Hashimoto’s thyroiditis (or Hashimoto’s disease) is an autoimmune condition that destroys cells in the thyroid gland and antibody-mediated immune processes. The disease is the most prevalent cause of hypothyroidism[i].
Numbers show that there are three to five cases of Hashimoto’s thyroiditis per 10,000 people every year. The number of people diagnosed with this autoimmune condition increases over time thanks to new diagnostic methods and active searching among family members of known patients.
Middle-aged women are at the highest risk of developing Hashimoto’s thyroiditis[ii]. Management of the condition requires lifestyle modifications that also include changes in diet.
Some patients enrich their diet with various nutrients and supplements including betaine. Is betaine helpful for patients with Hashimoto’s thyroiditis? Let’s find out.
What is betaine?
Betaine is an amino acid or a chemical that occurs in the body naturally.
Betaine is, in fact, a derivative of the nutrient called choline which is an essential nutrient that is found in the human body and many foods.
Basically, choline is a precursor of betaine. This means that in order for betaine to be synthesized, the body needs choline. When choline is combined with an amino acid called glycine, we get betaine.
Similarly to B-complex vitamins, betaine is considered a methyl donor, i.e., a compound which supports proper function of liver, aids body detoxification process, and promotes cellular functioning throughout the body.
As a methyl donor, betaine also supports proper function of the kidneys. Studies confirm that betaine protects internal organs, improves vascular risk factors, and enhances performance. Betaine is considered a vital nutrient in the prevention of chronic health conditions[iii].
As you can see, betaine is an important compound that participates in many processes in the body. Nowadays, supplements containing betaine are very popular, and an increasing number of patients with Hashimoto’s thyroiditis take them to manage their symptoms. Do they help? If so, how?
Betaine and stomach acid
Patients with Hashimoto’s thyroiditis and hypothyroidism often have low stomach acid (hypochlorhydria) or lack of stomach acid (achlorhydria). Hypochlorhydria is defined as a deficiency of hydrochloric acid in the stomach. This particular acid helps the body break down, digest, and absorb nutrients you ingest through food.
Hydrochloric acid eliminates parasites, bacteria, and viruses from the stomach in order to protect it from infections. People can be deficient in stomach acid due to a number of reasons including advancing age, unmanaged stress, nutritional deficiencies, medications, surgery of the stomach, and some health conditions.
Both hypochlorhydria and Hashimoto’s disease have some symptoms in common which can only confirm the strong relationship between the two conditions.
Signs and symptoms that both conditions have in common[iv][v] include hair loss, weak and brittle nails, fatigue and sluggishness, bloating and constipation, among others.
Cellini et al. reported that although stomach and thyroid have different functions and location, they still share similar morphologic and functional characteristics due to their common embryologic origin.
What’s more, the butterfly-shaped gland forms from the primitive gut. Thyroid follicular cells share with parietal cells the same endodermal origin. Parietal cells are the epithelial cells that secrete hydrochloric acid and intrinsic factor. Both thyroid follicular and gastric mucosal cells have the ability to concentrate and transport iodine across the cell membranes[vi].
Basically, both stomach and thyroid functions are connected, so it comes as no wonder why hypothyroidism and Hashimoto’s thyroiditis are associated with lack of stomach acid.
Why is this such a big deal? Low stomach acid puts us at a greater risk of contracting parasites from food, depletion of nutrients, food sensitivities, and small intestinal bacterial overgrowth (SIBO).
This is where betaine steps in! Supplementation with this compound proves to be useful for persons with low stomach acid because betaine contains hydrochloric acid.
Yago et al. found that supplementation with betaine significantly and safely decreased gastric pH in subjects with pharmacologically-induced hypochlorhydria by more than four pH units. These findings support the further investigation of betaine as a solid oral dosage form of hydrochloric acid, and it can contribute to the absorption of orally administered drugs.
A team of scientists explains that supplementation with betaine is a reasonable strategy for improved stomach acid in patients. The reason is simple, betaine supplements are affordable and available to all, and it’s easy to use them[vii].
By supporting healthy stomach acid levels and pH balance, betaine can also aid Hashimoto’s disease management.
The same team of scientists (Yago et al.) carried out a study which investigated the impact of betaine supplementation on the absorption of a drug called dasatinib in subjects with hypochlorhydria.
Regular intake of betaine reversed the impact of hypochlorhydria on exposure to dasatinib and poses as an effective strategy to mitigate drug-drug interactions[viii]. While this study didn’t involve Hashimoto’s patients per se, it did confirm that betaine can, indeed, reverse the impact of low stomach acid.
