One of the many causes of GERD appears to occur from lack of proper stomach acid production. I know that is counter to everything you have heard from mainstream medicine. Most people are told that they have too much stomach acid, which causes GERD. You see advertisements all the time on television for acid reducing medication like PPI’s. You know the commercials with Larry The Cable Guy telling you if you take a PPI you can eat a million hot dogs, ride four wheelers, and not suffer any GERD. Betaine hcl supplementation improves GERD symptoms for most people compared to PPI use, yet PPI’s are advertised everywhere.
The primary cause of GERD is not increased stomach acid but instead is from elevated gastric pressure. For GERD to occur, the LES has to be weakened, increase gastric pressure has to force stomach acid and pepsin into the esophagus, and uncontrolled excessive inflammation has to happen. Generally, throughout the day we reflux occasionally, from esophageal pressure changes, swallowing, and consuming of food. That being said for most people our esophagus can easily handle the reflux episodes and inflammation. For others, they cannot, and they develop reflux conditions like GERD. 1
So How Does Low Stomach Acid Production Cause GERD
Lowered stomach acid production facilitates overgrowth of pathogens and protein fermentation and malabsorption, which increase gastric pressure and stomach distension. The increase in gastric pressure and stomach pressure weakens the LES and causes GERD. 2 3
Stomach acid is produced by our stomach to help limit pathogen overgrowth, digest protein, activate digestive enzymes, signal an increase in mucin production in the stomach, and increase absorption of B12 later in the gastrointestinal tract (intrinsic factor). So without proper stomach acid production, what happens to our digestion? 4 5 6
Microorganism overgrowth eventually occurs and leads to further digestive issues. Protein that is maldigested influences the microbiome, leading to overgrowth producing excessive amounts of hydrogen gas, causing distension, esophageal pressure changes, and LES weakness. Protein is broken down ineffectively from lack of stomach acid, causing excessive protein fermentation from overgrowth leading to increased hydrogen gas production and distension. Upper gut bacteria are also able to use glucose from our food as a source of fuel and increase hydrogen production leading to stomach distension. A hiatal hernia may eventually develop from worsening stomach distension increased further pressure on the LES and esophagus. The increased pressure would further weaken the LES and worsen GERD. 7 8 9 10
Overgrowth in the stomach and esophagus may lead to reduced probiotic Akkermansia muciniphila colonization, in the upper gut, which combined with reduced stomach acid production result in a reduction of mucosal barrier health in the stomach and esophagus. Increased endotoxin production from gram-negative overgrowth can increase inflammation in the stomach, causing gastritis, and increase inflammation in the esophagus, causing the symptoms of GERD. The esophagus is also able to produced limited quantities of bicarbonate (using carbonic anhydrase) to protect itself from reflux, its capacity is reduced if repeated reflux events are occurring. The worsening combination of increased inflammation (endogenous cytokines and chemical injury) from constant refluxing (due to increased gastric pressure) into the esophagus, reduction of mucosal integrity, and endotoxin inflammation causes the symptoms of GERD from excessive esophageal inflammation. 11 12 13 14 15 16 17
All of these issues occur from decreased stomach acid production. Most people are then prescribed PPI’s which reduce stomach acid further (the less stomach acid for a time, the less chemical injury to the esophagus). For a while, inflammation in the esophagus and stomach is reduced from a lack of chemical reflux. Overgrowth worsens over time and eventually, from increased inflammation, GERD symptoms occur again, for some stronger than ever and the cycle repeats itself. The PPI dosage is increased, symptoms abate, then later return worse than ever until the PPI’s dose is maxed out. A truly vicious cycle.
Betaine HCL, Does it Improve Digestion?
