Editor’s note: This article is presented for informational purposes only and is not meant to diagnose or treat any illness. If you have any health concern, see a licensed healthcare professional in person.
What is Betaine HCl?
Betaine hydrochloride (HCl) is a dietary supplement made from a combination of betaine and hydrochloric acid. Betaine (also called trimethylglycine) is found in certain foods and is also a product of choline metabolism.
Hydrochloric acid (HCl) is a very strong acid that is naturally produced by the stomach. It’s important in both digestion and immunity. It’s mainly used by natural health practitioners as a treatment for digestive issues. It comes in pill form and is sometimes combined with a digestive enzyme called pepsin.
For the record, Betaine HCl should not be confused with betaine anhydrous. Betaine anhydrous is a drug that is FDA-approved to treat homocystinuria and, potentially, liver disease.
FDA Regulations
Note that Betaine HCl is a supplement, not a drug.
That means it’s not regulated by the FDA and there are no standards for usage and dose.
In fact, The FDA doesn’t recognize over-the-counter drugs that contain betaine HCl as safe or effective.
Still, personal testimonies and online reports suggest that it’s helpful for various medical conditions.
This article will focus specifically on betaine HCl.
Summary: Betaine HCl is a supplement made from betaine and hydrochloric acid. It’s used by natural health professionals to treat various digestive issues. Betaine HCl is not regulated by the FDA.
Betaine HCl and Hypochlorhydria
Betaine HCl is said to help remedy hypochlorhydria.
Hypochlorhydria refers to when the stomach is not as acidic as it should be. An acidic stomach is very important for both healthy digestion and immunity (1, 2).
Stomach acidity is measured by a term called pH, with a low pH indicating an acidic environment, and high pH indicating an alkaline environment.
The rise in pH seen in hypochlorhydria results from a low concentration of hydrochloric acid in the stomach’s gastric juice. Similarly, achlorhydria is a complete lack of HCl in the gastric juice (1).
Betaine HCI May Only Help Temporarily
As betaine HCl contains hydrochloric acid, it’s been said to improve digestive function and other conditions that stem from weak stomach acid.
However, low stomach acid is most often a symptom of another health problem, rather than a disease itself. As you would expect then, betaine HCl does appear to restore stomach acidity somewhat… but only temporarily.
In one study of 6 healthy adults with drug-induced hypochlorhydria, a single 1500 mg dose of betaine HCl significantly lowered gastric pH (increased acidity) within six minutes for all volunteers.
However, gastric pH of all subjects returned to previous levels in just under two hours (3).
Another study found similar results. Betaine HCl was effective in lowering gastric pH within an average of 12 minutes for 10 healthy volunteers. Stomach pH returned to previous levels within 69 minutes, on average (4).
As such, the best way to permanently restore a healthy stomach pH would be to treat the underlying cause.
Common causes of hyperchlorhydria include H. pylori bacteria and atrophic gastritis. Long-term use of acid-reducing drugs, including H2-receptor agonists and proton-pump inhibitors (such as Omeprazole for reflux) are also a risk factor.
HIV, gastric bypass surgery, and certain autoimmune conditions have also been shown to lower stomach acid (5, 6, 7, 8).
Summary: Betaine HCl is said to correct low stomach acid (hypochlorhydria), which is linked to several digestive and immune conditions. However, research indicates it only helps temporarily.
Betaine HCl, Acid Reflux, and Functional Dyspepsia
Acid reflux is a common condition in which gastric acid moves upward from the stomach into the esophagus.
Most people have experienced it at least once. Frequent episodes of reflux are symptomatic of gastroesophageal reflux disease (GERD) or functional dyspepsia
Proponents of betaine HCl argue that food breaks down in the stomach more slowly when stomach acid is inadequate. This means food sits in the stomach longer (slower stomach emptying), creating upward pressure on the lower esophageal sphincter and causing reflux.
Small studies have found stomach emptying to be especially slow in those with hypochlorhydria. And there does appear to be links between delayed stomach emptying, GERD, and functional dyspepsia (9, 10, 11).
However, studies have not been able to establish hypochlorhydria as a direct cause of GERD or functional dyspepsia. This may be because many factors can contribute to GERD or dyspepsia in the same person.
Additionally, these conditions can also exist with normal stomach acid levels (11).
Aside from case studies, betaine HCl hasn’t been studied as a therapy for acid reflux or GERD (12, 13).
Until there is more solid research – or unless your doctor recommends it – betaine HCl is not recommended for reflux or dyspepsia.
Summary: There’s indirect evidence that hypochlorhydria may contribute to reflux and functional dyspepsia. However, there is no research that indicates betaine HCl is useful in treating either condition.
Betaine HCl and Drug Absorption
Certain medications are less effective if the stomach is too acidic or too alkaline (14).
Some of the strongest research in support of betaine HCl relates to medication absorption in those with hypochlorhydria.