As a result, betaine takes both a direct and indirect approach to help patients with Hashimoto’s disease manage their symptoms.
Betaine and pepsin
Pepsin is a potent enzyme in the gastric juice, and its primary function is to break down and aid digestion of proteins such as those found in meat, dairy products, seeds, and eggs. In your digestive tract, pepsin participates only in partial degradation of proteins into smaller units named peptides.
Then, peptides are either broken down further by pancreatic enzymes, or they are absorbed into the bloodstream from the intestine[ix].
Bearing in mind that both betaine and pepsin play a role in stomach acid levels, they are usually taken in combination.
Evidence on this subject is still scarce, but patients with Hashimoto’s disease report they feel much better when they take the supplement. For example, a survey of 2232 people with Hashimoto’s thyroiditis showed that out of 627 patients who took betaine and pepsin about 59% said it made them feel better.
Approximately 33% said supplements made them feel worse while only 7% experienced no changes in symptoms. Basically, more than half of people who take betaine and pepsin to manage symptoms of Hashimoto’s thyroiditis experience beneficial effects.
Those who did not experience improvement in their symptoms were, most likely, not deficient in stomach acid and hence supplementation with betaine and pepsin wasn’t necessary.
Another possibility is that they did not take the right dosage.
Patients who reported improvement after supplementation with betaine and pepsin reported energy boost, pain relief, and improved mood[x].
Despite the fact more studies are needed to investigate the relationship between betaine and Hashimoto’s thyroiditis, current evidence is promising.
One of many mechanisms through which this compound could help manage Hashimoto’s is through cardiovascular disease risk reduction.
Chen et al. found that patients with Hashimoto’s thyroiditis are at an increased risk of heart disease compared to the general population[xi]. Betaine is well-known for its potential to decrease levels of homocysteine in the blood thus directly lowering the risk of heart disease.
This happens because the high concentration of homocysteine[xii] is considered a significant factor for cardiovascular conditions, but through betaine supplementation, it can be managed properly.
Overweight and obesity are major problems nowadays. The rates of people with excess weight keep growing alongside the increased risks of many diseases and health conditions.
Sometimes people gain weight due to a sedentary lifestyle and unhealthy diet, but in other instances, some underlying causes could contribute to overweight and obesity.
For example, persons with Hashimoto’s thyroiditis and hypothyroidism are associated with weight gain. In fact, unexplained weight gain is one of the most prominent symptoms of these conditions. The reason why Hashimoto’s disease and hypothyroidism contribute to weight gain is down to the fact that body composition and thyroid hormones are closely related.
Hormones secreted by the butterfly-shaped gland regulate thermogenesis, basal metabolism, and play a significant role in glucose and lipid metabolism.
Hypothyroidism reduces metabolism and thermogenesis, decreases metabolic rate, and correlates with higher BMI and obesity[xiii].
Weight gain can aggravate other symptoms of Hashimoto’s disease and hypothyroidism, thus making it difficult to manage the condition properly.
Betaine can help with this aspect too. Cholewa et al. found that supplementation with betaine improves not only athletic performance but also exhibits favorable effects on body composition[xiv] too. Through enhanced muscle strength, energy boost, and improved athletic performance betaine supplementation helps users keep their weight in a healthy range.
This can both, directly and indirectly, contribute to the management of Hashimoto’s thyroiditis.
Other benefits of betaine
The reality is that betaine isn’t one of the most popular supplements in the world, although an increasing number of people are starting to use it regularly.
Benefits of betaine go beyond the positive effects mentioned above. They also extend to:
- Assists in the detoxification process and exhibits positive effects on the health and function of the liver
- Protects digestive tract from damage
- Helps alleviate muscle aches and pains; this is particularly useful if we bear in mind that many patients with Hashimoto’s disease experience symptoms such as muscle weakness, aches, and pains
- Helps repair bodily damage from alcoholism
Who shouldn’t take betaine?
Similarly to other nutrients and dietary supplements, betaine is considered safe for general consumption.
However, it may not be suitable for some people. For instance, if you have a history of peptic ulcers or gastritis, you may want to think twice before taking betaine, especially with pepsin. The same applies to people who are taking NSAIDs, steroids, and other medications that may cause an ulcer.
