Because I believe that this could be the bottleneck reason for so many of your own SIBO relapses, I wanted to investigate even more on all things stomach acid. I began in one place, and while there, it took me to achlorhydria. So I’m starting here today.

This is a common question,

Why do you think your SIBO kept relapsing?

Honestly, I think it’s hard to ever truly know for sure. But we narrowed it down to low stomach acid (hypochlorhydria).

SIBO and Stomach Acid

If you’ve never considered a lack of stomach acid to be the bottleneck for SIBO relapses, please consider this:

A reduction in gastric acid can result in bacterial overgrowth in the stomach and proximal small bowel, and the number of organisms rises as the intragastric pH rises.

Adequate stomach acid is critical. While the pH levels in our body run on a scale of 0 – 14 (0 being most acidic and 14 most alkaline), the GI tract varies from just 1 – 8.

This is because we want and need acid in the GI tract in order to appropriately break down food for digestion. For those of you who are highly visual learners as I am, this is a fantastic graphic (and information from the National Institutes of Health back it up perfectly).

What is Achlorhydria Digestive System pH levels #digestivesystem #ph #guthealth #agutsygirl

First, how do you know if you have adequate stomach acid? You could start with my 33 Ways to Tell if You Have Low Stomach Acid.

What is Achlorhydria

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What is Achlorhydria #digestivesystem #ph #guthealth #agutsygirl

Achlorhydria is when there is the absence of hydrochloric acid in the stomach. In other words, whereas hypochlorhydria indicates very little stomach acid, achlorhydria indicates almost no stomach acid.

What is Achlorhydria stomach acid #digestivesystem #ph #guthealth #agutsygirl

Hypochlorhydria is already associated with all the low-stomach acid problems, but with achlorhydria, there might be even more. Here is a list of some problems associated with achlorhydria (not necessarily comprehensive):

  • acid reflux
  • anemia
  • bacterial overgrowth (<– there you go!)
  • bloating 
  • changes in vision
  • diarrhea
  • general weakness
  • hair loss
  • indigestion
  • nausea
  • severe nutritional deficiencies (B12 is probably the most common)
  • undigested food in stools
  • weak, brittle nails

(Sources: HERE and HERE)

Like hypochlorhydria, the risk for achlorhydria increases with age (stomach acid decreases with age). Other risk factors include: hypothyroidism, medications (yes, even the overuse of those acid-blockers your doctor keeps telling you to constantly take for heartburn), surgery, h.pylori and other gut infections, and autoimmune conditions.

How do I know if I have achlorhydria?

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What is Achlorhydria stomach acid testing #digestivesystem #ph #guthealth #agutsygirl

  1. Make note of any signs and symptoms you might have.
  2. Keep track of your at-home stomach acid test outcome.
  3. Prepare appropriately for your doctor’s visit.
  4. Based on all of that, here are some follow-up tests your doctor might perform:
    1. Gastric pH and endoscopy (Doing an endoscopy? Don’t worry. I’ve got you covered with all these tips and tricks.)
    2. Esophageal pH monitoring
    3. Heidelberg test
    4. General blood count for nutritional deficiencies

And by the way, once achlorhydria is confirmed, a hydrogen breath test can check for bacterial overgrowth. You see? Hand-in-hand, achlorhydria and SIBO can and oftentimes do co-exist.

For me, because I’ve healed so much, I’m not concerned with if I have/had hypochlorhydria or achlorhydria. If I had to do this journey over again, I think I would want to know. 

Stomach acid is critical. I can’t stress it enough. 



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  1. I am all over this stomach acid thing!!!!!! I have a peds GI appt for Ashley the beginning of April and want to go in with my notepad of info and questions. So thankful for you!!!

  2. Hello Sara I am glad I came across this article. I too have hypochlohydria caused by H.pylori I really want to ask if the damage is reversible and if my stomach will ever produce it’s own acid? I have taken triple therapy for H.pylori and it has not worked. I am going through a real tough time in life of not being able to eat and losing weight rapidly! What was your cause of low stomach acid? It would be great to here back from you.

    Thank you

    Kind regards

      1. Hello Sara, hope you are well, and thank you for your reply I was totally happy. Did you have H.pylori or just SIBO?

        Many thanks

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