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Betaine and Betaine Hydrochloride
DESCRIPTION
Betaine or trimethylglycine is a quarternary ammonium compound that was first discovered in the juice of sugar beets (Beta vulgaris). Betaine is a metabolite of choline (see Choline) and is a substrate in one of the two recycling pathways that convert homocysteine to L-methionine. The other and principal recycling reaction is catalyzed by the enzyme methionine synthase and uses methylcobalamin as a cofactor and 5-methyltetrahydrofolate as a cosubstrate (see Folate and Vitamin B12).
Betaine is also known as trimethylglycine, N-trimethylglycine, glycine betaine, glycocoll betaine, oxyneurine and lycine. Its chemical name is 1-carboxy-N,N,N-trimethylmethanaminium inner salt. The molecular formula of betaine is C5H11NO2, its chemical formula is (CH3)3N+-CH2COO- and its molecular weight is 117.15 daltons. Betaine is very soluble in water and has a sweet taste. It is widely distributed in plants and animals. The hydrochloride of betaine is known as betaine hydrochloride, betaine HCL and pluchine. Its chemical name is 1-carboxy-N,N,N-trimethylmethanaminium chloride. The pH of a 5% aqueous solution of betaine hydrochloride is 1.
Betaine is represented by the following chemical structure:
ACTIONS AND PHARMACOLOGY
ACTIONS
Betaine may lower elevated homocysteine levels in some. Betaine may also have lipotropic and hepatoprotective activity. Betaine hydrochloride is a delivery form of hydrochloric acid and may aid in digestion in some.
MECHANISM OF ACTION
Betaine-homocysteine methyltransferase (BHMT) is a zinc metalloenzyme which catalyzes the transfer of a methyl group from betaine to homocysteine in the formation of methionine. BHMT is found in the liver and kidneys and may also exist in brain tissue. Betaine acts to lower homocysteine levels in some with primary hyperhomocysteinemia/homocystinuria via this enzyme. Betaine has also been found to lower homocysteine levels in some animal studies, again, via BHMT. Mild to moderate elevation of homocysteine without homocystinuria is thought to be an independent risk factor for coronary heart disease. Betaine may lower elevated homocysteine levels in some with mild to moderate hyperhomocysteinemia, but this needs to be confirmed. A good group for such a study would be those with the C677T mutation for 5-methylenetetrahydrofolate reductase which occurs in approximately 10% of the population.
A lipotropic agent is defined as a substance that prevents the deposition of fat in the liver or accelerates its removal. The condition of fatty degeneration is called steatosis. Betaine, choline and L-methionine have been found to prevent or to reverse hepatic steatosis in experimental animals. It is thought that the lipotropic activity of betaine, choline and L-methionine is mediated via the body's principal transmethylating agent, S-adenosylmethionine (SAMe). SAMe is involved in a number of biochemical functions that may promote liver health, including its role in the formation of phospholipids which are essential for normal cell membrane formation and function (see S-Adenosyl-L-Methionine). SAMe's methyl group is derived from betaine via the betaine-homocysteine methyltransferase reaction which provides the immediate precursor of SAMe, L-methionine. Choline is metabolized to betaine via the enzymes choline dehydrogenase and betaine aldehyde dehydrogenase. Thus, through a couple of transmethylations, the methyl group in choline winds up as the methyl group in SAMe.
Betaine has been found to protect the livers of experimental animals against the hepatotoxins ethanol and carbon tetrachloride. The hepatoprotective effect of betaine is thought to be mediated via SAMe, as discussed above. Betaine may have hepatoprotective activity as well as lipotropic activity in humans, but this has not been confirmed. Another possible hepatoprotective mechanism of betaine, at least in animals, may be due to its osmolyte activity. Betaine has been shown to be an intracellular osmolyte in rat liver macrophages (Kupffer cells) and sinusoidal endothelial cells, and may play an important role in the functions of these cells.
As an interesting aside, the osmoprotective effect of betaine has been found to be cytoprotective in the deep freezing of stallion sperm and also has been found to protect salmon from the physiological stress induced by transfer from fresh water to seawater. The osmoprotective effect of betaine may be due to an interaction between this substance and chloride ions. There is as yet no evidence that the osmoprotective effect of betaine has any consequence for humans.
Betaine hydrochloride is a delivery form of hydrochloric acid. Some with hypochlorhydria have used betaine hydrochloride alone, or in combination with pepsin, as a digestive aid.