A combination of betaine and pepsin may not be suitable for persons who use proton pump inhalator medications because they exhibit opposite effects. The best thing to do is to consult your healthcare provider who will inform you whether it’s safe to take betaine on its own or in combination with pepsin.
If taking supplements, it’s very unlikely that you’ll experience adverse reactions but to avoid potential complications you may want to stick to the recommended dosage.
Every brand provides dosage instructions on the product packaging.
Sources of betaine
While most people buy betaine supplements to manage symptoms of Hashimoto’s disease, there’s always an option to introduce foods containing this compound into your diet.
Or if you already have, then just raise the consumption to obtain sufficient levels of betaine. The best sources of betaine include:
- Wheat Bran
- Rye Grain
- Amaranth Grain
- Bulgar grain
- Sweet potato
- Turkey breast
- Beef and veal
Betaine is a naturally-occurring substance that our body needs for various functions. We can also find betaine in food and as a dietary supplement.
Many patients with Hashimoto’s disease take betaine on its own or combined with pepsin to manage symptoms they experience. Evidence on this subject is scarce, but they do report an improved quality of life and symptom relief.
Positive effects of betaine are down to its potential to improve stomach acid levels which tend to decrease in people with Hashimoto’s disease.
[i] Mincer DL, Jialal I. Thyroid, Hashimoto’s Thyroiditis. StatPearls (Internet), Treasure Island (FL) 2016 https://www.ncbi.nlm.nih.gov/books/NBK459262/
[ii] Hashimoto’s thyroiditis, My VMC https://www.myvmc.com/diseases/hashimotos-thyroiditis/
[iii] Craig SA. Betaine in human nutrition. American Journal of Clinical Nutrition 2004 Sep;80(3):539-49. Doi: 10.1093/ajcn/80.3.539 https://www.ncbi.nlm.nih.gov/pubmed/15321791
[iv] Hashimoto’s disease, Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/symptoms-causes/syc-20351855
[v] What is hypochlorhydria? Healthline https://www.healthline.com/health/hypochlorhydria
[vi] Cellini M, Santaguida MG, Virili C, et al. Hashimoto’s Thyroiditis and Autoimmune Gastritis. Frontiers in Endocrinology. 2017;8:92. doi:10.3389/fendo.2017.00092. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405068/
[vii] Yago MAR, Frymoyer AR, Smelick GS, et al. Gastric Re-acidification with Betaine HCl in Healthy Volunteers with Rabeprazole-Induced Hypochlorhydria. Molecular Pharmaceutics. 2013;10(11):4032-4037. doi:10.1021/mp4003738. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946491/
[viii] Yago MR, Frymoyer A, Benet LZ, et al. The use of betaine HCI to enhance dasatinib absorption in healthy volunteers with rabeprazole-induced hypochlorhydria. AAPS Journal 2014 Nov;16(6):1358-65. Doi: 10.1208/s12248-014-9673-9 https://www.ncbi.nlm.nih.gov/pubmed/25274610
[ix] Pepsin, Britannica https://www.britannica.com/science/pepsin
[x] How betaine with pepsin can help with Hashimoto’s, Thyroid Pharmacist https://thyroidpharmacist.com/articles/hashimotos-and-low-stomach-acid/
[xi] Chen WH, Chen YK, Lin CL, et al. Hashimoto’s thyroiditis, the risk of coronary heart disease, and l-thyroxine treatment: a nationwide cohort study. Journal of Clinical Endocrinology and Metabolism 2015 Jan;100(1):109-14. Doi: 10.1210/jc.2014-2990 https://www.ncbi.nlm.nih.gov/pubmed/25272307
[xii] Olthof MR, Brink EJ, Katan MB, Verhoef P. Choline supplemented as phosphatidylcholine decreases fasting and postmethionine-loading plasma homocysteine concentrations in healthy men. American Journal of Clinical Nutrition 2005 Jul;82(1):111-7. Doi: 10.1093/ajcn.82.1.111 https://www.ncbi.nlm.nih.gov/pubmed/16002808?dopt=Citation
[xiii] Sanyal D, Raychaudhuri M. Hypothyroidism and obesity: An intriguing link. Indian Journal of Endocrinology and Metabolism. 2016;20(4):554-557. doi:10.4103/2230-8210.183454. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911848/
[xiv] Cholewa JM, Wyszczelska-Rokiel M, Glowacki R, et al. Effects of betaine on body composition, performance, and homocysteine thiolactone. Journal of the International Society of Sports Nutrition. 2013;10:39. doi:10.1186/1550-2783-10-39. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3844502/
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