March 13,
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Acid reflux affects just about everyone. And when it strikes, your first instinct may be to reach for an antacid like Tums.
But are antacids the right choice for acid reflux?
We asked an expert what you need to know before choosing an acid reflux medication.
If you have mild acid reflux pretty infrequently, antacids can be the right choice says Gena Cobrin, MD, gastroenterologist with Hartford HealthCare’s Digestive Health Institute.
“Antacids provide immediate, temporary relief when you are already experiencing acid reflux,” she notes. “But they don’t prevent it.”
These can be purchased over-the-counter and include Tums, Rolaids, Mylanta and Alka-Seltzer.
The good news, says Dr. Cobrin, is that there are many ways to improve acid reflux. Try making some simple lifestyle changes, like:
“If you have frequent symptoms after making lifestyle changes or despite taking antacids, you have some options available,” Dr. Cobrin says.
> Related: 4 Home Remedies for Heartburn That Actually Work
Besides antacids, there are other types of acid reflux medication. Some are available over the counter and others by prescription. These include:
Acid reflux medication isn’t one-size-fits-all. But a doctor can help you decide what medication is right for you.
“Your course of treatment will depend on your symptoms,” says Dr. Cobrin. “In patients with mild or occasional symptoms, we often recommend step-up therapy. This means you would start with antacids, then move up to H2RAs, and eventually to PPIs.”
But if your symptoms are more severe?
“In that case, we recommend step-down therapy, meaning you start with a PPI and work the other direction,” she says.
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If your acid reflux is that persistent, treating it yourself likely isn’t the best option.
“Frequent, severe acid reflux can be a sign of something more serious,” says Dr. Cobrin. “It’s important to keep your doctor informed, and find the treatment plan that’s right for your specific symptoms.
And if your doctor suspects that something more serious is going on, they might recommend an endoscopy.
“Patients with worsening symptoms, erosive esophagitis, or Barrett’s esophagus need to be on medications. If you have concerns, speak to your doctor right away and find a treatment plan that works for you.”
A food with a pH below 4.6 is high in acid. This includes many citrus fruits, plums, grapes, pomegranates, and several other fruits. Tomatoes, which are technically a fruit, are also acidic.
Defining acidity
The pH value tells you if something is an acid, a base, or neutral.
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For example, battery acid is extremely acidic at 0, while liquid drain cleaner is very alkaline at 14. Pure distilled water is in the middle at 7. It’s neither acidic nor alkaline.
Just like different substances, different parts of the human body have different pH levels. Your ideal blood pH is between 7.35 and 7.45, which is slightly alkaline. The stomach is typically at a pH of 3.5, which helps food break down properly.
If you suspect you have problems with acidity, you can make changes to your diet to help improve symptoms. Foods that are considered acidic must have a pH level of 4.6 or lower.
Foods that tend to cause more acidity in the body and that you may need to limit or avoid include:
Research supporting the connection between foods like animal protein and dairy and chronic disease due to a change in the body’s pH is limited. New research may shed more light on this connection, or expose other reasons why reducing animal products is beneficial for health.
Here’s a list of fruits and their pH from Clemson University. They are listed from most acidic to least:
Generally, citrus fruits have a low pH, meaning they are acidic. Citrus and other acidic foods may contribute to symptoms in those with upper gastrointestinal issues like an ulcer or reflux.
It’s important to remember that fruit juices are acidic, too. Because of this, you should use a straw when drinking fruit juices. This keeps the fruit juice from coming in direct contact with your teeth.
If fruit doesn’t aggravate upper digestive symptoms, they are a healthy food to eat daily and have been shown to reduce chronic disease risk. Despite their initial acidity, most fruits are alkalizing.
Vegetables, especially fresh vegetables, are generally not considered acidic. Here’s a list of vegetables and their pH levels:
You may choose to avoid high-phosphorus drinks such as beer or hot chocolate made from packets of cocoa mix. Mineral sodas or sparkling water can be a good substitute. If you do wish to drink alcohol, go with lower phosphorus red or white wine.
When it comes to the benefits of a more alkaline diet, research published in the Journal of Environmental and Public Health says that no conclusive evidence suggests it improves bone health. However, it may help limit muscle loss, strengthen memory and alertness, and help you live longer.
Some alkalizing (or neutral) foods and beverages you can incorporate into your diet include:
A diet that includes too many acid-producing foods, such as protein or sugar, can cause acidity in your urine as well as other negative health effects. This may cause a type of kidney stone called uric acid stones to form.
It’s been speculated that too much acidity can also cause bone and muscle deterioration. This is because bones contain calcium, which your body uses to restore your blood’s pH balance when it becomes too acidic.
Some evidence suggests that phosphoric acid, commonly found in darker sodas, is linked to lower bone density, especially when it replaces milk, a calcium- and protein-rich beverage. Too much acidity can also increase your risk for cancer, liver problems, and heart disease.
Some foods and beverages produce less acid than sodas or protein, but they still don’t provide the major alkalizing effect of most fruits and vegetables. Experts don’t always agree on the exact food lists.
Aim to limit these foods since they may be affecting your acid-base balance or affecting your health in negative ways:
If you’re worried about acid wearing down bone, you can take small amounts of sodium bicarbonate. University of California, San Diego, researchers suggest doses that are less than 5 grams.
You shouldn’t take sodium bicarbonate during mealtimes because it can interfere with your digestion. Getting enough dietary calcium, vitamin D, phosphorus, and magnesium may also be helpful for offsetting the negative effects of acid on your bone.
Because waste products tend to be acidic, researchers at the University of California in San Diego suggest eating more sources of alkaline-producing foods, such as fruits and vegetables, at a 3-to-1 ratio. The pH of a food before you eat it is less important than what it turns into once it’s inside your body.
While rare, it’s possible for the urine’s pH to be too alkaline. However, in the United States, too much acid tends to be a more common problem. This is because of the high rates at which people eat animal protein, sugar, and grains. Higher rates of prescription drug use also contribute to the problem.
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