If you’ve been following me for a while, you’ll likely have heard of betaine with pepsin — betaine with pepsin is 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.
You may have been told that you have too much stomach acid, and that you need to go on medication to help reduce the acid your stomach is producing…. And chances are that, if you’re like me, you’ve taken the advice of mainstream doctors and websites, but still don’t feel well or “human.” What if I told you that it may actually be the opposite; that you may not be producing enough stomach acid? What if I told you that there is a supplement that can help you on your Hashimoto’s journey to feel human again and get your energy back?
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 and dairy free in 2011. The medication did reduce my cold intolerance, need for sleep by about one hour, and anxiety; while eliminating dairy and gluten helped to stop my acid reflux, irritable bowel syndrome, joint pain, and reduced my thyroid antibodies.
However, my fatigue persisted.
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 a.m. without an alarm, and 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!
Continue reading about my journey with betaine with pepsin, and how it changed my life — overnight!
In this article, you’ll learn:
- How common low stomach acid is in those with Hashimoto’s
- How betaine with pepsin can help Hashimoto’s and pain
- Who should not take betaine with pepsin
- Recommended betaine with pepsin supplements and proper dosing
- Additional 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, we are 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 has low stomach acid include: acid reflux (this condition, that is conventionally treated with acid suppressant, 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 acidity in the gastric opening. Betaine HCl used to be available as an over-the-counter (OTC) drug, marketed as a stomach acidifier and digestive aid. However, 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.
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 2015 survey of 2232 people with Hashimoto’s, out of 627 people who took betaine HCl and pepsin, 59 percent 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), reduced pain (40 percent), and improved mood (35 percent). One fourth of people felt that this supplement also helped them with losing weight.
Betaine HCl and pepsin 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 may not need to expend as much energy on digestion, and since digestion is one of our body’s biggest energy expenditures, we often begin to have a surplus of energy.
- The amino acids found in proteins become bioavailable, helping with the creation of neurotransmitters and fuel for our bodies.
- We will be less likely to react to our foods, as the food particles will get broken down into individual amino acids before they move further down into our gut.
- We will feel lighter after we eat, and will not have cravings for food when full.
Pain and Hashimoto’s
When we assist our digestion with the use of betaine with pepsin, it is possible to reduce pain. As I mentioned above, forty percent of people with Hashimoto’s reported a reduction in pain with the use of betaine with pepsin. Why does betaine with pepsin reduce pain? At first, this caught me a bit off guard, but the more I thought about the mechanism of action, the more it made perfect sense. Betaine and pepsin break down protein bonds in food, thereby aiding digestion, reducing intestinal inflammation, and even leading to reduced systemic inflammation and less pain for many people.
Trimethylglycine (betaine) can also be helpful for breaking down homocysteine, which has been associated with inflammation. Furthermore, it can increase the amount of SAMe, a naturally occurring substance with mood-boosting and pain-relieving properties, within the body.
Who Should Avoid Betaine with Pepsin?
Some people should NOT take betaine with pepsin. For example, people who have a history of peptic ulcers or gastritis, or those who take NSAIDs, steroids, or other medications that can cause an ulcer, should not take betaine with pepsin.
Signs and symptoms of an ulcer include a dull pain in the stomach, weight loss, nausea/vomiting, acid reflux, bloating, and burping. Pain improves when you eat, drink, or take antacids.
Signs and symptoms of gastritis include a gnawing/burning in your upper abdomen, nausea/vomiting, and 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 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 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 production.
- 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 thiamine.
Proper Dosing of Betaine with Pepsin
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
I recommend Rootcology Betaine with Pepsin, which provides 750 mg of betaine hydrochloride, along with 33 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) 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.
Beets are also a rich source of betaine. If you have the MTHFR gene mutation, beets are especially good for you, as their betaine content can break down homocysteine (individuals with the MTHFR gene mutation have trouble processing the amino acid homocysteine, elevated levels of which have been associated with heart disease, difficult pregnancies, birth defects, and possibly an impaired ability to detoxify). One to two servings per week would be recommended — and since they are high in sugar, you will want to pair them with a healthy fat or protein source.
A great example of self-discovery with low stomach acid was when I wrote my first book. I had always loved writing and dreamed of writing a book that would help others, but I thought becoming an author would be impossible — especially while working at a full-time job and with my 12 hour sleep demands!
Once I started to take betaine with pepsin, I had a breakthrough. I discovered that I had low stomach acid… and it was truly affecting my thoughts, the pain I was experiencing, my extreme fatigue, and my every move. When those symptoms resolved, and my energy started to skyrocket, I was finally able to follow my dream and write a book to help others with Hashimoto’s.
I hope this article sheds some light and brings hope to you if you are suffering from any of the above symptoms — pain, fatigue, gastric infections, and acid reflux, to name a few. Finding your proper dose of betaine with pepsin may bring you relief so that you, too, can follow your dreams that may have been held back due to low stomach acid.
As always, please discuss the use of supplements with your personal doctor or pharmacist. This article is for informational purposes only, and I am not able to advise on whether this, or any other supplement, would be appropriate for you and your specific health needs, without a comprehensive health assessment.
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.
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- Rojas Hernandez CM, Oo TH. Advances in mechanisms, diagnosis, and treatment of pernicious anemia. Discov Med. 2015;19(104):159-168.
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- 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.