Holiday help for heartburn

It's that time of year when food and wine merchants thrive, tons of hors d'ouevres are consumed at office parties, families convene for feasts, glasses are raised to "Auld Lang Syne," and heartburn remedies fly off pharmacy shelves.

About 20 percent of people in the U.S. suffer at least once a week from symptoms of acid reflux, or heartburn (also known as dyspepsia, indigestion, sour stomach, or agita), and another 20 percent have it less frequently. A smaller but substantial percentage of the population has heartburn often enough (two or more times a week) to have earned the diagnosis of GERD (gastroesophageal reflux disease). No wonder the sales of heartburn remedies add up to billions of dollars a year.

Causes and complications
The food and drink you swallow are transported by strong, involuntary contractions of the muscular esophagus into your stomach through an opening guarded by a powerful muscle called the lower esophageal sphincter. The closure of that sphincter prevents stomach acid from backing up, or refluxing, into the esophagus. Those involuntary mechanisms are so powerful that you can swallow quite well while doing a headstand.

But when the sphincter doesn't close properly, whether because of a genetic weakness, excessive fat ingestion, obesity, or reasons unknown, acid reflux can wreak havoc on the relatively delicate esophageal lining, causing inflammation, irritation, and, sometimes, ulceration. Victims feel it as a distinctive burning sensation located under the breastbone, which may or may not be related to meals and commonly occurs at night.

Long-standing reflux into the lower part of the esophagus can cause changes in the appearance of the lining cells, a condition called Barrett's esophagus that can turn into esophageal cancer in about 1 of every 200 cases. If the reflux reaches the upper portions of the esophagus, it can irritate adjacent structures and cause wheezing, coughing, hoarseness, or chronic sore throat, which often leads to misdiagnoses, especially when the usual reflux symptoms are minimal or absent.

What to take
Since heartburn is an easily recognizable symptom (although at times it can be confused with angina pectoris, or heart pain), it is a natural for self-medication. And there are many over-the-counter products to treat it. Those products can be divided into three categories--antacids, histamine-2 receptor blockers (H2 blockers), and proton-pump inhibitors (PPIs)--that vary in how they work, how quickly they work, how long they work, and how well they work.

If your heartburn occurs occasionally and unexpectedly, as is apt to happen to many of us once or twice this holiday season, your best bet is a simple antacid such as generic or store-brand versions of Maalox, Mylanta, Rolaids, or Tums. They come in various dosage forms--liquid suspensions, tablets that you chew or swallow, effervescent solutions, and chewing gum--from which you can choose. They all work in a few minutes by neutralizing the acidity in the esophagus. Their effect lasts up to a few hours, plenty long enough for reflux symptoms to have ceased.

If you know from bitter experience to expect heartburn in certain situations ("I love pizza, but it always gives me agita"), take an H2 blocker beforehand, which stops histamine from stimulating stomach acid production. There are four available, formerly only by prescription but now over the counter as well as generically: cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75, Zantac 150). They all start working in 30 minutes to 1 hour and one dose can last up to 12 hours. One product, Pepcid Complete, combines famotidine with an antacid for both immediate and longer-term relief.

When heartburn happens more than once or twice a week, taking antacids several times a day is much too labor-intensive, and even continuous twice-daily use of H2 blockers may not be very effective. At that point, more complete blockage of stomach acid production is called for. Enter PPIs, which actually block the mechanism in the stomach cells that releases acid into the stomach. The first of those to be approved, omeprazole, is available over the counter as Prilosec OTC. It may take days for these medications to provide complete relief, so they are not appropriate for occasional or intermittent heartburn. If there is no improvement from Prilosec OTC or your symptoms recur after a 14-day course, medical evaluation is mandatory.
—Marvin M. Lipman, M.D.

Dr. Lipman has been Consumers Union's chief medical advisor since 1967. He is a diplomate of the American Board of Internal Medicine (certified in endocrinology and metabolism) and is clinical professor of medicine emeritus at New York medical College.

5 steps to healthier winter skin

Cold, dry air, friction from heavy clothing, and indoor heating can turn your skin dry, itchy, and prone to cracks. Here's how to keep from drying out this winter.

