Dr. Izabella Wentz, PharmD

Thyroid Pharmacist

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Hashimoto's & Low Stomach Acid

How Betaine with Pepsin Can Help with Hashimoto’s

Medically reviewed and written by Izabella Wentz, PharmD, FASCP

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Many moons ago, 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- and dairy-free in 2011. The medication did reduce my cold intolerance, need for sleep by about one hour, and anxiety. Furthermore, eliminating dairy and gluten helped to stop my acid reflux, irritable bowel syndrome, and joint pain, as well as reduced my thyroid antibodies… but my symptoms of fatigue and brain fog persisted.

When I first became chronically exhausted, I would sleep as long as possible. This was much easier as a college student. Unfortunately, it led to having less time to study for my exams, but I soon learned to compensate. I would sleep all day, then stay up all night to study. After taking my exams at 7:30 am, I would then come home and sleep more.

Other times, when I had to wake up with fewer than 10 hours of sleep, I would often be struck with diarrhea. I remember saying to my mom, “It’s like I need to sleep so that my body can process everything I ate, and when I wake up too early, it’s still not processed.”

I started taking one new supplement on Friday, February 10th, 2012 — one capsule with each meal. 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 am most mornings that 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.

Within two short days, 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 telling myself to do for months. As the week went on, I felt myself having more and more energy, and actually became more and more talkative. Additionally, the mental fog had 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 had improved as well.

This supplement was betaine with pepsin — an enzyme used to support protein digestion. I want to share a little more about this one supplement that was my first “AHA” moment for getting my health (and life) back.

In this article, you’ll discover:

  • How common low stomach acid is in those with Hashimoto’s
  • How betaine with pepsin can help Hashimoto’s and pain
  • Who should not take betaine with pepsin
  • Recommended betaine with pepsin supplements and proper dosing
  • Additional ways to support low stomach acid

Low Stomach Acid and Hashimoto’s

If you’ve been following me for a while, you’ll likely have heard of me talking about betaine with pepsin — 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.

You may have been told that you have too much stomach acid, and that you need to go on medication to help reduce the acid your stomach is producing… And chances are that, if you’re like me, you’ve taken the advice of mainstream doctors and websites, but still don’t feel well or “human.”

What if I told you that it may actually be the opposite — that you may not be producing enough stomach acid?

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, we are 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 on poorly digested proteins. In one small study, 54 percent of people with hypothyroidism were found to have SIBO.
  • Nutrient depletions – Especially in calcium, iron/ferritin, and B12.

If prolonged, low stomach acid 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.

Symptoms of Achlorhydria or Hypochlorhydria

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 lead me to believe that a person with Hashimoto’s has low stomach acid include:

  • Acid reflux (this condition, which is conventionally treated with acid suppressants, can actually be caused by low stomach acid)
  • Low B12
  • Low ferritin or iron levels
  • Fatigue despite thyroid medications
  • Constipation/diarrhea

What is Betaine HCl and Pepsin?

Betaine HCl and pepsin (also known as betaine hydrochloride and pepsin, or simply betaine 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 the 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 acidity in the gastric opening. Betaine HCl used to be available as an over-the-counter (OTC) drug, marketed as a stomach acidifier and digestive aid.

It was later removed from OTC use in 1993 due to insufficient evidence of it working, and was banished to being a dietary supplement by the FDA. Please note that this difference means 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.

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 2015 survey of 2232 people with Hashimoto’s, out of 627 people who took betaine HCl and pepsin…

  • 59 percent said that it made them feel better
  • 33 percent said that it made them feel worse
  • 7 percent saw no difference in symptoms

The improvement rates lead me to believe that 50-70 percent of people with Hashimoto’s are likely deficient in stomach acid. Those that felt worse were likely not deficient, as taking the supplement can make a person with adequate stomach acid feel worse for a short time (burning in the throat and stomach upset may occur). Those that did not see any improvement may not have been dosed adequately, as betaine with pepsin dosages needs to be individualized.

The biggest improvements seen after taking this supplement were improved energy levels (58 percent), reduced pain (40 percent), and improved mood (35 percent). One-fourth of the people who took betaine with pepsin felt that this supplement also helped them with losing weight.

Betaine HCl and pepsin 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:

  1. The body may not need to expend as much energy on digestion, and since digestion is one of our body’s biggest energy expenditures, we often begin to have a surplus of energy.
  2. The amino acids found in proteins become bioavailable, helping with the creation of neurotransmitters and fuel for our bodies.
  3. We will be less likely to react to our foods, as the food particles will get broken down into individual amino acids before they move further down into our gut.
  4. We will feel lighter after we eat, and will not have cravings for food when full.

Pain and Hashimoto’s

When we assist our digestion with the use of betaine with pepsin, it is possible to reduce pain.

As I mentioned above, 40 percent of people with Hashimoto’s reported a reduction in pain with the use of betaine with pepsin.

Why does betaine with pepsin reduce pain?

At first, this question caught me a bit off guard, but the more I thought about the mechanism of action, the more it made perfect sense. Betaine and pepsin break down protein bonds in food, thereby aiding digestion, reducing intestinal inflammation, and even leading to reduced systemic inflammation and less pain for many people.

Betaine can also help break down homocysteine, which has been associated with inflammation and increased risk of cardiovascular conditions, especially for those with the MTHFR gene mutation (more on the MTHFR gene mutation in the sections below).

Furthermore, betaine can increase the amount of SAMe, a naturally occurring substance with mood-boosting and pain-relieving properties, within the body.

Who Should Avoid Betaine with Pepsin?

Using this supplement in excess can lead to stomach irritation, and I always recommend a slow dose titration to determine your optimal dose.

That said, some people should NOT take betaine with pepsin. This supplement should not be used by those with a history of peptic ulcers* or gastritis**, those with an active H. pylori infection, or those with an overproduction of acid. Discuss with your primary care practitioner before taking if you are pregnant or breastfeeding.

(*Signs and symptoms of an ulcer include a dull pain in the stomach, weight loss, nausea/vomiting, acid reflux, bloating, and burping. Pain improves when you eat, drink, or take antacids.

**Signs and symptoms of gastritis include a gnawing/burning feeling in your upper abdomen, nausea/vomiting, and fullness after eating. Symptoms can improve or get worse after eating.)

