Magnesium For Acid Reflux

When faced with acid reflux or other gastrointestinal disturbances, physicians and pharmacists may have advised you to take some medication containing magnesium. Magnesium is an important ingredient in themedication. Let us thoroughly examine acid reflux and magnesium's role in the management of this condition.

Overview

Gastroesophageal reflux disease, or acid reflux, occurs when your stomach contents travel up to the esophagus instead of moving further into the intestine. If your stomach contents keep on finding their way upward to the oesophagus, then it is named as Gastroesophageal reflux disease (GORD (UK)/GERD (USA). You may have gastroesophageal reflux if you are experiencing: 

• Indigestion/Heartburn 
• An unpleasant taste in your mouth 
• Bloating 
• Feeling sick 
• A hoarse voice 

There are various causes of gastroesophageal reflux or acid reflux, such as 

• Spicy and/or highly processed food and drinks 
• Stress and anxiety 
• Pregnancy 
• Smoking 
• Being overweight 
• Non-steroidal anti-inflammatory medications like aspirin and ibuprofen (NSAIDs) 
• It may also occur when the sphincter muscles in your lower esophagus become weak

Gastroesophageal reflux can be treated by taking over-the-counter antacid medications. Antacids (which contain magnesium) tend to neutralise the pH of the stomach acid and can calm or prevent refulx. A few simple lifestyle changes may also be recommended by your physician.

How does magnesium affect acid reflux?

Usually, for gastroesophageal reflux or acid reflux, antacids are prescribed by physicians. Antacids are the drugs that counteract the acid in your stomach to relieve indigestion or heartburn and are best taken after meals or before you go to sleep.  Magnesium is considered an important part of antacid formulations. Magnesium in the form of: 

• Magnesium hydroxide 
• Magnesium carbonate 
• Magnesium trisilicate
• Magnesium glycinate
• Magnesium malate
• Magnesium citrate

These forms of magnesium can be used in the antacids used for treating GORD. 

Magnesium decreases excessive  acid production and inhibits the release of pepsin, a pro-inflammatory signalling molecule. Magnesium can reduce spasms of the lower esophageal sphincter and prevent the release of acid into the esophagus. Magnesium is also needed for adequate stomach acid production. People who have hypochlorhydria (less than average acid production in the stomach) are shown to have a low levels of minerals including magnesium due to malabsorption.

Favourable effects of magnesium supplementation

• Magnesium trisilicate reacts with gastric the fluid. This forms gelatinous silicon dioxide and protects the ulcerated mucosal surfaces and favours healing
• Magnesium hydroxide tends to neutralise gastric acid by reacting with the hydrochloric acid in the stomach. It forms water and magnesium chloride. It directly affects the acid in the stomach and increases the pH of the stomach (de-acidifying). The increased pH of the stomach leads to the inactivation of the pepsin
• Magnesium carbonate reacts with hydrochloric acid in the stomach. It leads to the formation of carbon dioxide and magnesium chloride. This causes the stomach acidity to be neutralised 

Which magnesium is best for acid reflux?

All the magnesium salts are used in the antacids. They are used for the same purpose; relieving the body of increased stomach acid. Antacids tend to neutralise acidity. The various magnesium salts work differently but for the same purpose. Magnesium hydroxide is most commonly observed in the market and used by patients. In some medications, it is in combination with aluminum salts (aluminum hydroxide). Magnesium hydroxide reacts with HCl to form magnesium chloride and water. The magnesium chloride formed does not have much effect, and is gentle on the stomach.

Furthermore, magnesium increases the pH of the stomach. In the presence of high pH, the pepsin (an enzyme that digests protein) is not activated and can be used by the body as a pro-inflammatory molecule.

Magnesium-containing antacids are widely available and can be purchased from any pharmacy. Maalox 175mg/200mg Oral suspension is an example of a magnesium hydroxide-containing antacid. 

How much magnesium should I take for acid reflux?

• The recommended dose of magnesium hydroxide in the patients over 12 years old is 30 - 45 mL. It is recommended that this be mixed with water and given at bedtime
• Magnesium carbonate, which leads to the formation of magnesium chloride and water, is not recommended in pediatric patients. The recommended dose in adults is 10 mL, 3 times a day (30mL)
• Magnesium trisilicate  used for forming silicon dioxide. Adult dosage is recommended to be 80mg in tablet form or 10-20 mL, 3 times a day

Taking magnesium more than the required or recommended dose can result in serious adverse effects affecting the gastrointestinal tract. Therefore, it is advised not to use magnesium salts excessively. Use them as per the guidelines of the prescriber.  

