Have you ever wondered why we take TUMS to relieve heartburn or Pepto Bismol when we have a stomach ache? Today, we'll share how these drugs exert their effects and offer insights so you can navigate your digestive health with confidence.
M: I’m Professor Megan
S: and I’m Professor Susan, and we’re
Both: Your Nutrition Profs!
M: We are registered dietitians and college professors who have taught more than 10,000 students about health and nutrition. We have answered a LOT of questions about nutrition over the years –
S: Some questions we get asked every year and some are rarely asked but very interesting.
M: We’re here to share our answers to these common (and uncommon) nutrition questions with you.
S: So bring your curiosity and let’s get started.
Both: Welcome to our class!
S: Hey everybody, welcome to our podcast! Want to know what’s on the menu today Megan?
M: Yes!
S: Well on today's episode we’re going to answer the question “how do those over-the-counter gastrointestinal medications work?”
M: This is such a great topic. We often take for granted that if you have heartburn you can take some TUMS or if you have constipation you can take a stool softener. But what are these medications actually doing? I mean, how do they actually work?
S: You know, it’s probably because I’m such a science nerd–
M: Me too!
S: –but I love talking about the gastrointestinal tract, also called the GI tract (that’ll be easier for us to say, right?)... I mean, I do think digestion is fascinating.
M: I mean, honestly it’s probably part of why we became dietitians –
S: Yeah!
M: –so we could study this in detail and not be like weird!
S: So true!
M: Well, the human GI tract is essentially one long tube extending from the mouth to the anus and in the average adult it’s about 30 feet long!
S: What?? If you’re an international listener (and we hope you are!), that’s about 9 meters and that's about the width of a pickleball court for those who play pickleball!
M: Yep, it’s super popular right now.
S: And because there are folds in the walls of the tract, the surface area is about the size of half of that court… if you pulled it out and laid it flat.
M: That’s a lot of area and really opportunities for something to potentially go wrong.
S: Oh for sure… for sure! So this 30 foot tube is divided into sections or organs. Organs like the esophagus, the stomach, and the intestines. Between the organs are these muscular– let’s call them “doors”. The official word, the sciency word is sphincter. And these open and close to allow food to pass through or not pass through from one organ to another.
M: On our episode a few weeks ago, we talked about saliva and the mouth, where the GI tract begins. Today we’re going to start a little bit further down the tract with a common condition called heartburn.
S: So heartburn… it is– you know, it’s really so common.
M: It is.
S: You know I don’t know anyone who’s not had heartburn, I think..
M: Agreed.
S: Yeah, I mean, most of us have experienced it at one time or another. But let’s talk about the the science behind heartburn.
M: Good idea. So it’s commonly called heartburn because the pain occurs very near the heart, in the center of the chest, but it actually has nothing to do with the actual heart.
S: That kind of confused me before I knew anything about anatomy, I was like “why do they call it heartburn?” Well it’s also known as acid indigestion, acid regurgitation, some people call it sour stomach. There may be some other terms for it as well. A more severe version of heartburn is called gastroesophageal reflux disease also known as GERD.
M: Heartburn occurs when the contents of the stomach flow back up into the esophagus… which should be a one-way.
S: Yeah, things should just go in one way and not the other. But here’s what happens… in the stomach, we produce something called gastric juice. This “juice” contains digestive enzymes (to break down nutrients), it contains hydrochloric acid, a little bit of bicarbonate, and, of course, mucus. We produce 2-4 liters of this gastric juice every day!
M: It’s so crazy to think about, but we produce so much fluid in our bodies! 2-4 liters of gastric juice and remember, 2 liters of saliva!
S: That is why we need to stay hydrated. That’s a lot of juice.
M: It is! Well let’s talk a little about this hydrochloric acid in the stomach. It’s an extremely strong acid, almost as strong as battery acid. And in our episode about ulcers we talked quite a bit about why we need such a strong acid in our bodies.
S: Right, it’s necessary for the physical breakdown of food and for the destruction of harmful bacteria. It also plays a role in activating some enzymes, it triggers the release of some hormones, and it denatures proteins. So denaturing is a sciency word for unraveling these large proteins. And you have to unravel these proteins before they can be split up or broken down and absorbed as usable nutrients.