Do not take betaine with pepsin if taking blood thinners, non-steroidal anti-inflammatory drugs (NSAIDs), steroids, or other medications that may increase one’s likelihood of developing an ulcer. I also recommend avoiding this supplement if you are taking proton pump inhibitors or other acid-suppressing medications, as these will negate the effect of the supplement.

Additionally, while having hypothyroidism or Hashimoto’s in itself can cause low stomach acid, as can aging and genetics, 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 and pepsin supplementation:

  • H. pylori infections, which can trigger Hashimoto’s.
  • B12 deficiency, which may be associated with a vegan diet or with anti-parietal cell antibodies (proteins that are produced by our immune system and mistakenly target specific cells within the stomach lining).
  • Adrenal dysfunction, which can deplete nutrients required for stomach acid production.
  • The MTHFR mutation, which 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.
  • Other nutrient deficiencies, especially thiamine.

Proper Dosing of Betaine with Pepsin

Betaine HCl and pepsin should be taken with a protein-rich meal, starting with one capsule per 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.

Dosing example:

  • Meal No. 1: Took one capsule, didn’t feel symptoms
  • Meal No. 2: Took two capsules, didn’t feel symptoms
  • Meal No. 3: Took three capsules, didn’t feel symptoms
  • Meal No. 4: Took four capsules, felt symptoms
  • Target dose: Three capsules (one capsule less than what resulted in symptoms)

Betaine with Pepsin Recommended Dosing

Recommended Supplements

I recommend Rootcology Betaine with Pepsin, which provides 750 mg of betaine hydrochloride, along with pepsin, and is free of fillers and common reactive ingredients like gluten, dairy, soy, and pesticides.

Rootcology Betaine Pepsin

I also like the Betaine HCL supplement from Pure Encapsulations, which contains vitamin C derived from non-GMO corn dextrose, in addition to betaine and pepsin. 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 diluted apple cider vinegar or lemon juice can support digestion in some cases of low stomach acid. For apple cider vinegar, I recommend one teaspoon of apple cider vinegar in one glass of cold water. For lemon juice, I recommend squeezing the juice of one lemon into a cup of hot water. Please note that these substances should also not be used with an ulcer or gastritis.

If you want to take betaine and pepsin to help break down homocysteine due to having the MTHFR gene mutation, please note that beets are also a rich source of betaine, and their betaine content can break down homocysteine. (Individuals with the MTHFR gene mutation have trouble processing the amino acid homocysteine, elevated levels of which have been associated with heart disease, difficult pregnancies, birth defects, and possibly an impaired ability to detoxify.) One to two servings per week would be recommended — and since they are high in sugar, you will want to pair them with a healthy fat or protein source.

Takeaway

The connection between low stomach acid and Hashimoto’s was a huge “AHA” moment for me, and led me to write my first book. I had always loved writing and dreamed of writing a book that would help others, but I thought becoming an author would be impossible — especially while working at a full-time job and with my 12-hour sleep demands!

Once I started to take betaine with pepsin, I had a breakthrough. I discovered that I had low stomach acid… and it was truly affecting my thoughts, the pain I was experiencing, my extreme fatigue, and my every move. When those symptoms resolved and my energy started to skyrocket, I was finally able to follow my dream and write a book to help others with Hashimoto’s.

I hope this article sheds some light and brings hope to you if you are suffering from any of the above symptoms — pain, fatigue, gastric infections, and acid reflux, to name a few. Finding your proper dose of betaine with pepsin may bring you relief so that you, too, can follow your dreams that may have been held back due to low stomach acid.

As always, please discuss the use of supplements with your personal doctor or pharmacist. This article is for informational purposes only, and I am not able to advise on whether this or any other supplement would be appropriate for you and your specific health needs, without a comprehensive health assessment.

To learn more about betaine with pepsin in addition to other helpful interventions, please consider picking up a copy of Hashimoto’s Protocol and Hashimoto’s: The Root Cause.

I hope this information helps you on your journey!

I’d love to hear from you! Have you been having trouble with symptoms of acid reflux? Have you tried betaine with pepsin and seen improvements with supplementation?

P.S. For continued updates and interaction, please become a part of our Facebook and Instagram communities, and sign up for our newsletter. I love interacting with our readers!

References

  1. Betaine HCl with Pepsin. Supplement Information. Pure Encapsulations. https://www.purerxo.com/thyroidpharmacist/rxo/products/product_details.asp?ProductsID=929. Accessed October 9, 2015.
  2. Kohli DR, Lee JZ-E, Koch TR, Talavera F, Anand BS, Greenwald D, et al. Achlorhydria Clinical Presentation. Medscape. https://emedicine.medscape.com/article/170066-clinical#b5. Updated July 15, 2016. Accessed May 3, 2018.
  3. Daher R, Yazbeck T, Jaoude JB, Abboud B. Consequences of dysthyroidism on the digestive tract and viscera. World Journal of Gastroenterology. 2009;15(23):2834-2838. doi:10.3748/wjg.15.2834
  4. Osborne D, Sobczynska-Malefora A. Autoimmune mechanisms in pernicious anemia & thyroid disease. Autoimmun Rev. 2015;14(9):763-768.
  5. Rojas Hernandez CM, Oo TH. Advances in mechanisms, diagnosis, and treatment of pernicious anemia. Discov Med. 2015;19(104):159-168.
  6. Gerenova, Manolova M, Tzoneva VI. Clinical significance of autoantibodies to parietal cells in patients with autoimmune thyroid diseases. Folia medica (Plovdiv). 2013 Apr-Jun;55(2):26-32.
  7. Lauritano AC, Bilotta AL, Gabrielli M, Scarpellini E, Lupascu A, Laginestra A, et al. Association between hypothyroidism and small intestinal bacterial overgrowth. J Clin Endocrinol Metab. 2007;92(11):4180-4184.
  8. Betesh AL, Santa Ana CA, Cole JA, Fordtran JS. Is achlorhydria a cause of iron deficiency anemia? Am J Clin Nutr. 2015;102(1):9-19.
  9. Jensen RT. Consequences of long-term proton pump blockade: insights from studies of patients with gastrinomas. Basic Clin Pharmacol Toxicol. 2006;98(1):4-19.
  10. Oudi ME, Aouni Z, Mazigh C, et al. Homocysteine and markers of inflammation in acute coronary syndrome. Exp Clin Cardiol. 2010;15(2):e25-e28.
  11. Aghili R, Jafarzadeh F, Bhorbani R, Khamseh ME, Salami MA, Malek M. The association of Helicobacter pylori infection with Hashimoto’s thyroiditis. Acta Med Iran. 2013;51(5):293-296.

