The present study was designed to evaluate the effects of dietary betaine on pig performance and serological and hematological indices during thermoneutral and heat-stressed conditions. Individually housed pigs ( = 64; 39.0 ± 1.5 kg BW) were assigned within weight blocks and sex to 1 of 8 treatments. Treatments consisted of 2 environmental conditions (thermoneutral or heat-stressed) and 4 levels of betaine (0, 0.10, 0.15, and 0.20%). Room temperatures followed a daily pattern with a low of 14°C and a high of 21°C for the thermoneutral environment and a low of 28°C and a high of 35°C for the heat-stressed environment. Experimental diets were fed from d -7 (7 d prior to imposing temperature treatments; constant 21°C) until 28. Respiration rate and rectal temperature were measured on d 0, 1, 2, 3, 7, 14, 21, and 28, and blood samples were collected on d 3 and 28. Heat stress reduced ( ≤ 0.008) ADG (0.710 vs. 0.822 kg/d) and ADFI (1.81 vs. 2.27 kg/d) and increased G:F ( = 0.036; 0.391 vs. 0.365). Betaine tended to quadratically increase G:F ( = 0.071; 0.377, 0.391, 0.379, and 0.366 for 0, 0.10, 0.15, and 0.20% betaine, respectively), regardless of environment. Heat stress increased ( ≤ 0.001) respiration rate (48 vs. 23 breaths/30 s) and rectal temperature (39.47 vs. 38.94°C) throughout d 1 to 28. Betaine at 0.10% reduced rectal temperature in heat-stressed pigs but not in control pigs (interaction, = 0.040). Heat stress increased serum cysteine and triglycerides and reduced Ca, alkaline phosphatase, and lipase, regardless of day of sampling ( ≤ 0.048). Heat stress increased serum creatine phosphokinase (CPK) and K and reduced osmolarity, Na, urea N, methionine, homocysteine, the albumin:globulin ratio, and blood eosinophil count on d 3 but not on d 28 (interaction, ≤ 0.013). Heat stress increased serum Mg, globulin, creatinine, amylase, and γ-glutamyltranspeptidase and reduced , the urea N:creatinine ratio, alanine aminotransferase, NEFA, hemoglobin, hematocrit, and red blood cells on d 28 but not on d 3 (interaction, ≤ 0.034). Betaine increased serum osmolarity and NEFA and reduced CPK and K on d 3 but not on d 28 (interaction, ≤ 0.060) and increased serum creatinine and reduced amylase on d 28 but not on d 3 (interaction ≤ 0.057). Heat stress reduced growth, disturbed ion balance, and increased markers of muscle damage. Betaine had a minor impact on alleviating heat stress with the possible exception of early days of heat exposure. The beneficial effect of betaine was diminished by pig adaptation.