My experience with hypochlorhydria and diagnosis thereof

As I said last week, my hypochlorhydria probably started at birth.  My symptoms included the following:

  • High protein or fiber foods felt like they just sat in my stomach.  I felt nauseous and just generally icky.  For you World of Darkness fans, imagine a vampire ate human food.  That is what it felt like.
  • High protein meals in particular often gave me a headache.
  • These symptoms were noticeably better if I had soda with the meal.
  • There were years I lived on spaghetti and tomato sauce.  Tomatoes are highly acidic.
  • Blood sugar issues.  My fasting blood glucose level tests always came back perfect, except for the fact that I was emotionally destroyed by them.  I tended to crash after more than an hour without food.  My ex-boyfriend (we broke up almost five years ago but remain very good friends) still gets a haunted look if you mention me with low blood sugar to him.
  • Despite this, I was really bad at anticipating hunger.  By the time I noticed, the pin was already out of the grenade.
  • I always felt insecure about food, even though I’ve always lived in a home with a full fridge.
  • Low cortisol levels, especially in the morning, but cortisol too high at night.
  • Low thyroid numbers.
  • I could feel like I was starving at the same time I felt disgustingly full and bloated.  I had been on the HCl for almost 9 months before it occured to me food could be a solution for hunger.
  • Poor dental health, despite having the best care money could buy since infancy.
  • A running list of nutritional deficiencies.

I was seeing a “functional medicine” doctor (with an MD), who spotted and treated the nutritional deficiencies and hormonal issues, but not the root cause. I’ll admit most of the symptoms are pretty nonspecific, but I did bring the soda thing to her.

Some time later, I was referred to a psychiatrist for possible anxiety issues.  I think that psychoactive drugs are invaluable when necessary but also pose some serious risks, and should be used with caution.  I found a psychiatric ARNP who advertised a nutritional focus and talked to her.  She listened, and suggested that I might have an anxiety disorder, but she also saw signs that I might be incapable of digesting food, and that that could be contributing.

There’s are several ways to test for hypochlorhydria (also called achlorhydria).  There’s some expensive, highly technical ways involving an endoscopy or a pill with a pH lab and a radio transmittor. Or you can take an HCl supplement with a protein heavy meal.  If you don’t get heartburn, congratulations on your newfound diagnosis.

My ARNP originally phrased this as “if the pill makes feel better, you have hypochlorhydria”, but that was a mistake.  I was so deficient that a single pill did not make a damn bit of difference.  The instructions on the bottle say “1-2 pills per meal”: that would not get me through half a pear, much less meat.    When I first started, I pretty much alternated one bite meat, one HCl pill.  That’s calmed down some, although sometimes I still need quite a lot

I listed the improvements in my health in the last post, so I won’t repeated them.  I don’t want to exaggerate, so let me be clear that HCl pills did not magically fix everything wrong in my life, or even my body.  But they improved a lot of things, and they laid the groundwork for other interventions that cured other things.

HCl supplements are not the only treatment for low stomach acid.  Dr. internet also recommends Apple Cider Vinegar.  I tried it and found it burned my throat, but that could be related to the long term heartburn I had.*  There are also digestive enzymes: I found them useless before I started HCl, but they’re occasionally helpful now.  

Of course you’d ultimately like to know why your stomach acid is low.  That was the first question everyone asked me when I told them my new diagnosis.  I was completely uninterested.  I had only just gotten access to a source of sustenance that the rest of the world took for granted, and I spent several months just luxuriating in that.  But eventually, I was ready to dig deeper.

There was a gap between when I was emotionally ready and when I actually did the tests, because they’re super unpleasant.  The first one was a stool sample.  I’m not so squeemish as to put off medical care because eww poop, but getting the sample was a logistical nightmare.  It needed to be mailed overnight after collection, which means a weekday.  I probably have one of the most flexible, understanding offices on the planet, but I still didn’t feel right organizing a stool sample in the bathroom.  Maybe if I could have mailed the whole stool, but the test required me to take samples from several different parts of feces (so it’s representative) and mail in just those.  So it took a while for me to manage that.  Eventually I did, and they tested me for many different things, and I came back positive for Heliobacter pylori.  We’ll cover the science more in a future post, but the short version is my doctor put me on some unpleasant herbs for a month.  Since then I feel better but am not using noticeably fewer HCl pills.

The second test was for SIBO (small intestine bacterial overgrowth).  SIBO is one of the reasons we can’t just label bacteria good or bad, because it refers to  bacteria that are healthy and necessary in the  large intestine moving into the small intestine, where they smoke and curse and litter.

The SIBO test is terrible and I hate it.  To prep for it you need to go 12 hours on a very restricted died (basically rice and eggs), and then 12 hours of fasting, and then three hours breathing into tubes (still fasting).  I can’t go more than an hour without eating at the best of times, but I stupidly did this two days after finishing the unpleasant herbs for H. pylori treatment, and all I wanted in the world was fiber.  I spent those 27 hours miserable and angry and physically shaking with hunger.  It took me a full day after the fast to be able to leave the couch.

After all back, the results came back indicating a mild SIBO infection.  I can only do so many things at once and I had more pressing issues at the time, so I put off treatment for the month.  Treatment in this case means “antibiotics that cost more per day than many people earn.”  The other choice was to live on specialized diet shakes for weeks.  I have severe emotional issues around food and excellent insurance, so expensive antibiotics were the right call for me.

I would like to tell you how that went, but as of the time I’m writing this I’m only halfway through treatment.  I should be done by the time this is published**, but it may take weeks to identify the effects.  So for now I will dig into the relevant science.

Coming up: the science of H. pylori and SIBO.

*Probably caused by food allergies, not low stomach acid.

**I wrote the set of digestive posts more or less simultaneously, because it wasn’t clear how the information should be organized until I’d done it.