There are three things that cause reflux in my opinion.

1. Weak connective tissue that leads to a hiatal hernia. Pure speculation, but I would eat more copper, zinc, gelatin, magnesium, fat soluble vitamins (especially vitamin K).

2. Upwards pressure from colonic fermentation of indigestible fiber (the short chain fatty acids seem to act like a signal to slow down digestion, probably to give the body time to extract all those extra fermentable calories). Google FODMAPS. They cause GERD, from 5-15 hours after meal time. Limit them and you will have no GERD!

3. Weak lower esophageal sphincter pressure. This is a matter of wear after a period of stress (e.g., the day after you eat a lot of FODMAPS) or have been awake for a long time. Protein tightens the LES, ice does too, calcium carbonate too. Fat weakens it, so does peppermint. The LES is also under central nervous system control. So, marijuana helps. More importantly, certain other neurotransmitters may help. Some of them have cardiac complications - that's why neurotransmitters are NOT a common therapeutic target for GERD. That said, acetylcholine increases LES pressure, which is important because... betaine may upregulate acetylcholine, leading me to my last point:

If betaine HCL does help GERD, there are other plausible mechanism that have nothing to do with the HCL or pepsin in it. In particular... the betaine! Since betaine may upregulate acetylcholine which tightens the lower esophageal sphincter, the effect on acetlycholine may account for the benefit that some people experience (especially since most people report relief don't after until at least a few days to weeks of pill popping - they are filling up bodily stores of acetylcholine in thta time). Instead of betaine HCL, perhaps you should just eat eggs, liver, and heart or spinach and wheat bran, if you digest them well.

Are you taking tablets or capsules?

I tried this once, and my experience was that taking 10 tablets did nothing, but taking a single capsule created the warmth.

Interesting that you got relief without feeling that, though. My issue wasn't heartburn, but rosacea, so I didn't have any direct feedback like that. I guess if it's giving you relief, then the warmth doesn't really matter.

I'm skeptical about the idea that most people have low stomach acid and that taking HCl caplets until you feel a warm feeling is a solution. Poliquin seems to be disconnected from most of the science behind gastroenterology:

http://tnation.t-nation.com/free_online_forum/diet_performance_nutrition_supplements/rebuttal_to_charles_poliquins_article_on_stomach_acid_ (sorry for the tnation link, not a t nation article just reposted there)

I take Betain HCL as well with meals. I am down to about 2-3 250 mg capsules with each meals, and sometimes 4 if I am going to have a larger, more protein dense meal (e.g. a big steak). I find that the warmth gets created if I take the capsules approximately 5 minutes before eating the meal than if I take them right before. I've also noticed the warmth if I take them a few minutes after I have finished eating. One other observation is that the warmth is more noticeable/easier to come by at breakfast than at dinner.

All I can advise is to experiment with timing and dosage. I would advise that you be careful with the dosage. Ultimately, your goal is to reduce GERD and improve digestion. If you think that occurs with 3 pills despite not having a warm feeling, then stay at 3.

If I recall correctly, Robb Wolf recommends taking no more that 6 NOW Foods caps at a meal, even if you don't get the warmth.

To the person who stated they don't get the burning sensation: I am experiencing the same thing but I still have very bad heartburn despite taking full doses of beatine for 3 weeks. Did you ever experience the burning/ warmth. How long after you started the beatine did you get relief rom your symptoms?

Don't discount that acetylcholine link if kombucha is working for you. Guess what: compounds in kombucha stimulate acetylcholine production. Surprise!

I've taken Bettaine HCL w/ Pepsin in the past and I am taking it now (9 capsules morning and evening). My digestion was awful!! It takes a few days for the B-HCL to kick in. I always have to exceed the dosage (way beyond protocol) in order for it to work. I exceed the amount because when taking it as directed, there is no effect. I take a handful of supplements and herbs - so without B-HCL, nothing gets absorbed. I feel a "slight" burning in my stomach that lasts for only about 5 minutes. That's when I know it's working. My BM's are normal (1-2 times per day-every other day) and there's no more ongoing burping. The gas has decreased a whole lot and I'm also seeing the positive effects in my skin and hair. I can't go by any research, I just go by results! Everyone is different and what works for some, might not work for others and vice versa. I just love the slight "burning" sensation because it's telling me that it's working and I see great results! The burning isn't uncomfortable at all. I take more when I eat heavy proteins and make sure that I take it right before taking my supplements or eating my food. It works for me!!