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).
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 too much stomach acid. It's the opposite. Low stomach acid is an epidemic! 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. Since very few doctors 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 tested for low stomach acid? No? I have never met anyone that has. 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; they do not remedy the cause.
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 and is essential for proper digestion and improved immunity.
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.
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 reduce the amount of stomach acid produced by the stomach. One of the best-selling proton pump inhibitors is called Prevacid, which goes by the generic name Lansoprazole. 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.
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).
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
Taking Betaine HCl is the recommended approach for low stomach acid. Betaine HCl ensures the complete breakdown of food in the stomach. Further, the increased acid levels in the stomach 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.
What can Betaine HCl do for you?
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. Until your HCl levels are normalized, take Betaine HCl with Pepsin. The chances are that if your stomach has insufficient HCl, it will not produce sufficient Pepsin. It is HCl that causes the stomach to produce Pepsin naturally. Once your stomach acid levels are normalized, the additional Pepsin is not required anymore. This is why I prefer to purchase my Betaine HCl and Digestive Enzymes separately. Another good reason to purchase Betaine HCl and Pepsin separately is that some people are sensitive to Pepsin. This is the case with my wife. She gets nauseous after taking digestive enzymes (even without Betaine HCl).
5. Do not take Betaine HCl with meals that do not contain protein. For example, if you just have a salad for lunch without any protein, taking Betaine HCl is unnecessary and could result in a mild burning sensation in the pit of your stomach. While not as painful as heartburn, it is still not something you will not enjoy. If you experience this or if you take a larger dose than required (see 6 below), you can mix ½ teaspoon of baking soda in 8oz of water and drink it. Repeat every 10 minutes until it is gone.
6. Taking the wrong dosage of Betaine HCl. I've also read on the internet where people suggest finding your tolerance right away by taking Betaine HCl until you feel a burning sensation in your stomach. I don't agree with this and prefer that people I advise to gradually 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 to 3 days. If you have no burning sensation (almost guarantee you won't), add another capsule with one of your other high protein meals for the next two days. Every two to three days, add an additional capsule until either all of your symptoms have disappeared or you experience a slight burning sensation in your stomach. The largest dosage I've heard of anyone taking was 8 capsules for one meal. This would be the exception rather than a normal dose. I've never taken more than 4 capsules with one meal (500mg caps).
7. Adding to number 5 above - you don't need the same dosage at every meal. Vary your dosage based on the amount of protein you are digesting. I find I need to take extra (2-3 caps) if I am eating a large piece of beef (10-12 oz), but I only need to take one capsule if I have chicken (6 oz). And as I said above, if you are just eating salad, I wouldn't take any Betaine HCl.
How to Determine How Much Betaine HCl to Take?
The proper dosage of beating 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 we see with our readers. 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
- Eat a meal that contains at least 15-20 grams of protein (about 4 to 6 ounces of meat).
- Start by taking 1 capsule (500mg or less) of Betaine HCL midway through or at the end of your meal.
- After the meal and make a note of how you feel - things to look for: burning sensation in the pit of your stomach.
- Stay at this dosage of 1 capsule for another day of meals with protein. If you don't notice a burning sensation on the 3rd day, take 2 capsules with your next protein meal.
- Stay at this dosage for another day of meals with protein. If you don't notice a burning sensation, stay with that dosage for another day and then try 3 capsules with your next protein meal.
- Keep increasing the number of pills taken with each meal until you notice a burning sensation in your stomach, as described in step #3.
- When this happens, you will know your ideal Betaine HCL dosage is 1 pill less. For example, if you felt the discomfort going from 5 pills to 6 pills, then 5 pills are your proper dosage for a normal meal.
- When you feel discomfort, this can be relieved by drinking an 8-ounce glass of cold water with a ½ teaspoon of baking soda. Repeat this every 10 minutes until the sensation goes away.
Over time you will experience this burning sensation at some point and occasionally even after finding your optimal dosage. This indicates that you now need one less capsule again. Eventually, you may only need one per day or one every other day.
Can Betaine HCl Be Harmful?
Excessive amounts of Betaine HCl can cause burn the stomach lining. The key is to always start with low doses. Start with one capsule with your largest meal of the day that contains protein. Increase dosages 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. ADD MORE INFO HERE
Betaine HCl with Pepsin. Add these to your diet when you consume protein. When you feel warmth in your stomach, that means you are taking enough. Then back it down by one pill and monitor your response. Some people need one capsule; others need more as everyone is unique and have different levels of stomach acid.
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. 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.
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.