Hold the heartburn on Thanksgiving

For many people, the Thanksgiving feast means overindulging, which can lead to a bout of indigestion and heartburn. But the easiest way to manage heartburn is to prevent it from happening in the first place. Keep your belly jolly this turkey day by trying these simple steps:

• Cut back on caffeine and alcohol
• Eat smaller meals
• Eat fewer fatty foods
• Go easy on spicy foods
• Give up smoking

If your heartburn is still bothering you, adjusting your bed may help soothe your stomach at night. Raise the head of your bed using wooden blocks, so that your head is higher than your feet. One small study found this helped ease heartburn symptoms.

A longer range strategy is losing weight if you need to, which may give you another reason to hold back on that second helping of stuffing during Thanksgiving.

If the diet changes don’t bring relief, then it may time to try a medicine. Your first and best bet is to try an inexpensive over-the-counter antacid like Maalox, Mylanta, Rolaids, Tums, or acid-reducing drugs called H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75, Zantac 150). All of those products are available without a prescription as low-cost generics.

If your heartburn persists and you experience it twice a week or more for weeks or months on end, then you should see a doctor because you may have gastroesophageal reflux disease, or GERD. This is a serious condition that can cause damage to your esophagus, if left untreated. The good news is that drugs called proton pump inhibitors, or PPIs, can help keep GERD under control. In our Best Buy Drug report, we recommend two over-the-counter proton pump inhibitors as your best first option if you have been diagnosed with GERD:

•   Prilosec OTC
•   Generic omeprazole OTC

Another option might be the nonprescription version of Prevacid, called Prevacid 24HR, which recently hit store shelves earlier this month.

All of these are just as effective and safe as more expensive PPIs but remember, if you are having an acute bout of heartburn on Thanksgiving day, a PPI should not be what you reach for first.  In most cases, an antacid or an acid-reducing H2 blocker is all you need.

—Steve Mitchell, associate editor, Consumer Reports Best Buy Drugs

Tips for staying flu-free during holiday travel

You may have heard that the swine (H1N1) flu outbreak has potentially peaked in the U.S. It’s possible—the CDC noted recently that flu-like activity has declined in every region of the country, though some areas are still seeing increases. But even at a declining rate, this year’s flu activity already outpaces a typical flu year, which generally doesn’t get going until December. “Even when a peak has occurred,” says Anne Schuchat, M.D., director of the National Center for Immunization and Respiratory Diseases, “half of the people who are going to become ill haven't gotten ill yet.” And there’s always the possibility of a second wave during a flu pandemic.

Officials also warn that holiday travel could lead to a bump in flu activity. So don’t let your guard down just yet. If you’re traveling during this Thanksgiving holiday, make sure you take some precautions. “The first step is to travel well," said Schuchat. “That means travel only when you are well.” Other precautionary measures that the CDC recommends, which should be familiar to readers of this blog, are:

• Washing hands frequently with soap and water or an alcohol-based hand sanitizer containing at least 60 percent alcohol
• Covering your coughs and sneezes with tissues or your sleeve
• And vaccination, especially if you’re in a priority group

The risk from flight
If you are flying this holiday season, crowded planes aren’t just a nuisance; they can actually increase your chances of infection. A review of studies published in 2005 in the British medical journal The Lancet called commercial airlines “a suitable environment for the spread of pathogens carried by passengers or crew.” However, they also concluded that the “perceived risk is greater than the actual risk.”

Q&A: Crunch the fat away?

I do 200 crunches a day but still have a lot of fat around my midsection. Shouldn't they get rid of that? —S.S., by e-mail 

Alas, no. Crunches and other abdominal exercises can improve the appearance of your midsection by firming muscles and pulling fat in a bit. But the only way to lose fat there—or anywhere else—is to burn more calories than you consume, which generally requires doing aerobic exercise such as biking or walking. (Crunches burn a few calories but not enough to get rid of fat.) Aim for at least 30 minutes of aerobic exercise most days of the week, plus twice-weekly strength training for your abdomen. And there’s really no need to do hundreds of crunches. One or two sets of eight to 12 reps work just as well and pose less risk of an injury.

Obesity drug Meridia may raise risk of heart attack, stroke, death

The weight-loss drug Meridia may be another example of the treatment being worse than the disease. Early data from a recent study suggests that people taking Meridia (sibutramine) face a higher risk of heart attack, stroke and death than those on a placebo pill. But the Food and Drug Administration isn’t raising a red flag on Meridia just yet. The agency says it is still analyzing the data before drawing any conclusions, but adds that the findings underscore the recommendations on Meridia’s labeling that people with a history of heart problems or stroke should not take it.