PHARMACOKINETICS
Betaine is absorbed from the small intestines into the enterocytes. It is released by the enterocytes into the portal circulation which carries it to the liver where there is significant first-pass extraction and first-pass metabolism of betaine. The principal metabolic reaction is the transfer of a methyl group from betaine to homocysteine via the enzyme betaine-homocysteine methyltransferase. The products of the reaction are L-methionine and dimethylglycine. Betaine hydrochloride is converted to betaine in the alkaline environment of the small intestine.
INDICATIONS AND USAGE
Anhydrous betaine has been useful in the treatment of homocystinuria and betaine may be helpful in other conditions characterized by elevated plasma homocysteine levels. Betaine hydrochloride is used as a digestive aid in some. There is some suggestion in animal research that betaine may be hepatoprotective in some circumstances.
RESEARCH SUMMARY
Betaine has been shown in numerous studies to be of significant benefit in all three primary types of homocystinuria. Clinical improvement has been reported in about 75% of the cases treated with betaine in these studies.
It has been suggested but not yet demonstrated that betaine might also be useful in other conditions characterized by elevated plasma homocysteine levels, such as those that have been noted in some with premature vascular disease and chronic renal failure.
Since hyperhomocysteinemia is thought to be an independent cardiovascular risk factor, betaine's role as a potential cardioprotector is suggested but, again, not yet demonstrated. Recently it was hypothesized that some of red wine's putative cardioprotective activity could be due to the fact that betaine is added to some wines via beet sugar used to increase alcohol content. More research is needed.
Several animal studies have indicated that betaine exerts some hepatoprotective effects. In one of these studies, betaine significantly speeded recovery of carbon tetrachloride-injured liver. It has also been credited with helping to protect against alcoholic steatosis resulting from dietary ethanol. Whether it might help similarly protect against or reverse fatty infiltration of the liver in humans has not yet been studied.
Betaine hydrochloride has been used for some time as a digestive aid. Those with excessive stomach acid should avoid this use.
CONTRAINDICATIONS, PRECAUTIONS, ADVERSE REACTIONS
Betaine and betaine hydrochloride are contraindicated in those hypersensitive to any component of a betaine- or betaine hydrochloride-containing product.
PRECAUTIONS
Pregnant women and nursing mothers should avoid the use of betaine and betaine hydrochloride supplements.
Those with gastritis, gastroesophageal reflux disease (GERD) or peptic ulcer disease should avoid the use of betaine hydrochloride supplements.
ADVERSE REACTIONS
Occasional nausea, vomiting and diarrhea have been reported.
INTERACTIONS
NUTRITIONAL SUPPLEMENTS
Folic acid: Concomitant use of betaine and folic acid may be additive with regard to the possible lowering of serum homocysteine levels.
OVERDOSAGE
There are no reports of betaine overdosage in the literature.
DOSAGE AND ADMINISTRATION
Betaine and betaine hydrochloride are available as dietary supplements.
There are no typical doses for the management of mild to moderate hyperhomocysteinemia. Three grams taken twice daily were used in one small preliminary study showing a serum homocysteine-lowering effect.
Those who use betaine hydrochloride as a digestive aid, typically take a dose of 600 to 650 milligrams (usually in a combination product with pepsin) following a meal.
HOW SUPPLIED
Capsules — 650 mg
Tablets — 300 mg, 350 mg, 600 mg
LITERATURE
Barak AJ, Tuma DJ. Betaine, metabolic by-product or vital methylating agent? Life Sci. 1983; 32:771-774.
Barak AJ, Beckenhauser HC, Tuma DJ. Betaine effects on hepatic methionine metabolism elicited by short-term ethanol feeding. Alcohol. 1996; 13:483-486.
Barak AJ, Beckenhauser HC, Tuma DJ. Betaine, ethanol and the liver: a review. Alcohol. 1996; 13:395-398.
Barak AJ, Beckenhauser HC, Badakhsh S, Tuma DJ. The effect of betaine in reversing alcoholic steatosis. Alcohol Clin Exp Res. 1997; 21:1100-1102.
Brower IA, Verhoef P, Urgert R. Betaine supplementation and plasma homocysteine in healthy volunteers. Arch Inter Med. 2000; 160:2546-2547.
Davies SEC, Chalmers RA, Randall EW, Iles RA. Betaine metabolism in human neonates and developing rats. Clin Chim Acta. 1988; 178:241-250.
Gahl WA, Bernardini I, Chen S, et al. The effect of oral betaine on vertebral body bone density in pyridoxine-non-responsive homocystinuria. J Inher Metab Dis. 1988; 11:291-298.
Holme E, Kjellman B, Ronge E. Betaine for treatment of homocystinuria caused by methylenetetrahydrofolate reductase deficiency. Arch Dis Childhood. 1989; 64:1064.
