It seems betaine HCL is often recommended for those suffering from "low stomach acid" -- which, as I understand, is having too high stomach pH for proper digestion (especially for proteolysis via pepsin). However, I have a few questions then -- though I'm not sure if my reasoning is correct here:

Understandably, one wouldn't want to drink pure or highly concentrated HCl by itself to increase stomach acid! But then, what role does the betaine play?

I'm guessing betaine HCl probably does not dissolve in water to give the same pH as just straight (or concentrated) hydrochloric acid -- since then it would seem just as dangerous as drinking plain HCl!

In that case, if it doesn't decrease the pH as much, making it safe for oral consumption, what value does it bring for "lowering stomach pH" anyway? I mean, one could just drink a little vinegar or citric acid for the same effect?

Or, perhaps, is betaine-HCl just a means of some "delayed release" of HCl to lower stomach pH without hurting the mouth and esophagus during its initial consumption? Betaine may just be a useful amphoteric here, given it's quarternary ammonium and carboxylic acid groups (although not just any amphoteric, such as water, may suffice here!)

Alternatively, could the value of betaine HCl simply be in providing a source of $\ce{Cl-}$ anions, possibly for increased pepsin activity? (I'm not sure if pepsin requires merely low pH or specifically also needs $\ce{Cl-}$ anions as well) Betaine-HCl seems to be often formulated with additional pepsin enzyme(s) as well...

  • $\begingroup$ One factor could be that betaine has a pKa of 1.8, considerably higher than HCl and somewhat close to stomach pH. Pure HCl could have a pH of 0 or lower. Betaine is also a biocompatible osmolyte. $\endgroup$ – Curt F. Mar 27 '17 at 3:54

Betaine HCl is usually delivered in capsules which pass through the mouth and esophagus intact. Regarding the webmd article that says " Even if it were true, betaine hydrochloride wouldn’t help. It only delivers hydrochloric acid but does not itself alter stomach acidity." This statement seems contradictory. Indeed, I found article the tests stomach ph after betaine hcl usage and confirms that indeed it reduces it: https://www.ncbi.nlm.nih.gov/pubmed/23980906

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  • $\begingroup$ But in that study it looks like the pH measurements were taken on rather fasted patients, not after having a moderate amount of solid food intake. I'd imagine a much greater amount of betaine HCl would be required in that case to significantly raise stomach acidity -- which, im guessing, is another reason why the FDA banned it in the first place. $\endgroup$ – ManRow May 12 '17 at 23:23

Looks like I was right to be skeptical, according to WebMD:

Betaine hydrochloride is a chemical substance made in a laboratory. It is used as medicine.

Betaine hydrochloride has an interesting history. Betaine hydrochloride used to be included in over-the-counter (OTC) products as a “stomach acidifier and digestive aid.” But a federal law that went into effect in 1993 banned betaine hydrochloride from use in OTC products because there wasn’t enough evidence to classify it “generally recognized as safe and effective.” Betaine hydrochloride is now available only as a dietary supplement whose purity and strength can vary. Promoters still claim that some health conditions are due to inadequate stomach acid, but this claim has not been proven. Even if it were true, betaine hydrochloride wouldn’t help. It only delivers hydrochloric acid but does not itself alter stomach acidity.

Betaine hydrochloride is also used to treat abnormally low levels of potassium (hypokalemia), hay fever, “tired blood” (anemia), asthma, “hardening of the arteries” (atherosclerosis), yeast infections, diarrhea, food allergies, gallstones, inner ear infections, rheumatoid arthritis (RA), and thyroid disorders. It is also used to protect the liver.

Don’t confuse betaine hydrochloride with betaine anhydrous. Use only the FDA-approved betaine anhydrous product for the treatment of high levels of homocysteine in the urine (homocystinuria). This is a symptom of some rare genetic diseases.

How does it work? It isn't known how betaine hydrochloride might work.

from http://www.webmd.com/vitamins-supplements/ingredientmono-312-betaine%20hydrochloride.aspx?activeingredientid=312&activeingredientname=betaine%20hydrochloride

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