This article is not intended to diagnose or treat any diseases.
Due diligence is a necessary part of the healing process. If you believe you are worth the effort, then seek the knowledge you need to reveal the truth.
In the world of functional medicine and nutrition we use a large array of herbs, vitamins, minerals, amino acids and other biological substances to restore function and support healing. Most of the supplements we use are fairly safe. Even when the diagnosis is incorrect or if a side effect occurs, most reactions will resolve quickly with no permanent harm. However, there is a handful of supplements that can cause, at best, a setback and, on occasion, significant side effects. Betaine hydrochloride (HCl) is one of them. When used appropriately and under the correct diagnosis, Betaine HCl can have seemingly magical effects on conditions like acne, eczema, asthma, idiopathic malnutrition, GERD and other digestive issues. However, a visit to most mainstream medical websites will advise you, “Do not take Betaine HCL”. This is with good reason. Betaine HCL can exacerbate several underlying health conditions and, in rare instances, can cause life-threatening health issues.
Betaine HCL is used to treat a condition called hypochlorhydria (insufficiently strong stomach acid). Although it hasn’t been subject to rigorous clinical trials, here is the simplified hypothesis; when acid is the stomach is not strong enough (pH between 1.5 and 3.5) animal protein cannot be effectively digested into amino acids and smaller protein fragments. As a result, the stomach somehow detects this problem and continues to produce weak acid. The weak acid fills up past the stomach and into the esophagus. Unlike the iron-clad lining of the stomach, the esophagus is easily damaged by acid. The thinking is that Betaine HCl works by restoring the correct pH (increasing the acidity) of stomach acid. When the correct dosage achieved, the excess production of weak acid stops and normal digestion of protein and minerals resumes. If the correct dose is not achieved, supplementing with Betaine HCl has little value. Practitioners, here is a link to a method that was originally presented by Jonathan Wright M.D. on how to figure out the correct dose of Betaine HCl. As the author describes, most cases require no more than 2500mg for reestablishing adequate acid levels. I have seen a few cases where the replacement dose was over 6000mg per meal.
Accurate Diagnosis is Crucial
There are many downstream health issues that can arise from inadequate digestion of protein. These include IBS, excessive flatulence, leaky gut syndrome, asthma, acne, allergies, eczema, acid reflux, idiopathic malnutrition, premature osteoporosis etc. There are scientifically sound explanations for each of these that we will discuss another time. However, any of these conditions can be caused by other factors and, none of them is a defining symptom of low stomach acid (hypochlorhydria).
Most importantly, acid reflux, often diagnosed as GERD, is NOT a pathognomonic symptom of hypochlorhydria. The exact same symptoms can be caused by overgrowth of bacteria and in small intestine, excess production of acid, stagnation of the motor migrating complex and, more commonly, by excess histamine. This is why decades of research produced two classes of drugs to treat GERD. These are the proton pump inhibitors (PPI’s) and H2 blockers (Histamine receptor blockers). It can be implied that the effectiveness of these two categories of drugs in treating symptoms can shed some clarity on the root of the problem. In more complex cases, hypochlorhydria and excess histamine will occur simultaneously.
The Big Cautions With Betaine HCl
Esophageal Damage and Strictures
Pills of Betaine HCl can get lodged in areas where the esophagus has narrowed from scar tissue or has shrunk from old age. This usually causes a strong, sharp pain. If the pill remains for more than a couple of minutes, it can literally burn the area. If this happens, the irritation can last several days and it is best to discontinue the course of Betaine HCl therapy until it is completely healed. To prevent damage to the esophagus in cases like these, it is crucial to flush the area until the pill is small enough to move on. This can be done by sipping a weak solution of baking soda in warm water (1/4 tsp per 12 oz of water) OR by diluting a full dose of a liquid antacid in warm water. DO NOT use baking soda if the patient has high blood pressure. This scenario is more common in elderly patients and it is better to break up the Betaine HCl capsules before swallowing them. As a general rule, if this happens, don’t hesitate to seek medical attention.
Exacerbation of Gastritis
Gastritis is inflammation of the stomach lining. It has many causes but ultimately occurs because the cells lining the stomach cannot replace themselves quickly enough to maintain the integrity of the tissue. When this happens, any small amount of acid can quickly damage the lining. This is a potentially dangerous situation as ulcers can form. Possible causes include excessive alcohol consumption, use of corticosteroids and NSAIDS, stress, excess acid production, nutritional deficiencies, excess levels of histamine and infection.
Combine a stomach that is severely irritated by excess histamine and add Betaine HCl and you have yourself a new condition that can take several weeks to fully heal.
Symptoms of gastritis can easily go unnoticed. This is especially true for people who are busy, overwhelmed and/or highly driven. I meet people all the time in my practice who have had low to mid-grade symptoms of gastritis for years without giving it a single consideration that something could be wrong. This can also happen because some people have an altered perception of pain in their digestive tract. Nerve blocks and cauterizations as well as medications, like antidepressants, narcotics and opioids, can reduce pain sensations. Practitioners! Confirm your diagnosis before prescribing Betaine HCl and proceed cautiously with the dose. DO NOT assume that patients will notice side effects immediately.
