Popping an antacid to cope with troublesome digestive symptoms can often offer fast and easy relief.
And antacids aren’t addictive. They can be found anywhere from pharmacies to gas stations, and they’re considered among the safest of remedies.
But, like most medications, antacids don’t address the underlying cause. Using them routinely can also lead to a vicious cycle by contributing to gastrointestinal damage that creates more of the very symptoms that you’re trying to resolve.
Dr. Vikki Peterson, a functional medicine practitioner and chiropractor with Root Cause Medical Clinic, told The Epoch Times that taking an antacid tablet is fine for the occasional upset stomach but can also establish a trajectory of worsening health if abused.
“It will decrease the symptoms. If that happens twice a year, and got you relief and got you out of pain, then OK. It’s not going to give you any bad results,” she said. “When you’re getting into the chronic nature of using them, it’s time to really figure out the why behind it and not just keep putting up with symptoms.”
As the name implies, antacids are designed to relieve excess stomach acid. What many people don’t realize, however, is that low stomach acid also mimics the symptoms of too much acid, namely heartburn, an uncomfortable burning in the center of the chest that can sometimes be quite severe, and reflux, acid making its way up the esophagus and even into the throat.
Why We Reach for Antacids
Hypochlorhydria is a condition characterized by too little output of hydrochloric acid by the stomach, and hyperchlorhydria is the opposite. As opposites, they shouldn’t be treated the same.
The problem is that without tests, it’s impossible to know what’s happening with your stomach acid. Most people assume that they have hyperchlorhydria, and in addition to self-diagnosing, they tend to self-medicate with over-the-counter (OTC) solutions such as antacid tablets. These work by reducing stomach acid or neutralizing it by interfering with the enzyme pepsin that’s used to break down food in the digestive process.
Antacids are approved by the U.S. Food and Drug Administration for occasional mild cases of heartburn and reflux. They aren’t intended for daily symptoms, although according to Cleveland Clinic, they can certainly provide relief for more serious, long-term issues such as gastroesophageal disease (GERD), stomach ulcers, and gastritis.
“They contain calcium carbonate and magnesium hydroxide, which are safe to take periodically and in small quantities. Taking large amounts of antacids could raise blood levels of calcium and magnesium, but in normal recommended amounts, they are considered very safe,” Dr. William Li, medical doctor and New York Times bestselling author of “Eat to Beat Your Diet: Burn Fat, Heal Your Metabolism, and Live Longer,” told The Epoch Times in an email.
Hidden Dangers of Antacids
However, chronic usage can go on for years—unknown by doctors—among people who don’t realize the risks of underlying conditions. A JAMA Internal Medicine study of 155 subjects in 1998 revealed a variety of diagnoses among a cohort of people who hadn’t sought medical attention for their heartburn but had been taking OTC antacids for an average of 11 years.
Seventy percent had moderately severe heartburn, and many had more concerning symptoms such as hoarseness, pain or difficulty in swallowing, or wheezing. Many ultimately had serious underlying diseases and conditions. The study warned that while generally safe, antacids can cause acid rebound, affect lower gastrointestinal tract function, and produce drug interactions that can lead to drug absorption, binding, and elimination issues.
“Long-term requirements for symptom control by OTC medications for symptomatic relief may signify underlying pathological conditions, and such medications may mask serious disease,” the authors of the study wrote.
Those warnings are often dismissed. Meanwhile, stomach acid irregularities create more damage to the body. Cleveland Clinic and others warn that taking antacids won’t address the root cause of heartburn and reflux.
Dr. Peterson has noticed that OTC antacids can also act as a “gateway drug” to controversial proton-pump inhibitors (PPIs), which work by turning down the mechanism that produces hydrochloric acid.
Long-term PPI use has been associated with a number of other conditions, including dementia and severe gastrointestinal disease. There are concerns that PPIs are overprescribed and taken for longer than intended while the root causes still go unaddressed.
Overreliance on antacids is a problem that isn’t diminishing. A March 2022 review published in the Journal of International Medical Research reported an increase in gastrointestinal (GI) symptoms since the beginning of the COVID-19 pandemic that were connected to a change in dietary habits and increased anxiety related to lockdowns. Where GI issues arise, antacids often follow.
