Antacids: Are they destroying your gut?

The holidays are a time to spend time with family and friends and to take a much-needed break from work. But between the stress of holiday shopping, the buckets of candy, and belt-busting feasts, there's a lot about the holidays that could burden the digestive system. So it's no surprise that digestive issues are the number one health risk that doctors see in the emergency room during the season of overindulgence.

If you've had one too many slices of apple pie, reaching for a Tums will not do you much harm. But if your holiday schedule includes multiple parties with rich food and alcohol, you may want to think twice about relying on an antacid.

How antacids work

True to their name, antacids work by mellowing out the acid in your stomach. For those who suffer from heartburn, that translates to considerably less chest pain resulting from acid burns in the esophagus. But while all antacids do the same thing, how they do it makes a difference to your gut. There are three different types of antacids:
Acid neutralizers (Tums)
Histamine antagonists (Pepcid AC)
Proton pump inhibitors or PPI (Prilosec)
Acid neutralizers contain salts (calcium, aluminum, or magnesium) that temporarily neutralize gastric acid already in the stomach. This option works best for people who need immediate, short-term relief.

Histamine antagonists reduce acid production by directly affecting the cells of the stomach. Usually taken before a meal, they begin to work after an hour and can last up to 12 hours. PPI are the strongest antacids on the market. It can take several days for them to take full effect but can suppress symptoms for 24 hours, making it popular with people who suffer from chronic digestive issues, like GERD (gastroesophageal acid reflux disease). It's for that same reason that PPI are the most dangerous of the antacids. Because while reduced stomach acidity can ease symptoms of discomfort, it also means that your food isn't digesting properly.

How antacids make heartburn worse

So how is heartburn—something that affects your esophagus—connected to the bacteria in your intestines?

Stomach acid makes for an aggressively inhospitable environment for bacteria. And while many probiotics are resistant, gastric acidity deters ingested pathogens. Now we're discovering that it could work both ways: that acidity plays a preventative role in the overgrowth of bacteria from the microbiome.

Taking PPI reduces the protective quality of the stomach, and bacteria that would have been destroyed can now make their way into your intestines to build colonies. This phenomenon of having too many bacteria in the upper digestive tract is called small intestine bacterial overgrowth (SIBO).

And when these new microbial colonies create gas (as bacteria do), it doesn't exit the same way it would if it were in the lower digestive tract. Instead, the excess gases create pressure, forcing stomach acid up through the esophagus and causing a chronic form of heartburn called gastroesophageal reflux disease (GERD). So the supplement you take for heartburn can worsen your heartburn over time.

Antacids may not kill off your microbiome, but it will mess with the balance of your digestive system, and balance is the key to keeping your gut happy. Maybe next time, before taking an antacid before a big meal, you should take a probiotic.