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 levels 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:
The Heidelberg Stomach Acid Test 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, then 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 levels 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), then 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 then 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 then 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 5–8 umol/L. If B12 levels are low, then 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 levels and 2 or more of these findings are on lab work then 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 Comprehensive Blood Analysis which looks at all of these metabolites and so much more.
The Baking Soda Stomach Acid Test:
The Baking Soda Stomach Acid Test is a very easy, at-home test to check your stomach acid levels that 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, then it would be a sign of insufficient stomach acid production.
If you have early and repeated belching or indigestion, then 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 levels and overall HCL 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.
Possible Outcomes:
- You Don’t Notice Anything: If you don’t feel any difference, then it is most likely you have low stomach acid levels.
- You Notice Indigestion: If you experience a burning, hotness or heaviness in your chest, then 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 6 ounces 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, then 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.
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Sources For This Article Include:
1. Stomach Acid Test – MedlinePlus
2. 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.
3. Stack BH. Use of the Heidelberg pH capsule in the routine assessment of gastric acid secretion. Gut. 1969;10(3):245-246.
4. 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.
5. 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
6. 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.
Just eat a lot of fresh, or slightly cooked veggies, especially greens, and very little starchy foods. Green tea instead of coffie. Black tea with milk, the British style. Nothing more needed. You are lucky to have high stomach acid, because low acid, and specifically, achlorhydria are precoursors of the stomach cancer.
Hello, I tried the baking soda test and I belched 3 times in the first 2 minutes. Then once again I belched 2 times at 5 minutes. What is my issue because I have very bad heartburn most of the time after I eat. Although, I did stop all Pepcid Medicine and began to eat a radish after meals and the heartburn has become 85% less. So I have been testing foods and it seems that so far that nuts, english muffins and potato chips give me serious heartburn. Can anyone help to tell me if my stomach acid is to high or to low. I did try ACV once and it burned the heck of of my chest, so apparently the ACV (Apple Cider Vinegar) was way too strong, so does that mean my stomach acid is too high? Because the Baking Soda test gave me different results and I am much more confused now, please help! Thank you so much.
Hey Lisa, This would indicate that you have excessive stomach acid production and possibly a hiatal hernia or even possibly a stomach ulcer. I would recommend following some of the suggestions in this article and eliminating foods that give you the worse heartburn. https://drjockers.com/hiatal-hernia-natural-treatment/
I have read that heartburn can be a sign of low acid on several health websites. It’s anti intuitive, but there you are. Sounds like you should be tested in a clinic.
you shouldnt be eating chips and bread if you want to fix your stomach
I’ve been told cayenne pepper pills will cure an ulcer. Start out slowly with the capsules. I had an H pylori test yesterday. That’s where the dr wanted to start. Two weeks without Prilosec was Hell. I’ve lost 10 pds!
Nelida
I have GERD and the Zantac and Prilosec and laletly the protomix work only for some time, now the doctor at my suggestion want to do the Bravo test to measure the acidity question why do you think the medication is not working with me ? Do you think I have to take a different approach and tell my doctor to look for other ways to treat my problem?
From the 7 days 3 o 4 have bad reflux even with Zantac please help
Sorry to hear that! I would recommend working with a functional health practitioner to get to the root cause. Here is a helpful article: https://drjockers.com/functional-nutrition-tips-to-find-a-great-health-coach/
You write about chloride bloodserum levels . My bloodserum for chloride is 104 but only because I take Low chloride diet. I react on food high in chloride . So..would I have too much stomach acid as when I would eat normal my bloodserum for chloride would probably be much higher and if so would omeprazol lower the chloride?
