5 Ways to Test Your Stomach Acid Levels:
Low stomach acid, also called hypochlorhydria is one of the major underlying causes in chronic inflammatory conditions. Most people who develop low stomach acid will never trace their health condition back to this issue. The medical system rarely gives any consideration to stomach acid levels and most natural health practitioners don’t fully address this issue as well.
Stomach acid is also called HCL for hydrochloric acid based around its chemical composition of one part hydrogen and one part chloride. There are many symptoms associated with low stomach acid and a few lab tests and at home tests one could perform in order to see if they have this problem. These 5 tests include:
The Gastric Acid Secretion Test:
This is a highly invasive and expensive test that is typically only used by medical doctors if the individual has a diagnosed stomach ulcer. It is only covered by insurance in cases of stomach ulcers (1)
Doctors find it helpful to see if the anti-ulcer medication that was prescribed is working and to see if there is any material coming into the stomach from the intestines.
This test consists of having tube inserted into your stomach through the esophagus in order to suck out any existing stomach fluid. You will also need an injection of the hormone gastrin into the body in order to stimulate the stomach cells to release acid.
The stomach should normally have 20-100mL of fluid with a pH between 1.5-3.5. A low level of fluid and/or high pH would be indicative of either achlorhydria or hypochlorhydria.
The Heidelberg Stomach Acid Test:
This is considered the gold standard test for hypochlorhydria. This test gives an exact result to the capability of the stomach to produce acid. It typically costs around $350 and most insurance plans do not pay for it.
This test works by using a small capsule with a specific wireless electronic transmitter that records the pH of the stomach as you drink a solution with small amounts of baking soda. Baking soda is sodium bicarbonate which has hydroxide (OH-) ions that reduce acidity.
The baking soda will naturally neutralize the HCL in the stomach. If the acid does not return to normal after the baking soda is swallowed than that is a positive test for hypochlorhydria (2).
The typical protocol looks like this:
- Avoid any acid suppressing drugs for at least 4 days before the test.
- Fast for 8-12 hours
- Swallow the small electronic capsule
- Drink a solution of baking soda
- The test will record the time it takes to reacidify.
This will determine if you have too much acid production (hyperchlorhydria), too little or none at all, called achlorhydria (3).
This test will show a graph of your pH levels at regular intervals of time. The video below shows more detail if you are interested.
The CBC and CMP:
A skilled clinician can diagnose low stomach acid off of routine complete blood counts (CBC) and comprehensive metabolic panels (CMP) if they know what they are looking for. Patient history should always be a big factor with this but here are the major signs on these tests.
The nice thing about the CBC and CMP is that they are routine tests for medical doctors and are nearly always covered by insurance if you go through your primary care medical provider. Here are the indications that I look for:
Low Chloride Levels: One of the main components of hydrochloric acid is chloride. When we see low chloride levels in the blood under 100 (101-106 is functionally normal) than it is a sign of low HCL.
Abnormal Serum Protein and Serum Globulin Levels: Since HCL is needed for protein digestion, when these levels are abnormal such as a serum protein under 6.9 or over 7.4 g/dL and globulin level under 2.4 or over 2.8 g/dL than it could be a sign of low HCL. Especially if liver enzymes are relatively normal.
Low Phosphorus Levels: If phosphorus levels are low, with a vitamin D deficiency and/or hyperparathyroidism than it may be a sign of low HCL production.
High BUN Levels: A lack of stomach acid may result in a high amount of nitrogenic waste (from poor protein digestion) in the bloodstream. This can be seen as a BUN (blood urea nitrogen) level of 20 or more.
Abnormal MCV//MCH/MCHC: This has to do with the size of the red blood cell (RBC). Methylation with B12 is a critical part of the RBC maturation process in the bone marrow. Inadequate B12 will result in immature RBC’s that will be larger and less effective at carrying oxygen to cells.
HCL is also necessary for iron absorption, so if these numbers are below normal along with low Hct, Hbg, etc. it could be an iron deficiency related to low HCL.
Normal MCV should be between 85-92
Normal MCH should be between 27.7-32%
Normal MCHC should be between 32-36%
Additional Lab Testing:
High Homocysteine Levels: Stomach acid is critical for B12 absorption (4). B12 is one of the key components of methylation which keeps homocysteine levels between 4-7 umol/L. If B12 levels are low, than homocysteine will be elevated.
Low B12 Levels: Intrinsic factor is a glycoprotein in the stomach that is necessary for B12 absorption. With inadequate HCL production, intrinsic factor will be unable to work effectively and the individual will develop a B12 deficiency (5).
When a patient history indicates symptoms of low stomach acid and 2 or more of these findings are on lab work than it is a good clinical assumption that the individual needs to focus on strategies to improve HCL production.