Note: Originally published in October 2015, this article has been revised and updated for accuracy and thoroughness.

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Disclaimer: The information contained herein is for informational purposes only and should not be construed as medical advice. Please consult your physician for any health problems and before making any medical or lifestyle changes.

Lifestyle changes can result in improved thyroid function and/or an increased absorption of thyroid hormone medications, leading to a lower required dose and possible symptoms of hyperthyroidism at a dose that was previously stable. Please discuss lifestyle changes with your physician and ensure that your thyroid function is monitored every 6-8 weeks while making lifestyle changes. Symptoms of overmedication include, but are not limited to: rapid or irregular heartbeat, nervousness, irritability or mood swings, muscle weakness or tremors, diarrhea, menstrual irregularities, hair loss, weight loss, insomnia, chest pain, and excessive sweating. Do not start, change, increase, decrease or discontinue your medications without consulting with your physician.

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Comments

  1. Thank you for this great information. Is it okay to do a trial of betaine with pepsin if someone has leaky gut? Also, would the supplements have a high oxalate content like beets (I have kidney stone issues)?
    Reply

    • Patricia- 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. Here is the link! 🙂

      http://www.purerxo.com/thyroidpharmacist/rxo/products/product_details.asp?ProductsID=929

      Reply

    • Jessica- The digestive enzymes should stimulate your body’s own production
      of acid, and help you extract nutrients from your food. After some
      time, you should be able to get off the enzymes as your own body
      begins to produce enough digestive acid. Alternatively, lemon juice
      and apple cider vinegar can also help to produce more digestive acid. I do use the Pure Encapsulations brand of Betaine with Pepsin. Here is the link! 🙂

      http://www.purerxo.com/thyroidpharmacist/rxo/products/product_details.asp?ProductsID=929

      Reply

      • I have also started taking betaine with pepsin along with glutamine, zinc and probiotics to help with digestion, leaky gut and rebuilding my gut flora. I also take selenium. When can I expect or how will I know when I can stop taking these, mostly the betaine with pepsin? I just don’t know the duration that I should be taking these supplements. Thanks!

        Reply

  6. Dr. Wentz~ First I thank you for all your hard work to help find the root causes of Hashimotos. So, I have suspected low stomach acid for some time now, and I attempted the Betain HCL w/ Pepsin challenge. I was up to 9 pills with no discomfort, and I was nervous that I would injure myself if I took more. Thoughts on this? Thanks again.
    Reply

  7. Yes, you are SO RIGHT about the hypochlorhydria being a root cause of Hashimoto’s. And what’s the root cause of the hypochlorhydria? B6 deficiency. And what’s the root cause of the B6 deficiency? A common but utterly under diagnosed metabolic condition called Pyroluria. PYROLURIA – look into it.
    Reply

  8. Hi, thank you so much for sharing this information. I know this is probably on an individual basis, but for how long would you need to take these pills (weeks/months?) and when would you know is an appropriate time to eventually lower your dose or stop taking it all together ? Thank you 🙂

    Reply

  9. Thank you so much for taking the time to write this article! I have wondered if I have low stomach acid and many if the symptoms listed are ones I deal with. I was diagnosed with Hashi’s 5 years ago and it’s been a journey learning how to help my body! Is the Betaine with pepsin something that once started always needs to be taken or does your stomach start to eventually make more acid on its own? And when taking the Betaine can other vitamins be taken at the same time or will it affect absorption ? Thank you so much again!

    Reply

  10. Dr. Wentz,
    I have read most of your book. It is not clear to me what was the root cause of your Hashimoto’s. Was it the low stomach acid the root cause of your Hashimoto’s?

    Reply

  11. Dr. Wentz – Thank you so much for all your hard work and great information! I am devouring your recent book and it is very helpful! I started taking Betaine with Pepsin and got a wonderful response of energy and sense of well being. Unfortunately, I also got itching in my pubic area. I’ve tried apple cider vinegar and lemon to increase stomach acid, but betaine with pepsin was more effective. Do you have any suggestions for how to use it with less side effect? (itching occurred with one dose of 650mg)

    Reply

  12. Why acid reflux came back with taking ACV with lemon in the mornings? I was able to regulate my digestion with the diet for Hashimoto’s and now I have very bad acid reflux. Betaine appears to help me. I hope it gets better with time. Should I avoid acidic foods?

    Reply

  13. Dr Wentz, I am slightly confused about exactly when the best time is to take the betaine with pepsin tablets. In your post you mention to take it at the end of the meal but most other articles indicate to take it before the meal and one even says it should be taken in the middle of the meal. Can you please clarify why it is better to take it at the end of the meal and must it be the moment you finish the meal or can it be 5 or 10 minutes after the meal?

    Reply

    • Tesla – thank you for following this page.

      You should start with the directions on the bottle and adjust your dosage from there. I cannot tell you specifically what you can and cannot do over the internet as I could be held liable for what would happen to you.

      Reply

      • I have tried EVERY way, and for me, taking a little of my meal before I take my enzymes then finishing helps minimize any acid/ burning feeling. Also, I only take the betaine HCl w pepsin with a protein meal. If it’s only vegetables and light carbs, I take lighter enzymes.

        Reply

  14. Thank you for your work! In your experience, is there a maximum number of pills or should people keep going up until they “feel the burn”

    Reply

  15. Hello Dr. Wentz, I’ve been supplementing with Betaine plus Pepsin for over a year now. During this time I found out I have a pork allergy and just made the connection after reading your article that the pepsin is derived from porcine. Do you know if there’s a supplement with only hydrochloride acid?

