Updated: Feb 2
Antacids are often the go-to medication for stomach and digestion issues. But few patients understand how these medications can alter the stomach environment and cause nutrient deficiencies.
History and Usage of Antacids
Antacids were originally developed as a treatment for peptic ulcer disease. Over the years, however, doctors have increasingly recommended antacids for a range of conditions including heartburn, gastroesophageal reflux disease (GERD), and even osteoporosis. Recently, the global antacids market was projected to be worth nearly $20 billion by 2025. Market surveys show that 11 percent of the American population uses antacids daily.
What is an Antacid?
Antacids are medications that do not require a prescription. They’re often a combination of compounds from various salts of calcium, magnesium, and aluminum as the active ingredients.
In 1979, pharmaceutical companies began introducing a new class of drug to control acid secretion in the stomach. Termed “Proton Pump Inhibitors (PPIs)”, these drugs were originally available only by prescription but are now available over-the-counter in brands such as Prilosec and Nexium.
Around the same time, a similar class of drug called “H2 Blockers” was also introduced, again only available via prescription from doctors. Similarly, there are now over-the-counter versions of H2 Blockers, including Tagamet and Pepcid AC.
How These Drugs Work
It’s important to understand how antacids and proton pump inhibitors work in the body. For antacids, the compounds act to neutralize the acidic level of the stomach and by inhibiting pepsin, an enzyme that assists in breaking down proteins.
Proton pump inhibitors work slightly differently. They bind to the proton pumps, which are found within the parietal cells of the stomach. Parietal cells are the cells in the lining of the stomach that secrete hydrochloric acid and intrinsic factor, a protein critical for vitamin B12 absorption. By binding to the pumps the PPIs block a particular enzyme in the pump or the pump itself, thereby preventing acid production.
H2 Blockers also block and prevent acid production, but do so by traveling to specific receptors in the stomach’s parietal cells. The medication inhibits certain chemical reactions so that the cells aren’t able to produce as much stomach acid. H2 Blockers are thought to be less powerful than PPIs but more effective for treating nighttime acid production.
Whether using traditional antacids that neutralize stomach acid or H2 Blockers or PPIs to block and prevent stomach acid, the objective is to decrease the acid so that the stomach and/or esophagus region can heal from ulcers or irritation.
How the Stomach Works
It’s also important to understand how the stomach works and the role of stomach acid.
The food we eat, while attractive and appetizing, is not directly and immediately useful to our bodies. Food ultimately provides fuel for energy and also micronutrients for the many functions our bodies perform. To become useful, food must first break down into the various components that our body can absorb. The first step of digestion begins in the mouth, but it’s in the stomach that the most action occurs.
Two important steps take place in the stomach during digestion:
Hydrochloric acid is secreted by the parietal cells and begins to break down food. This is critical for breaking down protein.
The acid triggers the release of pancreatic enzymes to then neutralize the acid and to further support digestion as the contents of the stomach move into the small intestine
In short, stomach acid is critical for the proper digestion of food, particularly protein foods.
The Effect on Nutrients
Given the importance of stomach acid in the process of digestion, it shouldn’t be surprising that eliminating stomach acid can adversely affect nutrient absorption. Specifically, there are several nutrient depletions caused by the different antacids and acid-suppressing medicines discussed above:
H2 Blockers can deplete calcium, folate (B9), iron, vitamin B12, and vitamin D
Proton-pump inhibitors can deplete magnesium and vitamin B12
These nutrient deficiencies can be consequential, particularly for those people who consume antacids and acid suppressants for long periods of time. And because these medicines can induce a rebound effect, meaning that removal of them can increase acid production, people often consume them for months or years before they realize the side effects.
Two of the most concerning deficiencies are vitamin B12 and calcium. Nutrition Review reports that PPIs and H2 blockers significantly increase the risk of vitamin B12 deficiency in elderly patients. Vitamin B12 requires gastric acid for absorption. The elderly population is already prone to deficiency in intrinsic factor, a protein necessary for B12 absorption. Symptoms may include trouble walking or changes in memory, conditions that may be mistaken for aging or dementia.
The Journal of the American Medical Association reported on a study that concluded that the use of PPIs for over one year results in people being 2.5 times more susceptible to hip fracture than control subjects (1). Researchers believe the drastic drop in calcium and vitamin D absorption that occurs with PPIs is the cause.
Getting to the Root Cause of Digestion Issues
Antacids and acid suppressants can be highly effective for short-term excess acid and for healing from stomach ulcers and esophageal irritation. Some doctors and researchers, however, believe there are multiple causes for the burning sensation that’s often diagnosed as GERD. And some of them may surprise you.
One theory is that certain unhealthy lifestyles can cause acid reflux, namely weight gain, smoking, physical inactivity, drinking too much alcohol, and eating large meals before bed. The good news is that many of these behaviors are controllable, and addressing them can prevent the side effects of acid medications.
Jonathan Wright, M.D. proposes a different theory in his book, Why Stomach Acid Is Good For You. He argues that GERD and related conditions are often the result of too little stomach acid, a condition called hypochlorhydria. He explains that when there is acid deficiency, poor digestion makes food putrefy and ferment in the stomach. This produces discomfort, bloating, and the gas that “refluxes” back into the esophagus. The fermented food can be acidic, causing the burning sensation patients often describe. Furthermore, Dr. Wright argues that antacids and acid suppressants are merely band-aids and don’t address the underlying cause.
Hopefully it’s become clear that there’s more happening in your stomach than the simple passage of food. The digestion process requires a number of factors, not the least of which is stomach acid. Altering the delicate balance may result in nutrient deficiencies and health impairments.
If you experience a burning sensation after eating, I recommend working with a functionally-trained doctor who can help you understand the root cause of your suffering.
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(1) Yang, YX, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 296 (24): 2947-53