Discover the pros and cons of using antacids for acid reflux relief, their limitations, potential risks, and alternative treatment options for more sustained relief. We will also consider the benefits and side effects of proton pump inhibitors (PPIs) and the potential for combining antacids and PPIs for effective management.
Understanding acid reflux and its treatment options
Acid reflux, also known as gastroesophageal reflux disease (GERD), is a common condition that affects roughly 20% of people in the Western world. It occurs when stomach acid flows back into the esophagus, causing a burning sensation in the chest and throat which is why we refer to it as heartburn [1]. While lifestyle changes and dietary modifications can help manage acid reflux, there are various treatment options available. Heartburn medications come in two forms, antacids and blockers. Antacids neutralize stomach acid. Blockers are either H2 blockers or proton pump inhibitors (PPIs) and they reduce stomach acid which can help your stomach and esophagus heal. Both types may pose some risks, but PPIs may produce more serious ones.
What are antacids and how do they work?
A very popular and inexpensive option is antacids. Antacids are over-the-counter medications that provide temporary relief from acid reflux symptoms. They work by neutralizing the excess stomach acid, reducing the irritation and discomfort caused by the reflux. Antacids typically contain ingredients like calcium carbonate, magnesium hydroxide, or aluminum hydroxide, which react with the acid to form salts and water [1].
Pros of using antacids for acid reflux relief
Antacids offer several benefits when it comes to relieving acid reflux symptoms. First, they provide quick relief, offering immediate comfort from the burning sensation and pain. This is particularly useful for individuals who experience occasional heartburn or acid reflux episodes. Antacids are readily available over the counter and do not require a prescription, making them easily accessible for anyone in need. Additionally, antacids are generally considered safe for short-term use and have a low risk of side effects.
Antacids also provide a convenient solution for those who prefer a non-pharmaceutical approach to managing their acid reflux. Many are a more natural remedy that works by neutralizing the excess stomach acid, rather than suppressing its production. This can be appealing to individuals who prefer to minimize their reliance on medication or are concerned about potential side effects.
Cons of using antacids for acid reflux relief
Despite their advantages, antacids are not without their limitations. One of the main drawbacks is that antacids only provide temporary relief and do not address the underlying cause of acid reflux. While they can effectively alleviate symptoms in the short term, they do not offer a long-term solution. This means that individuals who rely solely on antacids may find themselves needing to take them frequently to manage their symptoms.
Another downside of antacids is that they may interfere with the absorption of certain medications. Antacids can reduce the acidity in the stomach, which can impact the breakdown and absorption of other drugs in the digestive system. This can potentially reduce the effectiveness of medications taken simultaneously with antacids. It is important to consult with a healthcare professional to understand any potential interactions before using antacids.
The dangers of chronic antacid use
Antacids can be a good treatment for heartburn that occurs once in a while. More common side effects may include constipation, diarrhea, allergic reaction or food sensitivity. Prolonged and excessive use of antacids can disrupt the natural balance of stomach acid, leading to a condition known as acid rebound. Acid rebound occurs when the body produces more acid to compensate for the neutralizing effect of antacids. This can result in a worsening of acid reflux symptoms and a dependency on antacids for relief.
If you take too much or take antacids for longer than directed, you could get an overdose of calcium and experience nausea, vomiting, mental status changes or kidney stones. If you take large amounts of antacids that contain aluminum, you may be at risk for calcium loss, which can lead to osteoporosis.
Another concern with chronic antacid use is the potential for nutrient deficiencies. Stomach acid plays a crucial role in the digestion and absorption of nutrients, including vitamins and minerals. By reducing stomach acid levels, antacids may impair the body’s ability to absorb these essential nutrients, leading to deficiencies over time. This can have a negative impact on overall health and well-being.
Alternatives to antacids for acid reflux treatment
For individuals seeking long-term relief from acid reflux, there are alternative pharmacologic treatment options available. One such popular option is the use of proton pump inhibitors (PPIs). PPIs work by reducing the production of stomach acid, providing more sustained relief compared to antacids. They are available both over the counter and by prescription and are considered more effective for managing chronic acid reflux.
The benefits of proton pump inhibitors (PPIs)
Proton pump inhibitors offer several benefits for individuals with acid reflux. Importantly, they provide longer-lasting relief compared to antacids. By reducing the production of stomach acid, PPIs help to prevent the occurrence of reflux episodes. This can significantly improve the quality of life for individuals who experience frequent or severe acid reflux symptoms.
