Eructation (burping)

Eructation (burping)

by Dr. Michael Kane

As a teenager I took great pride in my eructative ability.  I was a champion burper.  My mother used to cringe when I would arrive home from school and instead of shouting “I’m home”,  I would let out a loud belch.


The pride was certainly misplaced, as I know now chronic eructations could be a sign of digestive dysfunction.

One of the common issues seen with chronic burping is something called hypochlorhydria.

Hypochlorhydia is defined as low stomach acid.

Since adequate amount of stomach acids are required for the breakdown and absorption of nutrients having low acid production can have a long range impact on overall health.

Low stomach acid can manifest in other symptoms besides burps other signs of low stomach acid include:

  • bloating
  • upset stomach
  • nausea when taking vitamins and supplements
  • heartburn
  • diarrhea
  • gas
  • desire to eat when not hungry
  • indigestion
  • hair loss
  • undigested food in stool
  • weak, brittle fingernails
  • fatigue
  • GI infections
  • iron deficiencies
  • deficiencies of other minerals, such as magnesium, calcium, and zinc
  • protein deficiencies
  • neurological issues, such as numbness, tingling, and vision changes

A number of chronic health conditions have been associated with low levels of stomach acid these include:

  • acne
  • psorasis
  • eczema
  • Roseacea
  • Lupus
  • allergies
  • asthma
  • autoimmune disorders
  • osteoperosis
  • anemia

finding the cause.

Low acid production can be the result of a few causes

  1. Vitamin deficiency
  2. pylori infection
  3. Chronic stress
  4. Medications
  5. Stress

5 Ways to test stomach acid levels

  1. Gastric acid secretion test.

Highly invasive and expensive, this test is typically done if a patient is diagnosed with a stomach ulcer. It can be helpful to track if anti-ulcer medication is working and to see if material from the intestines is coming back into the stomach.

  1. The Heidelberg Stomach Acid Test.

Considered the gold standard test for hypochlorhydria, a small capsule with a radio transmitter is ingested to measure the pH of the stomach as you drink a solution with baking soda (reduces acidity). The baking soda will naturally neutralize the HCL in the stomach. If the body does not return it to normal, it’s an indication of hypochlorhydria.

This test provides a graph showing your specific stomach response to the baking soda challenge, and can help determine if you have hypochlorhydria, hyperchlorhydria (high acid), or achlorhydria (complete lack of acid). At a cost of about $350, this test is not covered by most insurance plans.

  1. CBC and CMP.

These are common factors on a metabolic blood panel, typically covered by insurance. A skilled clinician can diagnose hypochlorhydria by taking into account these lab results in combination with your symptoms.

We want to look at these 5 markers: Albumin, Alkaline Phosphatase, Chloride, Globulin and Calcium. These markers help us to explore the possibility of low stomach acid, which is a very common problem that practitioners see these days. If a pattern is present, and the client history and complaints support our suspicion, we can then dive deeper into understanding the client’s dysfunction.


  1. Betaine HCl challenge.

An at-home test considered to be quite reliable, however false positives are possible so it’s recommended to repeat the test three times. The betaine HCl costs about $20. If you have low stomach acid, you can then take it to help restore your HCl levels.

  1. Buy Betaine HCl with pepsin and gentian root.
  2. Eat a high-protein meal containing at least 6 ounces of meat (veggies are allowed with this).
  3. Take one betaine HCl pill with your meal
  4. Finish the meal and observe what happens.

Possible outcomes:

  1. You notice no symptoms. This is likely a sign of low stomach acid.
  2. Indigestion. Burning, heat, or heaviness in your chest likely indicate adequate stomach acid levels.

It is recommended to repeat the betaine HCl challenge two or three times to confirm your results. Three positive tests are a good indication of low stomach acid.

False positives are possible if:

  • You consume too little protein. A low protein meal doesn’t require much acid, so the betaine HCl can cause too much increase in acid.
  • You have esophageal sphincter dysfunction. A hiatal hernia or poor esophageal sphincter tone can cause increased indigestion symptoms. Rule this out with a medical exam if you suspect it.
  1. Baking soda stomach acid test.

While not as accurate as the above tests, this is a free at-home test you can use to get an indication of your stomach acid levels. The results can vary from person to person depending on interpretation of the results. Some use it as a baseline measure and to track changes over time.

First thing in the morning, before eating or drinking anything:

  1. Mix ¼ tsp baking soda in 4 to 6 ounces of cold water.
  2. Drink the baking soda solution.
  3. Time how long it takes for a burp to occur. Time it for up to 5 minutes:
  4. If you have not burped within five minutes, it may be a sign of insufficient stomach acid. Early and repeated burping may be due to too much stomach acid (do not to confuse this with small burps from swallowing air when drinking the solution). Any burping after 3 minutes is an indication of low stomach acid levels.

Associated tests

Low stomach acid can be associated with other health issues that have far-reaching consequences. If you suspect low stomach acid, ask our office about testing for the following:

B12 levels

Intrinsic factor is a glycoprotein in the stomach necessary for absorption of vitamin B12. When stomach acid is too low, intrinsic factor can’t do its job. This results in vitamin B12 deficiency, which is a serious health concern.

Homocysteine levels

Stomach acid is important for proper absorption of vitamin B12, a key factor in methylation that keeps inflammatory homocysteine at the right levels. When B12 is low, homocysteine elevates.

Supporting healthy stomach acid

Protein timing

Eat protein foods at the beginning of your meal to stimulate the digestive enzymes necessary for digesting protein.

Chew thoroughly

Chewing thoroughly is one of the most important parts of digestion. Food proteins need to be broken down to be properly digested.

Time your drinks

Limit liquid intake during meals until at least 30 minutes after a meal to allow for proper stomach acid production, pathogen sterilization, and protein metabolism.

Stay hydrated

Staying hydrated between meals helps support proper gut motility; this pushes the contents of the intestines out of the body instead of back into the stomach. This is very important for those who are prone to SIBO.

Consider betaine hydrochloride supplementation

Betaine hydrochloride (HCl) supplements help support healthy gut function and safely restore normal gastric acidity.

HCl with pepsin and gentian root.

Add HCl with pepsin to your diet when you consume protein. When you feel warmth in your stomach, that means you are taking enough. Then back it down a notch and monitor your response. Some people need one capsule, others need more as everyone is unique.


Typically used in conjunction with HCl, pepsin is considered very safe when administered to assist digestion.

Digestive enzymes

Taking digestive enzymes with meals helps to break down food proteins and therefore support digestion and the gut. Make sure to get a high-quality blend.

Apple cider vinegar

Taking one tablespoon of apple cider vinegar in a bit of water right before a meal can help with digestion. Be sure to work your way up to 1 tablespoon a little bit at a time to avoid adverse reactions.

Fermented foods

Fermented foods such as pickles, kimchi, miso, sauerkraut, and water kefir contains organic acids, enzymes and probiotics to assist with proper digestion. They are also anti-microbial and fight H. pylori, is an enemy of stomach acid production.

Keep in mind that those struggling with mold illness, candida, or other fungal infections typically do not handle fermented foods well. Consuming them could significantly increase symptoms. If this is what you experience, we recommend getting in touch with us to help remove those underlying infections.

Taking the time to improve your stomach acid levels will make a huge difference in your symptoms and quality of life.


 Please contact our office for more help with digestion or gut issues.