How to Dose Betaine HCl For Best Results
- Avoid all of your trigger foods while taking Betaine HCl.
- For the first two days take two capsules of Betaine HCl immediately after eating your largest meal of the day.
- On the third and fourth days take three capsules of Betaine HCl immediately after your largest meal of the day.
- Continue adding one additional capsule to your dosage every two days until you experience a warm, slight burning sensation in your stomach. This indicates that your stomach is producing more acid on its own.
- The next day reduce your dosage by one capsule. Take this new dosage of Betaine after eating your largest meal.
- Continue at this new dosage until you again feel the slight burning sensation in your stomach. This indicates that your stomach is now producing even more stomach acid on its own.
- Each time you experience the slight burning sensation reduce your dosage by one capsule. Continue at this new dosage until you experience the sensation again. Reduce by one more capsule. Keep repeating.
- After a few more weeks (depending on the max dosage you started with) your dosage should be down to just one capsule per day.
- At this point you can further reduce your dosage by taking one capsule every other day with your largest meal.
- Do this for a week and if you experience no GERD or acid reflux symptoms during this time you can stop taking Betaine.
- You can now start introducing your trigger foods back into your diet. Do this gradually, not all at once.
- If you feel the least bit bloated after eating a meal which included one of your trigger foods take one or two Betaine capsules. This does not have to be immediately after the meal. It could be hours - whenever you feel bloated. Start with one capsule and if that doesn't give relief take one more.
You can often tell a lot about the state of the nation's health from merely watching television commercials. Drug companies spend millions of dollars airing commercials promoting their health care products. One of their most heavily advertised products is digestive aids, and among the many best sellers in this category are those that deal with acid reflux disease and GERD (Gastroesophageal Reflux Disease). This is a multi-billion dollar industry.
These commercials would have you believe that excess stomach acid is an epidemic. It is not. A common misconception is that everyone who suffers from acid reflux disease or GERD have excessive stomach acid. It's the opposite. Low stomach acid is the primary cause of acid reflux and GERD!
In 98% of cases, Acid Reflux Disease and GERD are caused by not having sufficient stomach acid.
In an old 1989 survey of the prevalence of diagnosed hypochlorhydria (clinically low stomach acid), it was determined that at least 37% of healthy people over age 60 do not produce enough stomach acid. That seems low but since very few doctors ever test for hypochlorhydria, an accurate estimate of the occurrence of low stomach acid in the general population over the age of 45 could be as high as 90 percent.
Have you or anyone you know, ever been tested for low stomach acid? No? I have never met anyone that has either. Including myself.
Unfortunately, doctors do not test for low or high stomach acid. Instead, they will prescribe a PPI (proton pump inhibitor) or an H2 Blocker. These medications suppress your symptoms (for a while); but they do not remedy the cause. PPI's completely stop the production of stomach acid. PPI's are meant for treating people with stomach ulcers, giving the ulcers time to heal without being hindered by stomach acid. PPI's are not meant to be taken for longer than eight weeks.
What is Betaine HCl?
Betaine HCl (Betaine hydrochloric acid) is a dietary supplement made from Betaine and hydrochloric acid. Hydrochloric acid is a strong acid, naturally produced by the stomach. Its production is triggered by the ingestion of food, and is essential for proper digestion and improved immunity. As we age the amount of stomach acid that is produced is reduced.
Before 1993 Betaine HCl, was used in OTC products for better digestion, but the FDA passed a law in 1993 banning the use of Betaine HCl in OTC products. It was reclassified as a food supplement and stated as "Generally Safe and Effective." Betaine HCl is now only available as a dietary supplement. Personal testimonials and reports suggest it is beneficial for various medical conditions, including acid reflux and GERD.
Note: Do not confuse Betaine HCl with Betaine anhydrous (also called trimethylglycine or TMG). Betaine anhydrous is used to treat high levels of homocysteine in the urine. High levels of homocysteine are a symptom of arterial damage and blood clots. It's a totally different substance.