Maybe, there is not a lot of diagnostic information available that taking betaine HCL to reduce stomach pH and increase stomach acid production, but we do have promise. We do have an excellent study that measures gastric re-acidification using betaine HCL to try to improve the absorption of certain medications that require proper stomach acid for the breakdown. Prior studies have shown that absorption of certain drugs depend on stomach acid which explains why some medications like ketoconazole or antibiotics are recommended not to be taken with antacids. In a prior study, people taking the PPI omeprazole were given Coca-cola (pH of 2.5) and ketoconazole to see if it would increase absorption of the medication, which it did. 18
In the study, volunteers were given the PPI rabeprazole for five days, and their gastric pH was monitored throughout the study using Heidelberg PH capsules. The pH of the stomach was more alkaline in most of the volunteers who took the PPI for five days. When the volunteers in the study took 1,500 mg of betaine HCL, their stomach pH decreased to around one for more than an hour with no noted side effects. In people with healthy digestion, this level of stomach pH frequently occurs when we ingest our meals. Also, it did appear that at least short term use of betaine HCL does not create a negative feedback loop of decreased gastrin production leading to reduced production of stomach acid, marked by standard blood gastrin tests results during the study. 19
In people with low stomach acid levels, the use of betaine HCL in the short term can help decrease stomach pH, reduce overgrowth, and improve protein digestion. It is still best (until we get more data on long term gastric acid negative feedback loop and betaine HCL use) to improve endogenous stomach acid production by supplementing with bitter herbs like gentian and ingesting enough pure salt (chloride is used to make HCL). If you have ulcers or severe gastritis supplementation with betaine HCL should be done with caution to prevent worsening of symptoms. Finally, in people with H. pylori overgrowth increasing stomach acid production may cause severe inflammation from increased endotoxin and ammonia production from H. pylori and increased burrowing of the bacteria into the mucosal barrier. Use with caution in systemic stomach overgrowth, or if you have ulcers / gastritis. Supplementation with zinc carnosine, l-carnitine, and activated charcoal may reduce these issues. 20 21 22 23
Betaine HCL Protocol
The protocol for taking betaine HCL is simple and can improve your digestion. Start out with two capsules taken during a meal. If you feel like you have severe gastritis or feel pain, stop immediately! If your heartburn is worse, continue to increase the dose by one capsule every day for a week to see if it improves; if not, discontinue the betaine HCL. Increase the dosage of betaine HCL with every meal that contains protein (use betaine HCL only with meals that contain protein, if you are eating a salad do not supplement with and instead add some organic apple cider vinegar to your salad) by one capsule until your digestion improves. Your stools should become darker brown, your stool should be formed, you should have less indigestion, and your stomach should not be as bloated. After a few days reduce the amount of betaine HCL taken with each meal to see if your stomach is producing more acid. Take one capsule less each meal and see if your digestion worsens, if not, continue decreasing the dosage. Never take more than fourteen capsules in one meal. If you get gastritis or pain, consume 1/2 teaspoon of baking soda mixed well in a glass of filtered water to buffer the stomach pH for relief, then consult with your gastroenterologist. Your stomach should be able to handle the small doses of HCL in the supplement, if it cannot, work on fixing your stomach lining.
Premier Labs betaine hcl without pepsin is the brand I recommend. If you cannot order it, consider using Doctor’s Best betaine HCL with pepsin and gentian.
Pepsin is the main enzyme used by the stomach to digest protein. Pepsinogen activates and converts into the enzyme pepsin in the presence of stomach acid. Pepsin helps break down protein into amino acids the body can absorb and then becomes inactivated, by turning back into pepsinogen when it is mixed with bicarbonate released from the pancreas in the small intestine. This transformation protects the rest of the intestinal system from the pepsin and stomach acid. If you have silent reflux, pepsin is your main issue, and you want to avoid supplements with the enzyme. Some people also have adverse reactions to porcine based pepsin but can tolerate betaine HCL without it. 24 25
Lower stomach pH will ensure that the stomach microbiome is kept in balance, and protein digestion improves!
