Low stomach acid can be a major factor in digestive issues, nutrient deficiencies, and even more significant health problems. Many people are diagnosed with conditions like reflux or GERD and treated with acid blockers, but what if the problem isn’t too much acid, but too little?
In my journey with SIBO, IBS and Functional Dyspepsia, I was convinced I had low stomach acid. I had textbook symptoms, and had used PPIs like Omeprazole/Prilosec and H2 blockers like Ranitidine/Zantac for months on end. But taking supplements to increase my stomach acid didn’t really seem to be helping, so I wanted to find out once and for all what was going on with my stomach acid levels.
That’s where a test like the Heidelberg can come in, but is it worth it?
What are the symptoms of low stomach acid?
Low stomach acid AKA hypochlorhydria, can show up in several ways. Most of the symptoms are quite non-specific gut symptoms, so it can be tricky to work out if it’s stomach acid or something else that is the problem. The most common symptoms include:
Bloating, especially after high protein or fat meals
Indigestion or a feeling of food sitting in your stomach
Heartburn or acid reflux
Gas and burping
Nausea after taking supplements or eating certain foods
Feeling full quickly or after eating a small amount
When we think of acid reflux, we immediately think of too much stomach acid. In fact, there is a multi-million dollar pharmaceutical industry built around this very premise! However, low acid can cause the lower-oesophageal sphincter (LES) to malfunction, allowing stomach contents to reflux back into the oesophagus, leading to heartburn.
Another major issue tied to low stomach acid is poor nutrient absorption. When your stomach acid isn't strong enough, your body struggles to break down food and absorb vitamins, particularly B12, iron, calcium, and magnesium.
Over time, this can lead to deficiencies that affect your energy, immune system, bone health, and overall well-being. If you regularly experience fatigue or frequent illnesses, it could be a sign that low stomach acid is affecting your nutrient intake.
What can cause low stomach acid?
Low stomach acid can result from various factors, often related to lifestyle, stress, or diet. Some common causes include:
Stress: The biggie. Chronic stress can disrupt digestion and lower stomach acid production.
Age: Stomach acid production naturally decreases with age.
Diet: Diets high in processed carbs, sugars, or alcohol can impair stomach acid production.
Nutrient deficiencies: You need nutrients such as zinc, iron and B vitamins to produce stomach acid. It can become a vicious cycle of low stomach acid > poor nutrient absorption > low stomach acid.
H. pylori infection: This bacteria can damage the stomach lining and potentially either reduce or increase acid production.
Long-term use of acid blockers: Medications like PPIs (proton pump inhibitors) or H2 blockers are designed to lower stomach acid, but long-term use can result in the stomach not producing enough acid on its own.
Low stomach acid is not a root cause in itself - our bodies are designed to produce adequate acid for digestion, so if you do have low stomach acid it is important to work out why to avoid a lifetime of supplementation. For example, addressing nutrient deficiencies and stress can make a big difference in improving stomach acid levels.
How can you test for low stomach acid?
If you suspect you have low stomach acid, there are not many reliable ways you can test it.
The baking soda test is one common method touted online in the functional health space, although there is no science to support this method. It involves mixing a teaspoon of baking soda in water and drinking it first thing in the morning. The idea is that if your stomach acid is strong enough, you should burp within a few minutes, as the acid reacts with the baking soda to produce carbon dioxide gas. If you don’t burp after 5 minutes, supporters of this test will tell you you have low stomach acid.
I failed this test miserably. I didn’t burp at all. This only increased my belief that I had low stomach acid, and without the Heidelberg test I would’ve probably chased this root cause a lot further and seen no results.
The gold standard for measuring stomach acid levels is the Heidelberg test.
What is the Heidelberg test for stomach acid?
The Heidelberg test is an easy and non-invasive medical procedure specifically designed to measure the pH of your stomach acid. It involves swallowing a small capsule equipped with a radio transmitter. This capsule then measures the acidity in your stomach and relays the data back to a computer for instant analysis.
During the test, you’re given a solution of sodium bicarbonate, which is essentially baking soda. This is an alkaline solution which serves to challenge to your stomach’s pH. The test observes how quickly your stomach re-acidifies after ingesting the sodium bicarbonate, determining whether it returns to its normal acidic state or remains too alkaline.
