From the Guidelines
No, citric acid is not an antacid, as it can increase stomach acidity rather than neutralize it. Citric acid is actually an acid that has a low pH and would potentially worsen symptoms in people with excess stomach acid. Antacids are medications designed to counteract stomach acid and typically contain basic compounds like calcium carbonate, magnesium hydroxide, or aluminum hydroxide. These substances work by chemically neutralizing stomach acid to raise the pH and provide relief from heartburn, acid reflux, or indigestion. According to the American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease 1, antacids are rapidly acting agents that can be used for on-demand therapy, but citric acid is not mentioned as an antacid.
The most recent guidance from the AGA clinical practice update on the personalized approach to the evaluation and management of GERD 1 also supports the use of antacids, such as H2 receptor antagonists (H2RAs) or other antacids, for patients who require weaning down from acid suppression therapy. However, citric acid is not considered an antacid in this context either.
Some key points to consider when managing heartburn or acid reflux include:
- Using true antacids like Tums, Rolaids, Maalox, or Mylanta, which can provide relief within minutes
- Taking these medications as needed according to package directions, but not using them excessively without medical supervision
- Considering alternative treatments, such as H2RAs or PPIs, under the guidance of a healthcare professional
- Weaning down to the lowest effective dose or switching to a different medication when symptoms are adequately controlled, as recommended by the AGA clinical practice update 1.
From the Research
Citric Acid as an Antacid
- Citric acid is often used in combination with other ingredients, such as sodium and potassium bicarbonates, to create antacid formulations 2.
- In the study evaluating Alka-Seltzer Effervescent, a mixture of sodium and potassium bicarbonates and citric acid, the formulation was found to be effective in neutralizing gastric acid and increasing the pH of gastric contents in patients undergoing emergency surgery 2.
- However, citric acid itself is not typically considered an antacid, as it is an acid that can potentially exacerbate heartburn and acid reflux symptoms.
- Antacids are generally defined as substances that neutralize stomach acid and relieve heartburn and indigestion symptoms, and are usually composed of ingredients such as calcium carbonate, magnesium hydroxide, or aluminum hydroxide 3, 4.
Mechanism of Action
- The mechanism of action of antacids involves neutralizing stomach acid and increasing the pH of the stomach, which can help to relieve heartburn and indigestion symptoms 3.
- Citric acid, on the other hand, can potentially irritate the stomach lining and exacerbate heartburn and acid reflux symptoms, although it may also have some buffering capacity when combined with other ingredients 2.
Clinical Evidence
- There is limited clinical evidence to support the use of citric acid as an antacid, and most studies have evaluated the efficacy of antacid formulations that combine citric acid with other ingredients 2, 3, 4.
- The American College of Gastroenterology recommends the use of antacids, such as calcium carbonate or magnesium hydroxide, as first-line treatment for mild gastroesophageal reflux disease (GERD) symptoms 4.