Ask Dr Gary: Low acid restricts nutrition

For many years I suffered from a "stitch" under my left rib cage and a bloated feeling after meals. I was given antacids, endoscopies and antibiotics - to no avail. I searched on the internet and was surprised to find that millions of people, particularly the elderly, suffer from hypochlorhydria. I learned that a simple test was to drink dilute vinegar and if that eased the pain and bloating I was probably suffering from a lack of hydrochloric acid in my digestive system. I have since taken enzyme complex or hydrochloric acid tablets and am completely cured. -Robert, aged 79

"Low stomach acid production" is a relatively common disorder. I did a bit of reading and found that 20 per cent of normal, healthy 80-year-olds have low or no hydrochloric acid production. That tells us two things: it's fairly common, and at least for most people, quite minor.

But it's more than just the elderly that can have problems with stomach acid production: people who've had gastric bypass surgery, thyroid or autoimmune disease and even those on long-term proton pump inhibitors for acid reflux or gastritis are at high risk.

If you can't make stomach acid you can't absorb lots of nutrients, including essential ones such as calcium and magnesium, nor many vitamins. And bacteria that would have been killed by your stomach acid survive and overgrow in your intestines, sometimes causing diarrhoea or fever. Sufferers feel bloated, become nutritionally deficient, and can even develop pre-cancerous stomach lesions.

I would strongly caution anyone from self-diagnosing their chronic stomach problems. Gut pain, "acid reflux", and abdominal bloating can all respond to antacids, special diets, vinegar tests or whatever else.

Some will turn out to be H.pylori bacterial infections that can cause ulcers and need specialised treatment and others may turn out to be pre-cancerous lesions that need removal before they turn into true cancers. It takes a doctor, and sometimes one equipped with an endoscope, to tell the difference.

Stomach pains that are anything but transient and minor should be discussed with a GP.