Questions & Answers

In your July 2016 article regarding proton pump inhibitors (PPIs), you warn about the dangers of PPIs and instead recommend that we take medicines such as TUMS for heartburn. But you have also warned about taking calcium supplements, saying they may cause adverse cardiovascular events. Calcium is the main ingredient in TUMS. Is taking it the same as taking a calcium supplement? Are there similar dangers? Or are there no good options for heartburn?

As we note in our article, you should first try nondrug approaches that might help improve symptoms of heartburn. These include eating fewer “trigger” foods, such as chocolate or fried/fatty foods; drinking less coffee or alcohol; not eating too close to bedtime; raising the head of your bed; and maintaining a healthy weight. But if your heartburn persists, you should see your doctor before starting any medication to make sure that:

• You do not have a more serious condition, such as a gastrointestinal ulcer;
• Your heartburn symptoms are not due to a medicine you are taking, such as ibuprofen or aspirin; and
• You do not have kidney disease, which can be a reason not to take antacids.

If you and your doctor decide to start drug treatment for heartburn, you should first try over-the-counter antacids. As you correctly point out, some antacids (TUMS and ROLAIDS, for example) contain calcium. Healthy adults up to the age of 50 can safely consume up to 2,500 milligrams (mg) of calcium daily, and adults over 50 can consume up to 2,000 mg daily. Assuming you eat dairy products, you probably get about 1,000 mg of calcium daily from food, so you can safely take between 1,000 and 1,500 mg of calcium in antacid or supplement form.

Each tablet of regular-strength TUMS and ROLAIDS contains around 200 mg of calcium. So as long as you do not have kidney disease and are not taking other calcium supplements, you can probably safely take four to six of these regular-strength tablets per day for a limited period of time. Note that this is lower than the maximum of 10-12 tablets per day indicated on the product labels. Note also that other antacids (for example, MAALOX) do not have calcium but instead contain magnesium. Magnesium is another mineral that can cause serious side effects if taken in large amounts, so you should see your doctor before starting this or any antacid.

Finally, if your heartburn is not relieved after two weeks of daily antacid use, you should see a doctor to explore taking an over-the-counter or prescription histamine-2-receptor antagonist (for example ranitidine [ZANTAC] or famotidine [PEPCID]). If that still does not relieve your symptoms, you can consider a PPI for short-term use.