Bismuth: When Should It Be Used to Improve Your Digestive Health?

Bismuth: When Should It Be Used to Improve Your Digestive Health?

Here at Fix Your Gut we may seem harsh on most medications that are 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, there are some medications that 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 Uses

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

The mineral is also a weak antacid and the subsalicylate part of the compound has been shown to reduce inflammation in the gastrointestinal tract. It also has been shown to have antibacterial properties. The antibacterial properties might be why the mineral accelerates ulcer healing in people by limiting H. pylori overgrowth. Bismuth possibly reduces H. pylori’s iron uptake (there is one study that casts doubt on its iron deprivation ability, but the study mentions it still hinders H. pylori), reducing its ability for biofilm formation and cellular metabolism.2 3 4

Bismuth also has been found to bind with the endotoxins and enterotoxins that bacteria produce to help eliminate them from the body. Bismuth reduces E. coli overgrowth and endotoxin production in the intestines. The mineral limits symptoms in people who have ulcers, gastritis, infections, diarrhea, or GERD by these various mechanisms of action to help improve their digestive health.5 6 7

Bismuth is also useful in helping individuals with the lesser known third type of SIBO (small intestinal bacterial overgrowth) known as SIBO with hydrogen sulfide producing overgrowth. The mineral bonds with hydrogen sulfide and sulfur within the digestive tract to form bismuth sulfide. This bonding reduces the amount that may leak out of the gut and cause fatigue and brain fog if it crosses the blood brain barrier. If your stools become a very dark color when you supplement with bismuth, you may be either suffering from hydrogen sulfide producing overgrowth or your diet is very high in sulfurous foods. It is better to use bismuth supplements or medications that do not contain subsalicylate to determine hydrogen sulfide overgrowth, 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.8 9 10 11

Issues Associated with Use and Additional Recommendations

Minor side effects that the mineral may cause is 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 overgrowth within the digestive tract. In addition, bismuth use may cause headaches and nausea.12

Bismuth subsalicylate can cause some rare adverse reactions, including, bleeding, and systemic allergic reactions. I would avoid the use of bismuth subsalicylate if you are allergic to salicylates or suffer from digestive disorders that may increase bleeding like severe ulcerations or IBD. Children should not take bismuth subsalicylate, because it increases their chances of developing Reye syndrome, a serious, life-threatening medical condition. Finally, if you take any anticoagulant medication, any medication that increases your chances of bleeding (NSAIDS 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 form of the mineral instead.13

I recommend that you do not take bismuth longer than six weeks if possible because of the risk of bismuth poisoning. Bismuth poisoning symptoms include neurological issues, anemia, ataxia, myoclonus, and speech issues.14 15 16
To reduce bismuth concentrations our body uses glutathione, so it may be a good idea during use or afterwards to take a glutathione supplement to help facilitate clearance of bismuth from the body. Use with caution if you are dealing with hydrogen sulfide overgrowth, or use it after the overgrowth is reduced. Glutathione contains a thiol group, which may cause issues in people with hydrogen sulfide overgrowth. 17

Brands of Bismuth I recommend:

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

  1. Is priority one biofilm with bismuth sage to take for 8 weeks? I’m scared cuz I have low iron already and read it can interfere. Pls help thx

  2. Does the devrom still have the antibacterial effects that regular pepto bismol does?

  3. These comments still do not say what amount of pepto-bismol would cross the blood-brain barrier to cause serious brain damage…more than “fogginess.” What do you suggest?

  4. I too suffer from rottien egg smell coming through my breath and nose and my doctors pretend they can’t smell anything. Will bismuth help with this

  5. Thank for the content David. My circumstance is quite similar to yours. May I ask, whats the name of the Sublingual Glutathione tablet are you using?

  6. This is totally embarrassing, but I have a severe case of Hydrogen Sulfide SIBO. Question, have any of you guys experienced symptoms of H2S being expelled through the lungs causing noticeable reactions from others?? It’s a reality that I face on a daily basis.

    I’ve recently come across an article published about the benefits of Bismuth as it pertains to H2S SIBO. This got me to using Bismuth and it has remarkably improved with my symptoms?

    • James,

      I am experiencing a similar situation I believe. There is a odor emitting from my body even when my mouth is closed. I do believe I have HS2 Sibo. Have you found any all natural solutions. I am interested in trying Bismuth again. I don’t think it worked for me the first time I tried it because I was still eating large amounts of meat.

  7. Hi John, pretty sure I have h2s and bismuth is helping with my symptoms. Do you have any suggestions for herbal treatment to get rid of the h2s producing bacteria? I have 50% Clostridia in my gut and have read it can be a hydrogen sulfide producer. Thanks

    • Natalie, have you tried VSL # 3? I read through another SIBO blog that this is very effective. I’m trying this out for the first time myself. I will provide feedback soon.


  8. Hi John,

    what is the difference between chlorophyll concentrate internal deodorant pills such as Nature”s Way Chlorofresh and Bismuth Subgallate ills such as Devrom? Which work better for SIBO-C-induced Leaky gut symptoms. Because not only do I have gas that leaks, every other smell in my body does too. Should I use a mixture of the 2? Or focus on the one best suited for my illness and symptoms?

    Thanks in advance for the answer

    • Bismuth binds with the sulfate directly forming bismuth sulfate. In addition, bismuth has a weak antimicrobial component. Mixture of the two would be fine.

  9. I have high Desulfovibrio but also salicylate sensitivity as well as chemical sensitivity – so these products will not work for me. Any suggestions for bismuth without additives?

  10. This supplement contains Bismuth Citrate. Is it a good source to treat/determine whether H2S SIBO may be present? Can this cure H2S SIBO or only help the symptoms temporarily?

    • Or would the Devrom be the best choice if I suspect H2S SIBO?

      • Either bismuth products would work. It doesn’t cure H2S overgrowth but can help absorb some of the sulfide and lessen the symptoms.

        • Thanks John for your article, I’m going to try bismuth against the H2S problems I have, I do understand why you advise glutathione for detoxing, but my H2S problems got worse when using glutathione a few months ago (I think because glutathione contains high levels of Sulfur). My questions is should one not avoid supplements and food containing high levels of sulfur, when having SIBO problems with Sulfur reducing bacteria which cause H2S?

          Thanks for your reply.

          • You are correct, I overlooked in mentioning that glutathione is a single thiol group, I will add that in as well.

          • Dear John,

            For the last 2 months I have been using a Bismuth subsalicylate supplement (Pepto Bismol/ only 2 tablets a day). It at least controls a lot of my symptoms (together with avoiding sulfur in food) caused by SRB.

            Because I know I will still need 2 use this supplement for quite a while, I would like to ask if you would recommend a different Bismuth supplement (with the same effect on SRB and H2S), which could be a safer choice for long term use?

            PS: I have found a absorbable 50mg Sublingual glutathione tablet (use it 3x a week to get in some glutathione without swollowing it down into to GI-tract).

            Thanks again for your reply.

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