Aluminum hydroxide may increase urinary and stool loss of calcium.1 Also, aluminum is a toxic mineral, and a limited amount of aluminum absorption from aluminum-containing antacids does occur.2 As a result, most doctors do not recommend routine use of aluminum-containing antacids.3 Other types of antacids containing calcium or magnesium instead of aluminum are available.
Folic acid is needed by the body to utilize vitamin B12. Antacids,4 including aluminum hydroxide, inhibit folic acid absorption. People taking antacids are advised to supplement with folic acid.
Depletion of phosphorus may occur as a result of taking aluminum hydroxide. For those with kidney failure, reducing phosphorus absorption is the purpose of taking the drug, as excessive phosphorus levels can result from kidney failure. However, when people with normal kidney function take aluminum hydroxide for extended periods of time, it is possible to deplete phosphorus to unnaturally low levels.
A thick gel derived from algae has been used together with aluminum antacids to treat heartburn. Together, alginate gel and antacid were more effective at relieving symptoms5 and improving healing.6 Alginate is believed to work by physically blocking stomach acid from touching the esophagus. According to these studies, two tablets containing 200 mg alginic acid should be chewed before each meal and at bedtime.
Several studies have shown that combination of citrate, either as calcium citrate supplements or from orange and lemon juice, with aluminum-containing antacids increases aluminum levels in the body.7 , 8 , 9 Calcium in forms other than calcium citrate has been shown to not increase aluminum absorption.10 Drinking 7–10 ounces of orange juice provides sufficient citrate to be problematic.11 , 12 Intake of 950 mg calcium citrate greatly elevates aluminum absorption.13 People with renal failure may be at particular risk of kidney damage due to elevated aluminum levels if they combine aluminum hydroxide with citrate.14
1. Spencer H, Kramer L. Antacid-induced calcium loss. Arch Intern Med 1983;143:657–8 [editorial].
2. Anonymous. Is aluminum harmless? Nutr Rev 1980;38:242–3 [review].
3. Gaby AR. Aluminum: The ubiquitous poison. Nutr Healing 1997;4:3,4,11.
4. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458–63.
5. McHardy G. A multicentric, randomized clinical trial of Gaviscon in reflux esophagitis. South Med J 1978;71(suppl 1):16–21.
6. Graham DY, Lanza F, Dorsch ER. Symptomatic reflux esophagitis: A double-blind controlled comparison of antacids and alginate. Curr Ther Res 1977;22:653–8.
7. Walker JA, Sherman RA, Cody RP. The effect of oral bases on enteral aluminum absorption. Arch Intern Med 1990;150:2037–9.
8. Weberg R, Berstad A. Gastrointestinal absorption of aluminum from single doses of aluminum containing antacids in man. Eur J Clin Invest 1986;16:428–32.
9. Fairweather-Tait S, Hickson K, McGaw B, Redi M. Orange juice enhances aluminum absorption from antacid preparation. Eur J Clin Nutr 1994;48:71–3.
10. Nolan CR, Califano JR, Butzin CA. Influence of calcium acetate or calcium citrate on intestinal aluminum absorption. Kidney Int 1990;38:937–41.
11. Anonymous. Preliminary findings suggest calcium citrate supplements may raise aluminum levels in blood, urine. Family Practice News 1992;22:74–5.
12. Fairweather-Tait S, Hickson K, McGaw B, Redi M. Orange juice enhances aluminum absorption from antacid preparation. Eur J Clin Nutr 1994;48:71–3.
13. Nolan CR, Califano JR, Butzin CA. Influence of calcium acetate or calcium citrate on intestinal aluminum absorption. Kidney Int 1990;38:937–41.
14. Walker JA, Sherman RA, Cody RP. The effect of oral bases on enteral aluminum absorption. Arch Intern Med 1990;150:2037–9.
Last Review: 05-01-2013
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