One such drug is dasatinib, an oral chemotherapy medication used in chronic myeloid leukemia that is best absorbed at a pH of 6.0 or lower. Antacids and H2 blockers have been shown to reduce dasatinib absorption by up to 60% (4, 15).
By contrast, betaine HCl has been shown to markedly improve dasatinib. In a study of 10 healthy adults taking acid-reducing medications, each subject participated in 3 separate treatments:
- Treatment A was 100 mg of dasatinib alone.
- For Treatment B, volunteers took 20 mg of the proton pump inhibitor rabepazole twice per day until gastric pH was greater than 4.0. Then, they received a 100 mg dose of dasatinib.
- For Treatment C, volunteers took 20 mg of rabepazole twice per day until gastric pH was greater than 4.0. Then, they received a 1500 mg dose of betaine HCl, followed 5 minutes later by a 100 mg dose of dasatinib.
Dasatinib absorption for Treatment B was 92% lower than it was for Treatment A. But betaine HCl supplementation resulted in a 15-fold increase in drug absorption compared to Treatment B.
Additionally, drug absorption for Treatment C was 5% higher than Treatment A, which suggests that betaine HCl could slightly boost the effectiveness of dasatinib in the absence of hypochlorhydria (4).
However, many patients state these recommendations are over-simplified and often ineffective. And it makes sense that a one-size-fits-all approach does not work for IBD.
As a result, there are many unique IBD diets that have emerged which we’ll look at in the next section.
Nutrient Deficiencies and Trigger Foods
Although diet is not a cause of IBD, it plays a critical role in treatment.
One of the main reasons is because patients are at very high risk for nutrient deficiencies as the digestive system is not functioning properly.
The most common deficiencies are (12):
- iron
- zinc
- vitamin K
- folic acid
- selenium
- vitamin D
- B12
- vitamin B6
- vitamin B1
Recommended eating patterns for patients must account for these increased deficiency risks.
Foods known to trigger digestive stress should also be minimized. This includes large portions of high fiber foods (eg lots of watermelon), fatty (fried) foods, alcohol and caffeine (13).
Summary: Diet plays a critical role in treating IBD, particularly for preventing nutrient deficiencies and minimizing trigger foods. There are general eating guidelines for IBD patients, although many feel these are too generic and not always effective.
IBD and Specific Diet Plans
Specific diets have recently emerged with claims they help treat IBD.
The general theory is that they keep gastrointestinal inflammation to a minimum, which helps with pain and symptom management.
This is a look at the main ones:
A Low Fiber or Low Residue Diet
This eating pattern is typically prescribed for those in an acute phase of IBD (opposite of remission).
That is, when symptoms are flaring and active.
The idea is to limit the foods that add bulk to stools so that they pass as easy as possible through the digestive tract. It works very well as a short-term solution and is often prescribed in hospital and for a certain time period after hospital discharge.
In severe cases, parenteral nutrition will be used first, which nourishes patients with nutrients direct into the bloodstream. This gives the bowel complete rest (no digestive process is required).
The Specific Carbohydrate Diet (SCD) for IBD
The Specific Carbohydrate Diet (SCD) is an eating pattern that restricts complex carbohydrates.
These are larger carbohydrate molecules that can be harder to digest and are thought to contribute to symptoms.
Early studies suggest SCD may help manage IBD, particularly in children. The most recent study looked at 12 children with mild to moderate ulcerative colitis or Crohn’s disease following the SCD for 12 weeks.
Researchers found five participants (50%) achieved remission after 2 weeks and eight participants (80%) at 12 weeks (two participants dropped out in the beginning). Small changes in fecal bacteria and a reduction in markers of inflammation were also seen (14).
It looks promising, but note that it was ineffective for 2 patients, while 2 others were unable to maintain the diet and dropped out.
Theses results support findings in similar studies on children with IBD. They typically find the SCD is useful, but it’s not uncommon for patients to have difficulty sticking with the diet long term (15, 16).
As for adults, an online survey of 417 IBD patients found that about 33% of responders reported remission when on the SCD for a minimum of two months (17).
Overall the SCD shows promise and could certainly be worth a try after speaking to your doctor or dietitian. Just know that major organisations such as The Crohn’s & Colitis Foundation of America (CCFA) do not promote any particular diet.
Anti-Inflammatory Diet for IBD (IBD-AID)
The Anti-Inflammatory Diet for IBD, also known as IBD-AID, was derived from the Specific Carbohydrate Diet (SCD).
However, it contains a few ‘modifications’ based on more recent research into the human gut microbiome (gut bacteria). We now know that IBD patients experience changes in their gut bacteria compared to the general public (6, 7).
IBD-AID is split into four basic parts that need to be part of your daily diet:
- Prebiotics
- Probiotics
- Good balanced nutrition
- Avoidance of certain foods
Following these guidelines is said to promote a nutrient-dense diet while restoring balance between the “good” and “bad” bacteria in your gut. This should help manage IBD, theoretically.