The Role of Stomach Acid
Stomach acid is required to break down protein and keep the LES (lower esophageal sphincter) tightly closed. Stomach acid is made up of hydrochloric acid (HCl), potassium chloride, and sodium chloride. Hydrochloric acid activates digestive enzymes and plays a significant role in the breakdown of protein into amino acids. The lack of potassium and sodium chloride doesn't seem to be a factor—it's the hydrochloric acid that people tend to have trouble producing.
First, it's necessary to understand that stomach acid plays a significant role in the digestive process because it helps to break down food, chemically altering it so that the body can extract the required nutrients. The acid initiates the digestion of protein in the stomach and then triggers the pancreas to secrete digestive enzymes and the gallbladder to release bile into the small intestine. The acid is also responsible for killing pathogenic bacteria that enter the body via food.
80 Million Americans Suffer Have Low Stomach Acid
It's estimated that as many as 80 million Americans suffer from low stomach acid problems, including acid reflux disease and GERD. The valve that connects the esophagus to the stomach is called the Lower Esophageal Sphincter (LES). In simplest terms, without sufficient stomach acid, the LES is not triggered to close tightly enough, allowing stomach acid to back up into the esophagus. The result can be inflammation (swelling) and possible damage to the lining of the esophagus.
The pharmaceutical industry has developed many drugs to deal with the symptoms associated with GERD. One category of drugs is called proton pump inhibitors (PPIs), which stop the production of stomach acid produced by the stomach. Side effects of PPIs may include nausea, stomach pain, diarrhea and constipation.
Should you consider a natural alternative to such drugs?
Rather than blocking the production of stomach acid with meds, one way to quickly and effectively deal with GERD symptoms is to support the digestive system with adequate levels of hydrochloric acid (HCl). The over-the-counter (OTC), natural formulation I recommend to do this is called Betaine HCl, which will aid in the digestion of all types of foods.
Betaine HCl improves digestion by increasing stomach acid naturally. In the stomach, the Betaine HCl separates into Betaine and hydrochloric acid. The hydrochloric acid naturally increases the production of stomach acid.
Often included in many formulations are Pepsin, which aids protein digestion, and/or gentian root, which stimulates natural acid production by the parietal cells in the stomach.
I recommend taking Betaine HCl without Pepsin.
Pepsin added to the Betaine HCl is unnecessary because the hydrochloric acid will trigger your stomach to produce Pepsin. Adding supplemental Pepsin in addition to that produced as a result of the Betaine could result in too much Pepsin in your system.
At first this won't matter because of the small dosage of Betaine but when your Betaine dosage is increased so will the Pepsin. Pepsin is a major contributor to LPR. The extra Pepsin is refluxed into the esophagus and the larynx causing LPR.
Causes of Low Stomach Acid (Hypochlorhydria)
It is rare to find anyone over 40 years of age with normal stomach acid levels. Many have hypochlorhydria (clinically low stomach acid) or achlorhydria (almost no stomach acid). Normal stomach acid is measured in pH. Normal stomach acid should be in the range of 1-3 pH. Stomach acid in the range of 4-7 pH is considered too low or too alkiline.
The main causes of Low Stomach Acid is:
- Normal Part of Aging - The graph below shows that as people age the amount of stomach acid produced by their stomach is reduced. According to Jonathon Wright, M.D., "When we test people over forty years old who are experiencing heartburn, indigestion, and bloating, over 90% of them have inadequate acid production".
- Stress - Chronic stress can descrease stomach acid production.
- Vitamin Deficiency - Zinc and Vitamin B deficiency can lead to reduced stomach acid production. These deficiencies can be a result of inadequate diet or it could also be because you have insufficent acid to extract the nutrients from the food you eat.
- Acid Reflux Medications - taking OTC antacids and H2 Blockers will reduce stomach acid. PPI's will stop stomach acid production completely.
- H. Pylori - is an infection that can cause gastric ulcers resulting in reduced stomach acid.
- Gastic Bypass Surgery - can reduce the production of stomach acid.
Symptoms of Low Stomach Acid
Below is a list of some indicators of low stomach acid:
- Belching or gas within one hour of a meal
- Bloating and fullness shortly after eating
- Loss of appetite for meat
- Nausea after eating
- Brittle fingernails
- Undigested food in stool
- Foul-smelling stools
- Stomach pain
- Bad breath
- Loss of appetite
- Estrogen buildup
- Acne rosacea
What can Betaine HCl do for you?