The main test I use for this is the Total Thyroid Report which looks at all of these metabolites and so much more.
The Baking Soda Stomach Acid Test:
This very easy, at home test is basically free other than the cost of ¼ tsp of baking soda. This is a good one to do because it is safe and has no major cost involved.
This test works by creating a unique chemical reaction within your stomach that occurs when you mix the OH- ions of the baking soda with the hydrogen (H+) ions within the bodies stomach acid (HCL). The natural results should be a carbon dioxide gas production which will cause a burping effect.
This test does have many variables that can cause false positives or negatives. To minimize these variables and get a greater degree of accuracy, I recommend performing this test on 3 consecutive mornings to find an overall average.
It is also best to do this test first thing in the morning before eating or drinking anything. You are looking for pattern of results, not a simple one-time “yes” or “no.”
There is no published data on this method and the reliability is up for question. The results can vary from person to person depending upon how the individual interprets what they are experiencing. However, I still like it as a baseline measure and it is simple enough that you can retest every month to see if you notice changes.
Here is How You Do The Test:
- Mix ¼ tsp of baking soda in 4-6 oz of cold water, first thing in the morning before eating or drinking anything.
- Drink the baking soda solution
- Time how long it takes for a burp or belch to come about. Go up to 5 minutes. If you have not burped or belched within 5 minutes than it would be a sign of insufficient stomach acid production.
If you have early and repeated belching than it may be due to too much stomach acid. However, it is important not to confuse these with small little burps from swallowing air when drinking the solution. Any belching after 3 minutes is an indication of low stomach acid production.
Betaine HCL Challenge Test:
This is another at-home test that is quite reliable in my opinion, although there is no scientific data that I am aware of to prove this. There are studies that show that supplemental betaine HCL does reacidify the stomach for a period of time (6).
I typically recommend it for individuals who have the major symptoms of low HCL and have failed the baking soda test. It will only cost about $20 for a bottle of Betaine HCL, which is most likely a good investment since you will probably need it to help you restore your HCL levels if they are truly low.
To Perform the Test do the Following:
- Buy some Betaine HCL with pepsin (we use Acid Prozyme)
- Eat a high protein meal of at least 6 ounces of meat (you can have veggies too)
- In the middle of the meal (never in the beginning) take 1 Betaine HCL pill
- Finish the meal and observe what you notice.
- You Don’t Notice Anything:If you don’t feel any difference than it is most likely you have low stomach acid levels.
- You Notice Indigestion:If you experience a burning, hotness or heaviness in your chest than these are signs you have adequate stomach acid levels.
It is best to do this test 2-3 times in order to make sure you aren’t getting a false positive. There are 3 main reasons for someone getting a possible false positive.
- Didn’t Consume Enough Protein: Low protein meals don’t need much HCL and therefore the supplement can cause too much of an increase. Be sure it is as close to 6oz of meat as possible.
- Took the Capsule Before the Meal:This will almost always cause indigestion as your body isn’t ready for the supplement.
- Have Esophageal Sphincter Dysfunction: For some individuals, they may have a hiatal hernia or poor contractile activity of the esophogeal sphincter that can cause an increase in indigestion like symptoms. It is always good to get a medical exam to rule these things out before doing the test if possible.
If you get 3 positive tests in 3 separate meals than begin using the HCL supplement with the protocol I describe in detail in this article along with the 10 ways to improve your stomach acid levels naturally.
Sources For This Article Include:
- Stomach Acid Test – MedlinePlus
- DePestel, D. D., Kazanjian, P. H., Cinti, S. K., Kauffman, C. A. and Carver, P. L. (2004), Magnitude and Duration of Elevated Gastric pH in Patients Infected with Human Immunodeficiency Virus After Administration of Chewable, Dispersible, Buffered Didanosine Tablets. Pharmacotherapy, 24: 1539–1545.
- Stack BH. Use of the Heidelberg pH capsule in the routine assessment of gastric acid secretion. Gut. 1969;10(3):245-246.
- Rasool S, Abid S, Iqbal MP, Mehboobali N, Haider G, Jafri W. Relationship between vitamin B12, folate and homocysteine levels and H. Pylori infection in patients with functional dyspepsia: A cross-section study. BMC Research Notes. 2012;5:206.
- King CE, Leibach J, Toskes PP. Clinically significant vitamin B12 deficiency secondary to malabsorption of protein-bound vitamin B12. Dig Dis Sci. 1979 May;24(5):397-402. PMID: 378625
- Yago MAR, Frymoyer AR, Smelick GS, et al. Gastric Re-acidification with Betaine HCl in Healthy Volunteers with Rabeprazole-Induced Hypochlorhydria. Molecular pharmaceutics. 2013;10(11):4032-4037.