How to Know If You Need HCl Hydrochloric Acid Supplementation

Summary

In this informative video, Dr. Russo explores the role of hydrochloric acid (HCL) in digestion, discussing the prevalence of low stomach acid and its impact on nutrient absorption and gut health. He outlines symptoms that may indicate a need for HCL supplementation and provides a simple protocol for determining if HCL is beneficial. Dr. Russo emphasizes the importance of considering risk factors, such as age and autoimmune conditions, and suggests prioritizing dietary changes and foundational therapies before supplementing with HCL.

Takeaways

• 🔍 The prevalence of low hydrochloric acid (HCL) in the stomach is quite low, with studies showing it ranges from 2% to 15%, varying with age and health conditions.
• 🍲 HCL is essential for digestion as it ionizes minerals, allowing for their absorption, and helps in the conversion of pepsinogen to pepsin, which digests proteins.
• 💊 There is a lack of substantial research on the benefits of HCL supplementation for conditions like reflux or IBS, despite its common recommendation.
• 👨‍⚕️ Symptoms like burping, reflux, indigestion, and bloating may indicate a need for HCL supplementation, but these should be considered alongside other risk factors and health history.
• 👴 Age is a significant risk factor for low stomach acid, with prevalence increasing as one gets older, particularly noticeable after the age of 40.
• 🚫 Long-term use of acid-lowering medications like PPIs can contribute to low stomach acid levels, but short-term use for conditions like ulcers can be beneficial.
• 🌡 The optimal pH range for pepsin activity is narrow, highlighting the importance of maintaining the correct stomach acidity for proper digestion.
• 🛡️ Adequate stomach acid also serves as a defense mechanism against bacterial overgrowth and certain infections.
• 🧪 While lab tests for low stomach acid exist, they are not always reliable or necessary, and symptomatic improvement is a more practical indicator of need for HCL.
• 📈 The approach to HCL supplementation should be evidence-guided and empirical, starting with a low dose and gradually increasing based on symptomatic response.
• 🍏 Dietary changes, such as a low FODMAP diet, should be tried before HCL supplementation to address symptoms that might be resolved without the need for ongoing supplementation.

Q & A

What is the cephalic phase of digestion?

The cephalic phase of digestion begins when you first see or smell food, preparing your body for the digestive process even before the food reaches your stomach.

What role does hydrochloric acid (HCL) play in the stomach?

Hydrochloric acid (HCL) in the stomach helps ionize minerals like calcium, magnesium, and iron, allowing them to be absorbed later. It also helps in the decoupling of vitamin B12 from animal protein and activates the enzyme pepsinogen into pepsin for protein digestion.

Why is the correct pH level in the stomach important for digestion?

The correct pH level in the stomach, around 1.5 to 2, is crucial for activating the enzyme pepsinogen into pepsin, which is essential for protein digestion. Being too acidic or too basic can reduce the efficacy of this enzyme.

How does stomach acid contribute to the body's defense against infections?

Adequately acidified stomach contents can protect against fungal and bacterial overgrowth as well as parasitic infections, serving as one of the body's first lines of defense.

Can stomach acid affect the efficacy of probiotics?

No, studies suggest that stomach acid does not detract from the efficacy of probiotics, even when taken with food. Heat-killed probiotics have been found to be as efficacious as intact ones.

What is the purpose of sodium bicarbonate in the small intestine?

Sodium bicarbonate is released to buffer the acidic chyme from the stomach, allowing for non-burning entry into the small intestine and setting the optimal pH for the activation of many pancreatic enzymes.

How common is low stomach acid among the population?

Low stomach acid is not very prevalent. In young people under 55, it's less than 2%, and even in elderly populations, it ranges from about 5 to 12 percent, although some studies have reported higher numbers.

What are some risk factors for having low stomach acid?

Risk factors for low stomach acid include being over 65 years old, having an autoimmune condition, a history of H. pylori infection, long-term use of acid-lowering medications, and having any form of anemia.

What is the recommended protocol for determining the appropriate dosage of HCL supplementation?

