Betaine HCL, Will It Improve Your Digestion, GERD, or LPR?

 

 

 

Updated 2025

One of the many causes of reflux disorders appears to occur from having an elevated stomach pH. I know that is counter to everything you have heard from conventional medicine. Most people are told that they have too much stomach acid, which causes reflux disorders like GERD and LPR. You see advertisements all the time on television for acid-reducing medications, including antacids and proton pump inhibitors (PPIs). You have probably seen the television commercials with Larry the Cable Guy telling you that if you take a PPI, you can eat a million hot dogs, guzzle gallons of soda, ride four-wheelers, and not suffer reflux. Betaine HCL supplementation improves reflux symptoms for most people compared to PPI use, yet PPIs are advertised everywhere.

The primary cause of most reflux disorders is not increased stomach acid production; instead, it is elevated intra-abdominal pressure. Elevated abdominal pressure weakens our lower esophageal sphincter (LES) and forces gastric contents more frequently into our esophagus, and if our upper esophageal sphincter (UES) is weakened as well, into our larynx and oral cavity. Upper gut dysbiosis and small intestinal bacterial overgrowth (SIBO) cause increased microbial fermentation and gas production, leading to bloating and intra-abdominal pressure. Hiatal hernias and abdominal adhesions from gastrointestinal surgeries can also weaken our LES from improper gastrointestinal alignment and increased intra-abdominal pressure, causing reflux disorders. Generally, throughout the day, we occasionally reflux from occasional natural esophageal pressure changes, swallowing, belching, bending over, and laughing loudly. That being said, for most people, our esophagus can easily handle occasional reflux episodes and inflammation. For others, they cannot, and they develop reflux conditions, including GERD or LPR. There might be differences in the types of reflux materials, which can lead to different reflux disorders, which I have covered in the following linked Fix Your Gut YouTube video.1

 

How Does Elevated Stomach pH Cause Reflux Disorders Including GERD and LPR?

 

Our stomach is meant to have an acidic environment. Increased stomach pH facilitates microbial dysbiosis, bloating, delayed stomach emptying (in severe cases, gastroparesis), protein fermentation, and malabsorption. All of these issues result from increased stomach pH, which increases intra-abdominal pressure and causes the stomach to become displaced. This can lead to a hiatal hernia, putting further pressure on the esophagus and LES. The increase in intra-abdominal pressure, primarily gastric pressure, weakens the LES and causes reflux disorders, including GERD and LPR.2 3

Our stomach produces stomach acid to lower the stomach pH to help limit pathogen overgrowth, digest protein, activate digestive enzymes, signal an increase in mucin production in the stomach to protect from gastritis, and facilitate proper absorption of vitamin B12 later within our gastrointestinal tract (intrinsic factor). What happens to our digestion when we do not produce enough stomach acid, or the stomach acid we produce is neutralized?4 5 6

When you have a consistently elevated stomach pH, microorganism dysbiosis occurs, leading to further digestive issues. Our stomach is not sterile. However, a majority of the bacteria that live within our stomach, including probiotic bacteria like Lactobacillus, tend to be able to survive and thrive in acidic environments. Our stomach has a lower amount of microbes than other parts of our body because of the lower pH, enzyme exposure, and oxygen exposure. Most opportunistic bacteria that cause upper gut digestive issues have to be able to neutralize stomach acid and increase stomach pH to survive. Bacteria, including H. pylori, for example, produce the enzyme urease to metabolize urea, which is found in minute amounts within stomach chyme and produces carbon dioxide and ammonium ions, neutralizing stomach acid and increasing stomach pH. H. pylori cannot thrive in an acidic environment, and when one’s stomach pH is normal (between two to four at resting, one to three when eating), it tends to become dormant within biofilm within our mucosal barrier of our stomach. However, when your stomach pH is elevated, H. pylori becomes active and propagates, causing dysbiosis, which produces toxins depending on the strain that induce inflammation, reflux, gastritis, and ulcers. Maldigested protein within our stomach from an elevated stomach pH negatively influences our stomach’s microbiome. Maldigested protein increases fermentation and possible dysbiosis, producing excessive amounts of hydrogen gas and causing distension, esophageal pressure changes, and LES weakness. Upper gut bacteria can also propagate glucose from food ingestion and increase hydrogen production, leading to gas, bloating, and increased intra-abdominal pressure. A hiatal hernia may develop from worsening intra-abdominal pressure, further increasing pressure on the LES and esophagus. The increased pressure would further weaken the LES and worsen GERD.7 8 9 10