Hey Yvonne, I don’t recommend this prescription drug. I would recommend that you work with a functional health practitioner to get to the root cause of your problems and customize a specific plan for you. This article can help: https://drjockers.com/functional-nutrition-tips-to-find-a-great-health-coach/
your body balances it out
Hello Dr Jockers,
After suffering from reoccurring H-Pylori infections and hair-loss issues over the last 2 years, failed antibiotic regimens and no concrete diagnosis from medical or naturopathic doctors, I read your article and finally concluded that I have low stomach acid. I also got my iron, zinc, magnesium levels checked recently and they came low (in spite of me being a vitamin freak). I also used to get gas pain in the hollow of my stomach after meals, until I started using the Acid Prozyme supplement. My two main questions are:
1) I’m a vegetarian, how do I do the 6oz meal test? Can I do it with eggs?
2) I started with 1, 2, then 3 tablets. I did’t feel anything after the 3rd tablet (the post-meal pain disappeared though). Does that mean I need a higher dose? Or am I not feeling anything because I’m not eating a high protein meal?
Really appreciate your help! Thank you in advance!
Your experience sounds similar to mine. Measured low for minerals and was h. Pylori positive. It took two rounds to cure it, with 2 weeks of a cocktail of antibiotics including metronidazole. To help the cute I ate a bunch go sugar during that period (h. Pylori loves sugar and makes it more susceptible to the drugs.) In between the doses, I took probiotic bacteria and yeast to repopulate my gut, every day and for a few days after the medication stopped.
Good luck!
Thanks for sharing Susan!
I am 75 and have been taking different acid blockers for years, even went to ER for burning in my chest, just had an endoscopy and colonoscopy , had polyps removed. GI doctor said to famotidine! I took the baking soda test and did not burp for 15 minutes after, my b12 is low and am anemic, I also have been diagnosed with MGUS. I ordered the HCL with pepsin and going to start that today. Do you think I should have the test to measure my stomach acid? Thank You!
Hey Susan, I am so sorry to hear that you are struggling with these issues! It sounds like there is a lot going on. I highly recommend a functional health practitioner to work with you on your healing journey. This person will take a full health history intake and see all of your lab results to determine the proper testing that you may need. She will then be able to customize a specific plan for your healing journey! This article can help!
I am a 54 yeas old female who started Keto 8 months ago. A month into keto I developed acid reflux so I started with acv and lemon in my water through out day and before meals also did your protocol with the HCI supplements I worked my way up to 8 pills that are 648mg /c 130mg pepsin each. I have never felt the burning symptoms that they say you will feel when you reach your dosage but I stopped adding more because my natural path says not too, not sure what to do. Is it unsafe to add more? It is a lot of pills to swallow with my meals as it is they help with the reflux most of time but not sure if I am taking enough I have been taking them now for 7 months my hair is thinning and I have gas symptoms throughout day even while fasting and constipation unless I increase my magnesium or use smooth move teas. I also take Enzymes, DGL supplements, Bile salts and eat bitters with my dinner, my lunch is a kale shake and I don’t take these supplements with that. Not sure what to do or how long this will take. I want to add more of the HCL supplements but not sure how much is enough or safe to add. ?
Hey Rhanell, It sounds like there is a lot going on. I would recommend that you work with a functional health practitioner to get to the root cause of the problem. This article offers additional strategies that can help as well!
I am 41years old Female, and im new about Stomach problem. from my Endoscopic test my Gastro REPORT said : i have Chronic Gastris + stomach inflamation + Small Herniatal Hernia.
BIOPSY REPORT :
A. Stomach Random Biopsy :
Moderately Chronic INACTIVE GASTRIS
B. ESOPHAGUS BIOPSY:
Mild Chronic INACTIVE Gastris
I burbs alot, Brain fog, anxiety, depress, pain in the stomach , burning sensation, metal/sour taste in mouth. My Gastro gave me FEMOTIDINE & My Family Dr Gave me Prilosec. And i took Zanax for my anxiety. none of atomach meds help me and idk what to do anymore. After i read all the informations from you i know that i need help & need to do some test for my stomach issue. Dr Can you tell me what should i do to start to find out the root of my stomach issue so i can get help & taking right meds & eating right diet foods. Thankyou
Sorry to hear this Linda! I would encourage you to get a functional health practitioner. Here is a helpful article: https://drjockers.com/functional-nutrition-tips-to-find-a-great-health-coach/
Thanks for this helpful article Dr. Hockers.
