Here at Fix Your Gut, we may seem harsh on most medications recommended for digestion. Our opinionated views on medications may be true, but we are equally harsh on supplements that we feel may cause issues with their use as well. However, some medications can improve your digestive health when used correctly. All medications/supplements have their uses and drawbacks, and the mineral bismuth is no different.

Bismuth and Its Various Uses

Most bismuth medications that you purchase are chelated with salicylates. Bismuth subsalicylate is the colloidal compound of bismuth and salicylic acid (a known anti-inflammatory agent). Compounds containing the mineral are used in people suffering from ulcers, heartburn, gastritis, and diarrhea. Bismuth helps coat and protect the lining of your esophagus and stomach.¹

Bismuth is also a weak antacid, and the subsalicylate chelate of the compound has been shown to reduce inflammation within our gastrointestinal tract. Bismuth has also been shown to have antibacterial properties. The antibacterial properties might be why the mineral accelerates ulcer healing in people by relieving H. pylori dysbiosis within our stomach. Bismuth possibly reduces H. pylori’s iron uptake (one study casts doubt on its iron deprivation ability, but the study mentions it still hinders H. pylori), reducing its ability for biofilm formation and survival.^{2 3 4}

Bismuth has also been found to bind with Gram-negative bacteria-produced endotoxins and other toxins bacteria produce to help eliminate them from our body through our stool. Studies are mixed on whether bismuth relieves Gram-negative Escherichia coli dysbiosis. Still, the mineral does seem to reduce E. coli endotoxin-caused intestinal inflammation, binding to the endotoxins and eliminating them through our stool. The mineral also seems effective against Gram-negative bacteria, including Pseudomonas aeruginosa and Klebsiella. Bismuth also effectively relieves symptoms in people suffering from ulcers, gastritis, infections, diarrhea, or GERD by reducing endotoxin load to help improve their immune and digestive health.^{5 6 7 8}

Bismuth medications also exhibit potent inhibitory and bactericidal actions in Gram-positive bacteria, such as Staphylococcus aureus, methicillin-resistant strains (MRSA), Bacillus subtilis, Clostridioides difficile, and vancomycin-resistant Enterococcus (VRE). Bismuth medications exhibit potent inhibitory and bactericidal actions. MIC values for bismuth medications have been reported as low as 0.5 μg/ml against S. aureus strains, and activity is retained against multidrug-resistant clinical S. aureus strain isolates. Mechanisms include direct interference with S. aureus division (increased cell size and division defects were noted with electron microscopy), collapse of ATP pools, and membrane depolarization. Bismuth medications also work well against bacterial biofilms, including those produced by S. aureus.^{9 10}

Bismuth is also helpful in helping individuals with the third type of SIBO (Small Intestinal Bacterial Overgrowth), which is known as hydrogen sulfide-producing dysbiosis. The mineral bonds hydrogen sulfide, sulfite, sulfate, and sulfur within our digestive tract to form bismuth sulfide. This bonding reduces the amount that may leak out of your gut and cause oxidation within our mitochondria and our cells, which often causes fatigue and brain fog. If your stools become a very dark color when you supplement with bismuth, you may suffer from hydrogen sulfide-producing dysbiosis. If your tongue, gums, or oral cavity turns black or dark when swishing with and/or swallowing a bismuth-containing liquid or chewable, you might have hydrogen sulfide bacterial dysbiosis within your mouth. It is better to use bismuth supplements or medications that do not contain subsalicylate to determine hydrogen sulfide dysbiosis, which can cause bleeding in some people and melena (dark, tarry stools), which creates issues in determining the possible cause of the darkening of your stools from taking the mineral.^{11 12 13 14}

Finally, bismuth medications have also been studied for their antifungal capabilities. Candida albicans is particularly susceptible to the mineral, including fluconazole-resistant isolates and the multidrug-resistant emerging pathogen Candida auris. Bismuth medications show Minimum Inhibitory Concentration (MIC) values as low as 1–4 μg/mL (for C. auris) and demonstrate fungal antibiofilm and morphological disruption abilities. If I were suffering from Candida dysbiosis, especially thrush (swishing for a few minutes with a bismuth medication) or upper gut Candida dysbiosis, I would consider using bismuth medications.^{15 16 17}

Issues Associated with Use and Additional Recommendations

Minor side effects that the mineral may cause are a darkening of the tongue and stools from sulfur or sulfide bonding. Again, this “side effect” may be a useful diagnostic tool for determining hydrogen sulfide dysbiosis within your digestive tract. Rare severe allergic reactions can occur in people allergic to bismuth, including anaphylaxis, hives, and itching.¹⁸

I recommend that you do not take bismuth for longer than six weeks if possible, because of the risk of bismuth toxicity. Bismuth toxicity symptoms include ataxia, myoclonus, myoclonic encephalopathy, weakness, fatigue, anxiety, irritability, confusion, tremor, walking difficulty, and speech problems. Finally, prolonged high-dose or long-term use has been associated with bismuth-induced neurotoxicity (encephalopathy) and renal impairment, so caution is warranted if you are suffering from kidney dysfunction.^{19 20 21}

Bismuth subsalicylate (because of the salicylates) can cause adverse reactions, including rare allergic reactions (anaphylaxis, hives), increased risk of bleeding, increased risk of bruising, gastrointestinal ulceration, colitis, gastritis, nausea, tinnitus, loss of hearing, headaches, anxiety, irritability, rage, and vomiting. I would avoid the use of bismuth subsalicylate if you are allergic or sensitive to salicylates (tinnitus is a common sensitivity symptom) or suffer from digestive disorders that may increase bleeding, such as severe ulcerations or IBD. Children should not take bismuth subsalicylate because it increases their chances of developing Reye’s syndrome, a serious, life-threatening medical condition. Finally, if you take any anticoagulant medication, any medication that increases your risk of bleeding (warfarin, ibuprofen, naproxen sodium, for example), or anything with salicylic acid (aspirin, white willow bark), you may want to ask your doctor first before you use bismuth subsalicylate. If you cannot tolerate bismuth subsalicylate I would try to find a supplemental mineral form like Devrom.^{22 23}

Our body uses glutathione to detoxify bismuth, so taking a glutathione supplement during or after use may be a good idea to help remove bismuth from our body. Use caution when dealing with hydrogen sulfide dysbiosis or use it after it is reduced. Glutathione contains a thiol group, which may cause issues in people with hydrogen sulfide dysbiosis.²⁴

Brands of Bismuth I Recommend:

• Bismuth subsalicylate – Kaopectate Vanilla (No dyes, but contains some questionable additives including caramel, flavor, sucrose [possible GMO source], and xanthan gum)
• Bismuth subgallate – Devrom (contains xylitol, talc, and starch[possible gmo source])