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Mayonaise

Mayonaise

Burning up in speed
Dec 8, 2023
323
The use of antacids and acid reducers for the SN method has been widely debated and they're not considered to be an important part of the method anymore. Over time, the PPH stopped recommending their use, and the majority of members are probably not even considering using them. Many people think the less medications involved, the better it is, and it's a fair point.

Still, somebody might consider using them, for instance people with GERD or other stomach issues.
I have my reasons, and although they may be totally irrational and only due to anxiety, anyone interested is welcome to read my post.

Anyway, I'm sharing what I've learned and researched on the basics of antacids and acid reducers so hopefully anybody who's considering using them can find a detailed introduction to the topic here.
During my research, I've come across some interesting articles, which provide detailed technical information. This info is absolutely not necessary for the SN method, but I'm including it for people interested in science or medicine. I'm putting it in spoilers as to separate it from the basic information.

First, a quick collection of useful posts:


Pros and cons of using antacids/acid reducers

For a detailed explanation see Vizzy's thread "Antiacid debate" in the Useful posts spoiler.
In short:

- Pros: absorption of SN should be increased
- Cons: it might take more time to pass out. Also, reducing stomach acidity (raising pH) might interfere with the absorption of other drugs (i.e. antiemetics). Always refer to the antacid/acid reducer leaflet for such information. This is the biggest drawback in my opinion.


The difference between antacids and acid reducers

Antacids neutralize the acid in your stomach.
They provide fast, short-term relief. They start working within a few minutes, and have a short duration of action.

Acid Reducers work by reducing the production of acid in the stomach. They don't work on the acid that's already been produced.
They don't relieve symptoms as quick as antacids, but their effect lasts longer.


Antacids

They come as a liquid, chewable gummies/tablets and effervescent tablets. They can be bought from pharmacies and shops without a prescription.

Ingredients to look for include:
  • aluminium hydroxide
  • calcium carbonate (Tums)
  • magnesium carbonate
  • magnesium hydroxide (Milk of Magnesia)
  • magnesium trisilicate
  • sodium bicarbonate
According to this source:
  • calcium carbonate --> very high efficacy
  • magnesium hydroxide --> high efficacy
  • aluminium hydroxide --> modest efficacy
  • sodium bicarbonate --> low efficacy
This post refers to an article that suggests that sodium bicarbonate might not be a good idea. I did some research but can't tell whether this is true, false or simply inaccurate.

Calcium carbonate-based antacids are one of the most potent over-the-counter antacids, known to have a rapid, long-lasting, and effective neutralizing action that is increased by the addition of magnesium carbonate, as in Rennie® (Bayer).

The pH of the artificial gastric environment began at 1.0.

After addition of Rennie, it increased as follows:

pH = 3.0 in 40 seconds

pH = 3.5 in 53 seconds

pH = 4.0 in 1 min 13 seconds

pH = 4.5 in 1 min 54 seconds

The maximum pH of 5.24 was reached within 10 min and maintained for 9 min 56 s.

Between 30 min and 1 h, the pH began to gradually decline due to the continuous influx of hydrochloric acid.

Source

Some antacids contain more than one ingredient: for instance, Maalox contains Magnesium hydroxide + Aluminium hydroxide. I wrote a detailed post about it here.
Some antacids also contain other ingredients, such as alginate (a substance obtained from brown seaweed), which coats the gullet with a protective layer, and simethicone (which reduces flatulence).
Alginate is not recommended for the SN method.
How much to take?
Stan's guide suggests taking twice as much as the recommended dose (always refer to leaflet). An old version of the PPH recommended 5g of sodium bicarbonate.

When taking it?
I'd suggest taking the antacid 10-15 min before SN ingestion.