The recommended protocol starts with one capsule per meal for a few days, then increasing to two capsules per meal if no improvement is noticed. If there's still no response by four capsules per meal, it's likely that the body is producing sufficient HCL. If burning or discomfort occurs, it may indicate that the dosage is too high.

Why is it important to trial HCL supplementation after foundational therapies?

Trialing HCL supplementation after foundational therapies like dietary changes, probiotics, and addressing any diagnosed conditions helps to isolate the effects of HCL and ensures that any symptomatic improvements can be clearly attributed to the HCL supplementation.

What are some symptoms that might indicate a need for HCL supplementation?

Symptoms that might indicate a need for HCL supplementation include burping, reflux, indigestion, bloating, sustained fullness, and a history of anemia.

Outlines

00:00

🧪 Digestive Physiology and HCL's Role

Dr. Russo introduces the topic of hydrochloric acid (HCL) supplementation, discussing its importance in the digestive process. He explains the cephalic phase of digestion and the role of stomach acid in ionizing minerals, decoupling vitamin B12 from proteins, and activating the enzyme pepsinogen into pepsin for protein digestion. The video emphasizes the narrow pH range required for optimal pepsin activity and the potential consequences of overly acidic or basic conditions. Additionally, Dr. Russo touches on the protective role of stomach acid against fungal and bacterial overgrowth and clarifies misconceptions about probiotics and stomach acid.

05:01

📊 Prevalence of Low Stomach Acid and Supplementation Considerations

This paragraph delves into the prevalence of low stomach acid, highlighting the discrepancy between the research data and anecdotal evidence. Dr. Russo points out that while some claim a high prevalence of low HCL, studies show a much lower percentage, especially in younger individuals. He stresses the importance of considering symptomatic indicators and historical findings before recommending HCL supplementation. The paragraph also addresses the lack of research on the benefits of HCL supplementation for those with low stomach acid and the importance of not overgeneralizing the need for acid supplementation.

10:01

🔍 Identifying Symptoms and Risk Factors for Low Stomach Acid

Dr. Russo outlines the symptoms and risk factors associated with low stomach acid, such as upper GI issues like burping, reflux, and bloating. He also discusses the potential for malabsorption and its link to anemia. The paragraph emphasizes the need for caution when interpreting lab findings and the importance of considering age, autoimmune conditions, and medication use as risk factors for low stomach acid. Dr. Russo also mentions the potential for H. pylori infection to affect stomach acid levels and the importance of considering these factors when assessing the need for HCL supplementation.

15:03

🍽 Diet and Its Impact on Digestion and Stomach Acid

In this paragraph, Dr. Russo discusses the impact of diet on digestion and stomach acid levels. He explains how a high FODMAP diet can lead to excessive gas production and pressure against the lower esophageal sphincter, potentially causing reflux. The video references a study that supports this mechanism and suggests that dietary changes may be a more effective first-line treatment for GI issues than immediate HCL supplementation. Dr. Russo advocates for a low FODMAP diet and the careful reintroduction of foods to address GI symptoms before considering supplementation.

20:04

🧬 Testing for Low Stomach Acid and the Empiric Approach

Dr. Russo critiques the common methods for testing low stomach acid, such as wireless capsules and blood tests for gastrin, citing their limited effectiveness and potential for misinterpretation. He advocates for an evidence-guided empiricism approach, which involves setting up experiments and using the body's response as the primary indicator of success. The paragraph emphasizes the importance of clear symptomatic improvement as the key metric for assessing the effectiveness of HCL supplementation.

25:05

🛑 Protocol for HCL Supplementation and Assessing Its Effectiveness

This paragraph presents a protocol for HCL supplementation, starting with a low dose and gradually increasing based on symptomatic response. Dr. Russo advises against the traditional method of increasing dosage until burning occurs, as this may indicate tissue irritation. Instead, he suggests a cautious approach, increasing the dose incrementally and observing for signs of improvement or negative reactions. The paragraph also emphasizes the importance of sequencing therapeutic interventions, ensuring foundational therapies are tried first before considering HCL supplementation.