Taking Betaine HCl is the recommended approach for increasing low stomach acid. I recommend taking the Betaine after you have finished your meal. Ingesting food triggers your stomach to produce stomach acid. By taking the Betaine after your meal you allow your stomach to naturally produce as much stomach acid as it can on its own before introducing the Betaine.
If you take the Betaine prior to or during the meal your stomach will not need to produce stomach acid on its own or at least less than optimal. Over time your stomach will be encouraged to produce more and more stomach acid until it can produce enough on its own without supplementing with Betaine.
Taking Betaine HCl improve the absorption of protein, calcium, B-12 and iron. Using Betaine HCl has the potential of enabling you to eat less but absorb more nutrients from the food you eat.
Supplementing stomach acid levels offers the following benefits:
1. Enhanced Absorption of Vitamins and Minerals
HCl is necessary for absorption and assimilation of vitamins and minerals such as B12, folic acid, vitamin C, beta-carotene and iron, by increasing their bioavailability and effecting their cleaving from food. As pointed out by Dr. Jonathan Wright, MD, Medical Director of the Tahoma Clinic, an extensive number of macro minerals and trace minerals have low absorption rates in cases of low stomach acid, namely calcium, magnesium, zinc, copper, chromium, selenium, manganese, vanadium, molybdenum and cobalt. It has been established that many age-related cognitive disorders are linked to declining levels of stomach acid, which disrupt the absorption of folic acid and B12, two vital nutrients in optimal cognitive function.
2. Better digestion of protein
HCI starts the digestion of protein structures in the stomach by transforming pepsinogen into the proteolytic enzyme, Pepsin. Once it is formed, Pepsin acts to break proteins into smaller, easier to digest amino acids that are easily absorbed by the small intestine. When you don't have enough stomach acid, incompletely digested large protein molecules will be absorbed into the systemic circulation but may set off a host of food intolerances.
3. Protection of the GI Tract from Pathogens
In addition to breaking down your food properly and absorbing a host of nutraceuticals, HCl also plays an important role in maintaining a safe environment in the stomach. HCl reaches that goal by defending against orally-ingested pathogens and creating a defensive barrier to prevent bacterial or fungal overgrowth in the small intestine.
Restored acid levels can also destroy ingested bacteria and microorganisms. Stomach acid is important to prevent the proliferation of H. pylori (Helicobacter pylori), which is the bacteria that thrive in a low acidic environment and can cause peptic ulcers, gastritis and duodenitis and may be associated with gastric cancer.
Low stomach acid and GERD are digestive conditions that affect your quality of life. Fortunately, Betaine HCl may hold the promise of helping you get your life back.
What to be Aware of Before Taking Betaine HCl
1. Do NOT take Betaine HCl if you have a Peptic Ulcer. Betaine HCl might irritate stomach ulcers or stop them from healing. Once the ulcer has healed and you are off all antacid medication, you can start taking Betaine HCl.
2. I see suggestions on the internet indicating that Betaine HCl should be taken 10 to 20 minutes before a meal. I don't agree with this based on personal experience. Initially, I did this but found that occasionally I would start experiencing heartburn before the meal, and then I wouldn't feel like eating. Taking Betaine HCl before a meal can turn off stomach acid production for the meal. This is especially true if you are just starting to use Betaine HCl and your acid levels are still very low. I suggest taking Betaine HCl either half-way through the meal or at the end of the meal.
3. Do NOT take Betaine HCl if you are using any kind of NSAIDs such as ibuprofen, Tylenol, and aspirin or corticosteroids such as Prednisone, Celestone, etc. These drugs can cause damage to the gastrointestinal lining that Betaine HCl may aggravate, increasing the risk of ulcer or gastric bleeding. If you are taking these medications, a safe alternative to Betaine HCl is Digestive Bitters.
