Low Stomach Acid, Apple Cider Vinegar, Pancreatic elastase

Welcome to Healthy Gut Healthy Thyroid!

This is your weekly roundup of the BEST actionable steps for those people with thyroid and autoimmune thyroid conditions who want to restore their health…by healing their gut. Whether you have hyperthyroidism or Hashimoto’s you will benefit from the content in this newsletter.

In today's issue:

• Main Topic: Is Low Stomach Acid the Missing Link in Your Thyroid Healing Journey?

• Podcast Review: Could this be the end of chronic disease?

• Understand Your Tests: Understanding Fecal Elastase-1

• Ask Dr. Eric: Can apple cider vinegar stimulate stomach acid?

Is Low Stomach Acid the Missing Link in Your Thyroid Healing Journey?

In conventional medicine, it’s common to prescribe acid-blocking medications such as proton pump inhibitors (PPIs) for symptoms like heartburn and acid reflux. While there is a time and place for these medications, the reality is that many individuals taking PPIs may actually suffer from low stomach acid—not high.

Low stomach acid, or hypochlorhydria, occurs when the stomach doesn’t produce enough hydrochloric acid (HCl). In more extreme cases, a person may have achlorhydria, where there is a complete absence of stomach acid. A fasting gastric pH below 3.0 is considered normal; anything above this may indicate hypochlorhydria, while a pH above 7 indicates achlorhydria.¹

Common Symptoms of Low Stomach Acid

Not everyone with low stomach acid will experience symptoms, but some of the most common include:

• Indigestion

• Feeling full quickly after meals

• Heartburn or acid reflux

• Bloating

• Gas

• Undigested food in stool

What Causes Low Stomach Acid?

Several factors can impair the stomach’s ability to produce hydrochloric acid:

✅ Hypothyroidism – A well-documented cause of reduced stomach acid production.

✅ Chronic stress – Impairs parasympathetic nervous system function, which is necessary for optimal digestion.

✅ Acid-blocking medications (PPIs) – These suppress acid production directly.

✅ H. pylori infection – A common bacterial infection that can reduce stomach acid and damage the stomach lining.

✅ Pernicious anemia – Damages the parietal cells that produce stomach acid and intrinsic factor, affecting both digestion and vitamin B12 absorption.

✅ Gastric bypass surgery – Often reduces or bypasses acid-producing areas of the stomach.

Why Stomach Acid Is Essential

Low stomach acid isn’t just a minor inconvenience—it has far-reaching consequences:

Impaired nutrient absorption – Stomach acid is necessary for the breakdown of protein and absorption of minerals such as zinc, iron, selenium, calcium, and magnesium.

Overgrowth of microbes – Stomach acid serves as a barrier against ingested pathogens; inadequate acid levels may allow bacteria and yeast to thrive, increasing the risk for SIBO (small intestinal bacterial overgrowth) and Candida overgrowth.

How To Evaluate Low Stomach Acid

Symptoms alone aren’t enough to diagnose low stomach acid, since they often mimic those of high stomach acid. Consider the following methods:

Betaine HCl challenge – Involves taking increasing doses of betaine HCl with meals until a warming sensation is felt, indicating sufficient acid levels.

Baking soda test – Mix ¼ tsp baking soda in water and drink on an empty stomach. If you don’t burp within 3 to 5 minutes, it could suggest low stomach acid (though this test is less reliable than others).

Comprehensive gut testing – Functional stool testing can sometimes provide useful clues.

Treatment and Support

Supplementation with betaine HCl is often recommended to assist with protein digestion and improve nutrient absorption. However, this should be viewed as a temporary aid, not a long-term fix.

Addressing the underlying cause is essential. For example:

If hypothyroidism is present, optimizing thyroid hormone levels may help restore stomach acid production.

If stress is a factor, techniques like deep breathing, mindfulness, and vagus nerve stimulation can improve parasympathetic tone and digestion.

