Enzyme, HCL, and Ox Bile Directions:

This handout discusses how to use and determine your personal dose for
digestive enzymes, Betaine HCL w/pepsin, and Ox Bile. Each person will have a
different dose that works best for their needs, and that dosage may change over
time, as digestive function is restored. Determining the right dose for you is not
something we can test with a lab; there is some trial and error involved.

Using Betaine HCL w/Pepsin

HCL (hydrochloric acid) is a critical component of healthy digestion and is

produced in the stomach. Low or sub-optimal HCL production
(hypochlorhydria) can occur for many reasons including age (many people over
60 have hypochlorhydria), use of acid blocking medications, chronic bacterial
infections, and autoimmune gastritis (stomach inflammation).

Without enough stomach acid, it is difficult to digest protein and absorb

minerals and certain vitamins like B12. You are also at increased risk for food
poisoning and other infections.

Common Symptoms of Hypochlorhydria:

• Bloating, belching, burning and excessive gas immediately after meals
• A sense of fullness even with even smaller meals
• Indigestion, diarrhea or constipation
• Food reactions
• Weak, peeling and cracked fingernails
• Dilated blood vessels in the cheeks and nose
• Acne
• Iron deficiency
• Chronic or recurrent intestinal parasites and dysbiosis (abnormal gut flora)
• Undigested food in the stool
 • Chronic yeast infections

Brie may have recommended that you try Betaine HCL, either based on your
symptoms, or, based on the results of a functional blood chemistry profile.
Adequate HCL (hydrochloric acid, or, stomach acid) helps us to better digest the
proteins that we eat.

This simple at-home test can suggest that you have low stomach acid:

Do This 3 Mornings in a Row:

• Step 1: Mix 1/4 teaspoon of baking soda in four ounces of cold water first
thing. in the morning before eating or drinking anything.
• Step 2: Drink the baking soda solution.
• Step 3: Time how long it takes you to burp for up to five minutes.
• If don’t burp within five minutes, stop timing.
• If your stomach acid is good you should burp within 2‐3 minutes.

Recommended HCL Dosages/Protocols:

• Start slowly with 1 pill 10-15 minutes prior to a protein rich meal and
build up by one pill at subsequent protein containing meals, until a slight
burning, or warmth is noticed in the stomach. Note the number of pills at
which you notice the warmth. Your standard dose is 1 less than that.

• For example, if 5 pills burns, then take 4 each protein rich meal.

• The normal adult dosage I see in my practice is commonly 3250mg to

4550mg a meal. Many people are nervous to go as high as 5-6 caps, but I
have seen plenty of people who need 5,000 mg or more for an effective
dosage.

• HCL supplements should never be taken by anyone with an active ulcer,

or by anyone who is using anti‐inflammatory medication such as
corticosteroids (e.g. prednisone), aspirin, Indocin, ibuprofen (e.g. Motrin,
Advil, etc.) or other NSAIDS.

• HCL Supplements should not be used by patients with active

gastrointestinal bleeding.

• Capsules should never be opened and emptied on food or in beverages,

 as HCL is corrosive to tooth enamel.

• Once proper dosage has been determined, take HCL capsules during
the meal, rather than before eating.

• This article, written by my friends Steve and Jordan, helps to explain

common signs of low stomach acid, and, how it impacts our bodies:
http://scdlifestyle.com/2012/06/hypochlorhydria-3-common-signs-of-
low-stomach-acid/

Clarifications:

• If you eat a small snack between meals, you do not need to take HCL.

• If you experience burning or discomfort, you can mix ½ tsp of baking

soda in water and sip this to de-activate the HCL and soothe the
stomach.

• Dr Wright notes in his book that “paradoxically adverse symptoms are

most likely to occur in individuals with the lowest levels of stomach acid.
This is because these people are most likely to have atrophic gastritis (a
thinned-out stomach lining), which makes them more sensitive to even
small quantities of HCL than a normal, thicker stomach lining”. In other
words, a thinned stomach lining won’t have it’s normal protective
mechanisms, in which case, it is better to start with Digestive Bitters
formulas or apple cider vinegar in water. Ironically, the presence of
stomach acid in proper levels helps to maintain proper thickness of the
gastric lining!

• Avoid drinking large quantities of fluid with meals, as this will dilute
stomach acid and enzymes and promote indigestion.

• A healthy stomach is capable of withstanding high dosages of stomach

acid. If you are testing HCL and start to get up to a really high dosage
(more than 6 caps) and still don’t notice warming, first be sure that you are
waiting at least 15 minutes after taking it, before eating, to give yourself
enough time to feel the effects. If this is not the issue, then, use your
symptoms as your guide. Watch for reduced burping, bloating, farting,
and less constipation or diarrhea.

• Taking Betaine HCL will eventually help re-train your body to produce
optimal levels on its own. This typically occurs when digestive infections
have been cleared, and the gut starts to repair. You will notice a warming
sensation or heaviness when this starts to occur, at the same dosages
that used to be your normal. When you notice this, simply reduce your
 normal dose by one capsule per meal. Continue to do this until you no
longer need HCL.

Using Digestive Enzymes

Brie may recommend that you try using digestive enzymes with meals, either
based on symptoms like gas, bloating, constipation, and diarrhea, or, based on
lab results. Digestive enzymes are normally produced by the pancreas, and help
us to digest carbohydrates, fats, and proteins in our foods.

• Start with 1 cap per meal.

• Gradually increase from 1 to 2 caps per meal and watch for improvement
of symptoms.
• You may need to go up as far as 4 caps per meal.
• If you feel burning or discomfort, reduce your dose, or eliminate enzymes
for a day or so, and then reintroduce at lower dose.
• Things to look for are:
o Less bloating and gas
o Less digestive discomfort
o Improved stool consistency
o Less undigested food in stool
o Reduced diarrhea or constipation

Using Ox Bile

Like pancreatic enzymes and stomach acid, bile is produced naturally in the
body. Made in the liver and released by the gall bladder, bile acids help us to
digest and assimilate the fats that we eat in our food. With a healthy gall
bladder, bile is released into the intestines as needed, when we consume fat. If
you have had your gallbladder removed, or if your gallbladder function is
compromised (common with SIBO or digestive infections), you may not be
putting out enough bile to properly digest fat and absorb your essential fat
soluble vitamins.

• Start with 1 cap of Ox bile (125 mg) per meal containing fats.
• Gradually increase as high as 3 caps per meal.
• If you notice that 3 or more caps noticeably change your symptoms, Ox
Bile is also available in 500 mg capsules.
• Look for reduced gas, bloating, and improved stool consistency and
color.
• A key sign of poor fat digestion is yellowish or light colored stool. Loose,
greasy, or foul-smelling stools may also suggest fat malabsorption, as are
gas and belching, nausea after eating fat, very dry skin, and hormone
imbalance.