What Does Acid Have to Do With Alopecia?

Digestion doesn’t start once our food reaches our stomach. It begins with the thought, smell, and sight of our food. When our brain anticipates a meal, a complex interplay of gastrin, acetylcholine, and histamine stimulates parietal cells to secrete hydrochloric acid, which is our primary stomach acid.

The role of hydrochloric acid (HCl) is partly to metabolize the amino acids in protein. HCl initiates the production of pepsinogen, which is the precursor to pepsin. The proteins are then broken down into amino acids for absorption.

I first learned about the role of HCl in my Hashimoto’s practice starting 13 years ago. Many with Hashimoto’s—and autoimmunity in general—have a
deficiency of HCl (hypochlorhydria (low) or achlorhydria

And alopecia is no exception. In fact, low HCl is pretty chronic in the hair loss community. Below, I’ll show you an easy way to test yourself at home.

HCl is also critical for:

1. The absorption of vitamins and minerals, including iron, calcium, magnesium, zinc, and Vitamin B12. Not only is the thyroid very protein- and mineral-dependent, but so are our hair follicles. Go here to read more about the role of micronutrients in scalp and hair health. (And see below for more on the specific relationship between HCl and iron/ferritin—low ferritin is a significant problem for many with alopecia.)

2. Protection against infection. According to Dr. Gerald Mullen, author of The Inside Tract, “The naturally acidic environment in the stomach also provides a protective barrier against pathogens.” This includes conditions like SIBO (small intestine bacterial overgrowth) and candida (yeast). There’s a significant relationship between yeast and alopecia, as researched extensively by the functional medicine pioneer, Dr. Sidney Baker.

3. Helping to eradicate H. pylori, a specific pathogen common in the alopecia community. 

My goal with this post is to explain the low HCl, H. pylori, low iron/ferritin trifecta. Keep reading! 

What are the Symptoms?
Get this—the symptoms of low HCl are the same as an overproduction of stomach acid. (Slaps forehead.) Most notably, heartburn and acid reflux. 

This is why acid blockers and PPIs (proton pump inhibitors) do nothing and in fact, make matters worse. Why oh why the medical community continues to hand out PPIs like candy is beyond me, especially when more people have low HCl vs. an abundance of acid.

You could also experience bloating and distention, gas, and undigested food in your stool as well as peeling nails, dry skin, bone loss, and…hair loss.

Now, you don’t have to necessarily experience heartburn and acid reflux to have low HCl. I’ve worked with many clients who had neither of these symptoms and their HCl was in the tank.


The H. Pylori Relationship
For many, there is an inverse or teeter totter relationship between HCl and H. pylori, a pathogenic gut infection that can be challenging—but not impossible—to treat. 

It’s long-known that an infection is often a leg of the autoimmunity stool—and again, H. pylori, while present in about 50% of the population, is very common in the alopecia community. Eradicating any infection is important and many with alopecia have seen regrowth after testing for and treating this nasty bug.

In my coaching practice and my Reversing Alopecia mastercourse, I offer a stool analysis that tests for the presence of H. pylori and its possible virulence factors. Treatment can be multi-pronged and isn’t always straightforward. But again, it’s entirely possible to treat/eradiate.

Finally…Iron (and Ferritin)
Let’s round out this trifecta. 

We need an acidic digestive environment to absorb iron.

This abstract states, “The combination of results from [our] correlational and pathophysiologic studies supports the hypothesis that gastritis-induced achlorhydria can be an independent cause of [iron deficient anemia].”

Many in the alopecia community have anemia (low iron) and additionally, low ferritin, which is our iron storage protein. Ferritin shows what’s available for use—it’s said that ferritin is actually a better indicator of our iron levels.

Low ferritin is chronic for many with alopecia. The body will steal ferritin stored in non-essential tissue, like the hair bulb, and divert it to essential tissue to keep enough iron circulating in the blood. It’s essentially a leeching mechanism and can cause major shedding for many.

While some experts say that the jury is still out on this relationship, as one doctor put it, “all bets are off” in getting your hair back if your ferritin is low.

If you’re having a difficult time getting your iron and/or ferritin up, despite iron-rich foods and supplementation, low HCl could be to blame.

Several in the medical community state that ferritin needs to be between 80-90 ng/mL for optimal follicle health and hair growth—to maximize your anagen or “growing” cycle.

As an aside, ferritin is also needed for the transport of the thyroid hormone T3 (the active form of thyroid hormone) to cell nuclei and for the utilization of T3. This is why ferritin is often recommended on functional thyroid panels.

At-Home Test
I often recommend a full HCl challenge with a pepsin/betaine supplement, but a baking soda challenge can often work just as well. Children can even do it. I think most everyone has baking soda in their refrigerator and this experiment is super easy. 

Baking soda challenge:

1. First thing in the morning (no food or water), put 1/4 tsp of baking soda in 4 oz. of cold water (doesn’t have to be iced). 

2. Do this for 5 mornings.

3. If you start burping in approx. 2-3 min., you have adequate acid.

4. If you don’t burp for 5-6 min. or so, you likely have hypochlorhydria (low HCl).

If you have low HCl, you can supplement with pepsin/betaine or take digestive bitters. My favorite pepsin/betaine is Spectrazyme Metagest by Metagenics. My favorite bitters is Better Bitters (spray) by Herb Pharm. Bitters comes in flavors and is a better option for children.

If you have low ferritin, I suggest OptiFerin-C by Pure Encapsulations. For children, sneak organ meat into their meals as often as you can.

For the above suggestions, if you’re in the U.S., you can go here to set up a Fullscript account, where you’ll receive 15% off the highest quality supplements. Please work with your licensed healthcare provider on dosing. 

This may all seem a little complicated, but it’s really not. Other than the possible multi-pronged approached needed to clear H. pylori (I’m not assuming everyone has it!), managing HCl and iron/ferritin is pretty straightforward. You just need to know what you’re dealing with. 

1. Low HCl can make it challenging to absorb iron. Low iron/ferritin is a chronic issue for those with alopecia.

2. Low HCl can make it challenging to eradicate H. pylori. H. pylori is a chronic issue for those with alopecia.

3. If you’re having a hard time clearing H. pylori, check your HCl levels.

4. If you’re having a hard time raising your iron/ferritin, check your HCl levels. 

As I like to say, reversing alopecia is an inside job. If issues like the above aren’t addressed, no amount of lasers, oils, or needling is going to work to help you get your locks back. And the benefits of normalizing acid, raising iron/ferritin, and clearing H. pylori are SO far-reaching for the rest of your body and wellbeing. 

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What is your protocol for treating H.pylori?

Hi Lori, I don't have a specific protocol. Very generally speaking, things like mastic gum and olive leaf extract can be helpful, but there are many other natural products that can work, too. Again, it can really take a multi-pronged approach for some people. This is why my all of clients and students have a session with my functional medicine coach/former nurse colleage who has studied this extensively. I loathe the idea of someone taking antibiotics right out of the chute when there are natural supplements and botanicals that can be very effective.

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