Warnings
Antacids can affect the way some other medicines work, so it is generally recommended not to take other medicines within 2 to 4 hours of taking an antacid. This information should be included in the leaflet.
Antacids are safe for most people to take, but they're not suitable for:
- people with liver disease, kidney disease or heart failure – some antacids may not be safe for them
- people that need to control how much salt (sodium) is in their diet, such as high blood pressure or cirrhosis – some antacids contain high levels of sodium



Acid Reducers

There are two types of Acid Reducers: histamine H2 Receptor Antagonists (H2 blockers) and proton pump inhibitors (PPIs).
As with antacids, acid reducers can affect the way some other medicines work.


H2 blockers (Wikipedia | Wikipedia)

Histamine is one of the primary regulators of acid secretion, and the stomach's parietal cell receptors for histamine are of the H2 type.
H2 blockers act by blocking the action of histamine at these receptors. This decreases the production of stomach acid.

Histamine is a neurotransmitter involved in various physiological processes (see below).
It is synthesized in all tissues, but is particularly abundant in skin, lung and gastrointestinal tract.
  • allergic and inflammatory processes, as well as immune reactions. Histamine makes blood vessels more permeable (vascular permeability), causing fluid to escape from capillaries into tissues, which leads to the classic symptoms of an allergic reaction — a runny nose and watery eyes.
  • Secretion of Gastric Acid: histamine is one of the main stimuli for secretion of acid by parietal cells in the stomach. The histamine receptor on parietal cells is the H2 type, and blocking the binding of histamine to this receptor is a widely used method for suppressing gastric acid secretion.
  • Smooth Muscle Contraction: smooth muscle around bronchi in the lungs and within the intestinal tract respond to histmine stimulation by contraction. These effects on smooth muscle are manifest in a number of allergic reactions, for example, bronchocontriction in response to inhaled allergens.
  • Effects in the Nervous System: histamine acts as a neurotransmitter within the central nervous system. It appears to modulate a number of important processes in the brain, including wakefulness, cognitive ability and food consumption.
Histamine Receptors and Receptor Antagonists

Four histamine receptors have been identified. These different receptors are expressed on different cell types and work through different mechanisms, which explains the diverse effects of histamine in different cells and tissues.

Receptor TypeMajor Tissue LocationsMajor Biologic Effects
H1​
smooth muscle, endothelial cellsacute allergic responses
H2​
gastric parietal cellssecretion of gastric acid
H3​
central nervous systemmodulating neurotransmission
H4​
mast cells, eosinophils, T cells, dentritic cellsregulating immune responses

Sources:
https://en.wikipedia.org/wiki/Histamine
https://en.wikipedia.org/wiki/Histamine_receptor
https://vivo.colostate.edu/hbooks/pathphys/endocrine/otherendo/histamine.html

Examples of H2 blockers include:

Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid, Zantac 360°)
Nizatidine (Axid)

PPIs (Wikipedia)

PPIs act by blocking the gastric proton pump of the gastric parietal cells.
The proton pump is the terminal stage in gastric acid secretion, being directly responsible for secreting H+ ions.

Examples of PPIs include:

Dexlansoprazole (Dexilant)
Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Omeprazole (Prilosec, Zegerid)
Pantoprazole (Protonix)
Rabeprazole (Aciphex)

Some medications combine an Antacid with an Acid Reducer:
- Pepcid Complete combines an antacid (Calcium carbonate + Magnesium hydroxide) and an H2 blocker (Famotidine).
- Zegerid OTC combines a proton-pump inhibitor (Omeprazole) with sodium bicarbonate.


Differences between H2 blockers and PPIS

- H2 blockers usually start to work within an hour.

- PPIs cause a profound and prolonged reduction of stomach acid production. They may take longer to start working than an H2 receptor blocker (3 days circa), but relief will generally last longer.
They are considered the most effective medication for reducing stomach acid.