If H. pylori is detected, antimicrobial or herbal protocols should be considered.

Conclusion

Low stomach acid is a frequently overlooked factor in both gut and thyroid health. While symptoms can overlap with high acid, the consequences of low stomach acid—nutrient malabsorption, microbial imbalance, and chronic digestive discomfort—can be significant.

For individuals with hypothyroidism or autoimmune thyroid conditions like Hashimoto’s or Graves’ disease, addressing low stomach acid can be a pivotal step in the healing process. By identifying root causes and using targeted nutritional and lifestyle interventions, many people can restore healthy digestion and improve overall well-being.

 5 Steps To Reverse Hyperthyroidism and Avoid Radioactive Iodine and Thyroid Surgery

If you have hyperthyroidism (i.e. Graves’ disease, toxic multinodular goiter), visiting an endocrinologist is likely to result in one of the following three recommendations:

1. A prescription for antithyroid medication

2. Radioactive iodine

3. Thyroid surgery

While there is a time and place for conventional medical treatment, it’s crazy that most medical doctors don’t do anything to address the underlying cause of your condition.

The good news is that you can do things to reverse hyperthyroidism, which I discuss in my free webinar entitled “5 Steps To Reverse Hyperthyroidism and Avoid Radioactive Iodine and Thyroid Surgery”.

Click Here to register for the free webinar

Here are some of the things you’ll learn by attending this free webinar:

• How to avoid radioactive iodine and restore your thyroid and immune system health so you can feel great again and live a healthy life!

• The 4 main categories of Graves' disease triggers, and why you shouldn't overlook "hidden" hyperthyroid triggers

• How to break the "hyperthyroid cycle"

• How to address thyroid eye disease and toxic multinodular goiter

Click Here to register for the free webinar

Save My Thyroid Podcast Review

I have a podcast called "Save My Thyroid", where I discuss how people with hyperthyroidism and Hashimoto's can save their thyroid and regain their health. And during each edition of this newsletter I'll briefly discuss a recent podcast episode.

In a recent podcast episode I chatted with Lisa Tamati, a world-renowned longevity and health optimization expert. In this episode, she takes us through her powerful journey from ultra-endurance athlete to passionate health advocate, sharing how she helped her mother recover from a brain aneurysm and cancer using cutting-edge therapies. Lisa highlights why reclaiming your health starts with the right mindset, targeted nutrition, and smart supplementation.

Click Here to listen to the episode

Understand Your Tests

Understanding Fecal Elastase-1

Fecal elastase-1 is a key marker used to assess pancreatic exocrine function and is commonly included in comprehensive stool panels such as the GI-MAP and GI Effects. It is also available through many conventional laboratories via standard stool testing.

What Do Fecal Elastase-1 Levels Indicate?

A value greater than 200 mcg/g is considered within the normal reference range.

An optimal level is generally considered to be above 400 mcg/g, with some experts suggesting that levels above 500 mcg/g may be even more ideal.

A value below 200 mcg/g suggests exocrine pancreatic insufficiency (EPI).

Levels under 100 mcg/g are indicative of severe EPI.

In Patient Test #1, for example, the fecal elastase-1, is well below the normal reference range, indicating exocrine pancreatic insufficiency. You'll also know that the patient's steatocrit isn't within the optimal range, indicating fat malabsorption.

Patient Test #2 shows a fecal elastase-1 below the optimal range, indicating less than optimal pancreatic function.

And then Patient Test #3 shows an optimal fecal elastase-1 level.

