Antacids

(. . .and the problems with taking them!)

• Acid indigestion
• Normal Digestion
• What are Antacids?
• How do Antacids work?
• Side effects with Antacids
• Drug interactions with Antacids
• H2 Blockers
• 11 Complications from the Long-term use of Antacids
• Contraindications for the use of Antacids
• Antacids in Pregnancy
• Antacids in Breastfeeding
• Interesting Facts about Antacids
• Natural Treatments for acid reflux, GERD, and options for Antacid use

Acid indigestion is caused by a lack of stomach acid and an imbalance of intestinal flora. Food that is not digested due to a lack of stomach acid does not pass easily into your small intestine. It sits in your stomach and ferments. This fermenting process causes the undigested foods to bubble and roll about, causing acid reflux.

Acid reflux is caused when acid gets into your esophagus, and even a small amount will cause pain and discomfort. Taking an antacid in this case will cut the pain, but it will also insure that partially digested food gets into your intestinal tract and cause a host of problems: you don’t get the nutrition you need, the digestive system is overburdened, and your immune system suffers.

Normal digestion: Our stomach is designed to promote and maintain a healthy pH 3 acid environment. Stomach acid is important to digest proteins, it is an integral part of our immunity system in that it protects the body from germs we ingest in our food and water and it promotes and supports a friendly intestinal flora.

When this environment is consistently higher than pH 3.0, disease seeps in. So, if you are taking Prevacid, Prilosec, Protonix, Nexium, or other antacids (see list of Antacids link below), it’s time you re-evaluated the use of these drugs.

A healthy pH 3 environment within the stomach will digest meats and other proteins and break them up into their amino acid components so that the body can absorb these tissue-building particles and assist in the production and release of vitamins and minerals from the foods we eat. This food is then released into the first part of the small intestine (called the duodenum) through the pyloric valve where it is mixed with more alkaline digestive enzymes from the pancreas and gallbladder creating a higher pH

If your stomach pH gets higher than 3.0, it secretes more acid to keep the pH below 3.0. When heartburn or acid reflux medication interferes with stomach acid by raising the pH above 3.0, the stomach is no longer functioning like a stomach. It then creates chemical combinations that are not usable by your body.

This creates more problems for the rest of the digestive track because it has to work harder when the food particles are not broken down. When that happens, fermentation occurs which leads to gas and bloating. Some of these undigested food particles can cross the membranes of the intestine eventually causing the body to become allergic to many foods that it would normally be able to digest with a healthy stomach pH. This leads to IBS, gluten allergies, Crohn’s and a host of other allergy symptoms.

Our intestinal flora contains both good and bad microbes (bacteria, yeast etc.). The correct balance of acid and alkaline is necessary to support the growth of good microbes which make vitamins and antibiotics in our digestive tract. Changing this acid balance by the use of antacid medications reduces the amount of good microbes and encourages the growth of bad microbes (the ones that steal nutrients, produce gas, toxins and disease).

Blood Type A people seem to have lots of problems with digestion and are usually the people I see that are having stomach problems, GERD, acid reflux and can’t digest meat very well.

What are Antacids and what are they used for?

Antacids are medicines that neutralize stomach acid. Antacids are used to relieve acid indigestion, upset stomach, sour stomach, and heartburn. Additional components of some formulations include dimethicone, to reduce gas pains (flatulence) and alginic acid, which, in combination with antacids, may help manage GERD (gastro-esophageal reflux disease).

Antacids should not be confused with gastric acid inhibitors, such as the H-2 receptor blockers (cimetidine, ranitide and others) or the proton pump inhibitors (lansoprazole, omeprazole and others). Although all three classes of drugs act to reduce the levels of gastric acid, their mechanisms are different, and this affects the appropriate use of the drug.

Antacids have a rapid onset and short duration of action, and are most appropriate for rapid relief of gastric discomfort for a short period of time.

Antacids may be divided into two classes. . .