👴 When to Consider HCL Supplementation Based on Symptoms and Risk Factors

Dr. Russo concludes by summarizing the conditions under which HCL supplementation should be considered. He advises that it should be trialed after foundational therapies have been attempted and if there are persistent upper GI symptoms. He also highlights the importance of considering risk factors such as age, history of H. pylori infection, anemia, and the use of acid-lowering medications. The paragraph emphasizes the need for clear symptomatic improvement as evidence of HCL's effectiveness and encourages viewers to consult with healthcare providers before starting supplementation.

Keywords

💡Hydrochloric Acid (HCL)

Hydrochloric acid (HCL) is a key component of stomach acid that plays a crucial role in digestion by aiding in the ionization of minerals and the activation of the enzyme pepsinogen into pepsin. In the video, HCL is discussed in the context of supplementation for those who may have low stomach acid, affecting digestion and nutrient absorption. The script mentions that HCL supplementation comes in the form of betaine HCL and is important for the proper functioning of the digestive system.

💡Digestive Physiology

Digestive physiology refers to the biological processes involved in the digestion of food. The video provides an overview of this process, starting from the cephalic phase triggered by the sight or smell of food to the role of stomach acid in the ionization of minerals and activation of digestive enzymes. Understanding digestive physiology is essential for recognizing the importance of HCL and its potential supplementation.

💡Pepsinogen and Pepsin

Pepsinogen is an inactive enzyme precursor that is converted into the active enzyme pepsin in response to the acidic environment of the stomach, which is facilitated by HCL. Pepsin is responsible for the digestion of proteins. The video script highlights the importance of the correct pH level for this conversion to occur, emphasizing the role of HCL in creating the optimal conditions for pepsin activity.

💡Malabsorption

Malabsorption refers to the inability of the body to properly absorb nutrients from food. In the context of the video, low levels of HCL can lead to malabsorption due to the reduced activation of pepsin and impaired ionization of minerals like calcium, magnesium, and iron. The script discusses symptoms and lab findings that may indicate malabsorption, such as anemia and bloating.

💡Dysbiosis

Dysbiosis is an imbalance in the gut microbiome, characterized by an overgrowth of certain bacteria or a decrease in beneficial bacteria. The video mentions that low stomach acid can contribute to dysbiosis, as the acidic environment is one of the body's first lines of defense against overgrowth. Dysbiosis can lead to symptoms like bloating, gas, and potentially leaky gut.

💡Autoimmune Conditions

Autoimmune conditions, such as Hashimoto's hypothyroidism or pernicious anemia, involve the immune system attacking the body's own tissues. The script identifies autoimmune conditions as risk factors for low stomach acid due to the potential for autoimmune attacks on the parietal cells in the stomach, which produce HCL.

💡Probiotics

Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host, particularly the gut microbiota. The video discusses the use of probiotics as a therapeutic option for conditions like small intestinal bacterial overgrowth (SIBO) and IBS, and their role in maintaining a healthy gut environment.

💡Acid-Lowering Medications

Acid-lowering medications, such as proton pump inhibitors (PPIs), are used to reduce stomach acid production. The script mentions long-term use of these medications as a risk factor for low stomach acid, as they can suppress the natural production of HCL.

💡Anemia

Anemia is a condition characterized by a decrease in the number of red blood cells or less than the normal quantity of hemoglobin in the blood. The video script connects anemia to low stomach acid due to impaired absorption of iron and vitamin B12, which are essential for red blood cell production.

💡Empiric Testing

Empiric testing refers to a trial-and-error approach to treatment where interventions are based on observed responses rather than definitive diagnostic tests. The video advocates for an evidence-guided empiricism approach to HCL supplementation, where the individual's symptomatic response is the primary metric for assessing the effectiveness of the treatment.

💡FODMAP

Fermentable Oligo-, Di-, Mono-saccharides, and Polyols (FODMAPs) are short-chain carbohydrates that can be poorly absorbed in the small intestine, leading to symptoms in individuals with IBS. The script discusses a low FODMAP diet as a foundational therapeutic option to reduce symptoms of IBS and improve gut health before considering HCL supplementation.

Highlights

The research data on low hydrochloric acid (HCL) prevalence ranges from 2 to 15 percent, indicating a need for careful consideration before supplementation.

