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])