Digestive Support for Hypochlorhydria: It's Not Hype

You need stomach acid to digest your food and kill off pathogens...

Inadequate stomach acid levels can lead to a range of digestive and nutritional problems. For instance, insufficient gastric acid can hinder the proper denaturing of proteins, affecting protein digestion and potentially increasing food allergenicity. This environment also impairs the activation of pepsin, essential for optimal protein breakdown, and reduces the absorption of crucial micronutrients like calcium, iron, and several B vitamins. Moreover, reduced stomach acid compromises the body's ability to eliminate harmful ingested microorganisms, increasing the risk for conditions such as small intestinal bacterial overgrowth (SIBO) and infections from bacteria like Clostridium difficile.

Although the direct consequences of low stomach acid are well recognized, there is less consensus on how widespread this condition is, how best to diagnose it, and the most effective treatments.

The debate over the prevalence and impact of low stomach acid (hypochlorhydria) also extends to the discussion around treatment, particularly regarding the role of acid supplementation in digestion. Traditional medical views suggest that most healthy individuals produce sufficient stomach acid, yet "functional hypochlorhydria," or low acid during meals, appears to be more common, especially in older adults and those frequently using acid-suppressing medications. The integrative medicine community often employs an empirical approach to diagnose and manage low stomach acid, using increasing doses of betaine HCl during meals to determine the right level for symptom improvement. This method, though widely used and supported by positive anecdotal evidence, has yet to be rigorously validated in clinical research, highlighting a gap between clinical practice and established scientific evidence.

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Betaine HCl Supplement Protocol

1. Start with one capsule containing 350-750 mg of betaine HCl with a protein-rich meal. If no discomfort, increase to two capsules at the next meal.
2. If discomfort occurs after increasing the dose, neutralize with 1 tsp baking soda in water or milk, and reduce the dose for the next meal.
3. Gradually increase the dose by one capsule every two days, without exceeding 3,000 mg, until discomfort occurs. Then, reduce the dose by one capsule.
4. Establish a consistent dose once the appropriate level is found, adjusting for smaller or less protein-dense meals.
5. Discontinue use and consult a healthcare professional if discomfort continues despite dose adjustments.
6. Avoid using betaine HCl if you have peptic ulcer disease and do not open capsules as HCl can damage teeth and irritate mucous membranes.
7. Ensure the meal accompanying the betaine HCl is at least 500 calories with adequate protein to avoid gastric irritation.

Reference

Guilliams, Thomas G, and Lindsey E Drake. “Meal-Time Supplementation with Betaine HCl for Functional Hypochlorhydria: What is the Evidence?.” Integrative medicine (Encinitas, Calif.) vol. 19,1 (2020): 32-36.

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