4. I recommend taking Betaine HCl without Pepsin. Most formulations of Betaine contain Pepsin, but they don't promote taking the dosages necessary to normalize your stomach acid and relieve GERD. Small amounts of Pepsin are fine initially, but when you increase your dosage of Betaine (with Pepsin) and as your stomach begins to produce more stomach acid on its own, you may reflux the excess Pepsin into the esophagus and larynx. Excess Pepsin has been shown to cause Laryngopharyngeal Reflux (LPR).
5. I had the best results taking Betaine once per day with my largest meal. I felt that taking Betaine just once per day made it easier for me to determine my max dosage. With smaller meals, I would have had to take less Betaine and the mixing of dosages would have made it more difficult to determine my maximum safe dosage. The dosage taken at one meal could affect the next meal.
6. Taking the wrong dosage of Betaine HCl. I've also read on the internet where people suggest finding your tolerance the first day by taking Betaine HCl until you feel a burning sensation in your stomach. I don't agree with this and prefer that the people I advise to increase their dosage gradually over a few weeks. I generally advise taking one capsule, once a day, with your largest high protein meal for the first 2 days. If you have no burning sensation (almost guarantee you won't), add another capsule with your olargest meals for the next two days. Every two days, increase your dosage by an additional capsule until you experience a slight burning sensation in your stomach. This is very mild and is nothing like heartburn. it is more like the warm sensation you would get in your stomach if you drank a hot liquid too fast. The largest dosage I've heard of anyone taking was 16 capsules for one meal. This would be the exception rather than a normal dose. I've never taken more than 8 capsules with one meal (500mg caps). Everyon is different, so you must determine your own max dosage.
How to Determine How Much Betaine HCl to Take?
This section is summarized at the beginning of this article.
The proper dosage of Betaine HCl depends on a person's age, health and current level of stomach acid. It's important to find the correct dosage for your situation. Everyone will be different. If you fail to do this gradual dosage increase, you will not get the results you want.
Failing to take the optimal dosage is a very common problem with many people. Remember, the stomach is purposely built to handle extreme acid environments. If your correct dosage is 2400mg and you're only taking 1200mg, you're not really doing your stomach any favors. You must follow the process below to figure out the right dosage to get the maximum benefit.
Follow These Steps to Determine Your Correct Dosage of Betaine HCl
- Throughout this whole process avoid eating your trigger foods. Trigger foods are foods that cause symptoms for you.
- Only take Betaine once per day with your largest meal. I'm assuming this will be your dinner. I tried taking Betaine with every meal. Different sized meals require different doses of Betaine. This got very complicated very quickly and I found that taking Bataine with breakfast and lunch made it difficut to track my doses and harder to find my optimal dosage. I also found that the Betaine taken earlier in the day affected meals eaten later in the day. Taking it once a day worked very well and was easy to track.
- On the first two days, take 2 capsules (500mg to 650mg) of Betaine HCL after you finish your meal.
Note: If you can find capsules that are less than 500mg you will be more accurate on your dosing but they are extremely hard to find. Never attempt to ingest Betaine powder or Betaine that has been removed from the capsule. This will burn your throat and esophagus when you swallow it. It's very acidic.
- An hour or so after your largest meal make note of how you feel - things to look for: burning sensation in the pit of your stomach. It's unlikely this will occur with just two capsules. If it does, you probably don't need to take Betaine HCl.
- On the third and fourth day take 3 capsules after eating your largest meal. Make note of how you feel an hour or two after eating.
- Keep increasing the number of pills taken with each meal until you notice a burning sensation in your stomach. This burning sensation is very mild and is more annoying than it is painful. It is nothing like heartburn. It is more like the warm feeling you get in your stomach after drinking a hot liquid too fast. If this sensation is too much for you, drinking eight ounces of cool water with a 1/2 teaspoon of baking soda will relieve it quickly. Repeat this every 10 minutes as needed.
- This mild burning indicates that your stomach is now producing more stomach acid on its own and you need less Betaine to achive the same level of stomach acid. You should be experiencing less or reduced symptoms of acid reflux. Continue to avoid your trigger foods.
- Continue at this new dosage until you feel the burning sensation again. As before, reduce your dosage by one more capsule. Your stomach is now producing more stomach acid.