. . . those that work by chemical neutralization of gastric acid, most notably sodium bicarbonate; and those that act by adsorption of the acid (non-absorbable antacids), such as calcium and magnesium salts.

The chemical antacids show the most rapid onset of action, but may cause “acid rebound,” a condition in which the gastric acid returns in greater concentration after the drug effect has stopped. Also, since these antacids may contain high concentrations of sodium, they may be inappropriate in patients with hypertension.

How do Antacids work?

Different antacid medications work in different ways. Some have a single action, others have a combined action. The aim of each medication may be different. Antacid medications reduce the amount of gas in the stomach and intestines, provide a barrier to restrict the backflow of stomach contents into the esophagus (GERD), alkalize and neutralize the stomach acid, or restrict the production of stomach acid.

The problem is that antacid drugs simply suppress the condition and don’t get to the core cause of the digestive problems. Antacids only continue the cycle of heartburn, acid reflux, and drugs.

Antacids are composed of calcium, magnesium, and aluminum salts, but may also have simethicone and alginic acid in them as well. Most antacids are made up of a mixture of different ingredients, which aim to provide rapid but sustained relief and cancel out each other’s side effects.

Calcium and magnesium salts combine with the acids to neutralize them, but they are such common minerals in the body that they can also bind with other medications as well making them less effective.  Because the body adapts quickly to these minerals, a rebound effect can also happen with calcium and magnesium antacids.

Calcium. Calcium carbonate (Tums, Titralac, and Alka-2) is a potent and rapid-acting antacid. It can cause constipation. There have been rare cases of hypercalcemia (elevated levels of calcium in the blood) in people taking calcium carbonate for long periods of time. This can lead to kidney stones and kidney failure and is very dangerous.  Long-term use can cause whitish or white-speckled stools.

Some antacids (such as infant Gaviscon®) contain alginic acid, a gum which floats on the surface of stomach contents, which aims to provide a barrier to stop gastric fluids from being refluxed back into the esophagus. A fully upright position needs to be maintained to achieve the benefits of Gaviscon. This has grown out of favor because of its sodium and aluminum content which can affect the growth of bones causing Osteomalacia.  Also causes constipation and diarrhea.

Antacids containing aluminum (e.g. Maalox®,  Mylanta®) that neutralize stomach acid are composed of a metal ion (aluminum, magnesium, calcium, sodium) which is linked to an alkali (hydroxide, carbonate, bicarbonate, trisilicate). The alkali determines how long the antacid will work, the metal ion determines how quickly it will work (as well as likely side effects).

Side Effects of Antacids:

Side effects of aluminum containing antacids include: Diarrhea and constipation, feeling of discomfort, loss of appetite, mood or mental changes, weakness, calcium loss, osteoporosis, kidney stones, swelling or wrist or ankles, bone pain and pale or clay-colored stools. People who have recently experienced GI bleeding should not use aluminum compounds, if possible.

Signs/Symptoms of aluminum toxicity include:

• Alzheimer’s disease
• Behavioral difficulties among school children
• Clumsiness of movements
• Colic
• Dementia
• Esophagitis
• Gastroenteritis
• Inability to pronounce words properly
• Kidney damage
• Liver dysfunction
• Loss of appetite
• Loss of balance
• Muscle pain
• Parkinson’s disease
• Psychosis
• Senile and pre-senile dementia
• Shortness of breath & Weakness
• Staggering when walking

Two infants presented with growth failure and were found to have generalized osteomalacia (rickets) due to phosphate depletion from prolonged administration of an aluminum-containing antacid given for the symptoms of colic.

Side effects of magnesium containing antacids include:

Magnesium compounds are available in the form of magnesium carbonate, magnesium trisilicate, and, most commonly, magnesium hydroxide (Milk of Magnesia). The major side effect of these magnesium compounds is diarrhea.

