Probiotics and antacids both work in your gut. Antacids can help improve some digestion issues, whereas adding probiotics to your diet in the form of food or supplements is often recommended for gut health. So can you actually take probiotics and antacids together? Here's what you need to know.
A Probiotics Primer
Yogurt and other fermented foods like kefir and pickles are rich in probiotics, but you can also buy supplements made of the good bacteria and yeast that naturally live in our bodies, according to the Cleveland Clinic. These probiotics are part of a larger universe of live organisms called the microbiome — a mix of good and bad bacteria, fungi, viruses and protozoa that are constantly working to keep and restore the right balance.
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Although research about the actual efficacy of probiotics is still ongoing, people take supplementary probiotics for a number of conditions, per Cleveland Clinic. These include diarrhea and constipation, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO) and yeast and urinary tract infections.
The most common bacteria types you'll see listed on probiotics labels are Lactobacillus and Bifidobacterium, Cleveland Clinic notes, Another common ingredient, good yeast, is often found in probiotics in the form of Saccharomyces boulardii.
In addition to the type of bacteria or yeast they contain, probiotics are also categorized by colony forming units (CFU). According to the Office of Dietary Supplements, the CFU numbers indicate the number of viable cells per dosage.
Joan Weichun Chen, MD, a gastroenterologist, acid reflux specialist and assistant professor at the University of Michigan in Ann Arbor, doesn't recommend specific probiotic brands to her patients but says if a patient is interested in trying a probiotic, she recommends looking at the CFU and choosing one with a higher number first.
What About Antacids?
Antacids work in your gut in a completely different way from probiotics. According to the University of Michigan, antacids for mild to occasional heartburn work by neutralizing stomach acid.
Some antacids also have a foaming agent that floats on top of stomach contents. When this happens, acid from the stomach causes less damage when a person has reflux — the act of acid from the stomach going back up through the esophagus, the tube that connects the mouth and stomach.
Do Antacids Affect Probiotics?
"Probiotics and antacids have different primary targets," Dr. Chen says. While antacids work to slightly elevate the pH in the stomach, probiotics act primarily by renewing and enhancing good bacteria in the small intestine, the part of the digestive system that comes directly after the stomach.
According to Dr. Chen, probiotic supplements are often coated with a material that allows them to survive the stomach's acidity as they travel along the digestive system. Some have a delayed-release formulation so that their contents are dispersed after they clear those stomach acids. She adds that the two over-the-counter products have limited interaction, so it's fine to take them at the same time, as long as you take them in prescribed amounts.
Probiotics and PPIs Together
People who don't get relief from antacids may turn to a stronger class of anti-reflux medication called PPIs, or proton pump inhibitors. They work by decreasing the amount of acid in the stomach, according to the U.S. Food & Drug Administration. Over-the-counter PPIs can be used for frequent heartburn in 14-day courses of treatment. Prescription PPIs may be used to treat more serious conditions like gastroesophageal reflux disease (GERD), ulcers and inflammation of the esophagus over the course of many weeks.
If you're taking a PPI, you should always talk to your doctor before adding probiotics or any other supplement or medication to the mix, Dr. Chen says.
However, probiotics have the potential to play a helpful role if your PPI causes side effects. According to results of a pilot study of 36 patients published in February 2020 in the journal Scientific Reports, probiotics, along with prebiotics, actually improved PPI side effects like bloating, gas and belly pain — another reason to talk to your doctor about whether and when probiotics make sense for you.
Read more: The Best Foods to Eat and Drink for Indigestion
- Joan Weichun Chen, MD, gastroenterologist, assistant professor, University of Michigan, Ann Arbor
- Cleveland Clinic: “Probiotics”
- Office of Dietary Supplements: “Probiotics”
- University of Michigan: “Nonprescription Antacids for Heartburn”
- U.S. Food & Drug Administration: “OTC Heartburn Treatment”
- Scientific Reports: “The Effects of a Multispecies Synbiotic on Microbiome-Related Side Effects of Long-Term Proton Pump Inhibitor Use: A Pilot Study”
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