HCL supplementation, in the form of betaine HCL, can aid in the ionization of minerals and absorption of vitamin B12.

Stomach acid plays a crucial role in activating pepsinogen into pepsin, which is essential for protein digestion.

An optimal pH range for pepsin activity is vital, with too much or too little acidity impacting enzyme efficacy.

Adequate stomach acid is important for protection against fungal, bacterial overgrowth, and parasitic infections.

Contrary to common belief, stomach acid does not necessarily hinder the efficacy of probiotics.

Sodium bicarbonate is released to neutralize stomach acid, preparing the small intestine for absorption.

Low stomach acid prevalence is low in young individuals, less than 2%, and increases with age.

Autoimmune conditions and H. pylori infection are risk factors for low stomach acid.

Symptoms of low stomach acid include burping, reflux, indigestion, bloating, and sustained fullness.

Lab findings such as anemia can indicate a potential need for HCL supplementation.

The relationship between low stomach acid and dysbiosis is complex and requires careful assessment.

Diet changes, such as a low FODMAP diet, can be a first-line therapy before considering HCL supplementation.

HCL supplementation should be approached with caution, starting with a low dose and gradually increasing.

The optimal dose of HCL should not cause burning or discomfort, aiming for the 'Goldilocks zone' of stomach acidity.

Testing for low stomach acid is not always reliable, and symptomatic improvement is the best indicator of HCL need.

An evidence-guided, empirical approach to HCL supplementation is recommended for assessing its effectiveness.

Mason's case study illustrates a clear positive response to HCL supplementation after foundational therapies.

Transcripts

how do we account for the fact that the

research data looking at prevalence of

low HCL is two to maybe 15 percent right

these two do not equate and so this

tells us that we should be bridled and

said hmm okay let's make a case

justifying substantiating that the

person needs a chill

[Music]

[Applause]