M: And why doesn’t the strong acid damage the walls of the stomach? Well, special mucus. The mucus in gastric juice provides a protective barrier and helps lubricate the lining of the stomach. And it also helps maintain optimal pH.
S: Foods we eat mix with this gastric juice so that they can begin to be digested. This mix of food and gastric juice is called chyme.
M: So between the esophagus and stomach, we have one of those doors or sphincters. It’s called the lower esophageal sphincter or the gastroesophageal sphincter.
S: And sometimes, just to confuse things a little bit more, people call it the cardiac sphincter. But again, it has absolutely nothing to do with the heart!
M: Right. Well, this muscular ring opens to allow food we’ve swallowed to pass into the stomach, then it closes to keep it there.
S: But that sphincter does not always work 100% perfectly. Some foods and beverages can cause the door to get a little bit wonky and not shut all the way and that leaves some gaps. Common culprits are spicy or fatty foods, alcohol, extra large meals, excess body weight, being pregnant, smoking… honestly the list of things that can result in this wonky door could go on and on.
M: When this sphincter doesn’t close all the way it’s common to feel a burning sensation mid-chest, around where your heart is, hence the name “heart” burn. This pain or burning is because of the gastric juice-food combo coming back up into the lower part of the esophagus.
S: And because the esophagus doesn’t have that same special mucus that the stomach does to protect its lining, the acid will irritate or “burn” the esophageal walls and that causes pain.
M: And it’s very common. There are a few ways to help reduce the pain associated with heartburn as well as a few ways to prevent it.
S: First line of defense – antacids!
M: Yes!
S: You can get them over-the-counter and you can get them in liquids or chewable tablets or probably even gummies… I don't even know. And as the name suggests, these work primarily by neutralizing that stomach acid – they’re anti-acids.
M: So like we mentioned before, stomach acids have a really low pH of 1-2. These antacids have a pH range of 5 to 9. So they serve as buffers which neutralizes the acid and stops the pain.
S: The primary ingredients in the most common antacids are calcium carbonate which is found in TUMS and Rolaids and aluminum hydroxide and magnesium hydroxide which are found together in products like Mylanta and Maalox.
M: And we can’t forget Alka-Seltzer. It’s a commonly recommended medication for heartburn. It comes in tablet form that can be added to water to create essentially a fizzy drink. In fact the name itself describes its function, alka is for alkalinity (to buffer the acid) and seltzer due to its carbonation.
S: Alka seltzer is also pretty well known for the jingle “Plop plop fizz fizz, oh what a relief it is!”
M: I totally remember that!!
S: Yeah, maybe we should keep our day jobs…. Another really common treatment, Pepto Bismol, works by forming a protective coating over the lower esophagus and the stomach.
M: Pepto Bismol contains bismuth subsalicylate which is thought to help reduce inflammation, increase mucus formation, and stimulate the release of bicarbonate, which is another buffer or acid neutralizer.
S: So you can take these over-the-counter meds sporadically any time you have heartburn for the relief of the pain. Most people have it once in a while but it’s not a daily occurrence. But my grandfather, as he got older, he always had a roll of TUMS or Rolaids in his pocket, just in case.
M: Smart man! There are also a group of medications called proton pump inhibitors or PPIs that are usually recommended for frequent or severe heartburn which occurs 2 or more times per week for several weeks in a row. This more frequent bouts of heartburn is called GERD as we mentioned earlier.
S: These medications are also recommended for other GI conditions. We discussed these a few weeks ago in our ulcers episode.
M: Yes!
S: So these PPIs reduce acid production in the stomach by stopping the acid producing pump from working.
M: PPIs can be sold over the counter or at higher doses by prescription and include brands like Prilosec, Prevacid, and Nexium. And it’s typically recommended to take these within 30 minutes of your first meal of the day.
S: We also discussed Histamine2 blockers or H2 blockers in that same episode and they’re also recommended for GERD. You can get these over the counter or by prescription. Common brands you probably have heard of include Pepcid and Tagamet.
M: These H2 blockers work by preventing the action of histamine which is one of several things that stimulate stomach acid production. So less histamine means less stomach acid.
S: And if you read the label on any of the over-the-counter PPI or H2 meds it typically includes a statement about how long you should use them. It might say something like “do not take more than 14 days or more often than every 4 months unless directed by a doctor”.