There was only one study I could find to support these claims, which was a case series of 27 IBD patients (both ulcerative colitis and Crohn’s disease) who tried the IBD-AID.
There was 24 patients who had a good response, and 3 with a mixed response. Those who followed IBD-AID for 4 weeks or more were able to discontinue at least one of their IBD medications (18).
Just note that this was not a controlled trial where those following the diet were tested against those not on the diet (placebo group), so better level evidence is required before any strong recommendations can be made.
The University of Massachusetts has more detailed information on the IBD-AID diet here.
The Low FODMAP Diet for IBD
The low FODMAP diet is a type of elimination diet.
FODMAPs are short-chain carbohydrates known to cause digestive issues in people with irritable bowel syndrome (IBS).
The diet involves eliminating foods high in FODMAPs for between 3-8 weeks before strategically reintroducing them back into the diet. This allows you to identify what specific FODMAPs don’t agree with you.
It may be useful for IBD patients who have overlapping IBS symptoms, but there is no convincing research (yet) that it helps reduce gastrointestinal inflammation. Therefore, there is no clear evidence it helps treat IBD specifically and should be used with caution (19).
Note that in some instances, such as Crohn’s disease with strictures, a low FODMAP diet could do more harm than good. Always talk with your doctor or dietitian first.
The Maker’s Diet
The Maker’s diet is based on the Old Testament laws of the bible and is also known as the Bible diet.
The author says the diet is responsible for curing his Crohn’s disease at the age of 19, but it’s targeted at the general population as well.
There have been no studies conducted on this diet, and certainly not for treating IBD. The author also creates supplements and products that make extreme health claims, which the United States Food and Drug Administration (FDA) has cautioned and threatened with fines.
I cannot recommend you try the Maker’s diet.
Summary: The SCD diet appears promising for long-term IBD management, with a lot of early research being done. IBD-AID and the low FODMAP diet could be worth consideration as well, while the Maker’s diet is not recommended.
Supplements and Probiotics For Treating IBD
There are few supplements and probiotics that have been studied for IBD treatment.
This means the current evidence is in its early stages and often contradictory.
For example, a survey study on New Zealand Crohn’s disease patients found that many foods perceived as helpful to some were perceived as harmful to others, which adds to the confusion (20).
Here is what shows the most promise:
Curcumin (Turmeric)
Curcumin is the active ingredient in the spice turmeric.
It’s known to have powerful anti-inflammatory effects at high doses and should theoretically help with IBD.
A 6-month clinical trial found that 2 grams of curcumin daily alongside standard treatment for ulcerative colitis reduced intestinal inflammation and improved symptoms.
Curcumin use reduced recurrence of IBD symptoms, but these protective effects disappeared when curcumin was stopped (21).
These findings support what was observed in an earlier study of both ulcerative colitis and Crohn’s disease patients (22).
The clinical trial needs to be repeated before we can make any strong conclusions, but it’s certainly a promising area to consider.
Probiotics
Probiotics are “good” bacteria that can improve our health, particularly digestive health.
Most believe they may improve IBD by regulating the inflammatory response or altering gut bacteria composition. Researchers are now trying to determine which type of probiotics (which bacterial strains) are most beneficial (19).
Several probiotic varieties were identified as the best options for IBD at the 2015 Yale University workshop (23):
- Ulcerative colitis: E. coli Nissle and VSL#3. They appear more useful for maintaining remission than treating symptoms.
- Crohn’s disease: E. coli Nissle, S. boulardii and Lactobacillus rhamnosus (also called LGG). The evidence for these is much weaker than for treating ulcerative colitis.
Summary: Few supplements have been tested for IBD treatment. Curcumin is promising, as are several strains of probiotics depending on what type of IBD you have.
IBD and Restroom Access
Sometimes those with IBD will need to use a bathroom urgently.
Obviously this can be quite stressful when out in public.
Fortunately, many countries have cards or laws in place that allow IBD patients to gain access to a bathroom when needed.
- USA: The Restroom Access Act or Ally’s Law has been passed in several states. It allows those with IBD to use employee restrooms when no public restrooms are available.
- Australia and UK: There is a Can’t Wait Card that individuals can show when they need urgent access.
Inflammatory Bowel Disease Treatment: Summary
Inflammatory bowel disease (IBD) is a serious condition that requires strict medical treatment.
Diet changes are required alongside medicine to manage symptoms, correct nutrient deficiencies and reduce the risk of recurrence.
The most promising dietary patterns for preventing flare-ups are the SCD and IBD-AID, but there is still not enough research to make any strong conclusions. The low FODMAP diet is also an option if there is an overlap of IBS.
Curcumin supplements and certain probiotics may help too, but always speak with your doctor first.
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This post originally appeared on Diet vs Disease as Inflammatory Bowel Disease (IBD) and Treatment: Explained in Plain English
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