    Reply

  16. I was diagnosed with Mitochondrial Disorder 10 years ago by a Molecular Neurologist. I had follow-on evaluations at Mayo in Scottsdale and also participated in a research treatment study at the Barnes-Jewish clinic on the campus of St. Louis U. The outcomes were the same–confirmation of mito disorder, but no definitive treatment options, merely “strong” recommendations for taking Carnitor, COQ-10 and Alpha Lipoic Acid for life, which I’ve been doing daily since that time.
    Unfortunately, my health has continued to plummet, especially over the past year. My fatigue/dizziness are perpetual upon waking and never subside during the day, but worsen throughout the day.
    In addition to the aforementioned diagnosis, I they also confirmed that I have Fibromyalgia, MTHFR Deficiency, Peripheral Neuropathy, Ankylosing Spondylitis, Amyloidosis, Cervical Stenosis, Cervicogenic Dizziness, Autoimmune Neuropathy, Autonomic Fiber Sensory Neuropathy, Degenerative Joint Disease & Osteoarthritis, Adrenal Fatigue, Autoimmune Autonomic Ganglionopathy, and finally, military-related PTSD. Otherwise, I feel just terrific!
    With this expansive list of rare and problematic diseases and disorders, it’s been a challenge finding and keeping doctors that are specifically trained/knowledgable about treating these medical issues. Some have told me they simply don’t believe that I have all of these maladies, and others have said they don’t have the time required to research/treat these relatively uncommon issues, but encourage me to continue searching for a doctor that may be well informed and motivated for offering treatment.
    At the moment I’m basically in limbo because the neurologist I saw three times abruptly left her practice for family-related issues, so I’m back to square one trying to find a doc with this specialty. This is frustrating, disappointing and depressing.
    If you have any recommendations or suggestions I would appreciate hearing them.
    Thanks for your interest, have a pleasant day.

    Reply

  17. Thabks for this information! what can other reasons for low stomach acid be besides H. pylori? Because i was tested for that in a stool test and it was nrgative. is there a chance for false negatives? the lab recommended testing several times because they said H. pslori is excreted intermittently but my doctor refused to do that. So do you believe there could
    be another reason or should i test again?
    I havea pH of 7.

    Reply

  18. I was diagnosed with Hashimoto’s 7 years ago, after a bout with Alopecia U. Reading up on the symptoms and signs, I suspect I’ve had a low thyroid my whole life. One thing struck me in this article, however. The connection between H. Pylori and Hashimoto’s. In my early 20’s, I had been diagnosed with a peptic ulcer. H. Pylori had not been discovered yet, but I often wonder if that is what started my ulcer. Now, I can’t help but wonder if that is what triggered the Hashimoto’s. I have not had ulcer symptoms in over 20 years. Would it be safe for me to try Betaine HCl with Pepsin? I have all of the symptoms that you list in this article.
    Thank you!

    Reply

  20. I have been taking betaine HCL for a couple of years now and can’t seem to get my stomach acid to produce naturally. I am not sure why I still have low stomach acid. My thyroid levels are optimal and I don’t have any nutritional deficiencies that I know of. After taking a round of thiamine supplments I needed to increase my dosage of HCL. Any ideas how to get my body to produce higher levels of stomach acid on its own?

    Reply

    • Erica – thank you for following this page. We know that intestinal permeability (aka leaky gut) is present in every case of autoimmunity and often precedes the development of Hashimoto’s. Symptoms of leaky gut may include bloating, diarrhea, constipation, stomach aches, acid reflux and irritable bowel syndrome. According to the Institute of Functional Medicine, many people develop IBS 5-10 years before an autoimmune diagnosis. I was one of them and didn’t take my gut health as seriously as I should have. Gut problems are often caused by infections like H. pylori, parasites like Blasto, SIBO, an imbalance of bacteria, and enzyme deficiencies or food sensitivities (especially to gluten, dairy, and/or soy). Even stress can be a factor in gut permeability. Here is an article you might find interesting.
      6 DIFFERENT ROOT CAUSES
      https://bruno-michael-wentz.dev01.rmkr.net/articles/6-different-hashimotos-root-causes

      Reply

    • I supplemented Betaine HCl for 30 years and could never figure out why my stomach acid was so low. It did help me a lot. However, I began taking an iodine supplement at 12.5 mg daily 2 years ago and within 2 weeks, I had normal stomach acid. This has continued and is a blessing. My thyroid bloodwork has always been normal and has continued normal (TSH 1.1) – most recent testing was last month. I think there is more to the iodine controversy that needs to be addressed by you and other health care practitioners Dr Wentz.

      Reply

    • Carol – thank you for following this page. We know that intestinal permeability (aka leaky gut) is present in every case of autoimmunity and often precedes the development of Hashimoto’s. Symptoms of leaky gut may include bloating, diarrhea, constipation, stomach aches, acid reflux and irritable bowel syndrome. According to the Institute of Functional Medicine, many people develop IBS 5-10 years before an autoimmune diagnosis. I was one of them and didn’t take my gut health as seriously as I should have. Gut problems are often caused by infections like H. pylori, parasites like Blasto, SIBO, an imbalance of bacteria, and enzyme deficiencies or food sensitivities (especially to gluten, dairy, and/or soy). Even stress can be a factor in gut permeability. Here is an article you might find interesting.
      6 DIFFERENT ROOT CAUSES
      https://bruno-michael-wentz.dev01.rmkr.net/articles/6-different-hashimotos-root-causes

      Reply

  22. Hi there,
    Thank you for your amazing content and book. I just noticed that I have been taking Betaine HCI & Pepsin instead of the one with “J” that you have listed above. can you explain the difference? Do you suggest the other one to be used instead?

    Reply

    • Kelly – thank you for following this page. Not everyone will need every single supplement! In fact, I believe that most nutrients should come from the diet. This is why I always list food sources in the book and on the blog, for most of the nutrients, vitamins, minerals and probiotics that are depleted in Hashimoto’s. However, some may require/prefer supplements and the supplements on the website are a resource for those that do. I recommend getting tested for deficiencies to determine your need for a supplement as instructed in the book and blog. I also don’t recommend starting multiple supplements all at once. I recommend starting one at a time, and then adding another a week or so later once it has been confirmed that the first supplement is not causing any harm.

      I do have a full supplements chapter in my book. Have you checked it out? Not everyone should be taking every supplement and the book will help uncover your root cause. This will help you figure out your supplementation.

      Hashimoto’s Root Cause
      http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

      Hashimoto’s Protocol
      thyroidpharmacist.com/protocol

      Reply

  24. Sure would love to give this a try but the price, conversion, and shipping makes it cost prohibitive for us outside of the US….is there anywhere else that you can find something similar to at least trial it?