hey everyone welcome back this is Dr

Russo let's discuss hydrochloric acid

supplementation if this can help you

symptoms that indicate you might want to

trial hydrochloric acid and then what is

a simple protocol you can use to

determine if this is something HCL that

your system needs to function at its

best

okay well let's start with a little

overview of

digestive physiology

digestion doesn't technically start in

your gut even in your mouth it actually

starts when you first see or even smell

food what's known as the cephalic phase

of digestion but then we quickly go into

the stomach and this is where things

start to get pretty interesting stomach

acid does a number of things this HCL

hydrochloric acid that your stomach

makes you can also supplement with this

as betaine HCL but the acidic nature of

the stomach will actually ionize

minerals so this is where calcium

magnesium iron start to get a charge and

ionization allowing them to later be

absorbed also vitamin B12 is typically

attached or bound to animal protein and

the acid is needed to decouple or cleave

the B12 off of the protein so you can

later absorb it in addition to that we

oftentimes think that it's the acid that

helps us digest food including protein

almost like it melts it but that's not

actually how this works it's the

lowering of the stomach pH that then

gets the pH into the optimal range for

an enzyme known as pepsinogen to maybe

converted into pepsin and now this

enzyme is active and can start the

process of digesting protein and that's

one of the images I wanted to share with

you is and this is in

vitro data so take it with a grain of

salt but what you're seeing here is

plotted on one access pH going from most

acidic to most basic

and then the activity of this enzyme

pepsinogen to pepsin

and what you see is there's this narrow

range wherein you have the highest

amount of activity of this enzyme it's

about

1.52 on the pH scale

this is why it's so important for the

stomach to be correctly acidified

because this key enzyme pepsinogen is

activated into pepsin when your pH again

is in that range of about 1.5 to 2. but

one other thing to point your attention

to

the efficacy of this enzyme drops when

you go too basic or too acidic so there

is such a thing as being too acidic and

I just make that remark because it's

simple to fall into something out of

myself you know more is better

oftentimes in biology we want to aim for

this Goldilocks zone the optimal

physiological Zone to be in another

function that having adequately

acidified stomach contents can lead to

is protection against fungal bacterial

overgrowth and also a parasitic

infection this is one of our first lines

of Defense

I should also mention because you may be

saying yourself well boy if stomach acid

is antibacterial does that mean I should

not take a probiotic with food and the

stomach acid can damage the probiotic

and therefore I should be really careful

with special probiotics that are in

these capsules that don't allow the acid

to get at them and decrease their

efficacy and the answer here appears to

be no we've discussed one study in

particular that divided participants

into those taking probiotics before a

meal as compared to those taking

probiotics with a meal the results were

the same also the really pivotal

zorzella study that actually heat killed

probiotics and found they were just as

efficacious as intact probiotics so it

doesn't seem that acid detracts from the

ability of probiotics either

supplemented or in food from being able

to have positive effect

and then as the food as the kind the

soup that your food is now kind of being

digested into

moves into the small intestine it has to

be

de-acidified because the small intestine

remember is one membrane thick it's very

sensitive because it's the key

absorbative part of the intestinal tract

so you can't have this very acidic chyme

that goes into the small intestine

the body releases sodium bicarbonate to

buffer the acidic chyme and allow

absorption and non-burning entry into

the small intestine and what's so

fascinating about this is now that

you're becoming more basic into the

small intestine this is the optimal zone

of activation for many pancreatic

enzymes

and additionally this transition starts

to Signal other molecules that Cascade

digestion down the line like cck

so very important sort of priming of the

pump occurs in the stomach partially

dependent upon appropriate HCL release

and therefore appropriate acidification

so this is why HCL that is correct in

terms of the amount and the level that's

released is important however

how common is this because as

interesting as a physiology is we want

to be careful not to let our love for

physiology make us unproclaim will

anybody with a GI problem needs more

acid because look at all the cool stuff

that acid does so it's really important

to toggle from physiology to Stats to

have an understanding of how prevalent

this is and this is where we see

the prevalence of low acid is actually

quite low there's variability in the

studies but what you see is in young

people defined as those who are less

than 55 years of age the prevalence is

less than two percent of the population

now as you get older this increases but

most of the data are finding even in

elderly populations the range is about 5

to 12 percent 5 to 12. some studies

conversely have found as high as 70

percent

but the the principle I want to provide

you with or I guess the the summative

takeaway is that low stomach acid is not

super prevalent

and this is why looking at certain

symptomatic indicators that predict you

may have low stomach acid and also

historical findings are really important

and we'll come to those in just a moment

I also wanted to just quickly

mention that there's not a lot of

