If you’ve been following me for a while, you’ll likely have heard of betaine with pepsin. Betaine with pepsin was one of the most helpful supplements I came across during my health journey. I often tell the story about how this supplement changed my life. Excessive fatigue was my most challenging symptom.
I was chronically exhausted and needed to sleep for 11 to 12 hours to feel human. Things didn’t get much better, despite starting thyroid medications in 2010, and even going gluten free/dairy free in 2011 (though the former reduced my cold intolerance, need for sleep by about one hour, and anxiety, while the latter helped to eliminate my acid reflux, irritable bowel syndrome, joint pain and reduced my thyroid antibodies).
I didn’t think the fatigue would ever leave.
Quite honestly, I accepted it as part of who I was. But then, I started taking betaine with pepsin on Friday, February 10, 2012, one capsule with each meal containing protein. I was surprised to wake up the following morning at 8 am without an alarm. I had been dragging myself out of bed after 10 most mornings when I did not have to work. Strangely, I continued to feel energetic all day. I even stayed awake when my usually much more energetic husband took a nap. Things became easier, and all of a sudden, I felt that I had a surplus of time. I felt more at ease going to bed and even had time to meditate, something that I had wanted to do for years!
As the week went on, I felt myself having more and more energy and became more outgoing and talkative. Additionally, the mental fog was completely lifted, and I could come up with all sorts of clever words quickly! My co-workers commented on my good mood at work. My husband noticed that my sense of humor and memory even improved. I felt like my old, pre-Hashimoto’s self again, the self that I had not seen for almost ten years. I continued to increase the dose of betaine with pepsin, until one day, I woke up at 5:17 a.m. and decided to start writing the book: Hashimoto’s: The Root Cause.
I had always loved writing and dreamed of writing a book that would help others. I even took a writing workshop in 2007—the instructor suggested that working people have the best chance of writing a book by waking up two hours prior to their usual rising time and writing. With a full-time job and my sleep demands, I thought becoming an author would be impossible, and I gave up that dream. But now, here I was… doing the impossible, waking up a few hours before work and writing! Certainly, I thought, if I could wake up energized with six hours of sleep after feeling chronically exhausted for ten years, I could easily overcome Hashimoto’s and then write a book about it to help everyone else figure it out! This was a huge breakthrough. I figured out that I had been suffering from low stomach acid! Have you been experiencing symptoms related to low stomach acid as well?
In this article, I’d like to discuss:
- How common low stomach acid is in those with Hashimoto’s
- How betaine with pepsin can help Hashimoto’s
- Who should not take betaine with pepsin
- How to determine the dose that’s right for you
- Recommended betaine with pepsin supplements
- Alternate ways to support low stomach acid
Low Stomach Acid and Hashimoto’s
Studies have found that people with Hashimoto’s and hypothyroidism often have hypochlorhydria (low stomach acid) or achlorhydria (lack of stomach acid). When we have low stomach acid, this puts us at greater risk for many undesirable health consequences:
- Contracting parasites from our food – Stomach acid helps us sterilize our food, killing off potential infecting pathogens.
- Food sensitivities – Proteins that are not properly broken down are more likely to induce an antigenic response from our immune system leading to food sensitivities, especially to gluten and dairy.
- Small intestinal bacterial overgrowth (SIBO) – Without stomach acid which keeps them at bay, bacteria in the small intestine may grow and thrive on poorly digested proteins. In one small study, 54 percent of people with hypothyroidism were found to have SIBO.
- Nutrient Depletions – especially in iron, calcium, ferritin, and B12.
- If prolonged, low stomach acid can lead to hypergastrinemia, (excess secretion of gastrin, another digestive enzyme, as a compensatory mechanism due to low stomach acid), which can lead to tumors/cancerous growth in the gastrointestinal tract.
Symptoms of Achlorhydria or Hypochlorhydria
There aren’t too many tell-tale signs of low stomach acid, other than perhaps feeling full and tired after meals as well as experiencing acid reflux like symptoms. Nonetheless, low stomach acid is very common in Hashimoto’s. Signs and symptoms that would lead me to believe that a person with Hashimoto’s had low stomach acid include: acid reflux (this condition that is conventionally treated with acid suppressants can actually be caused by low stomach acid), low B12, ferritin, or iron levels, fatigue despite thyroid medications, and constipation/diarrhea.
What is Betaine HCl and Pepsin?
