Q. Because of concerns about side effects of PPI acid-suppressing drugs, I have switched to Tums. I rely on two or three of these antacids to control my heartburn. Is that safe? What else could I do?
A. If you are regularly taking Tums Extra Strength 750 to ease indigestion, you could be getting over 2000 mg of calcium carbonate daily. If you are also getting calcium from other sources, you might be getting too much, especially if you do this day in and day out.
There is growing concern about the safety of high doses of calcium. In 2010 an article in the BMJ raised the possibility that calcium supplementation might increase the possibility of heart attacks. The authors reviewed 11 studies involving roughly 12,000 individuals. Those taking extra calcium were about 30 percent more likely to experience a heart attack than the participants taking placebo.
The authors concluded:
“Calcium supplements (without coadministered vitamin D) are associated with an increased risk of myocardial infarction [heart attack]. As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population. A reassessment of the role of calcium supplements in the management of osteoporosis is warranted.”
They go on to note that:
“Calcium supplements acutely increase serum calcium levels to a modest degree. Serum calcium levels have been positively associated with an increased incidence of myocardial infarction in large observational studies…Ingestion of equivalent doses of calcium from dairy products has a much smaller effect than calcium supplements on serum calcium levels, which might account for the absence of a detrimental vascular effect of dietary calcium intake in the observational studies reviewed. Vascular calcification is an established risk factor for cardiovascular disease, and the process of vascular calcification is similar to osteogenesis [bone formation]. Because calcium supplements increase bone density it is possible that they may also increase vascular calcification and thereby cardiovascular events.”
Calcium Supplements vs. Antacids?
If you were paying close attention you would realize that the studies that were analyzed involved calcium supplementation rather than heartburn medicine. That said, calcium carbonate, the same ingredient in Tums, is often recommended as a calcium supplement. The difference is that Tums Extra Strength 750 comes with a warning:
“Do not use the maximum dosage for more than 2 weeks except under the advice and supervision of a doctor.”
Other Calcium Studies:
A study published in the journal Heart (May 23, 2012) suggested that people who took calcium supplements were at increased risk for a heart attack. This study involved 23,000 adults who were followed for 11 years.
Many people have suggested that regular use of calcium supplements without vitamin D is the problem. They assumed that if you just added vitamin D to the calcium supplement the problem would disappear.
The Women’s Health Initiative (WHI CaD) included a seven-year study of calcium supplementation plus vitamin D. It involved 36,282 postmenopausal women who were randomized to receive either the supplements (1000 mg of calcium and 400 IU of vitamin D) or a placebo. The authors of an analysis of the data concluded (BMJ, April 19, 2011):
“Calcium and vitamin D supplements increased the risk of cardiovascular events in the WHI CaD participants who were not taking personal calcium supplements at the time of randomisation. When these results are taken together with the results of other clinical trials of calcium supplements, with or without vitamin D, they strongly suggest that calcium supplements modestly increase the risk of cardiovascular events, particularly myocardial infarction. These data justify a reassessment of the use of calcium supplements in older people.”
It’s Not Just Women:
Some studies suggest increased risk for cardiovascular disease in men taking calcium supplements (American Journal of Clinical Nutrition, March, 2016).
Just to Add to Your Confusion:
To be fair, we need to tell you that not all analyses agree that regular calcium use leads to an increase in heart attacks or other cardiovascular complications. A meta-analysis of randomized controlled trials published in the Journal of Bone and Mineral Research (Jan., 2015) concluded that:
“current evidence does not support the hypothesis that calcium supplementation with or without vitamin D increases coronary heart disease or all-cause mortality risk in elderly women.”
By now you know that science is messy. That makes it hard for patients and health professionals to make sense of contradictory data.
What Else Can People Do to Ease Indigestion?
Long-term use of proton pump inhibitors (PPIs) like esomeprazole, lansoprazole or omeprazole have been linked to a range of complications including osteoporosis, vitamin and mineral deficiency, pneumonia, and C diff infections. You may want to consider less powerful acid suppressors such as cimetidine (Tagamet), famotidine (Pepcid) or ranitidine (Zantac). Other options include DGL (deglycyrrhizinated licorice), ginger or chamomile.
To learn more about other ways to ease indigestion you may find our Guide to Digestive Disorders helpful. It discusses medications as well as non-drug options.