research looking at what happens when we

give people HCL supplementation who have

low stomach acid you would think given

how ubiquitously recommended

supplementing with acid is there'd be

some decent literature showing that

patients with reflux benefit or patients

with IBS benefit what have you there's

not there's not really much research

here now also I should mention

it's not to say there is research

disproving the efficacy of HL there's

just generally a lack of data here there

are a couple studies that have looked at

those with known low stomach acid and

having had observed poor absorption of

certain medications and after

supplementing with acid improved

absorption of sad medication so there

are data here but there's not a lot so

this is why we have to build sort of a

contextual case

symptoms and historical risk factors to

help us dictate should we trial this

experiment

okay now the symptoms here are

predominantly upper GI in nature burping

reflux indigestion bloating sustained

fullness these are really important to

bear in mind

now there's also some lab findings

having a history of anemia as we've

discussed would logically be a risk

factor so low B12 low iron that you may

see on lab findings conversely there's a

lot of speculative lab findings if you

see a certain pattern of dysbiosis

or maybe even some would say dysbiosis

in general because remember that you

need the acid to protect against

dysbiosis

but this is why we have to look at

prevalence data

any clinician who's been running stool

testing will likely tell you you see

dysbiosis on almost everyone but then

how do we account for the fact the

research data looking at prevalence of

low HCL is two to maybe 15 percent right

these two do not equate and so this

tells us that we should be bridled and

said okay let's make a case

justifying substantiating that the

person needs HCL and so that's kind of

the process that we're going through

there's also other speculation if you

see low elastase high stiatocrit but

again there's not really good data to

support these and these are more

speculative so I would urge caution with

looking at a stool test and then saying

hmm I need HCL

normal caveats apply check this with

your healthcare provider with your

doctor but also realize that in my

opinion there's a lot of Tea Leaf

reading from stool tests justifying HCL

now coming back to how do we build this

case

risk factors age here is a very

interesting chart that shows you plotted

by decade of Life the prevalence of low

stomach acid and this was one of the

higher incidences reported in the

research where you see up to about 70

percent

so just to contextualize this is the

most charitable but what you're seeing

is a clear increase in prevalence of low

stomach acid that Associates with age

and that really doesn't start to move

until you're in your fourth decade of

life in your 40s so

there's probably and partially a natural

age-associated increase with HCL and

perhaps this is why it becomes more

important to have adequate dietary

protein intake as one ages because

there's this natural reduction of HCL

release therefore there could be a

progressive loss of viable absorption of

protein and hence more important to hit

your targets there's also likely this

observation of anabolic resistance as we

age meaning we're less prone to put on

and maintain muscle mass which is why

strength training is so important just

exercise in general and this likely has

to do with some of the loss of anabolic

hormone production like testosterone as

we age other risk factors are having a

diagnosed autoimmune condition and this

is because one of the causes besides age

of low stomach acid is autoimmunity

what's known as pernicious anemia or

antibodies against anti-parietal cell

antibodies APC and antibodies

and I did run this in the clinic for

many years I haven't found it to be very

fruitful part of the reason why is

because if someone does have

autoimmunity to those anti-parietal

cells it tends to be short-lived meaning

the autoimmune attack will only last or

at least come up on the blood work for a

short period of time and then once

there's been enough damage to those

cells there will no longer be antibodies

or at least that's one of the purported

hypotheses for why we don't always see

the antibodies match with the stomach

acid levels but it is and it has been

demonstrated that those with autoimmune

conditions are at higher risk for low

stomach acid in Hashimoto's hypothyroid

the prevalence is about 20 to 40 percent

of people

so that's something to to bear in mind

if you've had H pylori past or current

this can also perturbate perturbate

meaning it can increase or decrease your

stomach acid levels and again we

mentioned a history of anemia indicating

that lack of ionization of the minerals

therefore a lack of absorption and

probably obvious but worth stating a

long-term use of ppis or other acid

lowering medications

I delineate carefully long term because

some people especially those with ulcers

can derive notable benefit from four to

eight weeks of acid lowering medication

use and some Studies have found as high

as I believe a 90 percent resolution

rate of ulcers on eight weeks of

something like Omeprazole so while I

understand a natural-minded healthcare

consumer wants to mitigate the amount of

medication they use we should also not

be totally closed off if this is

something that may be beneficial for the

individual

and so in recap the risk factors and

just a quick visual for you here uh

being over 65 having it diagnosed

autoimmune condition H pylori long-term

and acid use and having any really any

form of anemia why do or why does

stomach acid cause symptoms well firstly

it can be due to malabsorption

along with that malabsorption