Betaine HCl and pepsin are naturally occurring components of gastric juice that make nutrients and amino acids from our protein containing foods more bioavailable by breaking down protein bonds. They are especially important for proper absorption of protein, calcium, B12, and iron.
Betaine, also known as trimethylglycine, is a naturally occurring amino acid derivative that is isolated from beets, and the acidic HCl version of it promotes gastric lumen acidity. Betaine HCl used to be available as an over-the-counter (OTC) drug, marketed as a stomach acidifier and digestive aid, but it was removed from OTC use in 1993 due to insufficient evidence of it working, and was banished to being a dietary supplement by the FDA. (Dietary supplement companies cannot make claims of the effectiveness of their products, while drug companies can make specific claims). However, studies done in 2014 did indeed find that betaine HCl can re-acidify gastric pH.
In other forms, trimethylglycine is also used to reduce fat tissue and increase lean muscle mass in pigs (though there are no studies to support it can do the same for humans), and can be helpful for breaking down homocysteine, especially in those with the MTHFR gene mutation. It can also be a helpful adjunct in depression, by increasing endogenous amount of SAMe, a naturally occurring substance with mood boosting and pain relieving properties. It is available as a supplement in the US, and as a drug in other countries.
Pepsin is a naturally occurring digestive enzyme that breaks apart proteins into smaller pieces so they can be properly absorbed by the small intestine. In supplements, pepsin is usually derived from porcine sources.
How Betaine with Pepsin Can Help with Hashimoto’s
In my May 2015 survey of 2232 people with Hashimoto’s, out of 627 people who took betaine HCl and pepsin, 59 percent of people said that it made them feel better, 33 percent said that it made them feel worse, while 7 percent saw no difference in symptoms. Based on the improvement rates, this leads me to believe that 50-70 percent of people with Hashimoto’s are likely deficient in stomach acid. Those that felt worse were likely not deficient, as taking the supplement can make a person with adequate stomach amounts feel worse for a short time (burning in the throat and stomach upset may occur). Those that did not see improvement may not have been dosed adequately, as betaine with pepsin dosage needs to be individualized.
The biggest improvements seen after taking this supplement were improved energy levels (58 percent of those who found it helpful reported this), reduced pain (40 percent reported this, to my surprise), and improved mood (35 percent). One fourth of people felt that this supplement also helped them with losing weight.
Betaine HCl and pepsin, which supports stomach acid production, can make a tremendous difference in a person’s symptoms because once we begin to digest our proteins correctly, a few great things can happen:
- The body does not need to expend as much energy on digestion, and since digestion is one of our body’s biggest energy expenditures, we often have a surplus of energy.
- The amino acids found in proteins become bioavailable, helping with creating neurotransmitters and fuel for our bodies.
- We are less likely to react to our foods, as the food particles get broken down into individual amino acids before they get further down into our gut.
- We feel lighter after we eat, and do not have cravings for food when full.
But some people should NOT take betaine with pepsin.
For example, people who have a history of peptic ulcers or gastritis or take NSAIDs, steroids, or other medications that can cause an ulcer, should not take betaine with pepsin.
Signs and symptoms of an ulcer: dull pain in stomach, weight loss, nausea/vomiting/acid reflux, bloating/burping. Pain improves when you eat, drink or take antacids.
Signs and symptoms of gastritis: gnawing/burning in your upper abdomen, nausea/vomiting, fullness after eating. Symptoms can improve or get worse after eating.
Using this supplement in excess can lead to stomach irritation, and I always recommend a slow dose titration to determine your optimal dose.
A person using proton pump inhibitor medications would not likely want to take betaine with pepsin, as these medications and the betaine with pepsin have opposing effects. Additionally, while having hypothyroidism or Hashimoto’s in itself can cause low stomach acid, as can aging and genetics, there are other root causes of low stomach acid that need to be considered.
Addressing these root causes should always be done in conjunction with betaine HCl with pepsin supplementation:
- H. pylori infections, which can also trigger Hashimoto’s.
- B12 deficiency, which may be associated with a vegan diet or with anti-parietal cell antibodies.
- Adrenal dysfunction, which can deplete nutrients required for stomach acid.
- The MTHFR mutation, which is associated with a buildup of homocysteine due to impaired methylation. There are two main pathways of breaking down homocysteine. One of them involves the use of Trimethylglycine (betaine), and this gene mutation could theoretically make someone trimethylglycine deficient.
- Other nutrient deficiencies, especially in thiamine.