    Reply

  25. Hello Dr. Wentz, this is SO exciting for me because I’ve been looking for my root cause after being diagnosed July 2016……I believe I have low stomach acid which I never thought possible because I don’t have the bloating or burping/gas that many others have, my biggest symptoms are severe fatigue and very irregular bm’s. I started drinking celery juice last week every morning and symptoms seems to be getting better…..something really clicked when I read that when your stomach can’t break down the food particles they can make you sick over time……..thank you SO much for your understanding of this disease and sharing your journey and the things that one can try to help with their own illness. I would like to try the Betaine with pepsin but at this time I do better with supplements in liquid form so will be looking into that as pills just seem to sit there and build up in my system making me sick, which makes total sense if they are not being broken down and utilized!!

    Reply

  27. Hi Isabella,

    You mention in your book that you shouldn’t take Betaine and pepsin if you have an H. Pylori infection. Can you tell us why? Thank you.

    Reply

    • Kristy – thank you for following this page. If you have Hashimoto’s and a history of ulcers, PPI use, NSAID use, or steroid use, I highly recommend testing for gut infections, especially H. pylori and SIBO, which could be triggers of gut symptoms and Hashimoto’s. As HCI may irritate stomach ulcers, best to test first! <3 Hope that helps.

      Reply

  28. Lots of good questions from others here. I really wish Dr. Wentz would stop using the canned responses and actually respond to the actual questions! It might be quicker to just give a simple response than to go find and copy and paste your canned response. It’s rather obnoxious to see a good question that many others probably have as well and then she just pastes some irrelevant canned response…

    Reply

    • Tim – Thank you for being here. It’s impossible for me to respond to tens of thousands of people without using pre-made responses. Many of the questions are the same. I appreciate your understanding.

      Reply

  29. I’ve seen wonderful results in how I feel taking the Betaine with Pepsin. I’ve had so much energy, and I feel so much better after my meals. It’s been a real mood booster, feeling like something’s actually working.

    I had a question, though. You say you need to take this after consuming protein-rich meals, but would you also recommend taking it after the AI Paleo Protein Powder? I’ve been taking this lately along with the Betaine wit Pepsin and I started wondering if it was necessary since my body wasn’t necessarily working as hard to digest it. What would you say?

    Reply

  30. I have Hash for 10 years and 2 years ago was diagnosed with an esophageal stricture. My Dr stretched it during an Endoscopy. He said I had inflammation below the stricture so gave me Omeperazole. I took it for a year or so then quit. I felt it was screwing up my Levothyroxine absorption. I have already tried taking Young Living Essential of Lemon. I felt great and had tons of energy. But was scared I was again altering my Levo absorption. I have reflux symptoms after 6 months of having the scripture stretched. Don’t know what to do. My endocrinologist says all my numbers are good. Will lemon essential oil work for me without changing my lab numbers?

    Reply

  31. Dr. Izabella Wentz I am 65 yrs old, female. Several years ago, on a doctors recommendation, my thyroid was treated with Radioactive Iodine. Recently I had to go to the ER with severe pain in my sternum and had a EGD a week later. My doctor told me that I am not producing enough stomach acid. I am on Armour Thyroid and I cannot take Levothyroxine. I am wondering about trying this Betaine HCl with Pepsin. I want to try something natural rather than having a doctor Rxing me. What do you think? Thank you.

    Reply

  32. I’m actually on 6 pills so far and no “burning” or “stomach discomfort” at all.
    Is that even possible? What’s the limit? lol

    Reply

  33. Right now I’m doing the Gut Protocol in your book Hashimoto’s Protocol. I’m up to 19 of the Betaine with Pepsin and I haven’t gotten the burning sensation in my throat. Should I keep going up in dose?

    Reply

      • Hi Dr Izabella I recently had Hiatal Hernia Surgery 1 1/2 months ago! I am on PPI med and I still seem to have difficulty breathing and possible acid reflux! I have hashimotos and celiac! Also I have been diagnosed with IBS! I believe I may have LPR and thats why I may have breathing problems and Voice Loss! I think this PPI could be making my acid worse! However, I was diagnosed with small peptic ulcers in my stomache several years ago, about 15 approximately! I want to see if pepsin will help me and I want to get off this PPI Med! Im concerned about the long term side effects of PPI! Also I need to get my voice back and brething under control! Please advise! What doctor can I go to that will detrrmine if I need pepsin or not? Or should I just order a test myself to see if I need pepsin? And do you think its ok for me to take pepsin since I had GERD, IBS, HIATAL HERNIA, possible LPR and PEPTIC ULCERS! Also, I had 3 ulcers in my esophegus that has healed I think! So please help me to decide a coarse of action as these current symptoms disrupt my life greatly!!! I need a plan! Thanks You for this post!

        Reply

  35. I’ve had stomach problems most of my life (first ulcer was at age 12). I currently take hcl w/pepsin, and I am SO thankful for it!
    My question is, is it normal to still have problems belching up food? Like solid or semi solid chunks. Is that a thing g happening to others, or am I the oddball out? What, if anything, is there to do about it?
    Thank you, in advance.

    Reply

  36. How would you address someone who refluxes all supplements (including collagen!)? LOVED your last book. Purchased nearly all the liver supplements recommended. Sadly I refluxed all of them. This seems to be a trend for me with supplements lately. Feel very defeated as I try to move forward with my health. Thinking about starting with your H pylori procotol. Or, how would you advise someone to get through this obstacle? Thank you for all you do!

    Reply

    • Sherri – thank you for reaching out and sharing your journey! I am so sorry to hear you are struggling with supplements. <3 I highly recommend that you work with a functional medicine clinician to be a part of your own health care team. It’s an entire medical specialty dedicated to finding and treating underlying root causes and prevent serious chronic disease rather than treating individual disease symptoms. I believe that everyone needs to find a practitioner that will let him/her be a part of the healthcare team. You want someone that can guide you, that will also listen to you and your concerns. You want someone that’s open to thinking outside of the box and who understands that you may not fit in with the standard of care. It's a good idea to ask some standard questions when contacting a new doctor for the first time. Something else to consider is you can work with a functional doctor remotely, via Skype. You could also contact your local pharmacist or compounding pharmacy, who may be able to point you to a local doctor who has a natural functional approach. I encourage you to keep looking for the right one for you! Here are some resources you might find helpful.

      CLINICIAN DATABASE
      https://www.thyroidpharmacistconsulting.com/clinician-database.html

      FIND A FUNCTIONAL MEDICINE CLINICIAN
      https://ifm.org/find-a-practitioner/

      Reply

      • Deeply appreciate your thoughtful and honest response. Overwhelmed trying to decide who will be the best match. Wish you were still seeing clients. 🙂 Thank you again for taking the time to share your thoughts.