- Continue this process until you are only taking one or two capsules with your largest meal. If you are symptom free at this dosage, you may reduce further by taking Betaine every other day. After a week at this dosage, if you are still symptom free, you can stop taking Betaine regularly.
- Now you can start reintroducing your trigger foods. Do this gradually starting with foods that caused the least symptoms. Try introducing one trigger food every few days, making note of how you feel. If you feel like you are bloated or feel like you are getting heartburn, take a capsule of Betaine. This should reduce the bloating and relieve the heartburn.
This process worked very well for me. It took me a few weeks to build up the nerve to try Betaine HCl. I wasn't fully convinced that taking something this acidic could help me. It didn't make sense to me. The first day I only took one capsule, and I felt nothing. The next take I took two. Again, I felt nothing. I continued increasing the dosage every other day. I got the burning sensation after taking 8 capsules. I reduced my dosage by one capsule at my next evening meal. So, my optimal initial dosage was 7 capsules. It took me seven more weeks to get down to one capsule every other day. I stopped after a few days and have been symptom free for six years.
I'd be lying if I said I never take Betaine anymore. I do take it occasionaly after a very large meal with lots of my trigger foods. I'll take one or two capsules and it will go away. This happens to me every six months or so.
Can Betaine HCl Be Harmful?
Excessive amounts of Betaine HCl can burn the stomach lining. This will occur if you take too much at once. The key is to always start with low doses and gradually increase your dosage over time. Start with one capsule with your largest meal of the day. Increase your dosage gradually until you experience a slight burning sensation in the pit of your stomach. This feels nothing like heartburn and can be relieved by drinking a few glasses of water. Reduce the number of capsules at your next meal. The amount of Betaine that causes this burning sensation is different for everyone. Do not try to guess your dosage.
Some people need one capsule (very few); others need more as everyone is unique and have different levels of stomach acid. If you get the burning sensation after just one or two capsules you probably don't need to take Betaine. Something other than low stomach acid may be the problem. If you have stomach ulcers you should not take Betaine until they are healed.
Side Effects of Betaine HCl
Betaine hydrochloride does not have many side-effects in most people. Nausea, stomach upset, diarrhea and a body odour all have been reported but only with high doses. If you notice any other effects, check with your doctor. As stated above, do not take Betaine HCl if you have stomach ulcers, or are on NSAIDs or corticosteroids.
Some brands of Betaine contain Fenugreek. Fenugreek helps soothe the gastrointestinal tract by providing mucilage to calm down inflammation by coating the lining of the stomach and intestines. Betaine HCl with Fenugreek supports normal digestion and helps alleviate many symptoms of digestive insufficiency. But, don't think that taking a lot of Fenugreek is a good idea. It can cause severe diarrhea (disaster pants).
References & Studies
 Takumi K, de Jonge R, Havelaar A. Modeling inactivation of Escherichia coli by low pH: application to passage through the stomach of young and elderly people. J. Appl Microbiol 2000 Dec;89(6):935-43. https://pubmed.ncbi.nlm.nih.gov/11123466/
 Brummer P, Kasanen A. The effect of hydrochloric acid on the indican metabolism in achlorhydria. Acta Medica Scan 1956;155:11- 14. https://pubmed.ncbi.nlm.nih.gov/13339277/
 Morihara M, Aoyagi N, Kaniwa N, Kojima S, Ogata H.Assessment of gastric acidity of Japanese subjects over the last 15 years. Biol Pharm Bull 2001 Mar;24(3):313-5. https://pubmed.ncbi.nlm.nih.gov/11256493/
 Young DG. A stain for demonstrating Helicobacter pylori in gastric biopsies. Biotech Histochem 2001 Jan;76(1):31-4. https://pubmed.ncbi.nlm.nih.gov/11440301/
Britton, E., & McLaughlin, J. (2013). Ageing and the gut. Proceedings of the Nutrition Society, 72(1), 173-177. doi:10.1017/S0029665112002807 https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/ageing-and-the-gut/A85D096755F5F7652C262495ABF302A0
The information contained here does not constitute medical advice and is not meant to diagnose, treat, prevent, or cure disease. Please contact your doctor. The information provided is for informational purposes only and are solely the views of the author.