A New (Okay, Actually Quite Old) Remedy for Heartburn

A colleague of mine recently published a video on Facebook that took me by surprise. Dr. Steve Jensen, the owner Jensen's Community Pharmacies in Dexter and Saline, Michigan, learned about a 'new" nonprescription product for heartburn. But it's not really new - it's been around for a very long time. Read on to find out why it's not well known here in the US, how it works, and its risks and benefits.

A brief review of heartburn and GERD

Heartburn happens when stomach acid finds its way from the stomach back into the esophagus (the tube leading from the throat to the stomach). Digestive juices containing acid were meant to stay in the stomach, so when they get into the esophagus it burns. Usually the muscular valve between the esophagus and stomach prevents acid backflow. But that valve can become less efficient for a number of reasons. Heartburn may occur rarely, but if it happens regularly the lining of the esophagus can be irritated or damaged. Frequent or chronic heartburn is often referred to as GERD (gastroesophageal reflux disease). And it affects nearly a quarter of the population in the US.

Treating heartburn and GERD

Keeping stomach acid out of the esophagus effectively treats heartburn symptoms and prevents damage to the esophagus. The most common remedies are available without a prescription, and easy to find.

Antacids - Antacids (Tums, Maalox, Gaviscon, Mylanta and others) neutralize stomach acid. They quite effective at providing rapid relief of symptoms, are relatively inexpensive and quite safe. The most common side effects are constipation and diarrhea. The biggest drawback is that they can be inconvenient to take regularly if you have frequent symptoms. And watch for drug interactions -- antacids may decrease the absorption of other meds, requiring them to be taken a couple of hours apart.

H2RA's - Famotidine (Pepcid and Zantac) and cimetidine (Tagamet) are histamine-2 receptor antagonists. They block the effect of histamine in the stomach to decrease acid production. Like antacids, these meds are good for relieving symptoms pretty quickly, but unlike antacids they can also be used to prevent acid reflux. Side effects are rare, but H2RAs do carry some important drug interactions, so check with a pharmacist or go to drugs.com if you take other meds.

PPIs - Proton pump inhibitors like Prilosec, Nexium, and Prevacid are available over the counter, too. These meds work by blocking the "pumping" of acid from certain cells in the stomach. They aren't that great at treating existing symptoms, but they're very effective at preventing them. So much so, that oftentimes they're used much longer than necessary. And with regular, long-term use, they can have important side effects like osteoporosis and nutritional deficiencies..

Enter (or re-enter) Alginates!

Alginates are substances that come from brown seaweed. They're actually part of thediet in some cultures, and so here in the US they're considered a dietary supplement. When alginates are taken in a high enough dose, they dissolve in the stomach contents and form a gel that "floats like a raft" on top of the stomach contents. This "raft effect" prevents the acid below from entering the esophagus. And research has shown that alginates can be at least as effective as other heartburn remedies, at least for some folks.

Why haven't we known about this all along? Well, that has to do with FDA regulations. The US version of the antacid Gaviscon, which we mentioned above, does contain alginic acid. But alginic acid was never approved as a medication in the US. So it can't be used in a high enough dose to be considered an active ingredient. If you look at the Gaviscon label, you'll see it listed as an inactive ingredient. At the same time, Gaviscon sold in other countries contains sodium alginate in a high enough dose to be effective for heartburn.

Nearly 25% of people in North America have at least weekly symptoms of GERD. And it's well known that the most effective acid-reducers (PPIs) are often overused, sometimes with long-term side effects. So researchers started looking more closely at the safety and efficacy of alginates in recent years. The research mentioned above looked at sodium alginate or alginic acid doses of 500-1000mg after meals and found that it compared well to other heartburn remedies for many of the study subjects.

If you want to try it

First, and very importantly, if you've been taking a PPI regularly for more than a few weeks, it's best to taper it over the course of a couple of weeks. You can do that while starting an alginate supplement, no need to wait.

Second, it's also important to know that you may not find any alginate supplements with seals of approval from outside organizations. Because the FDA regulates supplements so loosely it's hard to be sure you're getting a product of reliable quality. Do your best to find a product you feel you can trust. The video mentioned in the introduction to this post reviews the product pictured here.

From there, choose a product that can provide 500-1000mg of sodium alginate or alginic acid per dose. The recommendation is to take it after meals, and at bedtime if you tend to have symptoms overnight.

Research indicates that side effects are rare. There is a possibility that the "raft" of gel in the stomach may interfere with the absorption of some medications, though the significance of interactions isn't clear. For now it may be best to make sure you take prescription meds at least an hour before you take alginate.

Alginates appear to be worth trying if you 1) have mild heartburn symptoms, 2) have found yourself using a PPI for an extended period of time or 3) just want to try something new and see how it works. If you've ever taken an alginate supplement please share your experiences in the space below. Questions and other comments are also welcome, or you can contact us directly at Better My Meds. We love hearing from you!