Side effects of antacids containing sodium bicarbonate:

Nausea and vomiting, slow breathing, problems in urination (frequent urge) headaches, loss of appetite, mood or mental changes (feeling nervous or restless), muscles pain, tiredness and weakness. Avoid taking antacids containing sodium bicarbonate when the stomach is uncomfortably full from eating or drinking.

Drug interactions with Antacids:

Antacids have multiple drug interactions, usually due to inhibition of absorption of other medications. In rare cases, the absorbable antacids may alter the pH of the stomach contents or urine sufficiently to alter drug absorption or excretion. The interactions can be avoided by taking these other drugs one hour before or three hours after the antacid.

Some herbs and supplements that interact with antacids:

Acidophilus and Ginger

Drugs less absorbed when taking antacids include:

Tetracycline, Antifungals (Sporonox), Ciprofloxacin (Cipro), Propranolol (Inderal), Captopril (Capoten), Ranitidine (Zantac), Famotidine (Pepcid AC), Allegra (Fexofenadine is the scientific name of this antihistamine), Quinolone antibiotics (see antibiotic list), iron supplements

Antacids can also potentiate (make stronger) the following drugs:

• Valproic acid: Used to treat epilepsy, bipolar disease and migraines.
• Sulfonylureas: Drugs used to treat Type II diabetes including: Amaryl, Glyburide, Glucotrol, Chlorpropamide, Diabinese, Tolazamide, Tolinase Acetohexamide, Glipizide, Tolbutamide, Orinase, Glimepiride, Diabeta, Micronase, Glubenclamide and Gliclazide.
  • Quinidine: cardiac drug (trade names Quinidex and Quinora) used to treat certain heart arrhythmias.
  • Levodopa: and anti-Parkinson’s drug.
  • Dixoxin/Lanoxin: heart drugs used in treating congestive heart failure.

H2 Blockers

H2 blockers decrease the amount of acid made in the stomach by blocking, a substance produced by the body that encourages acid secretion in the stomach. H2 blockers were the standard treatment for the control (not cure) of duodenal peptic ulcers until the discovery of the core cause of ulcers (Helicobacter pylori).

Common H2 blockers include: Famotidine (Pepcid AC), Cimetidine (Tagamet), Ranitidine (Zantac) and Nizatidine (Axid). H2 blockers can interact with other drugs.

Famotidine (Pepcid AC): is the most potent H2 blocker. The most common side effect of famotidine is headache and it may also cause problems with kidney patients. There have also been reports of anxiety, depression, and mental disturbances.

Cimetidine (Tagamet): Can have side effects including mild temporary diarrhea, dizziness, rash, or headache. Cimetidine interacts with phenytoin, theophylline, and warfarin. Long term use of excessive doses (more than 3 grams a day) may cause impotence or breast enlargement in men; these problems resolve after the drug is discontinued.

Common side effects of Tagamet: are depression, confusion, hallucinations, impotence, and heart and kidney problems. Additionally, Tagamet interferes with the body’s ability to break down other chemicals, meaning you can get an overdose of blood thinners and anticoagulants which can cause you to bleed to death.

Ranitidine (Zantac): A common side effect of ranitidine is headache, diarrhea, constipation, upset stomach, vomiting, stomach pain, cough, dizziness or mild rash. May also damage the liver.

Nizatidine (Axid) is a new H2 blocker.

Long-Term Concerns of taking H2 Blockers.

There are some reports that long-term acid suppression with these drugs may cause cancerous changes in the stomach in patients who also have untreated H. pylori infections. More research is needed. There is also an increased risk for pneumonia in hospitalized patients; ulcer complications (perforation, bleeding) because not treating the core cause combined with covering up the symptoms can complicate things.

