Effect of calcium carbonate and aluminum hydroxide on human intestinal function

The effect of calcium carbonate (6 g daily) and of aluminum hydroxide (Amphojel, 7.2 g daily) on human gastrointestinal function was examined because these popular antacids have a documented effect on fecal fat, an undocumented association with constipation, and a putative ability to ameliorate cocarcinogenic effects of bile acids and fatty acids on colonic mucosa. Intake-output studies were conducted over periods of three weeks during which time dietary intake was controlled (20 g fiber daily), and the order of treatment (control, calcium carbonate, aluminum hydroxide) was randomized. Neither calcium carbonate nor aluminum hydroxide altered the mean intestinal transit time of eight subjects. Calcium carbonate increased daily output of feces from 106 +/- 30 (SD) to 131 +/- 41 g, of fecal fatty acids from 7.9 +/- 1.4 to 16.8 +/- 5.4 mmol, and of fecal 3 alpha-hydroxy-bile acids from 411 +/- 223 to 769 +/- 505 mumol. Aluminum hydroxide increased daily output of feces to 143 +/- 43 g, of fecal fatty acids to 12.4 +/- 5 mmol, and of fecal bile acids to 735 +/- 592 mumol. Both Ca2+ and Al3+ precipitated deoxycholate when these ions were incubated in vitro. These observations help to explain how these two antacids may lower blood lipids and ameliorate the effects of fecal bile acids and fatty acids on colonic mucosa.