How to Know If You Need HCl Hydrochloric Acid Supplementation
Summary
TLDRIn 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
🧪 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.
📊 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.
🔍 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.
🍽 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.
🧬 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.
🛑 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.
Mindmap
Keywords
💡Hydrochloric Acid (HCL)
💡Digestive Physiology
💡Pepsinogen and Pepsin
💡Malabsorption
💡Dysbiosis
💡Autoimmune Conditions
💡Probiotics
💡Acid-Lowering Medications
💡Anemia
💡Empiric Testing
💡FODMAP
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
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[Applause]
thank you
foreign
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