Dr. Amy Nett: Yeah, this is a great question. If someone’s not noticing any benefit with taking HCl and you’re not using it specifically to increase iron absorption, then I don’t think there’s any need to continue it. I think it’s worth trying because if patients are having GI symptoms, then see if some of that is due to poor digestive enzyme production, poor HCl, low HCl. So all of the cases you mentioned are reasonable to try. I actually very rarely use HCl. I will in the setting of gastroesophageal reflux if they don’t have gastritis, so that’s one time I’ll use it.
If patients come to me and they say, “I feel better taking HCl,” then I’ll say that’s fine, stay on it, we’ll get through gut treatment and then see how you do coming off of it. Or to increase iron absorption. Those are probably the three primary times. If someone just has SIBO, it’s rare that I’ll actually use it just if they have SIBO, especially if they’re relatively asymptomatic in terms of gut symptoms. So when exactly? It depends a little bit, but I think those three settings are primarily where I would use it and again no benefit, then no need to continue. Oh, the one other one might be if on their stool test if they’re not digesting foods very well, that would be the other one to consider. So if you do a Doctor’s Data stool test and you see that they’re having malabsorption issues or not digesting proteins particularly well, that could be another time to use HCl. So I think that about covers when I would use it.