When using magnesium for antacids, it is recommended to take magnesium after food or at bedtime. This is because the acid secretions are highest at these times Therefore, these are the perfect times for the additional salts to act and neutralise the gastric acid present in the stomach. 

Side effects and other concerns

Though the side effects of magnesium salts are minimal, as with all medications and supplements, they should be used cautiously. If you experience any of these symptoms after taking magnesium supplements, seek the advice of a medical professional.

Magnesium trisilicate intolerance symptoms:

• Allergic reactions 
• Difficulty in breathing 
• Swelling of lips, tongue, mouth, or face 
• Nausea and vomiting 

Magnesium trisilicate can interact with these conditions: 

• Constipation 
• Renal dysfunction 

Magnesium trisilicate can interact with these drugs and supplements: 

• Alcohol
• Antibiotics (e.g., Amoxicillin, Ciprofloxacin) 
• Diclofenac 
• Antidiabetic medication (e.g., Glipizide) 
• Aspirin 
• Ascorbic acid (Vitamin C)
• Zinc sulphate 
• Sodium chloride 
• Paracetamol (Acetaminophen)
• Potassium chloride 

Magnesium carbonate intolerance symptoms: 

• Allergic reactions
• Trouble in breathing 
• Signs of chest constriction 
• Fever 
• Wheezing 
• Swelling of the mouth, face, lips, or tongue 
• Blistered or peeling skin
• Severe diarrhoea 

The following diseases interact with magnesium carbonate

• Renal dysfunction 

The following drugs and supplements can interact with magnesium carbonate

• Other digestive medications (e.g, Omeprazole) 
• Aspirin 
• Thyroid medication (Levothyroxine) 
• Vitamin D2
• Vitamin D3 
• Alprazolam 
• Cetirizine 
• Zinc sulphate 
• Vitamine B12 
• Vitamin B6 
• Vitamin D 

Magnesium hydroxide intolerance symptoms: 

• Severe nausea, vomiting, or diarrhea
• No bowel movement after taking the medicine 
• The decline in the sense of taste 
• Bleeding in the rectum 

Magnesium hydroxide also interacts with the following diseases: 

• Inflammatory bowel disease 
• Renal dysfunction 
• Intestinal obstruction disorders

The drugs with which magnesium hydroxide interacts are:

• Aspirin 
• High blood-pressure medication (e.g., Furosemide, Metoprolol)
• High cholesterol medication (Atorvastatin) 
• Vitamin B12 
• Vitamin B6 
• Vitamin C
• Vitamin D3 
• Zinc sulphate
• Antihistimines (Cetirizine) 

Summary

The condition where the food and gases produced by the digestion of food finds its way back to the esophagus and causes trouble for the patient is known as acid reflux or gastroesophageal reflux. If this condition continues happening, then it can progress into gastroesophageal reflux disease (GORD). The symptoms of acid reflux or gastroesophageal reflux are heartburn, an unpleasant taste in your mouth, feeling sick, etc. Several factors, including the weakening of the lower esophageal sphincter and by foods or drinks may cause acid reflux. It may also be caused by anxiety, stress, pregnancy, and some medications like NSAIDs (aspirin). 

A physician may suggest a few modifications in your lifestyle and prescribe some drugs. Most likely, the medications prescribed for acid reflux have magnesium in them. Magnesium is considered an important medication in treating acid reflux or gastroesophageal reflux.

Various magnesium salts are used in antacid medications. The primary purpose is to lower the increased acid production, maintain the pH of the stomach, inactivate pepsin, and reduce the spasms of the lower esophageal sphincter. Antacids are usually taken at bedtime or after meals as there is increased acid production at this time, provideing the best working environment for the antacids. 

Magnesium trisilicate forms a gelatinous silicon dioxide substance that covers the ulcerated parts of the mucosa and favors healing. 

Magnesium carbonate forms magnesium chloride with hydrochloric acid, which neutralizes the increased acidity in the stomach.. 

The best of these magnesium salts, however, is magnesium hydroxide, commonly found in various formulations (liquids, tablets etc.)in the market. It is recommended to take magnesium as prescribed by a physician or other healthcare professional. 

An overdose of magnesium salts can cause serious side effects such as gastrointestinal disturbances (nausea, vomiting, and constipation), swelling of lips, mouth, tongue, or face, and difficulty in breathing. 

Various drug interactions are associated with magnesium salts such as aspirin, cetirizine, zinc sulphate, omeprazole, vitamin B complexes, vitamin D, and vitamin C. 

Avoid magnesium salts if you have renal dysfunction, constipation, and other intestine disorders.