Heartburn’that rising, burning sensation that happens when stomach acid, produced during digestion, flows back up and irritates your esophagus’affects about 40 percent of Canadians, according to a McMaster University study. If you’re one of them, whenever possible, avoid heartburn triggers such as greasy or spicy foods, caffeine, alcohol and lying down too quickly after eating. (Pregnancy and weight gain can also increase your risk.) But if the fire has already started, over-the-counter (OTC) remedies are available.
We asked Dr. Naoki Chiba, an associate clinical professor of medicine in the department of gastroenterology at McMaster University, and Derek Ho, a pharmacist and Shoppers Drug Mart store owner in Markham, Ont., for their suggestions. ‘All [OTC heartburn products] are pretty effective for minor symptoms and short-term use,’ says Chiba.
Always talk to your healthcare provider before trying new medications, follow package instructions and start with the lowest dose. Also, if you require the daily maximum dose of antacids for more than two weeks, see your doctor, says Chiba; you may need a prescription to get more effective relief. And remember, while heartburn flare-ups after eating certain foods aren’t too concerning, if you experience new symptoms, speak to your doctor (especially if you’re 50-plus and haven’t had problems before).
To relieve heartburn, indigestion, upset stomach, nausea and diarrhea: Bismuth Subsalicylate (e.g. Pepto-Bismol and Maalox Multi-Action)
How they work: Bismuth subsalicylate products are available in liquid, caplets or chewable tablets. Maalox Multi-Action is available in liquid only. They are as effective for heartburn as other OTC products, neutralizing stomach acid and stopping diarrhea by decreasing the flow of fluids and electrolytes into the bowel. They also have antibiotic and inflammation-fighting properties.
Need to know: You can take bismuth subsalicylate before or after eating. It can cause constipation if you take more than the recommended dose. People who are on blood thinners or are allergic to salicylates (e.g., ASA) should not take it. Also, because of the risk of Reye’s syndrome, children and teens should not take it if they have, or are recovering from, chicken pox or flu.
To neutralize acid: Antacids (e.g. Tums, Rolaids, Phillips’ Milk of Magnesia, Maalox and Alka-Seltzer)
How they work: Available in chewable tablets or liquid formulations, antacids contain one or more of several active ingredients, such as calcium carbonate (e.g., Tums, Rolaids), magnesium hydroxide (e.g., Phillips’ Milk of Magnesia, Maalox, Rolaids), aluminum hydroxide (e.g., Maalox) or sodium bicarbonate (e.g., Alka-Seltzer). These ingredients neutralize stomach acid.
Need to know: Sodium bicarbonate (e.g., Alka-Seltzer) isn’t recommended for people on a sodium-reduced diet, such as those with hypertension. Magnesium hydroxide in antacids can cause diarrhea, ‘especially if one takes a higher dose,’ says Chiba. Also, people with kidney problems should avoid too much magnesium. Aluminum hydroxide can cause constipation in some people, particularly if you’re taking it chronically. Also, avoid it if you have kidney disease, because aluminum hydroxide can build up and may cause kidney stones and salt retention. Talk to your pharmacist.
How they work: Active ingredients include famotidine or ranitidine. They decrease the acid your body naturally produces by blocking histamine (a chemical released during digestion), thereby stopping acid overload before it starts.
Need to know: These drugs, also known as H2 blockers, used to be available by prescription only, but are now available over-the-counter in tablet and chewable forms, at half the prescription dose. They’re more effective and longer-lasting than antacids and alginates (see right), so you should only need to take them once or twice a day. However, they’re not as fast-acting as some antacids, and taking an antacid within an hour of an H2 antagonist will reduce absorption. H2 antagonists work best when taken 30 minutes before a meal, so they have time to reach peak levels as your stomach starts producing acid during digestion.
To neutralize and decrease acid: Antacids combined with H2 Antagonists (e.g. Pepcid Complete)
How they work: They contain two active ingredients (calcium carbonate and magnesium hydroxide) that neutralize acid, plus an H2 antagonist that decreases acid production for up to 12 hours.
Need to know: Take these chewable tablets only twice in a 24-hour period. Recommendations that apply to antacids and H2 antagonists alone apply to this remedy, too.To prevent acid from entering the esophagus: Alginates (e.g. Gaviscon and Maalox Nighttime Antacid + Acid Reflux Barrier)
How they work: Alginates form a foamy layer on top of stomach contents, preventing acid backflow.
Need to know: Whether in chewable tablet or liquid form, alginates work best when taken right after a meal because they’re meant to sit on top of your food. But you can take them anytime heartburn starts up. Alginates may not be recommended for those with kidney disease.
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