Junnila M, Barak AJ, Beckenhauer HC, Rahko T. Betaine reduces hepatic lipidosis induced by carbon tetrachloride in Sprague-Dawley rats. Vet Hum Toxicol. 1998; 40:263-266.
Junnila M, Rahko T, Sukura A, Lindberg L-A. Reduction of carbon tetrachloride-induced hepatotoxic effects by oral administration of betaine in male Han: Wistar rats. A morphometric histological study. Vet Pathol. 2000; 37:221-238.
Koskinen E, Junnila M, Katila T, Soini H. A preliminary study on the use of betaine as a cryoprotective agent in the deep freezing of stallion semen. Zentralbl Veterinarmed A. 1989; 36:110-114.
Millian NS, Garrow TA. Human betaine-homocysteine methyltransferase is a zinc metalloenzyme. Arch Biochem Biophys. 1998; 356:93-98.
Smolin LA, Benevenga NJ, Berlow S. The use of betaine for the treatment of homocystinuria. J Pediatr. 1981; 99:467-472.
Virtanen E, Junnila M, Soivio A. Effects of food containing betaine/amino acid additive on the osmotic adaptation of young Atlantic salmon, Salmo Salar L. Aquaculture. 1989; 83:109-122.
Wendel U, Bremer HJ. Betaine in the treatment of homocystinuria due to 5,10-methylenetetrahydrofolate reductase deficiency. Eur J Pediatr. 1984; 142:147-150.
Wettstein M, Haussinger D. Cytoprotection by the osmolytes betaine and taurine in ischemia-reoxygenation injury in the perfused rat liver. Hepatology. 1997; 26:1560-1566.
Wettstein M, Weik C, Holneicher C, Haussinger D. Betaine as an osmolyte in rat liver: metabolism and cell-to-cell interactions. J Hepatol. 1998; 27:787-793.
Wilcken DE, Dudman NP, Tyrrell PA. Homocystinuria due to cystathionine beta-synthase deficiency - - the effects of betaine treatment in pyridoxine-responsive patients. Metabolism. 1985; 34:1115-1121.
Wilcken DE, Wilcken B, Dudman NP, Tyrrell PA. Homocystinuria - - the effects of betaine in the treatment of patients not responsive to pyridoxine. N Engl J Med. 1983; 309:448-453.
DESCRIPTION
Betaine or trimethylglycine is a quarternary ammonium compound that was first discovered in the juice of sugar beets (Beta vulgaris). Betaine is a metabolite of choline (see Choline) and is a substrate in one of the two recycling pathways that convert homocysteine to L-methionine. The other and principal recycling reaction is catalyzed by the enzyme methionine synthase and uses methylcobalamin as a cofactor and 5-methyltetrahydrofolate as a cosubstrate (see Folate and Vitamin B12).
Betaine is also known as trimethylglycine, N-trimethylglycine, glycine betaine, glycocoll betaine, oxyneurine and lycine. Its chemical name is 1-carboxy-N,N,N-trimethylmethanaminium inner salt. The molecular formula of betaine is C5H11NO2, its chemical formula is (CH3)3N+-CH2COO- and its molecular weight is 117.15 daltons. Betaine is very soluble in water and has a sweet taste. It is widely distributed in plants and animals. The hydrochloride of betaine is known as betaine hydrochloride, betaine HCL and pluchine. Its chemical name is 1-carboxy-N,N,N-trimethylmethanaminium chloride. The pH of a 5% aqueous solution of betaine hydrochloride is 1.
Betaine is represented by the following chemical structure:
ACTIONS AND PHARMACOLOGY
ACTIONS
Betaine may lower elevated homocysteine levels in some. Betaine may also have lipotropic and hepatoprotective activity. Betaine hydrochloride is a delivery form of hydrochloric acid and may aid in digestion in some.
MECHANISM OF ACTION
Betaine-homocysteine methyltransferase (BHMT) is a zinc metalloenzyme which catalyzes the transfer of a methyl group from betaine to homocysteine in the formation of methionine. BHMT is found in the liver and kidneys and may also exist in brain tissue. Betaine acts to lower homocysteine levels in some with primary hyperhomocysteinemia/homocystinuria via this enzyme. Betaine has also been found to lower homocysteine levels in some animal studies, again, via BHMT. Mild to moderate elevation of homocysteine without homocystinuria is thought to be an independent risk factor for coronary heart disease. Betaine may lower elevated homocysteine levels in some with mild to moderate hyperhomocysteinemia, but this needs to be confirmed. A good group for such a study would be those with the C677T mutation for 5-methylenetetrahydrofolate reductase which occurs in approximately 10% of the population.