Symptoms of Low Fecal Elastase-1

Not everyone with low fecal elastase-1 will experience overt digestive symptoms—especially when levels are less than optimal but still within the "normal" lab range. However, when levels drop below 100 mcg/g, symptoms are more likely to appear and may include:

• Diarrhea

• Bloating

• Abdominal discomfort or pain

• Greasy, floating stools (steatorrhea)

• Unexplained weight loss

Consequences of Low Fecal Elastase-1

The primary issue with low fecal elastase-1 is insufficient digestive enzyme output, particularly lipase, which is essential for fat digestion. This can lead to:

• Fat malabsorption

• Nutritional deficiencies (especially in fat-soluble vitamins A, D, E, and K)

• Unintentional weight loss

• Poor absorption of protein and carbohydrates

Common Causes of Low Fecal Elastase-1

Several conditions can contribute to reduced elastase production, including:

✔️Chronic pancreatitis

✔️Celiac disease

✔️Inflammatory bowel disease (IBD)

✔️Type 1 and Type 2 diabetes

✔️Gastric or weight-loss surgery

✔️Pancreatic cancer

✔️Excessive alcohol intake

✔️Low stomach acid (hypochlorhydria), which may impair pancreatic stimulation

Treatment Options for Low Fecal Elastase-1

The most common treatment for low fecal elastase-1 is pancreatic enzyme replacement therapy. This often includes broad-spectrum digestive enzyme supplements, sometimes combined with betaine HCl to enhance stomach acid and enzyme activation.

However, it’s important to go beyond symptom management and identify the root cause of the pancreatic insufficiency. In many cases, supporting overall gut health and addressing underlying conditions (e.g., celiac disease or hypochlorhydria) can improve enzyme output over time.

Ask Dr. Eric

During every issue I'll answer one or two questions that I think can benefit most people with a thyroid or autoimmune thyroid condition. If you'd like for me to consider your question for a future edition of this newsletter email your question to [email protected].

CAN APPLE CIDER VINEGAR STIMULATE STOMACH ACID?

Dr. Eric, even though I'm pretty sure I'm low in stomach acid I can't tolerate betaine HCL, and I was wondering if apple cider vinegar or bitter herbs can be an alternative option?

At several health seminars I’ve attended, the presenters have recommended apple cider vinegar (ACV) as a natural remedy to stimulate gastric acid production. Based on these recommendations, I initially advised some of my patients to use ACV for this purpose.

However, after adopting a more research-based approach, I found that there is currently no conclusive scientific evidence that ACV increases stomach acid production. While anecdotal reports are widespread, clinical trials supporting this specific use are lacking.

That said, there are multiple studies demonstrating that apple cider vinegar can positively impact blood sugar regulation and lipid profiles:

One 2023 meta-analysis concluded that ACV significantly reduced fasting blood glucose, HbA1c, and cholesterol markers^.2

Another study found that ACV supplementation improved glycemic control in individuals with metabolic disorders.³

An Alternative to ACV for Supporting Stomach Acid

If the goal is to increase stomach acid production, bitter herbs may offer a more targeted approach. Ideally, they should be taken 30 to 45 minutes before meals to help prime digestion.

Common bitter herbs include:

• Gentian root

• Dandelion

• Ginger

• Bitter melon

• Burdock root

• Artichoke leaf

While I frequently recommend betaine HCl to patients with low stomach acid, bitter herbs have the potential advantage of stimulating the body’s natural production of hydrochloric acid—rather than providing it exogenously through supplementation.

However, it's important to note that in cases of moderate to severe hypochlorhydria, bitter herbs alone may not be effective. In these instances, a combination approach—or direct HCl supplementation—may be more appropriate.

Additional Thyroid-Related Resources

Click Here Could this be the end of chronic disease?/Lisa Tamati (episode 194)

Click Here to access hundreds of thyroid-related articles and blog posts

Click Here to join the Graves’ disease and Hashimoto’s community

Click Here to purchase one of Dr. Eric’s thyroid-related books

Click Here to work with Dr. Eric and his team

References:

(1) https://www.ncbi.nlm.nih.gov/books/NBK507793/ 

(2) https://pubmed.ncbi.nlm.nih.gov/38028980/ 

(3) https://pubmed.ncbi.nlm.nih.gov/34187442/

That’s a wrap