        Reply

        • Sherri – you are very welcome! I do hope you keep me posted on your progress here. You may be interested in my 12 week online program called Hashimoto’s Self-Management Program that covers all of the strategies that I go through with my one-on-one clients, in a self-paced format, so that participants have access to all of the things I’ve learned about Hashimoto’s without having to schedule costly consults with me or another practitioner. In addition, any person that goes through the program will get access to a Quick search Q&A Database of 1000+ questions asked by past program participants, Root Cause Assessment based on 100’s of my clients’ root causes and triggers, 2-week Meal Plans, recipes, and shopping lists to get you started on the following diets: Paleo, Autoimmune Paleo, SIBO, Candida. Also, Discounts on lab tests, high-quality supplements, and consultations and much more to support you in your journey! There are a few requirements that you should pay attention to, such as my book which is a required read. <3

          Hashimoto’s Self-Management Program
          https://bruno-michael-wentz.dev01.rmkr.net/enroll-in-hashimotos-self-management/

          Reply

          • Dr. Wentz – deeply appreciate this dialogue. Know how precious your time is so it means so much that you’ve taken the time to respond to me, twice! Your program intrigues me for sure. I’ve consider it many times. Should be a simple and obvious “yes” but I’m struggling with how often I don’t seem to match the common path. My reactions and experiences seem different than others. It’s probably not that complicated… Maybe I’m missing that one little step that will create the change I’m needing. But sometimes it would be nice to talk to someone in the process. Will continue to consider the program. Can see a world of potential by signing up! So much gratitude for you! – Sherri

          • Sherri – you are very welcome! If you would like more information about my Hashimoto’s Self Management program please contact my team at info@thyroidpharmacist.com and they would be happy to help you further. I hope you continue to keep me posted on you progress here or on my Facebook page. <3

  37. I learned about this supplement reading your book but don’t recall the dosage info. I began taking because no matter what I ate I felt tired after meals. I eat relatively clean (free from gluten, dairy, processed foods) but still felt tired. It does seem to help but now I need to test the dosage because I’ve only taken 1 capsule at meals.

    Great article!

    Reply

  38. understanding digestive enzymes such as ox bile etc is for the small intestine etc
    vs
    Betaine with Peptin is for the stomach
    how does one know which one is needed

    Reply

    • Angelo – thank you for reaching out. 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. Here is an article that might be helpful as well.
      https://bruno-michael-wentz.dev01.rmkr.net/articles/using-enzymes-to-overcome-hashimotos/

      Reply

  39. Hi, I was just wondering about the contraindication between betaine and NSAIDs. I do take NSAIDS every once in a while. Is this okay, or are you more referring to people who take them regularly (like daily)?

    Reply

    • Trish – thank you for reaching out. I wish I could give you more direct advice but, each person will react differently. I would advise you to ask your personal pharmacist or a trusted clinician who’s care you are under. <3

      Reply

  40. Dr Isabella, thank you for all you do for Hashimotos people like me. I discovered your Root Cause Book in 2016 & immediately began AIP protocol. Helped immensely! My husband was in critical plane crash in that year & the stress load obviously did a number on me, in particular my gut! Last year has been AWFUL, bloating, serious constipation, many food sensitivities, weight loss. I tested three months ago for SIBO, it was positive, began treatment with Atrantil. Helped for one glorious month, then symptoms returned big time. So discouraging! I was out of town & the thought went through my mind about what you wrote re:low stomach acid & digestive enzymes. I pulled to nearest store & bought Betaine w/Pepsin & G.O.L. digestive enzymes…WOW!!! Just what my belly needed! All the symptoms are gone, I have been reintroducing foods from AIP (I had also been on FODMAPS), my digestion is steadily improving, my energy & mood better!! I take one digestive enzymes before my meal, then wait 20 min after my meal & take my Betaine. I followed your protocol on dosage. Dr Went, I truly thank you, your book & life story have helped me immensely. I’m very grateful!!

    Reply

    • Susan – Thank you so much for reaching out and for sharing your story! My mission is to collect 10,000 success stories with the hope of submitting them to a medical journal in the future. Understandably, you are probably very busy, but if you have some time, please do you mind sharing your full story with me here at this link? https://bruno-michael-wentz.dev01.rmkr.net/testimonial/

      These stories will go a long way in helping others who are going through a similar journey to yours. Thank you for your consideration!

      Reply

      • Dr Isabella, thank you so much, I would be humbled & honored to share my testimonial in hopes of helping others who struggle like I have. Where I live it’s near impossible to find a functional medicine Dr, so I’ve had to play my own doctor. I’ve done tons of research, your book being such a godsend! So..I will gladly share the stuggles & triumph on this journey of battling the many faces of Hashimotos!
        Thank you & God bless you Isabella!
        ~Susan Greiner

        Reply

  41. Hi Dr Wentz, I had sibo and got rid of it but now it is back. The last time I had sibo I supplimented with HCL with pepsin but I would gett terrible belching and burping even with one tablet. I stopped taking it bc I assumed this meant I had enough stomach acid. I have a very leaky gut celiac and lots of food intolerances and terrible ibs-c. I am under the care of a functional med dr and I read your Hashimotos book as I am “pre” hashimotos Great book! I do no tolerate any meat. Igg allergy response. My question is….if I do the vaking soda test and it shows I have low stomach acid how could I take HCL with pepsin if I only eat cook low fodmap veggies? That probably wouldnt be enough protien would it? How can I suppliment with it on a limited diet? Im thinking maybe its part of the reason why my sibo came back. My dr thinks it came back bc of slow motility not stomach acid. Any advice would be extremly helpful! Thanks.

    Reply

  42. How does a hiatal hernia play into the acid reflux (GERD) problem? I’ve found that digestive enzymes are helpful and the Betaine with Pepsin too. But I still have stomach and reflux trouble. I’m suspecting the hiatal hernia needs addressing. Do you have any thoughts on this? Thank you

    Reply

  43. Hi Dr. Izabella,
    I have been on synthroid for years with minimal problems. My doctor noticed that my fT4 was high and lowered my dose, even though my fT3 and TSH was normal. After 3 months my fT4 halved and my TSH shot up and my fT3 went below normal range. This threw my body into a state chaos. Even after returning to my previous dosage I have been suffering with awful mood symptoms and after reading this I suspect gastritis. That gnawing burn or ache in the chest you describe became unbearable. I couldn’t sleep. I started looking on the internet and found out about delayed gastric emptying and modified my diet to ease the symptoms. I have also moved to a synthroid/cytomel combination in order to circumvent the apparent conversion problem I seem to have. I notice you suggested that it is not wise to use Betaine HCL with pepsin when you have gastritis. In this situation have you used ACV with patients to help? Thanks in advance.