AntacidsH2 BlockersPPIs
Onset of action (how soon they start working)Within 5 minutesWithin 1hrCan take up to 4 days to take effect
Duration of action (how long they last)30 to 60 minutesLasts about 9-12 hrsLast 24 hrs up to 3 days.
End Result of ActionNeutralizes acid in stomachsuppress gastric acid secretionsuppress gastric acid secretion
Mechanism of action (how they work)block, histamine, one of the first stimuli for acid production. Block the proton pump that pumps protons (H+) into the stomach in exchange for potassium. H+ is acid.
Where they workIn stomach lumenInside parietal cells*.
"H2 blockers work by blocking the histamine receptors in parietal cells to decrease the amount of acid produced (although there are other stimuli so that some acid is still produced)."
Inside parietal cells
PPIs work by "shutting down the proton pumps in these cells and preventing the acid from being secreted into the stomach."
Efficacy (How well they work) PPIs yield greater acid suppression than H2 blockers. This is due to the fact that other stimuli, in addition to histamine 2, stimulate acid production in the stomach and H2-blockers only block histamine 2.

Source



Comparison studies between antacids and H2-blockers

The median time lag before pH > 3.0 was reached after drug administration was 5.8 min for Rennie, 64.9 min for ranitidine and 70.1 min for famotidine.
The onset of action in fasting volunteers was significantly faster with the antacid than with the two H2-antagonists. The duration of action was significantly longer with an H2-antagonist than with the antacid. Antacids are superior for rapid pain relief, whereas H2-antagonists might be better for symptom prophylaxis--for example for nocturnal dyspepsia.
Source

When evaluated in increments of 30 minutes, calcium carbonate had a rapid onset of action, neutralizing 6.7 mmol of acid in the first 30 minutes. However, its duration of effect was only 60 minutes. Famotidine had a delayed onset of action compared with antacid, beginning after 90 minutes. However, famotidine had a duration of effect of at least 540 minutes. At its peak effect, 210 minutes after administration, famotidine reduced acid secretion by 7.3 mmol per 30 minutes.

The antacid has a rapid onset and short duration of action, while the histamine2-receptor antagonist has a delayed onset and a prolonged duration. Their peak potencies are similar.
Source

Sources:
https://www.nhs.uk/conditions/antacids
https://www.webmd.com/heartburn-gerd/treating-heartburn-over-counter-medicine
https://familydoctor.org/antacids-and-acid-reducers-otc-relief-for-heartburn-and-acid-reflux
http://www.vivo.colostate.edu/hbooks/pathphys/digestion/stomach/acid_blockers.html


That's it. If you want to use any of these drugs, I'd recommend antacids instead of H2-blockers.
My choice would be calcium carbonate chewable tablets or gelatin capsules, 10-15 min before SN ingestion.

May we all find peace, and may our choice always be free.
 
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Beyond_Repair

Beyond_Repair

Disheartened Ghost
Oct 27, 2023
329
This is useful, thanks for doing the research and sharing the information!
 
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L

Ln42

Ihm/iai
Jun 13, 2018
125
I'm prescribed omeprazole should I use Tums as well?
 
Mayonaise

Mayonaise

Burning up in speed
Dec 8, 2023
323
Thank you for responding, I've been on 40mg for about 20 years.
My pleasure. If you take it regularly there's no need to take anything else, it'd do more harm than good. Just make sure the omeprazole does not interfere with the absorption of the antiemetic you will be taking
 
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Ln42

Ihm/iai
Jun 13, 2018
125
My pleasure. If you take it regularly there's no need to take anything else, it'd do more harm than good. Just make sure the omeprazole does not interfere with the absorption of the antiemetic you will be taking
That's reassuring thank you so much.
 
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blackwave

Member
May 9, 2024
21
Thanks for sharing your conclusions, taking or not antacids is still remaining a controversial topic
 
Onelegman

Onelegman

I use a translator
May 24, 2024
553
My pleasure. If you take it regularly there's no need to take anything else, it'd do more harm than good. Just make sure the omeprazole does not interfere with the absorption of the antiemetic you will be taking
I have also been taking 20mg of omeprazole for 20 years. I don't have heartburn, it's to prevent other pills from damaging my gut or my digestion, I guess it's a good way to avoid some central nervous system ailments. I have taken meto a few times and it does not interact in any way, they both do their job. You have answered a big question for me, thank you!
 
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