or along with really the low acid you

can lose some of that first line of

defense against things like overgrowth

and when you have overgrowth or

dysbiosis this can cause excessive gas

and that gas and cause symptoms but also

the dysbiosis

tends to correlate with leaky gut which

can cause a whole cast of symptoms in

and of itself

and one study here I want to share with

you small study but they helped to

document that patients who ate a high

FODMAP content so a high Prebiotic diet

which can oftentimes be stereotyped as

being healthy meaning

um

many fruits and vegetables are high in

prebiotics high in fodmaps which can be

a good thing but for some people a

short-term reduction in fodmaps can be

quite therapeutic and so this study

compared High FODMAP to low FODMAP

intake and what they found was those who

were eating a high FODMAP diet had

increased gas pressure against this

sphincter in the bottom of the throat

called the l-e-s the lower esophageal

sphincter that gas pressure pushed the

sphincter open and led to more reflux so

this was really vindicating for some in

the sibo community who for years have

been sort of proclaiming that this

mechanism was at play and this was one

of the key symptoms or or key studies

rather that documented if you eat too

much Prebiotic you can have excessive

gas and that gas can interfere with

sphincter function pushing that

sphincter open and allowing the acidic

chyme or soup from the stomach to reflux

upward and cause things like gerd but

one of the things that we can derive

from this study is that you may not need

to supplement with acid to fix your

problem

and it is a little bit of a chicken of

the egg but my perspective on this is we

should look to changes like Diet first

because we know that diet alone can help

remedy dysbiosis reduce gas levels

reduce leaky gut and just help the GI

sort of get back on track

so I'd much rather someone trial

cleaning up their diet with basic low

hanging fruit first second trialing a

low FODMAP diet and then reintroduce

because we know that low FODMAP

reintroduction is oftentimes very

successful sure might someone have a

food or two that bothers them in an

ongoing basis or might they have a few

foods that don't reintroduce well at you

know week six yes but many of these

people can successfully introduce at

month three or four or five so because

of this

my perspective is not to jump right to

acid supplementation because you might

be able to cure the source of the

problem and not need ongoing acid

supplementation now what about testing

what tests are available I would not

recommend quantifying low stomach acid

although you can make a case there's a

wireless capsule

there's also a serum or a blood test

called gastrin and I ran gastrin for a

while oh boy we had a researcher on the

podcast many many years ago they had

found that sibo small intestinal

bacterial overgrowth more commonly was

of bacteria from the upper GI meaning

the the stomach and the even mouth that

got into the small intestine and

overgrew more common for that to occur

than From The Bottom the large intestine

kind of escaping upward or you know

retrograde into the small intestine so

because the upper GI bacteria were the

more common populations that led to sibo

he speculated well if someone has an

elevated gastroenter I believe this

cutoff was 200 but I don't quote me on

that could be wrong but if you saw an

elevated blood gastrin that could tell

you that the person has low HCL

therefore a supplement with HL and I

tracked this for about a year and it was

very rare that we actually saw someone

who exceeded

his recommendation it was Richard

McCallum

um Richard McCallum on the podcast and

he had made that recommendation I tried

it for a while never really saw a

connection there was I mean maybe two

cases in a year so this is part of the

reason why um

um oftentimes a little bit bridled with

the amount of testing because I'll I'll

trial these things and I'm more often

disappointed that I am impressed and

similar with the antiparietal so

antibody test tracked it for many years

and it just wasn't really helpful now

this is my perspective which is

practical no-nonsense bottom line show

me demonstrate benefit

uh you know there's a different Paradigm

in functional medicine which is quantify

everything and the issue I take with

this is it oftentimes in my opinion does

more harm than good because it costs a

lot of money and then people get really

concerned about all these markers and

you end up treating Labs not treating

the person so this is why I'm an

advocate of the empiric tests and this

is the the approach we use in our

Consulting practice which we entitle

evidence guided so looking at evidence

and being Guided by evidence but not

being limited to evidence evidence

guided empiricism meaning we're going to

set up experiments and use your system

predominantly as the barometer telling

us was this experiment successful or not

and so we come to the protocol and this

is what I'll put up on the screen but

I'll talk through it for those of you

not watching this so there's sort of

this this Antiquated protocol that calls

for continue to increase your dose until

you get burning and then decrease your

dose by one or two capsules and I

strongly disagree with this protocol why

because the time you get burning you're

likely irritating the tissue so to go

right up to the point where your body's

saying no and then doing a little bit

less is probably very very far off from

that Goldilocks principle remember that

graph from earlier

there's this sort of inverted U for

pepsinogen Activation to pepsin and that

inverted U is at The Sweet Spot it's not

most acidic is most active so my

argument is if you go so acidic to the

point where people are noticing burning