Dysbiosis within our stomach and esophagus may lead to reduced probiotic Akkermansia muciniphila colonization within our upper gut, which, combined with increased stomach pH, harming mucosal barrier health within our stomach and esophagus. Increased endotoxin production from Gram-negative bacterial dysbiosis can increase inflammation within our stomach, causing gastritis and inflammation in our esophagus, causing reflux symptoms. Our esophagus can also produce limited quantities of bicarbonate (using carbonic anhydrase) to protect itself from reflux; its capacity is reduced if repeated reflux events occur. The worsening combination of increased inflammation (endogenous cytokines and chemical injury) from constant refluxing (due to increased gastric pressure) into our esophagus, reduction of mucosal integrity, and endotoxin inflammation causes reflux symptoms from excessive esophageal inflammation.11 12 13 14 15 16 17

All of these issues occur from increased stomach pH. Most people with reflux and stomach disorders are then prescribed PPI, which reduces stomach acid production, further decreasing stomach pH (the higher the reflux pH of the stomach chyme for a time, the less chemical injury to the esophagus). For a while, inflammation in the esophagus and stomach is reduced by reducing the pH of reflux. Dysbiosis worsens from elevated stomach pH and, eventually, from increased inflammation (induced by continued reflux containing pepsin and endotoxins). Reflux symptoms occur again, for some stronger than ever, and the cycle repeats. The PPI dosage is increased, symptoms abate, then later return worse than ever until the PPI dose is maxed out—a truly vicious cycle.

 

Betaine HCL, Does it Improve Digestion?

 

There may not be extensive diagnostic information available regarding the effects of betaine HCL on stomach pH and stomach acid production, but there are promising findings. A significant study has measured gastric re-acidification using betaine HCL to improve the absorption of certain medications that require adequate stomach acid for breakdown. Previous studies have indicated that the absorption of certain drugs depends on a lower stomach pH, which is why some medications, such as ketoconazole and certain antibiotics, are recommended not to be taken with antacids. In an earlier study, participants taking the proton pump inhibitor omeprazole were given Coca-Cola (with a pH of 2.5) along with ketoconazole to determine if this combination would enhance the absorption of the medication. The results showed that it did increase absorption.18

In the study, volunteers were given PPI rabeprazole for five days, and their gastric pH was monitored throughout the study using Heidelberg pH capsules. The pH of our stomach was more alkaline in most volunteers who took the PPI for five days. When the volunteers in the study took 1,500 milligrams 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, 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 test results during the study.19

In people with low stomach acid levels, using betaine HCL in the short term can help decrease stomach pH, reduce the overgrowth of opportunistic bacteria, and improve protein and food digestion. It is still best (until we get more data on long-term gastric acid negative feedback loop and betaine HCL use) to trigger 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 the worsening of symptoms. Finally, in people with H. pylori, dysbiosis, increasing stomach pH may cause severe inflammation from increased endotoxin and ammonia production from H. pylori and increased burrowing of the bacteria into the mucosal barrier. Use caution when experiencing systemic stomach dysbiosis or if you have ulcers/gastritis. Supplementation with zinc carnosine to help repair the stomach mucosa, l-carnitine (supplement with l-ornithine instead if you are suffering from hypothyroidism) to detoxify ammonia, and activated charcoal to bind endotoxins may relieve these issues.20 21 22 23

 

Betaine HCL Protocol

 