11 Potential problems associated with frequent or long term use of antacids in general include:

1. Poor digestion leading to allergies, bloating and gas.
2. Diarrhea, loose/watery stools and abdominal bloating form when large partially digested food particles ferment and draw extra fluid into the large intestine creating gas and watery stools.
3. Decreased absorption of a variety of nutrients such as folic acid, vitamin C, beta carotene, iron, calcium magnesium and zinc.
4. Increased risk of food allergies.
5. Reduced effectiveness of the antacids with long term use because the stomach can eventually compensate for extended use of antacids.
6. Increased risk of gastro-intestinal infections.
7. Bloating: Antacids containing sodium bicarbonate and calcium bicarbonate release carbon dioxide as they neutralize stomach acid. This may cause bloating in the stomach as well as cause an increased production of stomach acid.
8. Electrolyte imbalance: Some antacids that are absorbed may cause acid base and electrolyte disturbances—like baking soda and bicarbonates.
9. Impaired kidney function and the formation of kidney stones because the kidneys have to keep up with processing the mineral components of the antacids. Chronic use of antacids contributes to a phosphate depletion syndrome and kidney stones (See Stone Handout Link below).
10. Phosphate depletion (Hypophosphatemia): Prolonged use of aluminum containing antacids containing (such as Maalox® or Mylanta®) have been associated with phosphate depletion. Prolonged hypophosphatemia produces a number of effects on both the kidney and bone. So, how do you get phosphates back into your body? You crave things with phosphoric acid in them (soda pop).
11. Increased risk of rickets (Osteomalacia) which is thinning of the bones. Hmmm. I wonder how many people are having to take Fosamax because they have had extended use of antacids earlier in their life!

Contraindications to taking Antacids:

1. Antacids with high levels of calcium carbonate, sodium bicarbonate should never be given to infants.
2. Antacids should be avoided if any signs of appendicitis or inflamed bowel are present. These include cramping, pain, and soreness in the lower abdomen, bloating, and nausea and vomiting.
3. Antacids should not be given to children under six years of age.
4. Anyone who is on a low-sodium diet should check the list of ingredients or check with a physician or pharmacist before taking an antacid product. Increased amounts of sodium can cause hypertension.
5. Gaviscon® should NOT be given to pre-mature infants; infants with a fever, vomiting or diarrhea; or who are dehydrated. Gaviscon should be used with a caution on infants less than 6 months. Gaviscon® in combination with soy infant formula can result in severe constipation.
6. Taking too much antacid can cause the stomach to secrete excess acid. It is important to contact your doctor or pharmacist about the appropriate dose for you.
7. Do not take antacids for longer than 2 weeks unless under the advice and supervision of your physician.
8. Antacids in Pregnancy: Antacids are not classified under the pregnancy safety categories A, B, C, D and X. Occasional use of antacids in small amounts during pregnancy is considered safe. However, pregnant women should check with their physicians before using antacids or any other medicines. Pregnant women who are consuming extra calcium should be aware that using antacids that contain sodium bicarbonate or calcium can lead to serious side effects.
9. Antacids in Breastfeeding: Some antacids may pass into breast milk. However, no evidence exists that the ingestion of antacids through breast milk causes problems for nursing babies whose mothers use antacids occasionally.

Interesting Antacid Facts

• Antacids may affect the results of some medical tests, such as those that measure how much acid the stomach produces. Health care providers and patients should keep this in mind when scheduling a medical test.
• Calcium salts may also be used as diet supplements in prevention of osteoporosis.
• Aluminum carbonate is useful for binding phosphate, and has been effective in treatment and control of hyperphosphatemia or for use with a low phosphate diet to prevent formation of phosphate urinary stones. This application is particularly valuable in patients with chronic renal failure.
• Antacids with aluminum and magnesium hydroxides or aluminum hydroxide alone effectively prevent significant stress ulcer bleeding in post-operative patients or those with severe burns.
• Antacids that contain the drug simethicone (e.g. Mylicon®, Infacol®) are used to reduce the amount of gas in the stomach. Simethicone is a spreading agent added to disperse foam by encouraging bubbles to join together, thereby making it easier for them to be brought up with a burp. Simethicone has no significant effect on gas in the intestines.