1. Add humidity
   Place a water-filled bowl near a heating vent or radiator, or use a humidifier. The device should have a humidistat that shuts the humidifier off when the preset humidity level is reached.
2. Shun long, hot showers and baths
   Hot water washes away the skin's natural oils, so limit bathing to 10 minutes, use warm rather than hot water, and keep the bathroom door closed to lock in humidity. Skip antibacterial, deodorant, and perfumed soaps, which tend to be drying, in favor of a mild, moisturizing, scent-free cleanser.
3. Moisturize early and often
   Smooth on moisturizer—preferably with glycerin, fatty acids, ceramide, or cholesterol—after bathing, while your skin is damp. Reapply throughout the day, if necessary. Use a facial moisturizer or sunscreen with a sun-protection factor of at least 30, especially on sunny days spent out in the snow.
4. Pamper problem spots
   Lips chap easily because they lack sweat and oil glands. But don't lick your lips, since evaporation makes the chapping worse. Petroleum jelly works well, though lip balm or lipstick can help. Put on lotion after you wash your hands, and wear cotton-lined plastic or rubber gloves when cleaning dishes. If necessary, apply a heavy lotion at night and wear cotton gloves. Treat cracked heals with moisturizers containing lactic acid or urea. For severe cases, see a dermatologist.
5. Wear soft clothing
   Avoid wool and other rough fabrics. Wear cotton or silk next to your skin. Switch to an unscented fabric softener to avoid drying perfumes and chemicals. Finally, leave your electric blankets in storage—they can suck moisture from your skin as you sleep.

Tip of the day: How to handle a chatty M.D.

What’s up, doc?” may be the wrong question to ask your physician during an office visit. A recent study suggests that doctors already share too much personal information with patients. And while many do so to put patients at ease, it can actually be counterproductive. Researchers had actors pretend to be patients and secretly record visits with 100 doctors. Thirty-four percent of the time doctors chatted away about personal topics such as their own health or families. But 11 percent of those disclosures were deemed disruptive, and 85 percent were considered useless.

Since office visits are often too short to squander, get the most out of your time by writing out questions beforehand and prioritizing the three or four you want to talk about most. If you can’t get through the list, ask if you can follow up with e-mail.

Finally, an antidote to TV drug ads

If you watch any TV, you've seen the barrage of advertisements for prescription medications. They always start by showing someone in distress—from insomnia, allergies, erectile dysfunction or other medical condition. But after taking the drug, the person is either sleeping soundly or running through the fields, depending on the original ailment,  while the announcer reads a scary list of side effects in a voice so soothing that they almost sound fun.

The problem with such "direct-to-consumer," or DTC, advertisements is that they may generate excessive demand because people go straight to their doctors asking for this or that specific medication. In a 2006 survey by our National Survey Research Center, 78 percent of doctors said that patients asked them at least occasionally to prescribe drugs they had seen advertised on television, and 67 percent said they sometimes did so. And don't expect the ad barrage to let up.  While Congress recently gave the FDA more authority to regulate ads, it rejected a measure that would have allowed the agency to place a moratorium on ads for new drugs that raise safety concerns. The U.S. is one of only two countries in the world (the other is New Zealand) where such ads are legal. 

Well, starting this month, Consumer Reports is introducing an entertaining new online video series that will track and report on such ads. The videos are hosted by Associate Editor, Jamie Hirsh, and produced by the ConsumerReports TV News crew. This first installment concerns an interesting class of medications that are approved to treat something called "restless leg syndrome." That condition may sound fanciful, but it's a real problem. Something like 3 percent of Americans suffer from RLS, which is characterized by an uncontrollable impulse to keep moving your legs even when you are trying to go to sleep—which obviously could make sleep difficult.

Several years ago, doctors discovered that drugs that were originally developed to treat Parkinson's disease could provide meaningful help to people who suffered from moderate to severe forms of this condition.  But the drugs have serious side effects - one of the more bizarre involves a propensity for uncontrolled sexual or gambling impulses, as our video mentions. And while these medications may provide welcome relief to some RLS patients, the ads could leave anyone who ever suffered fidgetiness when trying to go to sleep to wonder whether he or she has RLS and should seek treatment.

We leave the rest to the video to explain, and we urge you to check back next month for the next installment in this fun and informative series!—Kevin McKean, Editorial Director

Learn more
Find more information on drugs commonly used to treat RLS in Consumer Reports' Medical Guide:

• Ropinirole (brand name Requip)
• Pramipexole (brand name Mirapex)