In the meantime, we’ve been concerned about the heart risks posed by Meridia for more than a decade, since it was first approved by the FDA in 1997 for the treatment of obesity. We’ve categorized it as a high-risk drug you should avoid if you have heart disease, high blood pressure or other significant health issues that might make you vulnerable.

Ironically, the study in question, which was conducted by Abbott Pharmaceutical, the manufacturer of Meridia, was designed to show that the drug reduced the risk of cardiovascular problems. Approximately 10,000 people who were 55 or older participated in the study. All were overweight or obese and had a history of heart disease or type 2 diabetes, plus one other factor that upped their cardiovascular risk. A preliminary analysis found that 11.4 percent of those on Meridia suffered a heart attack, stroke, or death, compared with just 10 percent of those on placebo.

The FDA said it is conducting an expedited safety review of Meridia and will announce its conclusion when finished. The agency also urged people taking the drug to report any adverse events they’ve experienced to FDA's MedWatch Adverse Event Reporting program.

So if drugs aren’t the answer to losing weight, what are your options? In general, we advise against the use of diet pills because the benefits are often marginal at best and sometimes come with dangerous side effects. Better and safer ways to shed pounds include healthy exercise and diet changes. For more on safe and effective weight loss strategies, compare treatments to see what works best (subscribers only).

—Steve Mitchell, associate editor, Consumer Reports Best Buy Drugs 

Study adds weight to case against cholesterol drug Zetia

 
Bad news continues to buffet the once-blockbuster cholesterol drug ezetimibe, which is sold under the brand name Zetia. Backing up research released last year, a new study has found that ezetimibe does not reduce fatty build-ups in the arteries, despite lowering levels of "bad" (LDL) cholesterol in the blood. On the other hand, one of the oldest treatments for high cholesterol—the B vitamin niacin—seems to help on both counts, say the researchers.

The study included 363 people with heart disease, or a high risk of the disease, who had been taking drugs called statins for several years to lower their cholesterol. Statins are the usual go-to drug when changes in diet and exercise don't reduce a person's cholesterol enough. But sometimes even statins fall short and people need additional treatment. Ezetimibe was approved by the FDA as a supplemental treatment, and for occasional use on its own, in 2002. Besides Zetia, you can also get a pill called Vytorin that combines ezetimibe with a statin (the earlier research looked at this combined form).

In the new study, half the people took ezetimibe and half took an extended-release version of niacin, in addition to their statin. All had regular ultrasound scans to check the narrowness of the arteries in their necks. The level of build-up in these blood vessels can help predict a person's risk of having a heart attack or stroke.

Q&A: Is an irregular heartbeat dangerous?

I seem to have an irregular heartbeat. Could that be dangerous? —D.S., Lady Lake, Fla. 

It could be. Minor, short-lived variations in heart rate or an occasional "skipped" beat are relatively common and usually completely harmless. But more frequent or sustained irregularities— like a recurrent racing heartbeat, or erratic rhythms that last for more than a few seconds—could indicate several serious problems, including heart disease, an overactive thyroid, or a reaction to certain drugs or dietary supplements. And the irregular rhythms themselves can cause dizziness, fainting, stroke, heart attack, or even sudden death in susceptible people. You should see your doctor right away to determine the cause of the perceived irregularity. If an electrocardiogram doesn’t turn up anything, your doctor will likely have you wear a continuous-recording monitor for at least 24 hours to provide a more complete picture.

Simple, cheap remedy for toenail fungus

I used to cringe when my yoga instructor told us to “take off your socks.” The big toenail on my right foot was an ugly flakey brownish gray, a condition I’ve had for years. It may have started when I was taking Tae Kwon Do and kept landing on my big toe while trying to do roundhouse kicking.

I don’t know which is more embarrassing, having a discolored toenail or being the only one in yoga class with socks on. I was also unhappy at the beach and the community pool in the summer. Yeah, I could paint my toenails, but I was hoping that if I let that big toe breathe, it would eventually get better.

The toe was not only discolored but sometimes uncomfortable, so I went to a podiatrist who said he thought I had a nail fungus and gave me a liquid topical with a brush (much like nail polish) to apply daily.  This I did for months and months without any noticeable change. I returned to the podiatrist and he clipped a piece of the nail to be analyzed, and it was confirmed, I had a fungus. He sent me for blood tests because the next form of treatment would be Sporanox (itraconazole), a prescription antifungal pill that carries serious health warnings and precautions. At first, it seemed as though the Sporanox was going to work and then the fungus returned. I was then given another liquid topical and another antifungal medicine.