A lipotropic agent is defined as a substance that prevents the deposition of fat in the liver or accelerates its removal. The condition of fatty degeneration is called steatosis. Betaine, choline and L-methionine have been found to prevent or to reverse hepatic steatosis in experimental animals. It is thought that the lipotropic activity of betaine, choline and L-methionine is mediated via the body's principal transmethylating agent, S-adenosylmethionine (SAMe). SAMe is involved in a number of biochemical functions that may promote liver health, including its role in the formation of phospholipids which are essential for normal cell membrane formation and function (see S-Adenosyl-L-Methionine). SAMe's methyl group is derived from betaine via the betaine-homocysteine methyltransferase reaction which provides the immediate precursor of SAMe, L-methionine. Choline is metabolized to betaine via the enzymes choline dehydrogenase and betaine aldehyde dehydrogenase. Thus, through a couple of transmethylations, the methyl group in choline winds up as the methyl group in SAMe.
Betaine has been found to protect the livers of experimental animals against the hepatotoxins ethanol and carbon tetrachloride. The hepatoprotective effect of betaine is thought to be mediated via SAMe, as discussed above. Betaine may have hepatoprotective activity as well as lipotropic activity in humans, but this has not been confirmed. Another possible hepatoprotective mechanism of betaine, at least in animals, may be due to its osmolyte activity. Betaine has been shown to be an intracellular osmolyte in rat liver macrophages (Kupffer cells) and sinusoidal endothelial cells, and may play an important role in the functions of these cells.
As an interesting aside, the osmoprotective effect of betaine has been found to be cytoprotective in the deep freezing of stallion sperm and also has been found to protect salmon from the physiological stress induced by transfer from fresh water to seawater. The osmoprotective effect of betaine may be due to an interaction between this substance and chloride ions. There is as yet no evidence that the osmoprotective effect of betaine has any consequence for humans.
Betaine hydrochloride is a delivery form of hydrochloric acid. Some with hypochlorhydria have used betaine hydrochloride alone, or in combination with pepsin, as a digestive aid.
PHARMACOKINETICS
Betaine is absorbed from the small intestines into the enterocytes. It is released by the enterocytes into the portal circulation which carries it to the liver where there is significant first-pass extraction and first-pass metabolism of betaine. The principal metabolic reaction is the transfer of a methyl group from betaine to homocysteine via the enzyme betaine-homocysteine methyltransferase. The products of the reaction are L-methionine and dimethylglycine. Betaine hydrochloride is converted to betaine in the alkaline environment of the small intestine.
INDICATIONS AND USAGE
Anhydrous betaine has been useful in the treatment of homocystinuria and betaine may be helpful in other conditions characterized by elevated plasma homocysteine levels. Betaine hydrochloride is used as a digestive aid in some. There is some suggestion in animal research that betaine may be hepatoprotective in some circumstances.
RESEARCH SUMMARY
Betaine has been shown in numerous studies to be of significant benefit in all three primary types of homocystinuria. Clinical improvement has been reported in about 75% of the cases treated with betaine in these studies.
It has been suggested but not yet demonstrated that betaine might also be useful in other conditions characterized by elevated plasma homocysteine levels, such as those that have been noted in some with premature vascular disease and chronic renal failure.
Since hyperhomocysteinemia is thought to be an independent cardiovascular risk factor, betaine's role as a potential cardioprotector is suggested but, again, not yet demonstrated. Recently it was hypothesized that some of red wine's putative cardioprotective activity could be due to the fact that betaine is added to some wines via beet sugar used to increase alcohol content. More research is needed.
Several animal studies have indicated that betaine exerts some hepatoprotective effects. In one of these studies, betaine significantly speeded recovery of carbon tetrachloride-injured liver. It has also been credited with helping to protect against alcoholic steatosis resulting from dietary ethanol. Whether it might help similarly protect against or reverse fatty infiltration of the liver in humans has not yet been studied.
Betaine hydrochloride has been used for some time as a digestive aid. Those with excessive stomach acid should avoid this use.
CONTRAINDICATIONS, PRECAUTIONS, ADVERSE REACTIONS
Betaine and betaine hydrochloride are contraindicated in those hypersensitive to any component of a betaine- or betaine hydrochloride-containing product.
PRECAUTIONS
Pregnant women and nursing mothers should avoid the use of betaine and betaine hydrochloride supplements.
Those with gastritis, gastroesophageal reflux disease (GERD) or peptic ulcer disease should avoid the use of betaine hydrochloride supplements.
