Betaine anhydrous

Category

Herbs & Supplements

Synonyms

Abromine, alpha-earleine, betaine, betaine glucuronate, BetaPure^TM, Cystadane®, glycine, glycine betaine, glycocoll betaine, glycylbetaine, hydroxide, inner salt, lycine, inner salt, oxyneurine, TMG, trimethylammonioacetate trimethylbetaine, trimethylglycine, trimethylglycocoll.

Note: This monograph covers betaine anhydrous, which should not be confused with betaine hydrochloride.

Background

Betaine is found in most microorganisms, plants, and marine animals. Its main physiologic functions are to protect cells under stress and as a source of methyl groups needed for many biochemical pathways. Betaine is also found naturally in many foods and is most highly concentrated in beets, spinach, grain, and shellfish.

Betaine supplementation has historically been used in the treatment of homocysteinuria due to genetic deficiencies in the cystathione beta synthase and methylenetetrahydrofolate reductase genes.

Betaine supplementation may reduce circulating levels of homocysteine, a potential risk factor for heart disease, stroke, cancer, and Alzheimer's disease.

Betaine supplementation has been thought to improve hepatic steatosis, from both alcoholic and nonalcoholic etiologies. While many animal studies have provided plausible mechanisms, data from human studies are limited.

Betaine in the form of cocamidopropylbetaine has been identified as a cause of contact allergy in some skin care products. In this same form, betaine has been studied as a potential replacement for sodium lauryl sulfate in toothpastes to reduce dry mouth, ulcers, and other mucosal irritations.

Since the 1980s, betaine has been used as a treatment option for subjects who have homocystenuria, due to a genetic defect in the cystathione beta-synthase (CBS) gene. Pyridoxine (vitamin B6) was beneficial in only 50% of CBS patients, and betaine was a therapeutic option for homocysteine reduction in these unresponsive patients. Benefit was also seen among pyridoxine-responsive patients.

Early anecdotal reports showed that among CBS variants, treatment with betaine, in addition to B6 and methionine restriction, prevented or delayed clinical complications of the disease, including cardiovascular disease before age 30.

Evidence

DISCLAIMER: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Cardiovascular disease (in homocysteinuric patients): Homocystinuria is a severe form of hyperhomocysteinemia caused by genetic defects in homocysteine-metabolizing genes, most commonly the cystathionine beta-synthase (CBS) gene. Patients with severely elevated homocysteine due to a genetic deficiency can use betaine treatment, in combination with other vitamins and diet restrictions, to reduce the risk of vascular events. Further studies are needed to determine whether betaine supplementation can lower cardiovascular risk within the general population.
Grade: B

Hyperhomocysteinemia: Overall, betaine supplementation has shown significant reductions in both fasting and postmethionine load homocysteine. However, additional studies are needed to make a strong recommendation.
Grade: B

Hyperhomocysteinemia (in chronic renal failure patients): Hyperhomocysteinemia is a complication found in 80% of end-stage renal failure patients and may contribute to the progression of atherosclerosis among these patients. The effect of betaine supplementation on reducing homocysteine concentrations within this population has only been studied in addition to folic acid. Additional study investigating betaine alone is needed to make a firm recommendation.
Grade: B

Steatohepatitis (non-alcoholic): Betaine raises S-adenosylmethionine (SAM) levels that may in turn play a role in decreasing hepatic steatosis. Additional studies are needed to confirm these results.
Grade: B

Cholesterol levels: Limited evidence from human trials suggests betaine supplementation increases total cholesterol, LDL cholesterol, and triglycerides, which may offset any benefit in CHD risk received through homocysteine lowering. However, the increase in cholesterol is relatively small. More study is warranted to confirm these results.
Grade: C

Weight loss: There is currently insufficient available evidence supporting betaine for weight loss.
Grade: C

Tradition

WARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
Alzheimer's disease, angina (chest pain), appetite stimulant, arthritis, asthma, atherosclerosis (hardening of the arteries), cognitive improvement, congestive heart failure (CHF), digestion enhancement, dyspnea (shortness of breath), erectile dysfunction, fatigue, high blood sugar/glucose intolerance, hormone related problems, immune stimulation, kidney function, libido (improvement), memory improvement, physical endurance.

Dosing

Adults (18 years and older)

Currently, there has been no recommended daily allowance (RDA) set by the United States Food and Nutrition Board for betaine. Manufacturers recommend that betaine powder be dissolved in water, juice, milk, or formula prior to administration and be administered in two doses of 3 grams each. For cardiovascular disease (hyperhomocysteinemics), 2-15 grams daily for up to 17 years has been used. For hyperhomocysteinemia, 1-6 grams daily of betaine for up to six weeks has been used. For nonalcoholic steatohepatitis, Cystadane® up to 20g daily for up to one year has been used.

Children (younger than 18 years)

In children, 250 milligrams per kilogram daily in children 6-14 years-old with cystathionine beta-synthase deficiency for three to six months has been used.

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

Avoid in individuals with a known allergy or hypersensitivity to betaine anhydrous or cocamidopropylbetaine, a form of betaine.

