1. ODX Knowledgebase
  2. Your Clinical Questions

Are there any precautions to use before supplementing with betaine HCL or Apple Cider Vinegar?

H. pylori and gastric or duodenal ulcer should definitely be ruled out before supplementing with betaine HCL to prevent further erosion.

Besides aging and H. pylori, other causes of GI ulcers include acid-blocking medications (e.g., proton-pump inhibitors), pernicious anemia, autoimmune gastritis, and mucolipidosis type IV. 1

Apple cider vinegar may cause distress if an esophageal ulcer is present, however, animal studies suggest that apple cider vinegar may be protective against stress-induced gastric ulcers."2

Since vinegar is a byproduct of fruit fermentation, it will retain the polyphenols found in the fruit. Polyphenols possess substantial antioxidant potential which may contribute to their protective properties.

“…significant decrease in free and total acidity, ulcer score and index, COX-2 enzyme activity and Proton pump (H+/K+ATPase) gene expression among vinegar fed rats compared with the results of the control group. On the other hand, there was a significant elevation in the percentage ulcer protection, eNOS enzyme activity, glutathione reductase gene expression, and CCK gene expression among vinegar fed rats compared to the control group. In conclusion, the present study revealed a protective effect of vinegar on stress-induced gastric ulceration…

Several studies in humans or in animals have demonstrated that polyphenols possess significant chemopreventive properties due to their antioxidant capacity23. Polyphenols are present in fruits, wines and their by-products like vinegars.” 2

“The following may cause hypochlorhydria: pernicious anemia, chronic H. pylori infection, long-term use of proton pump inhibitors (like Prilosec ®), autoimmune gastritis, and mucolipidosis type IV.”

A normal stomach acid level creates a pH of 1.5– 2.5. As we age, the parietal cells in the stomach lining produce less hydrochloric acid (HCl) or “stomach acid.” In fact, half of the people over the age of 60 have low stomach acid.

Low stomach acid can also be caused by long-term use of acid-blocking medications (i.e., Pepcid ®, Prilosec ®, etc.), which increases stomach pH to 3.5 or higher. This change in pH inhibits pepsin, which is necessary for protein digestion. Interestingly, symptoms of low acidity often mimic those of high acidity.” 1


  1. Noland, Diana, Jeanne A. Drisko, and Leigh Wagner, eds. Integrative and Functional Medical Nutrition Therapy: Principles and Practices. Springer Nature, 2020.
  2. Sakr, Hader Ibrahim, et al. "Protective effect of Apple Cider Vinegar on Stress-Induced Gastric Ulcer." JMSCR Vol 04, Issue 01, Page 8951-8963, January 2016