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Betaine HCl: How to Know When You Need It

Written by Dr. Michael Ruscio, DC on August 7, 2024

Written by Dr. Michael Ruscio, DC on August 7, 2024 — Reviewed by Heidi Turner

This Digestive Aid Could Make All the Difference

• Betaine HCl |
• When to Use It|
• How to Use It|
• Safety|
• Game Changer|

If you’re struggling with symptoms like belching, bloating, gas, diarrhea, and reflux fairly routinely, low stomach acid may be the culprit. The good news here is you don’t have to suffer—betaine hydrochloride (HCl), a dietary supplement used to help correct low stomach acid, can be very helpful. 

In this article, I’ll dive into what betaine HCl is, how to know if you need it, and a protocol for finding the right dose for you.

What is Betaine HCl?

Betaine is a nutritional compound extracted from certain plants like sugar beets. Betaine hydrochloride is an acidic version of this compound that acts as a source of hydrochloric acid in people with low levels of stomach acid 1.

Why is hydrochloric acid so important? As a component of gastric juice, it aids in protein digestion (amino acids), increases nutrient absorption, and protects against pathogens 1. 

If your stomach acid secretion isn’t where it should be, you can end up with:

• Gut infections like small intestinal bacterial overgrowth (SIBO) 2 3 4 5 6
• Nutritional deficiencies (especially iron, calcium, magnesium, vitamin D, vitamin B12, and folic acid) 6 7
• Stomach tumors or cancer 6
• Impaired digestive function 7

Betaine HCl offers a way to prevent or correct the impact of low stomach acid. There hasn’t been much research into using supplemental betaine HCl. But some studies show it helps make the stomach more acidic for just over an hour after taking it 8 9.

In  a recent case study, betaine HCl helped a patient with achlorhydria (no stomach acid) to 10:

• Restore healthy digestion
• Improve nutrient absorption
• Relieve symptoms like nausea, weight loss, and fatigue 

So, how do you know if you need betaine HCl?

When to Use Betaine HCl

Knowing when to use betaine HCl can be somewhat tricky. We encourage our clients to keep symptom journals. If the following symptoms are present, low stomach acid may be to blame 6: 

• Upper abdominal pain
• Weight loss
• Heartburn
• Nausea
• Bloating
• Diarrhea
• Acid reflux
• Feeling full soon after eating a small amount of food
• Vomiting
• Feeling excessively full long after eating
• Constipation
• Difficulty swallowing
• Changes in texture or color of the tongue
• Balance issues (from B12 deficiency)

Additionally, these factors and medical conditions increase the likelihood of low stomach acid 6:

• Autoimmunity
• Helicobacter pylori infection
• Anemia
• Over the age of 60
• Long-term use of prescription drugs or over-the-counter medications used to reduce stomach acid, like proton pump inhibitors (Nexium) or antacids (Tums or Pepcid)
• Gastric bypass surgery
• Cancer of beta-pancreatic cells (VIPoma)
• Hypothyroidism
• Gastritis

The symptoms of low stomach acid can be caused by a number of other conditions (including having too much stomach acid). To complicate matters further, some people with low stomach acid may not have symptoms at all. 

If you’re wondering about formal stomach acid testing, it’s not very reliable and accessibility is an issue, so it isn’t routinely done. However, there is an at-home betaine HCl protocol that may shed some light on this. I will explain this process below. 

How to Use Betaine HCl

When you’re not feeling well, it’s tempting to jump to supplements to find relief. However, our clients get the best results when they first work through a gut treatment protocol that targets the root causes of low stomach acid 6.

To briefly describe our process, we start with a whole-food diet (like the low FODMAP or Paleo diet) for a few weeks. Then we strategically filter in specific supplements—like triple therapy probiotics, GI repair nutrients, and herbal antimicrobials—while closely monitoring symptoms.

For many clients, walking through this process is enough to restore vibrant health. For others, they need a little more. One of our clients, Mason, is a great example.  

When we first met him, Mason had been facing gas, bloating, belching, a rumbling stomach, nighttime reflux, and loose stools for seven years. His gastroenterologist prescribed a proton pump inhibitor (a common reflux medication) but symptoms persisted.

After creating a healthy foundation with a low FODMAP diet, multi-strain probiotics, and gut repair nutrients, Mason’s symptoms improved by about 30%. 

He was still experiencing some negative symptoms, so we added a trial of betaine HCl and Mason experienced radical recovery. Mason said, “Almost immediately, all of my digestive issues went away.” If he missed a dose, gas and bloating returned. 

Betaine HCl Protocol

If you’re like Mason and still struggling with symptoms after working through a gut-healing protocol, you may want to consider betaine HCl. 

Here’s the process we use in the clinic:

If your body needs HCl, you’ll see improvement in your symptoms and overall wellness pretty quickly. Work with your practitioner to decide on the best maintenance dose for you.

Our gluten-free and dairy-free Digestive Acid HCl is a combination of betaine HCl and pepsin (a digestive enzyme or protease). We use it for the at-home testing protocol and for our clients who require a maintenance dose. 

A low dose (two capsules per meal) requires about one bottle per month, and a high dose (four capsules per meal) requires about two bottles per month. It’s reasonably priced, and we offer a discount when you set up a subscription with automatic shipping.

If you’ve tried this protocol for two weeks and don’t see any change in your symptoms, discontinue the betaine HCl and continue to look for the root cause(s) of your symptoms with a trusted healthcare provider. 

Betaine HCl Safety and Other Considerations

Betaine HCl is considered safe when used appropriately, but there are a few things I’d like to highlight.

It’s common for healthcare professionals to recommend increasing your betaine HCl serving size until you feel a burning sensation and then decrease your dose slightly. For example, if you feel a burning sensation in your stomach after taking eight pills, your ideal dose is seven pills. I don’t agree with this misguided approach because it can lead to taking very high doses of betaine HCl. 

For instance, I’ve seen clients who were taking as many as fifteen capsules per meal! If you have a healthy stomach lining, you may never feel a burning sensation, but you could be causing serious damage.

Additional betaine HCl safety considerations include:

• Never open the capsules—HCL is extremely acidic and will burn your mouth and esophagus.
• Avoid if you have active peptic ulcers (stomach ulcers).
• Stop if burning occurs, especially after 1 capsule.
• Do not take on an empty stomach; use only with food.

Betaine HCl: A Game Changer for Low Stomach Acid 

Low stomach acid can cause a myriad of negative symptoms, make it difficult to absorb nutrients from food, and pave the way for some long-term consequences.

Fortunately, betaine HCl can be a very helpful digestive support. If you need it, it can boost your stomach acid levels, helping you break down food and absorb nutrients more effectively.

Using betaine HCl is a great example of being evidence-based, not evidence-limited. There’s not a lot of formal data, but for our clients who need it, this supplement is helpful. We’re always on the lookout for more science on betaine HCl, but it’s not necessary before giving it a try.

Betaine HCl will likely be most effective when added to a healthy foundation. Check out my book, Healthy Gut, Healthy You, where you can find my Great-in-8 gut healing plan. If you traverse through this process but feel like you need more support, contact us for an appointment at the Ruscio Institute for Functional Health.

The Ruscio Institute has developed a range of high-quality formulations to help our clients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you. The information on DrRuscio.com is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.