Buzzword: Teeth bleachorexia

What does it mean? Bleachorexia is the compulsion for ever-whiter teeth.

Why the buzz? Americans have been snapping up at-home tooth whitening kits. We spent $343 million in 2008 on these products, which claim to give you a brighter smile in a week or so. And they can brighten teeth somewhat, our tooth whitener tests show. But how much tooth bleaching is too much? Can a person overdo it by wearing teeth whitening strips or trays too often?

The American Dental Association thinks so. While tooth whiteners may seem as innocuous as toothpaste, the ADA says if they’re applied improperly the chemicals in the products might damage your gums and teeth. And unsupervised use might mask an undiagnosed medical condition or an unknown allergy. 

Moreover, tooth whiteners are not regulated by the Food and Drug Administration. And some important information about the products is often missing from their labels. For example, last year the European Scientific Committee on Consumer Products recommended that home tooth-bleaching products contain no more than 6 percent hydrogen peroxide. But none of the eight tooth whiteners tested and rated (available to subscribers) by Consumer Reports included the peroxide percentage.

Finally, no one seems to know how often you can safely use tooth whiteners. The ADA simply says more studies are needed, especially for products containing a high concentration of hydrogen peroxide.

Q&A: Co-Q10 supplements for statin safety?

I’ve heard that people on cholesterol-lowering statin drugs should take coenzyme Q10 (Co-Q10) pills to prevent muscle damage. Does any evidence support that? —M.R.V., by e-mail 

Not enough to recommend taking the pills for that purpose. Muscle pain or, rarely, muscle damage is a known side effect of statins, and several studies have found that some of those drugs can reduce natural blood levels of Co-Q10. And extreme deficiencies of the compound can cause similar muscle problems, which then respond to Co-Q10 supplements. But no study has determined whether Co-Q10 reductions actually cause the side effect in statin users. And to our knowledge, only one small, unpublished study has indicated that the pills can relieve that adverse effect. More important, people who experience muscle discomfort while on a statin should talk to their doctor about stopping the drug, reducing the dosage, or switching to a different one rather than taking a supplement to try relieving the symptom, which might signal a more serious problem.

6 survival skills for a healthy—happy Thanksgiving dinner

For my family, Thanksgiving dinner starts early in the day and ends hours later after we’re all stuffed and exhausted. I call it the "food coma." While there’s lots of talk of elastic-waist pants, loosening of belts, and "never eating again after today," rarely is there discussion of scaling back on portions or eating in moderation—and why not? Because, by tradition, the holidays are a time for celebrating people, blessings, and second or third helpings of your mom’s famous stuffing. But for if you’re minding your waistline, or simply concerned with keeping up healthy habits you’ve worked hard to maintain throughout the year, Thanksgiving can feel like a huge setback. It doesn’t have to be, though. Here are six healthy survival skills to help you make it through the upcoming holidays without calorie overload:

Cut out the things you don’t love. Holidays provide the perfect landscape for overeating because there’s so much food. But, it’s likely there are several high-calorie, high-fat dishes you can do without. Decide what you really want to indulge in and go for smaller portions rather than heaping ones. And avoid nibbling on tons of fatty appetizers because they can add extra calories without making you feel full.

Don’t gobble, gobble. Slow down and enjoy your meal. Studies show that eating a meal quickly may inhibit the release of gut hormones that help you feel full.

Have your pie, and eat it too. No need to deprive yourself, and hurt grandma’s feelings in the process. Again, choose the dessert that you’ve been craving all day, rather than filling up on portions of all the cakes, pies, and puddings being served. If you’re a guest at someone’s celebration, bring a healthier dessert—such as a low-fat pumpkin pie, sorbet, or a fruit plate—even if you’re not asked.

Routine mammograms and the importance of rating preventive services

This week’s news from the U.S. Preventive Services Task Force (USPSTF) on routine breast cancer screening has caused quite the stir. The USPSTF shared their new ratings of preventive services for breast cancer: Mammograms work really well in women in their 60s, pretty well in women in their 50s and not so well in their 40s. If you want to have mammograms in your 40s prepare for more confusing results including additional imaging to clarify and in some cases, a biopsy to be certain. And their recommendations included a couple of small but important points: breast self exam doesn’t lead to early detection of breast cancer nor do breast exams by doctors (remember we are only talking about women who have NO symptoms). The big news: Doctors and patients in their 40s should talk to each other about what to do rather than just do the same thing all the time out of pure routine. What’s wrong with that?

We seem to have developed the view that more prevention is always better, more testing is better than less, and that more information is always helpful. But this week’s news challenges that notion…and that is what it was meant to do. Making decisions is hard, especially when we have a health problem. But it’s also true when there are health issues we may not have yet. Surprise, life isn’t simple.