Side Effects and Warnings

In the majority of clinical trials among healthy volunteers and renal disease patients, no adverse effects have been reported. In other studies, reported adverse effects are primarily gastrointestinal, such as diarrhea, stomach upset, gastrointestinal irritation, and nausea. However, these transitory events were not severe enough to require discontinuation of betaine use during clinical trials.

Betaine may also cause mental changes or body odor. Use cautiously in patients with psychiatric conditions.

Use cautiously in patients with renal disease or who are obese, as betaine may increase total cholesterol, LDL, HDL, and triglyceride levels when it is taken with folic acid and vitamin B6.

Pregnancy and Breastfeeding

Betaine is not recommended in pregnant or breastfeeding women due to a lack of available scientific evidence.

Interactions

Interactions with Drugs

Although not well studied in humans, betaine supplementation may lower homocysteine concentrations that are elevated by alcohol use.

Patients with renal disease may experience increases in total cholesterol, LDL, HDL, and triglycerides when betaine is taken with folic acid and vitamin B6. Betaine may increase total cholesterol and LDL cholesterol in obese patients. Caution is advised in patients with high cholesterol or those taking cholesterol-lowering medications.

Interactions with Herbs and Dietary Supplements

Patients with renal disease may experience increases in total cholesterol, LDL, HDL, and triglycerides when betaine is taken with folic acid and vitamin B6. Betaine may increase total cholesterol and LDL cholesterol in obese patients. Caution is advised in patients with high cholesterol or those taking cholesterol-lowering herbs or supplements, such as red yeast rice.

Attribution

This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Stephanie E. Chiuve, ScD (Harvard School of Public Health); Chi Dam, PharmD (Northeastern University); Nicole Giese, MS (Natural Standard Research Collaboration); Audrey Nealon, PharmD (Northeastern University); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Kris Swinney, PharmD (Northeastern University); Wendy Weissner, BA (Natural Standard Research Collaboration).

Bibliography

DISCLAIMER: Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

Abdelmalek MF, Angulo P, Jorgensen RA, et al. Betaine, a promising new agent for patients with nonalcoholic steatohepatitis: results of a pilot study. Am.J.Gastroenterol. 2001;96(9):2711-2717.

Alfthan G, Tapani K, Nissinen K, et al. The effect of low doses of betaine on plasma homocysteine in healthy volunteers. Br.J.Nutr. 2004;92(4):665-669.

Brattstrom L, Wilcken DE, Ohrvik J, et al. Common methylenetetrahydrofolate reductase gene mutation leads to hyperhomocysteinemia but not to vascular disease: the result of a meta-analysis. Circulation 12-8-1998;98(23):2520-2526.

Craig SA. Betaine in human nutrition. Am.J.Clin.Nutr. 2004;80(3):539-549.

Holm PI, Ueland PM, Vollset SE, et al. Betaine and folate status as cooperative determinants of plasma homocysteine in humans. Arterioscler.Thromb.Vasc.Biol 2005;25(2):379-385.

Kelly TL, Neaga OR, Schwahn BC, et al. Infertility in 5,10-methylenetetrahydrofolate reductase (MTHFR)-deficient male mice is partially alleviated by lifetime dietary betaine supplementation. Biol Reprod 2005;72(3):667-677.

Kharbanda KK, Rogers DD, Mailliard ME, et al. A comparison of the effects of betaine and S-adenosylmethionine on ethanol-induced changes in methionine metabolism and steatosis in rat hepatocytes. J Nutr 2005;135(3):519-524.

McGregor, D. O., Dellow, W. J., Robson, R. A., Lever, M., George, P. M., and Chambers, S. T. Betaine supplementation decreases post-methionine hyperhomocysteinemia in chronic renal failure. Kidney Int. 2002;61(3):1040-1046.

Miglio F, Rovati LC, Santoro A, et al. Efficacy and safety of oral betaine glucuronate in non-alcoholic steatohepatitis. A double-blind, randomized, parallel-group, placebo-controlled prospective clinical study. Arzneimittelforschung. 2000;50(8):722-727.

Olthof MR, van Vliet T, Boelsma E, et al. Low dose betaine supplementation leads to immediate and long term lowering of plasma homocysteine in healthy men and women. J.Nutr. 2003;133(12):4135-4138.

Olthof MR, van Vliet T, Verhoef P, et al. Effect of homocysteine-lowering nutrients on blood lipids: results from four randomised, placebo-controlled studies in healthy humans. PLoS.Med 2005;2(5):e135.

Schwab U, Torronen A, Meririnne E, et al. Orally administered betaine has an acute and dose-dependent effect on serum betaine and plasma homocysteine concentrations in healthy humans. J Nutr 2006;136(1):34-38.

Schwab U, Torronen A, Toppinen L, et al. Betaine supplementation decreases plasma homocysteine concentrations but does not affect body weight, body composition, or resting energy expenditure in human subjects. Am.J.Clin.Nutr. 2002;76(5):961-967.

van Guldener C, Janssen MJ, Lambert J, et al. Folic acid treatment of hyperhomocysteinemia in peritoneal dialysis patients: no change in endothelial function after long-term therapy. Perit.Dial.Int 1998;18(3):282-289.

Zeisel SH, Mar MH, Howe JC, et al. Concentrations of choline-containing compounds and betaine in common foods. J.Nutr. 2003;133(5):1302-1307.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.