M: And this is important because they could provide symptom relief but they may be masking a more severe underlying health condition like an ulcer or hiatal hernia.
S: And it’s estimated that nearly 20-30% of American adults have GERD. And that number might actually be higher than that!
M: Right because there are so many over the counter options many people are self-medicating instead of seeing a health care provider so we’re probably not capturing a true number of folks that are suffering with GERD
S: Well, the good news about heartburn is that there are so many treatment options. But the moral of the story is if you’re experiencing frequent heartburn you should probably tell your doctor. It may just be heartburn, but it may be something more serious.
M: Let’s move on down the GI tract and talk about nausea and vomiting.
S: Everybody’s favorite!
M: So nausea is a bit tricky because there are so many possible causes, from medications, stress, pregnancy, and even fear.
S: And you could have a stomach bug.
M: Right, like a foodborne illness.
S: Right, or the flu.
M: Yeah.
S: So you want to be careful not to treat nausea, the symptom, because you could be overlooking something more concerning.
M: Right, just like with the heartburn.
S: Mmm-hmmm.
M: So most of the time we don’t specifically treat the nausea and vomiting, and if we do the medications are usually prescription only. And these meds are called anti-emetics.
S: Sciency word!
M: Yes! They act on “vomiting centers” in the brain, stopping the nerve impulse to vomit.
S: Because the sciency word for vomiting is emesis!
M: Exactly.
S: So…anti - "emetics"… Vomiting center? I bet you didn’t know you had a vomiting center!
M: The human body is great!
S: It is! So these antiemetics can also block messages to the diaphragm and other abdominal muscles and that would reduce your ability to actually vomit.
M: You know, I think the two most common over-the-counter treatments are Pepto Bismol and Alka-Seltzer and we’ve already mentioned these and their role in managing heartburn… which makes sense as heartburn or sour stomach can also lead to nausea.
S: They’re so versatile!
M: They are!
S: There’s also an over-the-counter brand, called Emetrol, that contains dextrose, levulose, and phosphoric acid, and this medication can decrease stomach contractions and slow stomach emptying.
M: Another fairly common cause of nausea is motion sickness. Susan, do you ever get motion sickness?
S: Generally I don’t, at least not that it’s alarming.
M: Ok, well I’ve only ever had motion sickness as a kid, typically when I was reading in the backseat of the car, and we’d be driving particularly through winding mountain roads…
S: Especially after a big meal?
M: Oh yeah! But it’s actually quite common. It’s reported that 1 in 3 people are susceptible to motion sickness.
S: Motion sickness occurs when there is a mismatch between actual sensory inputs and what your body actually expects.
M: Well that makes sense.
S: Yeah, it does, right? I mean if you’re sitting on a boat, your inner ear can sense a rocking motion, but your body is telling your brain that you’re sitting still.
M: Confusing!
S: I know! That’s why, I guess, they tell you to look at something on the horizon that’s stationary.
M: Yeah, good advice.
S: –to try and get those things in sync.
M: Well there’s also an option in terms of over-the-counter meds, there’s meclizine, found in products like Dramamine and Bonine. It’s an antihistamine which blocks the signals to the brain that cause nausea, vomiting, and dizziness.
S: Oh, I did take Dramamine with me on a cruise last summer. And I took it the first night but I really didn’t need it but I had it there just in case. There were a lot of people on the cruise though that were wearing these Dramamine patches behind their ears or they took the meds every morning as kind of a prophylactic… so super common!
M: Well there is another remedy for nausea that you may have heard of… ginger. Ginger is an herb and it might help in a few different ways. It can speed up gastric emptying and help to get the contents of the stomach moving in the right direction. And it may also affect serotonin receptors in the gut which may help reduce nausea. But honestly, the exact methods of action of ginger are not fully known.
S: Magic!
M: Magic!
S: Well my dog Baxter, he used to get car sick on long trips–
M: Oh no!
S: Poor Baxter… So we would feed him ginger snaps every couple of hours. And once we started doing that he really didn’t seem to get as sick, and it might be that he was just distracted by ginger snaps! Probably not the healthiest way to treat it, but he did stop vomiting in the car!
M: I mean if it works– it works! But I wonder what your vet would say about that?
S: I never told our vet about it….sorry Dr Gutierrez if you’re listening!