Why Low Stomach Acid Occurs
Age is a risk factor for low stomach acid, as it’s associated with a decrease in hydrochloric acid, which also reduces the amounts of digestive enzymes and leads to malabsorption, according to Dr. Peterson.
Stomach acid is important to immunity because it kills bad microbes, such as infectious bacteria and viruses, which can be accidentally ingested and then migrate to the small intestine, where they can leak into the body and cause disease. Small intestinal bacterial overgrowth, or SIBO, is the condition of too many bacteria accumulating in the upper small intestine where they don’t belong.
At least one infectious bacterium, Helicobacter pylori, also causes low stomach acid because it creates chronic inflammation of the stomach.
Other causes of low stomach acid, according to Cleveland Clinic, are alcoholism, autoimmune diseases, and acid-reducing medications.
More than half the participants in the JAMA study reported that caffeine also made their symptoms worse. Generally, inflammation is a positive biological function that helps the body to repair tissue and defend itself against pathogens. However, when inflammation is prolonged, it can deplete the body and contribute to other diseases.
Because the gut microbiome—which is composed of bacteria, viruses, fungi, and other microorganisms—plays a role in modulating inflammation, it’s believed to be involved with symptoms associated with heartburn. Dr. Peterson said that anything introduced to the stomach can be a cause of inflammation and that repeated dietary exposures that cause or nurture inflammation will interrupt healing.
This functional hypothesis that SIBO is the root cause of GERD is made in Norman Robillard’s book “Fast Tract Digestion,” which proposes that gases made by the fermentation of out-of-place bacteria in the small intestine can compress the stomach and lead to acid shooting into the esophagus through the lower esophageal sphincter. Hiatal hernias can also put pressure on this valve, Dr. Peterson said.
Finding Safe Relief
In the short term, one alternative to antacids for quick relief is diluted apple cider vinegar. There’s no conclusive scientific evidence that it works, but it’s fairly low risk.
A long-term approach is weeding out medications and foods that might increase an inflammatory response in the body, Dr. Peterson said. Eating only foods that are one ingredient—a whole food diet—can slowly reverse symptoms.
“Americans eat horribly. Sixty-five percent of our calories are ultra-processed foods,” she said. “You can’t even call it food because it’s such a departure from what food is supposed to be. We have to work hard and make that extra effort not to get lured in by the food engineers that make foods so hyper-palatable and addictive.”
Dr. Li offered these additional tips:
- Sit upright with a straight back to help prevent stomach acid from flowing into your esophagus by gravity.
- Avoid eating too close to bedtime. Late-night snacks can get your stomach acids roiling to digest the food, and when you lie down to sleep shortly afterward, the acid flows up your esophagus and causes heartburn.
- Don’t drink alcohol, which can relax your esophageal sphincter, making it more likely that acid will travel from your stomach into your esophagus.
Dr. Li said that if you still have heartburn after implementing lifestyle changes, it’s time to visit a physician to look for more serious problems.
Testing Stomach Acid
If you’re concerned that you have stomach acid issues, it may be worth looking more closely. There are several different medical tests used to diagnose low stomach acid.
They include:
- The Heidelberg pH test: A small capsule with a radio transmitter is swallowed to measure the pH level in your stomach. After that, a baking soda solution is consumed to measure how long it takes your stomach to return to baseline.
- The SmartPill test: Similar to the Heidelberg test, this test measures gastric acid levels rather than pH.
- The gastric string test: A capsule attached to a string is swallowed. After 10 minutes, the string is removed and tested with pH paper.
Both Cleveland Clinic and Dr. Peterson also said the baking soda test can give you a general idea about low stomach acid. Baking soda combined with stomach acid produces carbon dioxide, which will cause you to burp.
To try the test at home, you can drink four ounces of cold water mixed with a quarter teaspoon of baking soda on an empty stomach. If it takes longer than five minutes to burp, there’s a likelihood that you don’t have enough stomach acid.