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.
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 health journey to feel human again and get your energy back?
Low Stomach Acid and Chronic Disease
Studies have found that people with chronic diseases 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 chronic disease. Signs and symptoms that would lead me to believe that a person with chronic disease 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 bio-available, 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 chronic diseases
In a 2015 survey of 2232 people with chronic diseases 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 chronic diseases 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:

1. 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.
2. The amino acids found in proteins become bio-available, helping with the creation of neurotransmitters and fuel for our bodies.
3. 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.
4. We will feel lighter after we eat, and will not have cravings for food when full.

Pain and Chronic Diseases
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 chronic diseases 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 chronic disease 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.
Dosing example:

• 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