M: Alright as we continue our trip down the GI tract into the intestines, another common complaint is excessive gas or flatulence. This can cause pain, sometimes severe pain, abdominal distention, and bloating… And then of course, not to mention… embarrassment.
S: For sure!
M: And it’s reported that nearly 1 in 7 adults in the U.S. experienced bloating in the past week.
S: That seems pretty high!
M: I think so too!
S: Flatus is the sciency word for the gas itself, and flatulence, also referred to as farting, is the act of passing that gas. But where does this gas come from?
M: Such a good question. Gas is a normal byproduct of the bacteria in our colon, our gut microbiome, feeding on and fermenting undigested food. It’s actually a perfectly normal response to a healthy gut!
S: You know what? I wonder if anyone has made a drinking game out of the number of times we reference the gut microbiome on our episodes. Everytime we say gut microbiome, take a drink!
M: You know, it might make for more interesting episodes – I am in! Let’s do it.
S: In some of these episodes we’d be drop down drunk by the time we were done. Ok, but back to GI meds…
M: Yes.
S: Swallowing air can also contribute to gas but it’s more likely to lead to belching than farting.
M: Makes sense.
S: Eating food very quickly, gulping liquids, chewing gum, and smoking– they are all associated with increased air swallowing.
M: And certain foods are more likely to increase gas including beans, lentils, cruciferous vegetables like cabbage and Brussels sprouts, bran in whole grains, and carbonated beverages.
S: All those foods that are so good for us!
M: And delicious!
S: Yeah. And some alternative sweeteners, like sugar alcohols, they can cause some gas and bloating. Sugar alcohols are things like sorbitol, xylitol, or mannitol. And foods that contain a lot of fructose and lactose can be problematic for those who have like lactose tolerance.
M: Absolutely! Ok, so what if you’ve already consumed these foods and have painful gas and bloating, what can you do then? Well, moving around, being physically active, gentle abdominal massage, and even some yoga poses – have you heard of wind-removing pose?
S: I think I’ve heard of it but you’re a yoga instructor – tell us a bit about wind-removing pose!
M: Ok, sure. In wind-removing pose you’re traditionally lying on your back and pulling one knee towards your chest while keeping the other leg out straight. And the idea is that you’re compressing your abdomen and the intestines and this helps with digestion and the expulsion of air from your colon. You could also do this pose standing if you have good balance or even eaning against a wall.
S: So that’s something you can do if you’re suffering from gas and bloating?
M: Yes, I used to go to a digestive focused yoga class the day after Thanksgiving for several years and we did this pose several times throughout the class…
S: I never would have thought that was such a thing… I can see though–
M: Yeah!
S: –it might be helpful… Well there are some pharmacological options as well, if you don’t have access to a wind-removing pose yoga class. So drugs like simethicone – you may not have heard of it – but it's sold as Gas-x, Gas Relief, Alka-Seltzer Anti-Gas, Mylanta Gas Minis, anything with gas in the name probably has simethicone in it.
M: So here’s how these work. Gas bubbles in the intestines have something called a high surface tension. This means the outer layer or “skin” of these bubbles can stick together tightly and become trapped in the mucus lining the intestines.
S: I really don’t want to know how they figured this out!
M: I know!
S: It is kind of fascinating though!
M: I love it! Well this simethicone weakens this tension allowing the gas bubbles to combine and form larger bubbles that are easier to pass out of the body.
S: Ok, so little bubbles become big bubbles become farts!
M: Yes! Science- it’s so easy!!
S: Well there is another over-the-counter option for gas and it’s called Beano.
M: Definitely heard of it.
S: Mmm-hmm. It’s not a drug, it’s an enzyme that helps to break down carbohydrates that are found in those “gassy foods” that we mentioned earlier like beans, so that they can be absorbed before they get to the colon. And if they don’t make it to the colon, they don’t get fermented and that means no gas!
M: So similar to how Lactaid works for those with lactose intolerance.
S: Right!
M: So they have difficulty making a digestive enzyme called lactase.
S: Exactly, I mean, without lactase, the sugar lactose that’s found in dairy products doesn’t break down and get absorbed, but again continues on into the large intestine where the gut microbiome (Drink!) feeds on it and it can cause excess gas, abdominal pain, diarrhea, all those negative side effects.