The focus in the media has been on the USPSTF recommendations without sufficient attention to some important context issues. These include:

1) Breast cancer (and for that matter almost all cancers) is not one disease. They afflict us in multiple forms each with a different natural history. Some breast cancers are very aggressive and respond slowly if at all to our treatment options. Others are slower growing and very responsive to treatment.

2) Mammography is a better test in some people and for some cancers than it is for others, especially when screening at an early stage is what we want from it.

3) The USPSTF focuses on recommendations for primary care doctors for patients with no symptoms getting routine care.

Drug prices increase as inflation rate declines

You may want to be extra vigilant buying brand-name prescription drugs these days. Prices for some of the most widely prescribed brands shot up an average 9% this year–the highest rate in over a decade–even as the overall inflation rate actually declined by around 1 percent.

This assessment* comes from Stephen W. Scholdelmeyer, a professor of pharmaceutical economics at the University of Minnesota’s PRIME Institute. The analysis includes drugs such as Nexium for heartburn (up 7.2%), Plavix to prevent blood clots (up 8.2%), Singulair for asthma (up 12.5%), Flomax for enlarged prostate (up 19.7%), and Fosamax and Boniva for osteoporosis (up 6.9% and 18.6%, respectively).

The analysis was done for AARP, which has closely monitored wholesale prices for a group of 219 drugs since 2002. "The pharmaceutical industry should be embarrassed when it sees its own price increases put side-by-side with the general inflation rate," said John Rother, AARP executive Vice President. "Even as the cost of most good and services drops, a person taking just one brand name drug now pays $200 more per year than a year ago."

Q&A: Preventing shingles?

A friend recently had a painful outbreak of shingles. How can I avoid that condition? —F.J.S., Franklin, N.C.

If you’re age 60 or older, you can get the shingles vaccine. About one in four adults who’ve had chicken pox will eventually experience shingles, a painful, blistering rash that occurs when the herpes zoster virus—which lies dormant in the body after a case of the pox—is reactivated by weakened immunity from age, disease, or another factor. The vaccine cuts your risk of a first outbreak in half, and reduces discomfort by about two-thirds in the event you do get shingles. (The odds of a second outbreak are much smaller, only about 1 in 20.) Your doctor should be able to provide the shot, which costs about $150 and is partly covered by most forms of insurance.

Partners in crime: Diabetes and obesity

The number of Americans with type 2 diabetes has almost doubled in the past decade, to an estimated 24 million. That includes the one in four who don’t even know they have the disease. And some experts believe it won't be long before that number exceeds 30 million.

Why the explosion? Obesity. Up to a third of us are now clinically obese. And since the vast majority of people with type 2 diabetes are also overweight, it's no wonder those two disorders are often referred to as twin epidemics. Indeed, three out of four respondents to a Consumer Reports survey of 5,012 people with type 2 diabetes said they were overweight. And overweight respondents were more than twice as likely to say that they were unsuccessful at managing their diabetes.

The good news is that efforts to rein in excess weight can help prevent and control the condition. For example, a three-year study published in the New England Journal of Medicine showed that for people at high risk for type 2 diabetes, a 7 percent weight loss through diet and 30 minutes of exercise, five days per week, resulted in a 58 percent drop in the expected incidence of the disease. And our survey found that efforts to control weight, by improving diet and increasing activity, were effective strategies for helping people successfully manage their diabetes. Diabetes educators and dietitians were rated as being more helpful than primary-care physicians and endocrinologists in educating patients about nutrition.

The bottom line: The solution to tackling obesity and diabetes is simple. You can't choose your parents, but there are no barriers to eating right and exercising.

—Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser

FDA cracks down on Web sites illegally selling prescription drugs

It’s buyer beware when it comes to purchasing prescription drugs over the Internet, but the Food and Drug Administration is looking to weed out some of the bad apples. The agency said it sent warning letters to 136 off-shore web sites that are illegally selling drugs to U.S. consumers.

The concern is that drugs sold by these web sites could pose a danger to consumers. "Many U.S. consumers are being misled in the hopes of saving money by purchasing prescription drugs over the Internet from illegal pharmacies," FDA Commissioner Margaret A. Hamburg, M.D., said in a statement. "Unfortunately, these drugs are often counterfeit, contaminated, or unapproved products, or contain an inconsistent amount of the active ingredient."

The agency said it also notified Internet service providers and domain name registrars that the web sites were violating U.S. law. The providers and registrars could terminate the sites or suspend use of the domain names. The FDA did not identify the web sites, but said that they did not represent U.S. or Canadian pharmacies.