Betaine HCl and pepsin should be taken with a protein-rich meal, starting with one capsule per meal. The dose should be increased by one more capsule at each meal until symptoms of too much acid are felt (burping, burning, warming in the stomach region, etc). At that point, you will know that your dose is one capsule less than what resulted in symptoms.
Drinking a mixture of one teaspoon of baking soda in a glass of water can reduce these temporary symptoms.
- Meal No. 1: Took one capsule, didn’t feel symptoms
- Meal No. 2: Took two capsules, didn’t feel symptoms
- Meal No. 3: Took three capsules, didn’t feel symptoms
- Meal No. 4: Took four capsules, felt symptoms
- Target dose: three capsules
Recommended Supplement Brand
I recommend Rootcology Betaine with Pepsin, which provides 750 mg of betaine hydrochloride along with 50 mg of pepsin, and is free of fillers and common reactive ingredients like gluten, dairy, soy and pesticides.
I also like the Pure Encapsulations brand, which contains Vitamin C derived from non-GMO corn dextrose, in addition to betaine and pepsin. The dextrose, a corn sugar, is consumed in the creation of the Vitamin C and does not contain corn proteins, which are the reactive component of corn for most people with Hashimoto’s who are corn sensitive. The supplement itself is hypoallergenic.
Alternate Ways to Support Stomach Acid
Others have found that apple cider vinegar (one teaspoon of apple cider vinegar in one glass of cold water) and/or lemon juice (squeeze the juice of one lemon into a cup of hot water) can support digestion in some cases of low stomach acid.
*Please note, this article is for informational purposes only, and I am not able to advise on whether this supplement or any other supplement would be appropriate for you and your specific health needs without a comprehensive health assessment. Please discuss the use of supplements with your personal doctor or pharmacist.
I hope this information helps you on your journey!
I’d love to hear from you!
Have you been having trouble with symptoms of acid reflux? Have you tried betaine with pepsin and seen improvement?
To learn more about betaine with pepsin in addition to other helpful interventions, please consider picking up a copy of Hashimoto’s Protocol: A 90-Day Plan for Reversing Thyroid Symptoms and Getting Your Life Back and Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause.
- Betaine HCl with Pepsin. Supplement Information. Pure Encapsulations. https://www.purerxo.com/thyroidpharmacist/rxo/products/product_details.asp?ProductsID=929. Accessed October 9, 2015.
- Kohli DR, Lee JZ-E, Koch TR, Talavera F, Anand BS, Greenwald D, et al. Achlorhydria Clinical Presentation. Medscape. http://emedicine.medscape.com/article/170066-clinical#b5. Updated July 15, 2016. Accessed May 3, 2018.
- Daher R, Yazbeck T, Jaoude JB, Abboud B. Consequences of dysthyroidism on the digestive tract and viscera. World Journal of Gastroenterology. 2009;15(23):2834-2838. doi:10.3748/wjg.15.2834
- Osborne D, Sobczynska-Malefora A. Autoimmune mechanisms in pernicious anemia & thyroid disease. Autoimmun Rev. 2015;14(9):763-768.
- Rojas Hernandez CM, Oo TH. Advances in mechanisms, diagnosis, and treatment of pernicious anemia. Discov Med. 2015;19(104):159-168.
- Gerenova, Manolova M, Tzoneva VI. Clinical significance of autoantibodies to parietal cells in patients with autoimmune thyroid diseases. Folia medica (Plovdiv). 2013 Apr-Jun;55(2):26-32.
- Lauritano AC, Bilotta AL, Gabrielli M, Scarpellini E, Lupascu A, Laginestra A, et al. Association between hypothyroidism and small intestinal bacterial overgrowth. J Clin Endocrinol Metab. 2007;92(11):4180-4184.
- Betesh AL, Santa Ana CA, Cole JA, Fordtran JS. Is achlorhydria a cause of iron deficiency anemia? Am J Clin Nutr. 2015;102(1):9-19.
- Jensen RT. Consequences of long-term proton pump blockade: insights from studies of patients with gastrinomas. Basic Clin Pharmacol Toxicol. 2006;98(1):4-19.
- Aghili R, Jafarzadeh F, Bhorbani R, Khamseh ME, Salami MA, Malek M. The association of Helicobacter pylori infection with Hashimoto’s thyroiditis. Acta Med Iran. 2013;51(5):293-296.
Note: Originally published in October 2015, this article has been revised and updated for accuracy and thoroughness.