A True Story of a Gastritis Nightmare
More than a decade ago, I had a nutrition consultation with a gentleman who had clear signs of gastritis. Although he didn’t think so, his lifestyle was extremely stressful. He was founder and CEO of a very successful chain of stores. He worked long hours and traveled frequently. Drinking too much alcohol was one way he compensated for the stress. His symptoms manifested as a dull ache (fairly mild) above his naval that was worse on an empty stomach, with water, with spicy food and about 20 minutes after eating (food usually absorbs acid for a few minutes before the stomach makes more). He denied any sign of dark, tarry pieces in his stool (a sign of bleeding in the digestive system). At the time of our meeting, he was preparing to leave for a big game hunting trip in east Africa. I insisted that he consult a physician before departing. His first week in the African bush he developed anemia as a result of a bleeding ulcer. It took several days for him to reach a facility with adequate medical care. He ended up having to have surgery and, more unfortunately, a blood transfusion that left him with a lifelong disease.
A significant percentage of women find that hormone therapy using birth control pills or natural progesterone supplementation is extremely effective for reducing acne blemishes and improving the overall health of the skin. It also helps to lighten periods, reduce cramping and contributes to an overall sense of well being. However, a certain subset of women experience a worsening of symptoms, increased blood pressure or feel just plain “crazy” soon after starting this type of hormone therapy. Fret not dear souls! This scenario has a simple explanation, is seemingly easy to fix and points to a situation that could build into more significant health problems later in life Progesterone, the natural form of the synthetic hormones used in birth control pills, is part of large family of hormones collectively called steroids. Most of us have heard of the more common steroid hormones like estrogen and testosterone. Others include the stress hormone cortisol and the blood pressure hormone aldosterone. When the body has an increased need for a particular hormone (for example cortisol) it can convert other hormones, like progesterone, into whatever hormone it thinks it needs. It does this with the help of enzymes. If you look at the diagram below, each arrow along the pathway is labeled with the name of the enzyme that drives the reaction. (Thanks to Walter F. Boron and Emile L. Boulpaep for their contribution of this beautiful diagram to Wikipedia. )
Notice progesterone, in the yellow, can convert easily to cortisol and aldosterone through the enzymes 21-hydroxylase and 11-betahydroxylase. The levels of these enzymes ultimately control how much progesterone is converted into cortisol and/or aldosterone. Sometimes there is an authentic need for more of a certain hormone. For example, higher amounts of cortisol are used by the body to moderate inflammation during an immune response or during times of increased stress. Sometimes, our genetic programming simply tells our body to make too many of these enzymes regardless of whether there is a need or not. Regardless of the cause, I am absolutely convinced that rooibos tea is an easy way to begin to slow down the conversion and depletion of progesterone. I got this idea after reading this study[i] demonstrating that rooibos tea had the ability to slow the activity of some of these enzymes and had a normalizing effect on cortisol and aldosterone precursors.
I suggested this to a few of my patients who I suspected were suffering from this specific scenario. At first, I was unsure if a simple cup of rooibos tea would be strong enough to have any significant impact. I was pleasantly surprised to find all them had noticeable results within a month. Every single one of them reported feeling calmer. Several of them reported an improvement in their sex drive. One of them had her high blood pressure return to normal within three weeks. All of them had significantly easier periods with fewer cramps and clots. One of them had a normal period for the first time in years. Previously, her periods were coming every three weeks and were accompanied by heavy bleeding. She was chronically anemic and alway felt worse with progesterone. This same lady ended up needing to reduce her dose of thyroid medication, which had been the same for years. I’m guessing this is partly because of the effects of cortisol on the thyroid through the adrenal-thyroid axis and maybe partly because progesterone boosts thyroid function. My acne patients who had symptoms of this scenario all improved by at least 20% and two ladies improved by about 70% after one month. Acne is multifaceted so it would be unlikely that rooibos tea would act as a magic pill but it definitely seems to help. I was REALLY encouraged by these results. The lady who had the high blood pressure had a relapse about two months after. At first we couldn’t figure out why but then realized that she had bought some rooibos tea that contained licorice, which is known to elevate blood pressure. When she stopped this her blood pressure returned back to normal within a week. There are a couple unknowns here. To reduce overall inflammation, I have all of my patients stop drinking coffee and alcohol and reduce their sugar intake to less than 7 grams per meal. If someone is still consuming these, I’m not sure if some of these substances might override the beneficial effects of the rooibos and continue to drive the pathway in the wrong direction. I would LOVE to hear your feedback.
Constructive comments that contribute, whether positive or negative, are welcomed. All others will be ignored or referred to trolls who are smarter than you and have nothing better to do.
[i] Schloms L, Storbeck KH, Swart P, Gelderblom WC, Swart AC The influence of Aspalathus linearis (Rooibos) and dihydrochalcones on adrenal steroidogenesis: quantification of steroid intermediates and end products in H295R cells. The Journal of Steroid Biochemistry and Molecular Biology [2012, 128(3-5):128-138]