Hypochlorhydria (low stomach acid)

Anecdotal reports and practitioner experiences suggest stomach acid (Hydrochloric acid or HCl) levels are often low in CFS. This could be due to many reasons, such as infections (eg. h pylori), nutrient deficiencies or low ATP. Low stomach acid sets the stage for numerous digestive and dysbiotic issues, many CFS specialists consider correcting HCl levels as fundemental to any CFS treatment protocal.

HCl metabolism:
HCl is created by the parietal cells in the stomach which use an ATP-dependant enzyme (H/K ATPase) to create the large pH gradient between them and the blood, they then secrete HCl in response to food intake. Various neurotransmitters (acetylcholine and GRP) and hormones (gastrin and histamine) regulate HCl production, it is also regulated by negative feedback mechanisms. HCl is required in the first step of protein digestion (where protein is denatured), it sets up the right pH to trigger various digestive enzymes, and many minerals and vitamins (especially B12) require HCl for efficient absorption. HCl is also required to sterilise food and discourage growth of bad bacteria/yeast in the small intestine.

Thus low stomach acid levels can cause low amino acid and nutrient assimilation (digestion and absorption) and gut dysbiosis (bad bacteria overgrowth). Low stomach acid also perpetuates itself, since you can go deficient in various nutrients required to make HCl.

Home bicarb test:
There is a simple home test that can be done to give a good basic indicator of HCl levels. All you need is some bicarbonate of soda. This is the most common home test procedure on the net for testing stomach acid levels:

[Take 1 level teaspoon of bicarbonate of soda dissolved in a little water, on an empty stomach *. [*That means 2½ hours after breakfast, lunch or dinner where no other foods, supplements or drinks other than pure (still) water have been consumed since the last meal.] If sufficient acid is present in the stomach, the bicarbonate will be converted into CO2 gas, which produces significant bloating and belching within 5 –10 minutes. If this happens, further action is unlikely to be required unless CO2 production is excessive.]

Basic HCl support:
- A slice of lemon (pH2-3) squeezed into a small amount of water with/after each meal (drink through a straw).
- Cider vinegar with each meal (drink through a straw).
- B-vitamins, magnesium and potentially anything that helps energy metabolism in the parietal cells in the stomach.

Stronger HCl support:
- Betaine HCl supplements (may also stimulate betaine-dependant BHMT methylation pathway)
- Allergy research group 'Diluted pure HCl' (drink through a straw).

Further testing:
- http://www.nutri-linkltd.co.uk/documents/GastroTestInstructions.pdf
- Acumen VEGF