Stomach Acid Production

Gastric acid is required for protein denaturation, pepsin activation, iron and B12 absorption and pathogen defence. Genuine hypochlorhydria occurs with atrophic gastritis, autoimmune gastritis, Helicobacter pylori infection, gastric surgery and long-term proton pump inhibitor use. It is not a common cause of reflux symptoms in otherwise healthy people, despite widespread claims. The baking soda burp test has no validity. Taking betaine HCl with an undiagnosed ulcer, gastritis or while on NSAIDs or PPIs risks mucosal damage. Suspected hypochlorhydria warrants B12, iron and H. pylori testing rather than self-treatment.

1) Get tested rather than assuming: B12, ferritin and H. pylori are the meaningful starting points. 2) Eat without distraction and chew thoroughly, since the cephalic phase drives a meaningful share of acid secretion. 3) Avoid drinking large volumes of fluid during meals, which dilutes gastric contents. 4) Do not take betaine HCl if you have or might have an ulcer, gastritis, or are taking NSAIDs or acid suppressants. 5) If you are on long-term PPIs, discuss deprescribing with your clinician rather than adding acid supplements. 6) Treat H. pylori if positive, since eradication can restore acid secretion. 7) Manage stress, which alters gastric secretion and motility. 8) Ignore the bicarbonate burp test entirely; it has no diagnostic validity.

• •Testing before treating
• •Mindful eating and chewing
• •Limiting mealtime fluids
• •H. pylori eradication if positive
• •PPI review with clinician
• •Stress management