M: So Lactaid contains the enzyme lactase, so it’s recommended to be taken with the first bite of food containing lactose so it can break down the lactose before it reaches the colon.
S: Yeha, same with Beano, take it with the first bite of what they call the offending food. So you do have to plan ahead!
M: Ok, it’s time to talk about what happens at the end of the GI tract.
S: The exit!
M: The exit! Let's talk about diarrhea. It’s not the most glamorous topic but when you’re talking about the GI tract, it’s a pretty common issue.
S: We did talk quite a bit about diarrhea in our second episode, it was called All About #2.
M: It’s still one of my favorite episodes!
S: It was good! So we absorb water back into our bodies in the colon, so when your GI system is moving things too quickly, there isn’t enough time to absorb the water and you may end up with loose, watery stools. And just like several other issues we’ve discussed, there can be a lot of potential causes.
M: Right. The cause could be a bacterial or viral infection, certain medical conditions, even some medications. And again, you want to be careful not to treat diarrhea, the symptom, and miss a more concerning cause.
S: Right, but if you do have an acute case of diarrhea, there are some over-the-counter meds you can take. Once again, Pepto Bismol can help. Bismuth subsalicylate can help your body absorb more water from your gut and it can help prevent certain bacteria from attaching and growing in the body. And the salicylic acid in Pepto Bismul can help reduce inflammation.
M: Pepto Bismol for the win, am I right? Do you remember that jingle from years ago? It’s good for everything!
S: Yeah, it basically just listed all the symptoms…
M: Yeah, it was nausea, heartburn, indigestion, upset stomach, diarrhea!
S: Yeah! Oh my god, they have these commercials now where people dressed in pink–
M: No!
S: –dance and sing that song!
M: I haven’t seen it!
S: Oh we just saw it on TV last night!
M: Try and let me know when you see it and record it!
S: I love those commercials! We’ll link one if we can find it!
M: Oh that’d be great! Well, Susan, did you know Pepto Bismol has been around since the very early 1900s? It was first developed to treat cholera in infants!
S: That’s really interesting.
M: I know!
S: I mean it’s 125 years old!
M: Yeah!
S: Wow! It makes sense though because cholera can cause GI symptoms.
M: Absolutely!
S: Hmmm.
M: I mean Pepto Bismol seems to be good for a lot!
S: It sure does!
M: We are not sponsored!
S: We are not sponsored by Pepto Bismol!
M: But we are open to it!
S: Totally open! But….
M: But back to current day diarrheal treatment…
S: Right, back to diarrhea!
M: So there are other treatments for diarrhea. There is also loperamide, sold as Imodium, although there is a prescription strength version of this as well. It works by slowing the muscular contractions and the movement of fluids through the intestines, allowing for greater absorption of water.
S: But honestly, diarrhea usually resolves on its own after a couple of days. If it doesn’t… then you need to go see the doctor.
M: Agreed. Alright, let's switch it up and get into the exact opposite… constipation.
S: Yeah.
M: Constipation is defined as having fewer than three bowel movements a week and having stools that are hard, dry, lumpy, and difficult or painful to pass.
S: You know, we don’t really know how many people suffer from constipation – it’s another one of those things that people don’t really like to talk about – but it’s estimated that nearly 15% of adults in the U. S. struggle with constipation.
M: And I actually read reports that suggest prevalence can range from 2 to 39% of adults in the U.S.
S: That’s a big range.
M: It’s a huge range! And constipation typically becomes more prevalent with age.
S: So if you have constipation, you do have some options for treatment. There’s something called the 3Fs. The Fs stand for fluid (which is water and juice), fruits (things like pears, grapes, apples, and prunes), and fiber. So fluid, fruits, and fiber – the 3Fs of constipation treatment.
M: That’s a good way to remember it!
S: It is!
M: And there is, of course, fiber in the fruits we just mentioned but you can pick any form of fiber you want. There’s others sources like legumes, beans and lentils, vegetables like artichokes and Brussel sprouts. These are a really good place to start… along with increased physical activity, if you are able.
S: The Dietary Guidelines for Americans recommend that most people consume between 20 and 35g of fiber from food every day. But research suggests most of us only get between 15 and 17g. It's also suggested that humans living 50,000 years ago probably consumed more than 100g of fiber a day!