- http://www.ncbi.nlm.nih.gov/pubmed/19191069 ↩
- http://www.ncbi.nlm.nih.gov/pubmed/19191069 ↩
- https://chriskresser.com/more-evidence-to-support-the-theory-that-gerd-is-caused-by-bacterial-overgrowth/ ↩
- Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006. ↩
- Smith, Margaret, Morton, Dion. The Digestive System: Systems of the Body Series, Churchill Livingstone, November 18, 2011. ↩
- http://www.ncbi.nlm.nih.gov/pubmed/1775933 ↩
- http://onlinelibrary.wiley.com/doi/10.1002/mnfr.201100542/abstract ↩
- Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006. ↩
- Smith, Margaret, Morton, Dion. The Digestive System: Systems of the Body Series, Churchill Livingstone, November 18, 2011. ↩
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000497/ ↩
- https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=6&cad=rja&uact=8&ved=0ahUKEwiMi7HAsInNAhVE5SYKHeTiC84QFgiIATAF&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F26100928&usg=AFQjCNHwDrV9jg-pkf-9V5-3xRNjSWd5Ew&sig2=LMZOEA5OYPL2ibKqew6YEg ↩
- http://www.pnas.org/content/110/22/9066.full ↩
- http://aem.asm.org/content/74/5/1646.full ↩
- http://www.hindawi.com/journals/ijoto/2012/646901/ ↩
- http://www.nature.com/gimo/contents/pt1/full/gimo15.html ↩
- http://www.voiceinstituteofnewyork.com/the-potential-use-of-pepsin-and-carbonic-anhydrase-isoenzyme-iii-ca-iii-as-diagnostic-markers-for-laryngopharyngeal-reflux-disease/ ↩
- http://jama.jamanetwork.com/article.aspx?articleid=2521970 ↩
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946491/ ↩
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946491/ ↩
- http://www.christopherhobbs.com/library/articles-on-herbs-and-health/gentian-a-bitter-pill-to-swallow/ ↩
- http://www.sciencedirect.com/science/article/pii/S0024320506005753 ↩
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297603/ ↩
- http://www.ncbi.nlm.nih.gov/pubmed/3719924 ↩
- Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006. ↩
- Smith, Margaret, Morton, Dion. The Digestive System: Systems of the Body Series, Churchill Livingstone, November 18, 2011. ↩
Hi John,
Can you share what you know about the Betain HCL and sulfur connection? There is some talk to avoid the supplement if you sulfur metabolism issues. Is this because you digest proteins better which in turn increases sulfur sensitivity in the duodenum and small intestine or the actual supplement itself? I have improved stools but some of my sulfur issues are slowly returning just wondering what your thoughts are. Thanks!
Dave
Hi, Thanks for the information. I’ve been successfully using Betaine HCL for some time now, but as of recently have been experiencing indigestion, heart burn, and bloating for unknown reasons. My Doctor wants me to start Zantac. What are your thoughts on this? I’m concerned that Zantac and Betaine HCL could have adverse reactions with each other?
Zantac and betaine HCL would cancel each other out since zantac would increase stomach Ph and betaine HCL would lower it. I would not take them both at the same time. I would recommend talking to your doctor about taking betaine HCL during meals and zantac in the afternoon away from food and before bed if really needed, where the pH of the stomach is naturally higher.
Great info, thank you! I would love to hear why some people, especially those with silent reflux, react negatively to pepsin…? Thank you!
https://fixyourgut.com/silent-reflux-lerd-a-digestive-condition-that-mimics-other-health-issues/
Hello! Why is it that you recommend the premier research labs hcl product? It’s more expensive, just wanted to check before I purchased!
Lack of pepsin, that most people react negatively to. Especially if you have silent reflux.
Hello, what would you call short term for this HCL protocol? 3 months? 6 months? And when starting a SIBO protocol (SIBO-c) is it okay to do these at the same time? thank you
2-3 months, yes it should be fine to do both at the same time. Of course ask your healthcare professional.
Hi! I have what I think is Silent Reflux (LPR). My stomach doesn’t appear to have enough stomach acid. I came to this conclusion after taking the “Baking Soda Test”. I drank 1/4 tsp of baking soda, mixed in a glass of water first thing in the morning. I never burped for over an hour & I tried this 2x.
I started drinking 1 tbsp of apple cider vinegar in a glass of warm water 30 mins before each meal. I’ve been doing this for 5 days. This has drastically helped me with my symptoms: less coughing in general (especially after meals), less mucus in my throat, food is getting easier to swallow, less burping, sleeping better.