ADVERSE REACTIONS
Occasional nausea, vomiting and diarrhea have been reported.
INTERACTIONS
NUTRITIONAL SUPPLEMENTS
Folic acid: Concomitant use of betaine and folic acid may be additive with regard to the possible lowering of serum homocysteine levels.
OVERDOSAGE
There are no reports of betaine overdosage in the literature.
DOSAGE AND ADMINISTRATION
Betaine and betaine hydrochloride are available as dietary supplements.
There are no typical doses for the management of mild to moderate hyperhomocysteinemia. Three grams taken twice daily were used in one small preliminary study showing a serum homocysteine-lowering effect.
Those who use betaine hydrochloride as a digestive aid, typically take a dose of 600 to 650 milligrams (usually in a combination product with pepsin) following a meal.
HOW SUPPLIED
Capsules — 650 mg
Tablets — 300 mg, 350 mg, 600 mg
LITERATURE
Barak AJ, Tuma DJ. Betaine, metabolic by-product or vital methylating agent? Life Sci. 1983; 32:771-774.
Barak AJ, Beckenhauser HC, Tuma DJ. Betaine effects on hepatic methionine metabolism elicited by short-term ethanol feeding. Alcohol. 1996; 13:483-486.
Barak AJ, Beckenhauser HC, Tuma DJ. Betaine, ethanol and the liver: a review. Alcohol. 1996; 13:395-398.
Barak AJ, Beckenhauser HC, Badakhsh S, Tuma DJ. The effect of betaine in reversing alcoholic steatosis. Alcohol Clin Exp Res. 1997; 21:1100-1102.
Brower IA, Verhoef P, Urgert R. Betaine supplementation and plasma homocysteine in healthy volunteers. Arch Inter Med. 2000; 160:2546-2547.
Davies SEC, Chalmers RA, Randall EW, Iles RA. Betaine metabolism in human neonates and developing rats. Clin Chim Acta. 1988; 178:241-250.
Gahl WA, Bernardini I, Chen S, et al. The effect of oral betaine on vertebral body bone density in pyridoxine-non-responsive homocystinuria. J Inher Metab Dis. 1988; 11:291-298.
Holme E, Kjellman B, Ronge E. Betaine for treatment of homocystinuria caused by methylenetetrahydrofolate reductase deficiency. Arch Dis Childhood. 1989; 64:1064.
Junnila M, Barak AJ, Beckenhauer HC, Rahko T. Betaine reduces hepatic lipidosis induced by carbon tetrachloride in Sprague-Dawley rats. Vet Hum Toxicol. 1998; 40:263-266.
Junnila M, Rahko T, Sukura A, Lindberg L-A. Reduction of carbon tetrachloride-induced hepatotoxic effects by oral administration of betaine in male Han: Wistar rats. A morphometric histological study. Vet Pathol. 2000; 37:221-238.
Koskinen E, Junnila M, Katila T, Soini H. A preliminary study on the use of betaine as a cryoprotective agent in the deep freezing of stallion semen. Zentralbl Veterinarmed A. 1989; 36:110-114.
Millian NS, Garrow TA. Human betaine-homocysteine methyltransferase is a zinc metalloenzyme. Arch Biochem Biophys. 1998; 356:93-98.
Smolin LA, Benevenga NJ, Berlow S. The use of betaine for the treatment of homocystinuria. J Pediatr. 1981; 99:467-472.
Virtanen E, Junnila M, Soivio A. Effects of food containing betaine/amino acid additive on the osmotic adaptation of young Atlantic salmon, Salmo Salar L. Aquaculture. 1989; 83:109-122.
Wendel U, Bremer HJ. Betaine in the treatment of homocystinuria due to 5,10-methylenetetrahydrofolate reductase deficiency. Eur J Pediatr. 1984; 142:147-150.
Wettstein M, Haussinger D. Cytoprotection by the osmolytes betaine and taurine in ischemia-reoxygenation injury in the perfused rat liver. Hepatology. 1997; 26:1560-1566.
Wettstein M, Weik C, Holneicher C, Haussinger D. Betaine as an osmolyte in rat liver: metabolism and cell-to-cell interactions. J Hepatol. 1998; 27:787-793.
Wilcken DE, Dudman NP, Tyrrell PA. Homocystinuria due to cystathionine beta-synthase deficiency - - the effects of betaine treatment in pyridoxine-responsive patients. Metabolism. 1985; 34:1115-1121.
Wilcken DE, Wilcken B, Dudman NP, Tyrrell PA. Homocystinuria - - the effects of betaine in the treatment of patients not responsive to pyridoxine. N Engl J Med. 1983; 309:448-453.