M: Wow!
S: I bet they were regular!
M: I bet they were too!
S: And we definitely don’t recommend that you consume that much, but most of us need more fiber.
M: So if you are increasing your fiber it’s recommended to do so slowly and to make sure that you’re also drinking plenty of water.
S: Or you could get constipated! I mean, ironic right?!
M: Exactly! Well if the fiber and water isn’t working and you want to take an over-the-counter product, there are two main approaches: stool softeners and laxatives. And, stool softeners are actually a type of laxative!
S: So there’s really just laxatives?
M: So really just laxatives.
S: Well let’s talk about a couple of these. Emollient laxatives do exactly what they sound like – they help soften the stool which makes it easier to pass. The most common one is docusate sodium and it’s sold as Colace.
M: Stool softeners work by allowing water and fat to build up in the stool which helps to prevent straining. But these should really only be used sporadically and for no more than a few days.
S: So stool softeners or emollient laxatives aren’t your only options. You could take bulk forming laxatives. These are essentially fiber supplements, specifically soluble fiber that dissolves in water. These cause the stools to absorb more water, creating a stool that is heavier and this triggers the colon to contract more forcefully and move the stool out. Some of the more common ones you’ve probably heard of are psyllium, sold as Metamucil and methylcellulose, which is sold as Citrucel.
M: I think Metamucil is pretty common.
S: Right.
M: There are also osmotic laxatives. These work by increasing the amount of fluid in the intestines, not the stool itself. This softens the stool and speeds up movement helping stool move just right on through. So polyethylene glycol sold as Miralax is one example.
S: And finally there are what are called stimulant laxatives. These stimulate the colon to contract forcefully to really move the stool though. These are the harshest laxatives and again they shouldn't be used for more than a few days at a time. There are two main categories, senna, sold as Senokot and Ex-Lax, and bisacodyl, sold as Dulcolax.
M: And abuse or misuse of these stimulant laxatives can lead to a dependence on laxatives to go at all, so we do want to use these sparingly.
S: And none of these laxatives should be used chronically. If you have longer term constipation please make sure to see your health provider and tell them about your symptoms.
M: And if you still have lingering questions about diarrhea or constipation, make sure to go back and listen to our second episode, All About #2.
S: It was a good one.
M: Alright everyone, we’ve done it! We’ve traveled through the digestive tract from heartburn to constipation… so let’s bottom line it.
S: Ok… bottom line, there are many OTC options depending on which part of your GI tract you’re trying to appease. You should probably keep some OTC meds at home in case something comes up, probably at least Pepto-Bismol. It seems to be used for a lot of things.
M: Right, it can be used for many of the conditions we mentioned – remember: nausea, heartburn, indigestion, upset stomach, diarrhea!
S: And you can get it in chews, gummies, liquid, tablets, I mean, any form you can think of.
M: But the over-the counter meds are for occasional issues, if you have chronic symptoms you should see your doctor.
S: Ok, so that’s an overview of several GI medications but before we go, we do want to emphasize that the information shared on this episode about gastrointestinal medications is for educational purposes only and is not intended as medical advice.
M: If you have any concerns about your gastrointestinal health or are considering any changes to your medication regimen, please consult your healthcare provider. They can provide personalized guidance based on your individual health needs and circumstances.
S: Remember, your health and well-being are of utmost importance, and seeking professional medical advice is always the best course of action for addressing any medical concerns.
M: Thank you for tuning in. Join us next time when we answer the question “Should I really drink 8 glasses of water a day?”
Both: Class dismissed.
S: We hope you enjoyed this episode. You can find the show notes and a list of sources on our website, yournutritionprofs.com.
M: Your homework is to follow us at your nutrition profs on Instagram and to listen to our next episode. You can listen on Amazon Prime, Apple Podcasts, Spotify, YouTube, or anywhere podcasts are found. We’d appreciate it if you’d “like” us, write a review, subscribe, and invite your family and friends to join us too.
S: If you have a nutrition or health question you’d like answered, let us know! We may even do a show about it! Send an email to yournutritionprofs@gmail.com or click on the “Contact Us” page on our website.
M: Thanks to Brian Pittman for creating our artwork. You can find him on instagram @BrianPittman77
Both: See you next time!