you are probably no longer at the

optimal position in that response curve

and it's also just Overkill some people

will say I was taking 12 pills per meal

and still didn't get burning so does

that mean I need to take 12 no it's

silly right so this is how we recommend

doing it

start off with and by the way always

check these things with your health care

provider this is for educational uses

only but this is a protocol you can

discuss with your healthcare provider

with your doctor

you start well firstly you make sure

that you're doing this in isolation

because

um what how do I say this here

uh confusion is the enemy of certainty

meaning if you're doing lots of things

it's very hard to know what's helping

and what's not helping so attempt do

this in isolation start with one capsule

per meal and do this for one or two days

maybe three the the time is not super

specific but you want to do one capsule

per meal for a couple days what do you

notice nothing then go to two capsules

premiere for a couple days what do you

notice symptoms improving great stop

there that's a good dose for you you can

go up to four capsules per meal if you

notice Nothing by four capsules per meal

my advice would be that you can conclude

and you don't need HCL and that your

body is producing sufficient HCL some

people will notice

a negative reaction to HCL right out of

the gate meaning they're you know

they're one pill in and they're starting

to get burning and warm I'd be careful

to maybe give it one or two more meals

just to make sure that wasn't a fluke

but this tends to go one of three ways

people get burning early on yay you have

adequate HDL production and you don't

need more and maybe your GI lining is a

little bit sensitive

two you notice nothing also yay you

don't need HCL

and then three a clear noticeable

improvement from the HCL

so

it's important to have this sort of a b

c that you're looking for because what

you don't want to do is say yeah I mean

I got the three and maybe it helped

if it helps and I'll share a case study

with you in a moment you'll notice that

it helps so

um you know Clarity here is what we're

looking for and if you're saying then

it's probably not helping you sequencing

here is also really important like I've

alluded to now a couple times

because again my perspective here is

symptomatic response is the chief metric

that we're looking to assess we have to

weed out symptoms that can be coming

from other things

so we should go through more of the

front line or foundational therapeutic

options first before we trial HCL this

would include dietary changes basic food

quality first low FODMAP as we outlined

a moment ago second

thirdly probiotics are oftentimes a

great tool to use because they can

resolve sibo IBS gerd improved motility

reduce leaky gut and then the fourth

thing you may want to consider always

checking this with your healthcare

provider might be either antimicrobial

or antibiotic therapy especially if you

have diagnosed H pylori diagnosibo once

you've laid this groundwork you've

probably seen I have no more diarrhea I

have better mental clarity

but I still have prolonged fullness and

some reflux it's not as bad as it was

but it's still there

this is when you're now at the opportune

position to trial HCL and this enters

Mason's story and by the way Mason if

you're watching this

um hope you're doing well he was a

really Hallmark example older gentleman

over 65 and late 60s and he had symptoms

for many years which had partially

responded to a vegetarian iteration of

the low FODMAP diet and I believe also

probiotics but he was still having

rumbling in his stomach gas and bloating

belching nocturnal or nighttime reflux

and some loose stools when he started on

the HCL he said he almost immediately

noticed a positive response

so this is what we're looking for right

if it is something that you need and you

do it at the right time when you've

reduced other variables the therapeutic

signal should be clear

and that's exactly what Mason's case

exemplifies so to sort of wrap this all

up

you should trial HCL you know firstly if

you've gone through some of the

foundational therapies first

and you're also noticing these

non-responsive or only partially

responsive upper GI symptoms especially

things like burping reflux extended

fullness

and also look to risk factors that

increase the probability that you will

benefit and this includes being over

about 60 years of age or in that realm

if you've had H pylori if you've had a

history of anemia if you are using acid

lowering medications

okay well I hope this helps you with

navigating how or when to use HDL and

just remember that this is not very

prevalent at best maybe 20 to 40 percent

of the population of those who have

Hashimoto's hypothyroid

and maybe most most most most charitably

for those who are in their 60s and 70s

you could see a 70 prevalence but

um not totally sold by that data point

because it's at odds with the majority

of the data which is showing that

younger people less than two percent and

those who are older geriatric it's you

know five to maybe 12 15 so taken

collectively not super common

but for those who need it can clearly

move the symptomatic needle do the right

things in the right order

perform this experiment in isolation and

then if this is the right thing for you

your body should give you a pretty clear

signal of symptomatic Improvement this

is Dr Michael hope that helps if this

has been helpful please like comment or

share this helps us get practical

information to improving gut health out

to more people and also our Consulting

practices here if you ever need some

help with how to navigate this feel free

to reach out anytime and we are more

than happy to help

[Music]

[Applause]

thank you

foreign