Hypochlorhydria is a deficiency of hydrochloric acid in the stomach. 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 to break down, digest, and absorb nutrients such as protein. It also eliminates bacteria and viruses in the stomach, protecting your body from infection.

Low levels of hydrochloric acid can have a profound impact on the body’s ability to properly digest and absorb nutrients. Left untreated, hypochlorhydria can cause damage to the gastrointestinal (GI) system, infections, and a number of chronic health issues.

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

  • bloating
  • burping
  • upset stomach
  • nausea when taking vitamins and supplements
  • heartburn
  • diarrhea
  • gas
  • desire to eat when not hungry
  • indigestion
  • hair loss
  • undigested food in stool
  • weak, brittle fingernails
  • fatigue
  • GI infections
  • iron deficiency anemia
  • deficiencies of other minerals, such as vitamin B-12, calcium, and magnesium
  • protein deficiency
  • neurological issues, such as numbness, tingling, and vision changes

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

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

  • Age. Hypochlorhydria is much more common as you get older. People over the age of 65 years are most likely to have low levels of hydrochloric acid.
  • Stress. Chronic stress may decrease production of stomach acid.
  • Vitamin deficiency. Deficiency of zinc or B vitamins may also lead to low stomach acid. These deficiencies may be caused by inadequate dietary intake or by nutrient loss from stress, smoking, or alcohol consumption.
  • 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 production of stomach acid.

Risk factors for hypochlorhydria include:

  • being over 65 years of age
  • high levels of stress
  • ongoing use of a medication that reduces stomach acid
  • vitamin deficiency
  • having an infection caused by H. pylori
  • having a history of stomach surgery

If you have questions or concerns about your symptoms or risk factors for low stomach acid production, speak with your doctor. They can help develop a treatment plan that is best for you.

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

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

Your stomach pH may indicate the following:

Stomach pHDiagnosis
Less than 3Normal
3 to 5Hypochlorhydria
Greater than 5Achlorhydria

People with achlorhydria have almost no stomach acid.

Elderly persons and premature infants often have much higher stomach pH levels than average.

Your doctor may also perform blood tests to look for iron deficiency anemia or other nutrient deficiencies.

Depending upon their evaluation and the severity of your symptoms, your physician may choose to refer you to a GI specialist.

Treatment for hypochlorhydria will vary depending on the cause and severity of symptoms.

Some physicians 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 your 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, a course of antibiotics can be prescribed by your physician.

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

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

Hypochlorhydria can cause very serious health problems if left untreated. If you have digestive changes or symptoms that concern you, it’s important to see your doctor promptly. Your doctor can help you determine if you have hypochlorhydria, and treat or help you manage the underlying cause. It’s possible to treat many causes of hypochlorhydria and prevent serious complications.