The results from the Heidelberg test provide an immediate and accurate reading of your stomach’s acid levels. Not only does it help identify if you have low stomach acid, but it can also highlight other potential issues, such as delayed stomach emptying or problems with the pyloric sphincter.
My experience of the Heidelberg test for stomach acid.
I suspected I had low stomach acid after suffering from indigestion, nausea, bloating, upper gastrointestinal pain and fullness after meals. I had spent months on acid suppressant drugs after a gastritis diagnosis that had only seemed to make my symptoms significantly worse.
I trialled betaine HCl which also seemed to make my symptoms worse. The pain started to deteriorate and I also started getting acid reflux. I knew that my gastritis had healed, so I was really confused at what was going on.
After a few months of frustration, I decided to get a Heidelberg test. I wanted to know for sure what was going on with my stomach acid levels instead of guessing. The test itself was straightforward, if a bit weird! I had to fast before the appointment so my stomach was completely empty.
At the start of the test I had to swallow the capsule with a small amount of water. The capsule remains attached to a string so they can pull it back up at the end - the experience of swallowing it was therefore quite strange (think gulping down a large vitamin on a string!) but it wasn’t painful at all.
The whole test took about 45 minutes, and during this time I challenged my stomach pH 3 times with a sodium bicarbonate drink. Each time, the capsule assessed how quickly my stomach would return to its normal acidic pH after this alkaline challenge.
Throughout the test, the data collected by the capsule was sent directly to a computer screen, allowing the practitioner to monitor my stomach’s functioning in real time. I found it fascinating to see the immediate feedback on how my body was reacting.
The worst part was the end of the test where they ask you to cough and simultaneously tug on the string to pull the capsule back up. This really activates your gag reflex and wasn’t particularly pleasant, although again not at all painful and it was over very quickly.
What did my Heidelberg test results show?
To my surprise, the test revealed that I didn’t have low stomach acid at all and my stomach acid levels were actually high. It also showed a problem with my pyloric sphincter - the valve that controls the passage of food from the stomach to the small intestine. It wasn’t functioning properly due to excess pressure of gas coming from my small intestine. This explained why I experienced so many stomach related symptoms, despite having enough stomach acid.
These are my full test results.
Number 1: Swallowing of the capsule.
Number 2: Sodium Bicarbonate Solution drunk
Number 3: Reacidified
Number 4: Sodium Bicarbonate Solution drunk
Number 5: Reacidified
Number 6: Sodium Bicarbonate Solution drunk
Number 7: Reacidified
In a normal, healthy stomach, it typically takes around 20 minutes to re-acidify to pH 1-2 after being challenged with a sodium bicarbonate solution during the Heidelberg test. Mine re-acidified within 10 minutes every time, suggesting high stomach acid.
You can after see that after the test finished, we kept the capsule in a bit longer and the pH kept fluctuating. This was alkaline mucus refluxing from the duodenum back into the stomach - showing the main issue was one with my small intestine.
What was eye-opening for me was that I’d been taking supplements like betaine HCl, thinking they would help increase my stomach acid, but in reality, they were likely making the situation worse by adding more acid to an already overly-acidic environment. Similarly, I had tried acid blockers in the past, which also worsened my symptoms due to their negative effects on the microbiome.
This experience really hammered home how important it is to understand the root cause of digestive issues before self-treating. It was clear that low stomach acid was not a root cause for me, and without testing I probably would’ve spent a lot more time thinking it was.
That said, I would never treat high stomach acid with acid suppressants unless there was active inflammation present, and if I had had a clear positive response to a Betaine HCl supplement, I also wouldn’t have done the test. It worked for me due to my confusing responses to both an increase and reduction in stomach acid, but I absolutely don’t think it’s necessary for most people.
To sum up:
The Heidelberg test is another tool for anyone struggling with digestive problems, especially if you suspect low stomach acid might be the cause but are struggling to tolerate Betaine HCl. It gives precise, real-time data about your stomach’s function and helps you understand whether your acid levels are truly the issue, or if something else might be going on.
In my case, the Heidelberg test helped me avoid further damage from taking unnecessary supplements and acid blockers. However, the test is not cheap, and I could only find one UK-based clinic offering it.
Contact me if you are thinking of having the Heidelberg test or would like any further info about my experience of it. 😊
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