My acupuncturist is putting me on a 6 week “Balancing Digestion Protocol” tomorrow, which I believe includes HCL. You mentioned that this enzyme should be avoided if you have Silent Reflux. Is this correct? I’m not sure if I read what you said properly.
Thank you!
Betaine hcl, can be fine by itself, but the pepsin in most Betaine supplements is what can be an issue. You do not want to reflux, extra pepsin.
Is there any reason that Betaine would cause me to be extremely bloated and gassy? I never get any burning from it but I seem to get really horrible sulfur smelling gas and bloating when I take it
I just found out seeking health has hcl without pepsin.
Great recommendation, thank you!
Hi, my name is Crystal and I’ve been bloated and gassy for the last year or so. I’ve had every study done GI studies, colonoscopy’s done, every gas x everything probiotic and I”m at a loss now. I do know the food moves through my digestive system slow…I need to know is there anything out here in this world to get this gas and bloating out…Please help :)
Maybe try triphala, Squatty potty, proper magnesium supplementation (see my magnesium blogs), moderate exercise, Perfect Health Diet, and proper hydration to help move things along which may help relieve your bloating and gas.
Is there any way to swallow betaine hcl without having to swallow whole capsules or tablets? I have to open capsules or cut tablets up into small pieces. Can’t swallow them whole.
No, it would irritate the mouth and upper esophageal tissue and if you aspirated it, it would severely harm your lings.
Could you further clarify your stance on pepsin? How to tell if we need it? I feel bloated and gassy after meals but I don’t feel like i have heart burn or chest pain or acid reflux.
Pepsin is an enzyme that the stomach releases to help with protein digestion. It becomes active when it comes it contact with something that has a low pH, like stomach acid for example. It is inactivated by bile and bicarbonate that is released into the duodenum so it does not ingest your intestines. Being bloated and gassy after meals might be SIBO, but if it is uppergut bloating in the stomach and belching it could be an uppergut infection.
Hi! Great article.
I was wondering if you have any insight into why Betaine HCL would trigger a gastritis episode in someone with low stomach acid and without h. pylori. I had used it before and saw no difference. I tried it again and had a negative reaction even though I have confirmed low acid.
You have some sort of uppergut overgrowth and just because you tested negative for H. pylori does not mean you do not have it. My guess is that you have H. pylori and when you take the betaine and it reduces the pH of your stomach it causes it to burrow itself into the mucosa barrier and cause irritation.
Thanks for your reply. I was a little confused when I called my symptoms “gastritis.” They actually seem to be similar to LPR (silent reflux) symptoms. When I take the Betaine, my stomach feels better for a time, but I get worse LPR throat symptoms; when I stop taking it, I have gas, bloating, and constipation, but less LPR. Could H. pylori still be the culprit?
I recently tried to kill my suspected SIBO with oregano oil.It seemed to be working, but then I ran out of my low dose Betaine and Pepsin Complex just as I was ending my herbal antimicrobial protocol, and things go worse again. Could have killing too much bacteria with the oregano while also reducing my betaine supplement at the same time given H. pylori a chance to overgrow? Should I avoid oil of oregano when trying to kill H. pylori (if I end up having it)?What would you recommend to someone like me to get rid of the H. pylori (I understand you cannot give individual advice)?
Thanks for your thoughts.
Yes, or it could be another uppergut bacteria Citrobacter, Enterobacter, or Proteus mirabilis. Yes, it would reduce the Lactobacillus in the stomach which could cause uppergut overgrowth. https://www.amazon.com/Pure-Encapsulations-selenomethionine-Hypoallergenic-Antioxidant/dp/B000H85L5Y/ref=sr_1_4_a_it?ie=UTF8&qid=1471393451&sr=8-4&keywords=selenium
Selenium for bacterial infection?
It may help as an antimicrobial agent. It might as well help to regulate positive thyroid hormone production, which would help the immune system function better.
I had a biopsy for h.pylori no sign of it but i have severe gas after i eat anything…dry mouth and decay in my mouth ….i dont know what to do i am weaing off the pysch meds….but nothing is being absorbed in my gut it just rumbles and i get lots of gas from all food…
https://fixyourgut.com/h-pylori-evil-mastermind-or-ally-part-2/