Hello! I did the Betaine challenge and was instructed to take it before meals. Started with 4 pills and then decreased down to none. I now have severe burning in my chest from acid reflux with anything I eat…which previously had never even took Tums. I’m not sure what to do. Any suggestions on healing my mucosal lining?
Sorry to hear this Sheri, here is a helpful article: https://drjockers.com/stomach-ulcers/
Dr Jockers–I am not sure if you know about the blood type diet or believe in it but I have read that A type blood tends to have lower stomach acid issues. The blood type diet says to eat mostly as a vegetarian. Do you believe in this? I am worried because I have a sensitive stomach and I have also had part of my stomach removed–sleeve gastrectomy with a duodenal switch. I have also read that stomach cancer is more prevalent in A type blood and people with partial gastrectomies. I definitely need help to balance my body so it can be the best it can. Sort of scared bc my Dad was just diagnosed with gastric adenocarcinoma and I have been reading up on it that lower stomach acid can allow viruses and bacteria to damage the stomach lining leading to cancerous changes. This is also why PPIs are implicated. Please help. Anything would be appreciated.
Hello Lynne,
Yes, we do not follow the blood type diet and don’t find it scientifically valid. Sorry to hear about your issues. I would recommend following the strategies in the gastric ulcer article here: https://drjockers.com/stomach-ulcers/
Dr. Jockers
Thank you very much for your article. It really helped us to find out my 12 years old son who has low stomach acid. He started to have SIBO two and half years ago, but all his GI doctors couldn’t figure out what caused it. I just found out that low stomach acid might cause SIBO two weeks ago. Since he is 12 years old, my husband disagreed to use Heidelberg Test. We exactly followed your instruction that used Betaine HCL with Pepsin to test him with protein meal three times, and he didn’t have any response to it, so we finally found out the cause of his SIBO. My son is 12 years and 4 months now, 5’1” and 96 pounds. The label of HCL with pepsin shows only for adults. Could you tell me if it’s safe for 12 years old? If so, how long can he continue using it?
Yes absolutely a 12 year old can use this and it will really help. He can use it as long as it is needed.
Dr. Jockers
After the three-time tests, his bowel movement became much better. He stopped using HCL yesterday, then he became constipated again today although he used ACV before his dinner, and lemon water before breakfast. Now we think it might be safe to use just one capsule a day with his dinner.
Please advise!
Thank you,
Yes find the right dosage he needs and keep him on that!
Dr. Jockers
Thank you very much for your quick reply.
Do you think it’s ok to take HCL with no protein meal? The label of HCL doesn’t mention it, but some experts said that only use it with protein meal.
Thanks,
Rui
Yes it is best to use it with protein in your meals. From a nutrition perspective, you should have protein in all your meals.
Thank you very much Dr. Jockers.
Have you had any experience with patients with esophageal achalasia, a neurological issue that causes LES to remain tightly closed as well as decreased/absent peristalsis? My son was diagnosed at 16 and had heller myotomy at 17 (where they tease the muscles of the LES to allow food to pass). He has heart/throat-burn (LPR) nearly constantly but his esophagus looked ok on the last scope and pH was normal but they didn’t test stomach or throat pH. Nothing seems to help the terrible taste and burning in his mouth, including PPIs and antacids. Also tried baking soda swish. Any suggestions for neutralizing the acid in throat and mouth? Thank you so much!
I realize this is an older post. Replying because I have personal experience with achalasia. Achalasia on its own is bad enough although a hiatal hernia could pose a secondary issue. Be sure to have him looked at for a hernia. Does he have a “button” (a bump) in the middle of his chest? A hernia can cause achalasia symptoms. UCLA hernia doc took care of both and going on 5+ years without relapse so far. Was initially treated with a PPI of course which made no difference at all.