PPIs are also effective in healing and preventing damage to the esophagus caused by chronic acid exposure. They can help reduce inflammation and promote the healing of esophageal tissues, reducing the risk of complications such as esophagitis or Barrett’s esophagus. This makes PPIs a valuable treatment option for individuals with more severe or chronic acid reflux [2].
The side effects of PPIs and their long-term use
While PPIs offer significant benefits, they are not without potential side effects. Common side effects of PPIs include headaches, nausea, diarrhea, and abdominal pain. The acid produced by the stomach has an antibacterial benefit because it destroys many types of bacteria that make their way down to your stomach. Suppressing stomach acid secretion for long periods might leave you more susceptible to certain bacterial infections. Clostridium difficile (often referred to as c. diff) is a bacterium capable of causing life-threatening cases of diarrhea and conditions like colitis, an inflammation of the colon lining.
In rare cases, long-term use of PPIs has been associated with an increased risk of certain health conditions, such as pneumonia, osteoporosis, and nutrient deficiencies [2]. More studies are also looking at the potential effects of long-term PPI use on the kidney. It has not been proven that PPI use causes chronic kidney disease, but some studies suggest there is an increased risk of chronic kidney disease in individuals who have normal kidney function before using a PPI [3,4,5]. This does not mean that everyone who uses PPIs will get chronic kidney disease, but it is important to know that there may be a risk. These studies did not include individuals who currently have kidney disease, so it is not clear if PPI use can make kidney disease worse.
Finding the right balance: combining antacids and PPIs for effective relief
In some cases, a combination of antacids and PPIs may be the most effective approach to managing acid reflux. Antacids can provide immediate relief for acute symptoms, while PPIs offer long-term control and prevention of acid reflux episodes. This combination can help strike a balance between immediate relief and sustained management of acid reflux.
Lifestyle Changes to Help with Acid Reflux
As an alternative to antacids and PPIs, there are some lifestyle modifications that you can do to help alleviate acid reflux. Some of the lifestyle modifications that have been studied for GERD include weight loss, head-of-bed elevation, and avoidance of tobacco, alcohol, and late-night meals. Another modification that has been suggested is avoiding large meals and those foods that may aggravate reflux symptoms like, caffeine, coffee, chocolate, spicy foods, highly acidic foods (oranges, tomatoes), and fatty foods.
Final Thoughts
Antacids can be a valuable tool for managing occasional acid reflux symptoms. They offer quick relief and are easily accessible without a prescription. However, they only provide temporary relief and do not address the underlying cause of acid reflux. For individuals with more severe or chronic acid reflux, proton pump inhibitors may offer more sustained relief and help prevent complications. It is important to consider the potential risks and benefits of both antacids and PPIs and work with a healthcare professional to find the most appropriate treatment approach.
Sources
[1] Garg, V., Narang, P., & Taneja, R. (2022). Antacids revisited: review on contemporary facts and relevance for self-management. The Journal of international medical research, 50(3), 3000605221086457. https://doi.org/10.1177/03000605221086457
[2] Kinoshita, Y., Ishimura, N., & Ishihara, S. (2018). Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use. Journal of neurogastroenterology and motility, 24(2), 182–196. https://doi.org/10.5056/jnm18001
[3] Wu, C. C., Liao, M. H., Kung, W. M., & Wang, Y. C. (2023). Proton Pump Inhibitors and Risk of Chronic Kidney Disease: Evidence from Observational Studies. Journal of clinical medicine, 12(6), 2262. https://doi.org/10.3390/jcm12062262
[4] Morschel, C. F., Mafra, D., & Eduardo, J. C. C. (2018). The relationship between proton pump inhibitors and renal disease. Jornal brasileiro de nefrologia, 40(3), 301–306. https://doi.org/10.1590/2175-8239-jbn-2018-0021
[5] https://www.nature.com/articles/s41598-021-83099-y
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https://www.webmd.com/heartburn-gerd/guide-chapter-heartburn-gerd-treatment
https://www.ifm.org/news-insights/gut-alternatives-ppis-h2-blockers/
https://safermedsnl.ca/reflux-medications-pros-and-cons
https://www.kidney.org/atoz/content/acid-reflux-and-proton-pump-inhibitors