    Reply

    • Tara – thank you for reaching out and sharing your journey. Some people 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.

      Reply

  44. I have read your articles on your website in relation to Gut Issues.

    I HAD severe Acid Reflux and Gas symptoms before started taking Betaine HCL with Pepsin. That one is a life changing advise. BUT

    my concerns are, for how long am i going to take this medicine for? I am only 41 and don’t wish to take supplements too early in my life. I am currently on a tablet a day in the evening and i am living fine with it. But i believe it is too much of extra supplements to be inserted manually, Are my worries genuine or am i okay to take carry on with HCL for longer period of time? What could be the side effects i may develop if i carry for longer time? Are there any other blood tests that i need to keep monitoring for any other side effect related changes?

    Reply

    • Zanikar – thank you for following my page! <3 I am not able to advise you without a comprehensive health assessment. I recommend that you discuss this with your personal doctor. If you have more specific questions on how and when to take particular supplements under normal circumstances, please do reach out to my team by email, at info@thyroidpharmacist.com and they will be more than happy to help ?

      Reply

  45. Hi, I developed a burning sensation in my upper abdomen which comes and goes daily one and a half years ago after my doc gave me PPI’s for reflux. I’ve had a gastroscopy which showed nothing. In Australia they don’t have the heidelberg test. I’m pretty sure I have low stomach acid. Have you ever heard of low stomach acid causing non ulcer pain? I’m on 1g of HCL but I don’t think its enough…I have low pancreatic enzymes and SIBO…Thank you!

    Reply

    • K/s – thank you for reaching out and sharing your journey. I am sorry to hear you are struggling with this. <3 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. Here is an article that might be helpful as well.
      https://bruno-michael-wentz.dev01.rmkr.net/articles/using-enzymes-to-overcome-hashimotos/

      I would suggest the low FODMAP diet as a good starting place to address your SIBO (Small Intestine Bacterial Overgrowth). It is also recommended during the treatment of SIBO (or suspected SIBO) that you limit the use of probiotics that contain prebiotics like fructooligosaccharides (FOS), inulin, and arabic gum, as well as foods high in prebiotics. Here is an article you might find helpful: https://bruno-michael-wentz.dev01.rmkr.net/articles/sibo-prevent-remission-hashimotos/

      Reply

  46. Hi Dr. Izabella! First, I want to thank you for everything you do. I am just starting your protocol and am feeling very hopeful. I take hydrocortisone for adrenal insufficiency ( secondary addison’s Disease) And feel like I have low stomach acid for sure. Since you said that taking betaine with pepsin with steroids is a bad idea, is there any alternative so that I can fix my hypochloridia?
    Thanks so much!
    Elena

    Reply

    • Elena – you are very welcome! Lemon juice and apple cider vinegar can also help to produce more digestive acid. The advice of a skilled medical practitioner who is familiar with your health history is always best. <3 I hope you also check out my book!

      Hashimoto’s Protocol Book
      thyroidpharmacist.com/protocol

      Reply

  47. Hi Dr Wentz-

    I know you typically can’t answer questions about supplementation here but i’ll try anyway! I started taking Thorne disgestive enzymes which contain betaine (480 mg) and pepsin (70mg), which I take twice a day. Is this enough? Or would it be wise to also try betaine / pepsin on top of these?

    Reply

    • Alex – thank you for reaching out! I hope you understand, I am not able to advise on this without a comprehensive health assessment. If you have more specific questions on how and when to take particular supplements under normal circumstances, please do reach out to my team by email, at info@thyroidpharmacist.com and they will be more than happy to help ?

      Reply

    • Salome – thank you for reaching out. <3 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 lead 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. Here is an article that might be helpful as well.
      https://bruno-michael-wentz.dev01.rmkr.net/articles/using-enzymes-to-overcome-hashimotos/

      Reply

  49. Thank you so much for recommending this! I’ve actually had the opposite problem of severe insomnia (I think brought on by chronic mold exposure)—and the Betaine HCL w/Pepsin is helping me sleep finally. Some mold docs recommend Chlorestyramine to use bile salts to rid the body of mycotoxins—and I wondered if Betaine HCL w/Pepsin does something similar? I am SO THANKFUL it’s finally helping me get some rest!

    Reply

    • Christy – thank you so much for sharing! I am so happy to hear you are finding the Betaine with Pepsin helpful and are able to get some rest as well. <3 Please keep me posted on your continued progress.

      Reply

  50. Hi Dr. Izabella,
    Thank you so much for everything that you do. It is inspiring. I have already implemented many of your suggestions with your Hashimoto Protocol and I am feeling a lot better already. My TPO has decreased a lot and I was able to halve the thyroxine. However, I still need a lot more sleep than before my thyroid issues started. That is why I am thinking of trying the Betaine with Pepsin. Although I am a bit hesitant as I have not experienced any obvious symptoms of low stomach acidity like acid reflux. There is no contraindication either. I am wondering whether the Wobenzym N you also suggest can achieve a similar result? The Betaine with Pepsin sounds very promising but I fear that this is a strong supplement. I haven’t fully understood whether you use the Betaine with Pepsin to raise your stomach acidity which will then be “fixed” or if you would need to use it continuously? Looking forward to hear back from you.

    Reply

    • Sarah – thank you so much for reaching out and sharing! I’m so happy to hear you are doing so well on the protocols! <3 I cannot advise you on whether the Betaine with pepsin or the Wobenym N would be appropriate for you and your specific health needs without a comprehensive health assessment. I do recommend that you discuss this with your practitioner. If you have any other questions about the protocols or supplements please feel free to email my team at info@thyroidpharmacist.com and they will be happy to help. I would also like to share this article that explaines the differences between the different enzymes. I hope you find it helpful as well:

      USING ENZYMES TO OVERCOME HASHIMOTO’S
      https://bruno-michael-wentz.dev01.rmkr.net/articles/using-enzymes-to-overcome-hashimotos

      Reply

  51. It would be nice if Dr Wentz or her team or anyone reading this thread could recommend digestive bitters that are compliant with an autoimmune protocol. I noticed that all of them have alcohol or seeds…
    I know that B vitamins play a role in stomach acid production but I think the article does not mention zinc. I’m not saying that one should supplement – just that it is also a nutrient to look into when all the other root causes of low stomach acid have been investigated.
    Thank you for your work Dr Wentz!

