People with serious acid reflux face a terrible dilemma. To control their uncomfortable symptoms, their doctors prescribe a powerful acid-suppressing drug such as dexlansoprazole (Dexilant), pantoprazole (Protonix) or rabeprazole (AcipHex). These drugs are proton pump inhibitors, or PPIs. Even if a person’s symptoms are not unbearable, they may be told to take a PPI to protect themselves from Barrett’s esophagus or a rare but serious complication, esophageal cancer.
Side Effects of PPIs:
The trouble is that the PPIs have been racking up serious side effects for the last few decades. When omeprazole (Prilosec) and lansoprazole (Prevacid) were first introduced, doctors believed their side effects were extremely minor. But since then we have learned that people who take a PPI are more likely to break a hip (Annals of Epidemiology, Apr., 2014), suffer diarrhea due to a C diff overgrowth (Expert Review of Clinical Pharmacology, July, 2013), develop chronic kidney disease (JAMA Internal Medicine, Feb., 2016) or have a heart attack (PLoS ONE, June 10, 2015). No wonder many readers have become nervous about taking a PPI.
What About Calcium Carbonate Instead of a PPI?
Q. Have any studies been done about the safety of taking calcium for reflux? I take at least four 500 mg generic tablets a day for my GERD. These keep the heartburn under control.
Usually, I take two at bed time so I won’t wake up with a bellyache. I’ve been doing this for years, since I do not want to take a PPI drug like Nexium. Will I regret this?
Calcium Carbonate Antacids Are Best for Short-Term Relief:
A. The calcium carbonate you take is intended for short-term symptomatic relief. Each 500 mg tablet supplies 200 mg of elemental calcium, so four would provide about 800 mg in a day. That is within the recommended dietary allowance of 1000 mg for adult men up to 70 years old. (Women over 50 and men over 70 are advised to get 1200 mg daily; to get this much, most people will need a supplement of some sort.)
What we don’t know is the long-term safety of calcium supplementation. A meta-analysis of 13 double-blind placebo-controlled trials found that women taking calcium supplements were 15 percent more likely to develop cardiovascular disease (Nutrients, Jan. 26, 2021).
In addition, a study published in the journal Gut (March 1, 2018) reported a connection between calcium plus vitamin D supplements and precancerous colon polyps. The volunteers in this controlled trial were taking 1200 mg of elemental calcium plus 1000 IU of vitamin D3. It took six to ten years for this complication to show up.
In consideration of these risks, you may want to consider other strategies for controlling your heartburn. However, you won’t necessarily need a PPI. You will find lots of options in our eGuide to Overcoming Digestive Disorders.
Resolving a Dilemma:
Q. I have severe acid reflux problems. For treatment, I use Pepcid Complete twice a day. I also use Gaviscon and DGL intermittently, but I worry about whether any of these is a PPI.
Of course, DGL is natural, but would you please settle this once and for all: is Pepcid Complete or Gaviscon considered a PPI?
A. Neither Pepcid Complete nor Gaviscon is a PPI (proton pump inhibitor). PPI drugs such as esomeprazole (Nexium), lansoprazole (Prevacid) or omeprazole (Prilosec) are very effective at healing ulcers and treating gastroesophageal reflux disease (GERD).
Over the past decade, however, scientists have discovered some disturbing side effects from PPIs. The list now includes strokes, heart attacks, kidney damage, dementia, weakened bones and infections.
Gaviscon contains the antacids aluminum hydroxide and magnesium carbonate. Pepcid Complete has three different compounds to help control heartburn: famotidine, calcium carbonate and magnesium hydroxide.
Controlling Reflux without a PPI:
For other strategies to ease indigestion and control heartburn we are sending you our Guide to Digestive Disorders. DGL (deglycyrrhizinated licorice) is a natural compound derived from licorice that can be helpful against heartburn. Other natural favorites for easing heartburn or reflux include ginger-persimmon tea or apple cider vinegar. Over-the-counter approaches include antacids such as Tums or Maalox, or a half-teaspoon of baking soda in a glass of water.