The protocol for taking betaine HCL is simple and can improve your digestion. Start with two capsules taken during a meal. If you get severe gastritis or stomach pain, stop immediately! If your heartburn worsens, increase the dose by one capsule daily 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 it and instead add some organic apple cider vinegar to your salad if it does not worsen your reflux [acid ingestion should be limited in people with silent reflux]) by one capsule until your digestion improves. Your stools should become dark brown; if they are not, your stool should become better formed, you should have less indigestion, and your stomach should not be as bloated if the betaine HCL is helping your digestion. After a few days, reduce the amount of betaine HCL taken with each meal to see if your stomach is producing more acid. Upper gut dysbiosis can produce ammonia, increasing stomach pH and decreasing acid production. Lowering the pH of our stomach during meals with betaine HCL can reduce ammonia-producing dysbiosis, allowing your stomach pH to return to normal levels. Take one capsule less each meal and see if your digestion worsens; continue decreasing the dosage. Never take more than fourteen capsules in one meal; doses that high of betaine HCL have been known to cause side effects like gastritis. 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. Wait a few minutes after mixing the baking soda in water for the bubbles to dissipate before consuming to prevent ingesting excess gas. 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.

I recommend Premier Labs betaine HCL without pepsin. If you cannot order it, consider using Doctor’s Best betaine HCL with pepsin and gentian.

If you suffer from dysphagia, use betaine HCL with caution. You would not want one of the capsules to become “stuck” in your throat or esophagus, dissolving and burning the lining, causing pill esophagitis. To prevent this, take the betaine HCL with filtered water and completely swallow the capsules.

Pepsin is an enzyme used by our stomach to digest protein. Pepsinogen is activated and converted into the enzyme pepsin in the presence of stomach acid. Pepsin helps break down protein into amino acids our body can absorb, which are then inactivated. When mixed with bicarbonate released from our pancreas within our small intestine, it turns back into pepsinogen. This transformation protects the rest of our intestinal system from pepsin and stomach acid. If you have silent reflux, pepsin is your main issue, and you want to avoid supplements with pepsin. Some people also have adverse reactions to porcine-derived pepsin but can tolerate betaine HCL without it.24 25

Lower stomach pH will ensure your stomach microbiome is balanced and your overall digestion improves!

  1. http://www.ncbi.nlm.nih.gov/pubmed/19191069
  2. http://www.ncbi.nlm.nih.gov/pubmed/19191069
  3. https://chriskresser.com/more-evidence-to-support-the-theory-that-gerd-is-caused-by-bacterial-overgrowth/
  4. Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006.
  5. Smith, Margaret, Morton, Dion. The Digestive System: Systems of the Body Series, Churchill Livingstone, November 18, 2011.
  6. http://www.ncbi.nlm.nih.gov/pubmed/1775933
  7. http://onlinelibrary.wiley.com/doi/10.1002/mnfr.201100542/abstract
  8. Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006.
  9. Smith, Margaret, Morton, Dion. The Digestive System: Systems of the Body Series, Churchill Livingstone, November 18, 2011.
  10. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000497/
  11. 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
  12. http://www.pnas.org/content/110/22/9066.full
  13. http://aem.asm.org/content/74/5/1646.full
  14. http://www.hindawi.com/journals/ijoto/2012/646901/
  15. http://www.nature.com/gimo/contents/pt1/full/gimo15.html
  16. http://www.voiceinstituteofnewyork.com/the-potential-use-of-pepsin-and-carbonic-anhydrase-isoenzyme-iii-ca-iii-as-diagnostic-markers-for-laryngopharyngeal-reflux-disease/
  17. http://jama.jamanetwork.com/article.aspx?articleid=2521970
  18. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946491/
  19. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946491/
  20. http://www.christopherhobbs.com/library/articles-on-herbs-and-health/gentian-a-bitter-pill-to-swallow/
  21. http://www.sciencedirect.com/science/article/pii/S0024320506005753
  22. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297603/
  23. http://www.ncbi.nlm.nih.gov/pubmed/3719924
  24. Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006.
  25. Smith, Margaret, Morton, Dion. The Digestive System: Systems of the Body Series, Churchill Livingstone, November 18, 2011.