I''ve been getting a lot of questions regarding Betaine HCl with Pepsin lately. This supplement can reduce fatigue, pain and even weight, as well as improve mood in people with Hashimoto's. But there are a few precautions to take with this supplement. Read my full article below:
My Thyroid Fatigue Breakthrough
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). You can read my full Hashimoto's story here.
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 been wanting to do for years!
As the week went on, I felt myself having more and more energy, and actually 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 Root Cause.
I had always loved writing, and dreamed about 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 write. 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 after only 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!
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 and poorly digested proteins. 54% of people with hypothyroidism were found to have SIBO, in one small study
- Nutrient depletions, especially in iron, calcium, ferritin and B12
- If prolonged 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
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 leave me to believe that a person with Hashimoto’s had low stomach acid include: acid reflux symptom (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 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), can be helpful for breaking down homocysteine, especially in those with the MTHFR gene mutation, and can be a helpful adjunct in depression, though increasing endogenous amount of SAMe, a naturally occurring substance with mood boosting and pain relieving properties, that is also available as a supplement in the US and 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% of people said that it made them feel better, 33% said that it made them feel worse, while 7% saw no difference in symptoms. Based on the improvement rates, this leads me to believe that 50-70% of people with Hashimoto’s are likely deficient in stomach acid. Those that felt worse, were likely not deficient- 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% of those who found it helpful reported this), reduced pain (40% reported this, to my surprise), and improved mood (35%). 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 expand 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 generally 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/Hashimoto’s in itself can cause low stomach acid, as can ageing and in some cases this can be a genetic issue, 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 Pepsinsupplementation:
- H Pylori infection (which can also trigger Hashimoto’s, article coming soon), treatment of indication is indicated to address the root cause
- B12 deficiency, which may be associated with a vegan diet or with antiparietal cell antibodies (B12 article)
- Adrenal dysfunction which can deplete nutrients required for stomach acid [Adrenals and Thyroid article]
- MTHFR mutation- the MTHFR gene mutation 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 [MTHFR Mutation Article]
- Other nutrient deficiencies, especially in thiamine [Thiamine and Thyroid Fatigue Article]
Betaine HCl and Pepsin should be taken after a protein-rich meal, starting with one capsule per meal, at the end of the 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 one capsule, didn’t feel symptoms
Meal No. 3: Took three capsules, didn’t feel symptoms
Meal No. 4: Took four capsules, felt symptoms
Target dose is: three capsules
Recommended Supplement Brand
I use the Pure Encapsulations brand of Betaine with Pepsin. The betaine is derived from beets, while the pepsin is porcine derived. It contains Vitamin C, which is derived from non-GMO corn dextrose. 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.
Hope this message helps you on your thyroid journey!
Your Thyroid Pharmacist,
Dr. Izabella Wentz, PharmD, FASCP
P.S. Have you seen improvements in your health through the root cause approach? Do you want to help others do the same? If so, I hope that you'll join me in my mission to help people with Hashimoto's recover their health!