    Reply

  52. Hi thank you for this article!

    I’ve suspected low stomach acid due to digestive issues, gas after eating and feeling like I’m not absorbing nutrients as I should be. I started with the Bicarb test and had no reaction, so then went on to try the Betaine HCL test as you’ve recommended.

    I’m not exactly sure what my symptoms are telling me as they’re not the symptoms listed. I started off with a very low dose of betain with pepsin (324mg) with no reaction, then increased to 648mg with no reaction, then to close to 1000mg. At this stage I felt a bit light-headed, heavy and a bit bloated, but no burning/warming sensation. I went back down to 648mg to check and I did feel clearer on this dosage. My bowel movement in the morning was good after this but I had an acrid taste in my mouth. Also my throat was a bit scratchy/coughing a little. Does this mean I do actually have enough stomach acid and the HCL is increasing it too much? I don’t seem to get heartburn/burning so I’m not sure if that means I do need more betaine or not.

    Any advice you can give me would be much appreciated!

    Thanks

    Reply

    • Parisa – thank you for reaching out. <3 If you have the heartburn after you take the betaine, there’s a chance that you either don’t have low stomach acid or that it is irritating you. So, I would stop taking it and discuss with further with your personal doctor who's familiar with your history.

      Reply

  53. I have just started on a carnivore diet to see if I can reduce my antibodies. I currently take Pure Encapsulations – Homocysteine Factors, which includes Trimethylglycine at 500mg, once per day. I am not experiencing acid reflux symptoms but am feeling fatigued. Could I add the pepsin and betaine now that I’m having an increased amount of protein at each meal? I have the MTHFR mutation.
    Thank you

    Reply

    • Desire – thank you for reaching out. <3 I am not able to advise on whether the Betaine with Pepsin 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.

      Reply

  54. Hey Shining Star I’m almost certain that you just dug up my root cause with the last ebook you sent me. I will begin using Betadine with pepsin as soon as I get my hands on some and follow up with my results. Thank you Dr. Izabella Wentz, Pharm D.
    Sincerely yours,
    John Pepitone

    Reply

  55. I’m about to try this out – but I’m a little confused! Should I take it with every meal – or just one meal per day?

    Reply

    • Nic – thank you for reaching out. <3 Betaine HCl and pepsin should be taken with each protein-rich meal, starting with one capsule per meal and following the instructions in the article above. If you have any questions please feel free to email my team at info@thyroidpharmacist.com and they will be happy to help you. <3

      Reply

    • I took this supplement, without realizing I had Hashimoto’s at the time, and got some very scary results in that I got up to 16 pills at one time and I still felt no burn. Then, I followed the advice from Fit for Life and separated starchy/higher carb foods from animal products, so that I was eating fully plant-based spaghetti and sandwiches, etc. or a piece of meat with some lovely non-starchy veggies. And, then, I only needed a few capsules for one day and quickly moved to not needing any at all.

      I don’t say this as a prelude to an argument or a promotion of a lifestyle choice and a link to a website. lol I say this to thank you for reminding me. I had my way of life severely interrupted and with that the brain fog came back so hard and I remembered taking this supplement and how much I had to take when doing the initial test, but I had forgotten the rest of it.

      So, thank you for reminding me.

      Reply

  57. Dear Dr Izabella,
    I am so grateful. Betaine with Pepsine has been a revelation. I discovered the low acid issue on your blog, did 4 consecutive days of the ‘burp test’ to find out I must have little to non acid in my stomach! So I started on the treatment and so far so good (great, even!) Thank you.
    Question: how long should this treatment last? How long until the acid production normalises? Or …will it ever rebalance?
    Also – some feedback – I was diagnosed with Hashimoto’s 20 years ago and am stabilised thanks to close monitoring and meds adaptation if necessary (dosage has only changed 2x) . All theough reading your book and articles, I never know if by ‘hashimoto sufferers’ you mean patients who are
    not stabilised (and have a wholde host of symptoms) or if it is regardless (ie: carriers of the autoimmune condition). I hope this makes sense?
    Gratefully yours.

    Reply

    • Anna-Rose – thank you for reaching out. Generally, 6 – 9 months, and then your own stomach acid production should come back; if not, you may have a thiamine deficiency, adrenal issues, H. pylori, SIBO, or other triggers. I like to think of remission as a journey, not necessarily a final destination. Your first goal should be to improve your symptoms, and get to a point where you are no longer symptomatic. The second goal would be to reduce your thyroid antibodies; any reduction is a great start, antibodies under 100 is considered a low risk of progression. If you can get them under 35, then you are no longer considered to “have Hashimoto’s on a blood test.” Your third and final goal should be to reverse the damage. This last part happens at a different rate in everyone. I hope this helps! ❤️

      Reply

  58. Hi, is there an alternative supplement that works if you have symptoms of low stomach acid but have had gastritis in the past?
    Thanks

    Reply

  59. Thank you for all of your detailed information, Dr. Wentz. It is so helpful! I have been diagnosed with low stomach acid, but my functional medicine doctor told me to take the Betaine HCl supplements before each meal. In your article, I noticed that you said to take the Betaine HCL after meals. I just wanted to clarify this as it seems like it’s important. Thanks for your help.

    Reply

    • Kim – thank you for reaching out. 💕 You can do it at the beginning of the meal, during or after. What I’ve found is, if you do it at the beginning or during the meal, basically you’re going to kick start your digestive process. If you do it at the end of the meal, you’re going to let your own digestive process take its course. And then, you’re going to kick it up if it isn’t working. So, I like to use it at the end of the meal. I’ve also found that sometimes you take it before a meal and then you forget to eat, or you don’t eat enough. And then you feel like you might have an adverse reaction to it, because you didn’t have enough protein for it to burn. Then you feel that burning feeling instead. That’s why I generally like to recommend it at the end; I feel like it’s safer. Here is an article you might find helpful.

      Hashimoto’s and Low Stomach Acid
      https://bruno-michael-wentz.dev01.rmkr.net/articles/hashimotos-and-low-stomach-acid/

      Reply

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