Here’s what’s wrong with traditional HCl Challenges (and what to do instead)Feb 23, 2021
So you’re convinced about the miraculous science emerging on gut health and its link to everything health. Man, if you could learn to leverage that to get rid of your symptoms, it would be a game-changer, amiright?
Compound this noble resolution of yours to improve your gut health with emerging literature that seems to attribute intestinal conditions and their inflammatory consequences to dysfunction happening northward in digestion – in the stomach – and you’re ready to take action.
You’ve decided to try to “fix your stomach acid” by using supplemental Betaine HCl. And hey, you just googled it and it looks like you’re supposed to do something called an “HCl Challenge” to figure out your dose. It looks pretty straight forward and easy.
You’re all set to jump in.
...those methods you find wallpapered over all of the self-purported gut gurus’ websites are actually pretty dang dangerous and wind up making many people’s problems way worse.
Especially if you’re in sensitive populations like those with an underlying condition (1 in 2 people in America).
So before we get into what’s wrong with the typical HCl Challenge methods, let’s first review exactly how it’s supposed to work.
Counterintuitively, these Challenge methods originate from a wonderful text by Jonathan Wright called “Why Stomach Acid is Good for You” – this book is actually a lovely amalgam of compelling early research about why the conventional medical community got the whole stomach acid thing wrong (i.e. we need it, it’s good for us, the problem isn’t too much stomach acid). I highly recommend reading it (while keeping in mind the HCl Challenge suggestions should be pretty much shelved).
In the methods, Wright suggests (and, now, everyone else also suggests) that you buy a standard supplement bottle of Betaine HCl, typically dosed at 500-750mg per capsule.
Once you’ve procured this, you begin by taking 1 capsule with every meal on Day 1.
Then on Day 2 you take 2 capsules with every meal.
Day 3 you take 3 capsules, and so on.
You carry on, increasing your dose by 1 capsule per meal with each day that passes until you experience a warming sensation in your stomach.
At that point, you’re supposed to return to the previous dose you were at before this warmth happened (i.e. if 5 capsules made you burn, your dose is 4).
The appeal of this procedure is easy to understand, it seems straight forward, and somewhat logical. Afterall, you must only have burning symptoms if you have too much acid – that makes sense.
Except that that’s not how it really works.
This leads in to the primary criticism that I lobby against this whole song and dance… which is that the protocol and the way that you determine your dose fails to account for the key player involved in warmth and burning sensations in the tummy: your protective mucosa.
Your mucosa is the layer of mucous-producing membrane that your body has in order to protect its tissue from the potent acids of the stomach and from large, destructive food stuff particles.
When your mucosa layer is optimal, your stomach may withstand high amounts of acid without symptom onset (such as warming). When it’s compromised, burning symptoms can occur even with very little exposure to minimal acid.
By this logic, somebody undertaking Wright’s Challenge who experiences warmth after just 1 capsule, under his instructions could be proclaimed “sufficient” and no use of HCl would be indicated for that individual.
But the reality is that your mucosa should be able to tolerate at least 2 capsules of acid at this dose without warmth. And indeed, if warmth is experienced at these low doses, rather than indicate the acid levels are sufficient, instead what we may conclude is that the mucosa is damaged and in need of healing before we can get any kind of an accurate read.
How likely is it that you have a damaged mucosa?
It’s extremely likely if a person is dealing regularly with acid-related symptoms - such as GERD, heartburn, acid reflux, belching, bloating, or bad breath - that their mucosa has been eroded from irregular acid activity in the stomach.
For example, when stomach acid is low, food moves through the stomach much more slowly as the stomach attempts to hold on to food in order to properly break it down and make it safe for the intestines before it is released into later digestion steps.
This delay increases the tissue’s exposure to the acidic contents. And though the mixture is not acidic enough to function normally, it is still acidic enough to be damaging given long-term exposure. Because the stomach tissue is only built to withstand short windows being exposed, damage to the mucosa ensues.
Low stomach acid, of course, results in the typical kinds of reflux kinds of symptoms, but it also almost always results in this delayed emptying time.
With this in mind, jumping right into supplementing with Betaine HCl without addressing the mucosa first for these populations, can actually further irritate the tissue and make symptoms worse, or even create structural damage.
A precursory mucosa-repair step should thus be implemented to avoid this damage, and to make the warmth sensation a more accurate read.
As a side note, some people never experience this warmth sensation no matter how much HCl they take! These people require more hand holding, and need to learn how to systematically correlate their use of HCl to their benefit. I go over this process in great detail in The Upper Gastric Bundle (learn more about that HERE).
Life in the fast lane is the best way to burn!
This gives way to my second criticism of Wright’s methods, which is the high dose increments used, and the fast pace with which the dose is increased.
As we are all individuals and may metabolize and process Betaine HCl at different rates, it may be worth considering a lower and slower approach. This is especially the case for those sensitive populations who might react strongly to new substances – such as those in the autoimmune community.
Many of these people find it useful to use lower dose increments so that their bodies have time to acclimatize to the new substance and adjust internal processes accordingly ( i.e. releasing food more quickly into the small intestine rather than hanging onto it in the stomach and getting bloated, or shutting the Lower Esophageal Sphincter as acidity increases in the stomach to reduce reflux symptoms).
Without allowing the time for the body to make these adjustments, especially for populations who may have been on proton-pump inhibitors or acid-blocking medications, you can endanger your body as it’s taken by surprise by the acid, and can’t shift fast enough to accommodate it.
This may result in negative side effects, such as burning, or digestive distress. Whereas moving low and slow would allow the body to make these shifts gradually, lowering the likelihood of this symptom onset.
No complementary support
The third criticism I have of these methods, is that without taking more targeted actions in tandem with Betaine HCl to support natural stomach acid producing abilities, you may not be addressing the problem as well as you could.
Including specific raw material nutrients necessary for stomach acid production should be a hallmark of any stomach acid fixing protocol.
This is especially true if the user is not yet following a nutrient-dense properly prepared whole foods diet.
These populations would do well to consider adding in stomach acid supporting nutrients such as zinc, B12, B6, B1, and a therapeutic dose of hydrolyzed amino acids.
Now, it doesn’t really make sense to add this stuff in before you reach your dose as your stomach’s pH won’t be low enough to absorb any of it – as you may know, low stomach acid often can present with the symptom of feeling nauseous after you take vitamins.
So really, these adjuncts could be considered once you feel confident your acidity has been restored, and your HCl dose has been found.
Stay at your dose forever?
Finally, the last criticism I have of these traditional methods are that they imply that once you find your dose, that this is where you’ll stay for every meal regardless.
But actually, there are many factors that may impact your endogenous HCl need, including stress, travel, protein content in a meal, or other circumstances. In fact, a dose may need to change according to the unique situation at hand.
In fact, when people fail to account for the dynamic nature of their exogenous stomach acid need due to the unique circumstances that arise, they can often end up experiencing negative side effects from their HCl use because they haven’t made the proper adjustments.
It can be very useful, therefore, to follow a set of guidelines about adjusting your dose on an ongoing basis so that you avoid going overboard and taking too much acid when you don’t need it, then mistakenly thinking you should stop all together because of the acid symptoms that materialize, and so that you avoid taking too little when circumstance may require extra support, then experience a resurgence of symptoms associated with low stomach acid.
I guess it all boils down to this: the traditional HCl challenge methods are just too darn simple and don’t account for much needed nuance when considering stomach acid’s interaction with other physiological systems and environmental cues.
I do have a few thoughts about what the right approach to restoring stomach function looks like (a 4 step process that makes this work B.S.A.F.E.). Check here to read up on what this looks like.