caused by small amounts of stomach acid getting into the esophagus due to changes in pressure associated with low levels of stomach acid. It is very, very rare for someone to have too much stomach acid. In reality, we’re facing epidemic proportions of people with low stomach acid.
If you go to the doctor for heartburn or GERD, the standard treatment is a prescription for a PPI medication (proton-pump inhibitor) like Prilosec, Nexium, Zantac, or Pepcid. This treatment is a band aid for your symptoms at best, and at worst (and most common) it can be the start of new and worsening issues. When these acid reflux medications are used they actually lessen or completely eliminate stomach acid. This makes you incredibly vulnerable to worsening GI issues.
A recent cohort study concluded that those who took PPI’s for more than 1 year had an associated 17% increased risk of death. (Read more: Heartburn drugs linked to fatal heart and kidney disease, stomach cancer.) These medications were not designed to be used for more than 6-8 weeks but are often taken for years. While the medications do provide welcome relief from heartburn symptoms, they can lead to osteoporosis, nutrition deficiencies, and heart disease, each of which can contribute to higher risk of death.
So what is causing the reflux?
It all comes down to keeping the esophageal sphincter tightly sealed to prevent reflux, or backflow, of stomach contents into the esophagus. Poor digestion of food from too little stomach acid and enzymes slows digestion and stomach emptying. Not having enough stomach acid increases intra-abdominal pressure (IAP), much like the fermentation process that occurs in beer and wine. The pressure in the stomach then pushes against the lower esophageal sphincter reducing its ability to keep a tight seal. Even small amounts of acid moving into your esophagus cause significant pain and burning since the esophagus is not protected from the pH of stomach acid like the stomach lining. This describes the mechanism behind why heartburn occurs with meals, or shortly after eating. However, the esophageal sphincter can weaken over time, causing more consistent heartburn unassociated with a meal. Untreated, long-term reflux can damage the esophagus.
The Functional Medicine Approach to Treating Low Stomach Acid
The conventional approach to reflux (treatment with heartburn medications like PPIs) does address the main symptom of hypochlorhydria. However, the conventional approach fails to address the root cause of hypochlorhydria. There is actually no conventional treatment that directly addresses low stomach acid. The mainstream medical community does not recognize low stomach acid as a condition to be treated, focusing only on the symptoms that it creates.
Those symptoms are treated with a variety of medications, such as:
- PPI’s for reflux/GERD
- Steroids, biologics, and anti-inflammatory medications for Inflammatory Bowel Disease (IBD)
- Various antiemetic and antidiarrheal medications for Irritable Bowel Syndrome (IBS) and IBD
- In the case of gallbladder issues, surgery is the only option. (And yes, hypochlorhydria can be part of your gallbladder issues.)
The GI tract is incredibly complex, and supporting optimal GI health requires more than matching a medication to a symptom. More importantly, none of these conventional treatments solve the underlying issue: low stomach acid.
You deserve a better standard of care. Fortunately our functional medicine approach to low stomach acid offers hope.
Despite hypochlorhydria being responsible for, or contributing to, almost every GI-related health issue, it is relatively straightforward to treat. It generally requires supplemental HCL and digestive enzymes in addition to making diet changes. This combination helps the body maintain adequate levels of HCL on its own over time, therefore requiring less and less supplemental HCL.
Lab Testing for Hypochlorhydria
Accurately diagnosing some GI issues (like Small Intestine Bacterial Overgrowth, or SIBO) can be challenging. Fortunately, testing for hypochlorhydria is one of those scenarios where, if it looks like a duck and quacks like a duck, it’s probably a duck (with low stomach acid).
The HCL Challenge Test is a great way to determine if your stomach acid is low. It also has the huge benefit of actually treating low stomach acid at the same time. The challenge consists of:
We strongly recommend performing the HCL Challenge Test with a practitioner as there are times it is not appropriate to do, and you will benefit from their experience and clinical judgement.
A Heidelburg Stomach Acid Test can be done by your medical doctor, but it is a bit cumbersome and does not reveal much more information than would be gleaned by the more common method of performing an HCL Challenge Test while treating with HCL. Sometimes the patient experience is a better “lab test” than the sophisticated labs available.