Last year alone, Americans spent $942 million dollars on over-the-counter antacids, and a whopping 13.6 billion dollars on prescription acid suppressants. So how can we manage our acid reflux disease, and other similar symptoms? Are antacids always a good idea? Dr. Leo Galland, a medical advisor to the consumer newsletter “Bottom Line Personal” and author of the book “The Fat-Resistance Diet,” offers tips and natural remedies that could make us stop popping those pills.
Millions of Americans take drugs to relieve excess stomach acid. In fact, acid-suppressing drugs are among the most frequently prescribed medications in the US. They fall into two categories:
* Proton-pump inhibitors like Prilosec, Prevacid, Nexium, Aciphex and Protonix. What they do is inhibit the enzymes that transport acid from the acid-secreting cells into the lining of the stomach.
* H2 blockers like Zantac, Pepcid, Axid and Tagamet. H2 blockers inhibit the activity of histamine in the stomach. Histamine stimulates stomach cells to secrete more acid.
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Nationwide
Although these drugs can be effective at relieving symptoms like heartburn and abdominal pain, they may have serious long-term side effects. Regular use of acid-suppressing drugs is associated with increased risk of hip fractures, probably because of impaired calcium absorption. Taking acid-suppressors also increases your risk of acquiring a food-borne intestinal infection or experiencing the overgrowth of bacteria in the stomach and small intestine. Overgrowth of bacteria in the stomach probably explains some other risks associated with regular use of acid suppressors including pneumonia, stomach cancer and vitamin B12 deficiency.
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Gastroesophageal reflux vs. gastritis
Acid suppressing therapy is primarily used to treat two kinds of problems — gastroesophageal reflux (GERD) and gastritis (inflammation of the stomach lining). In gastroesophageal reflux, contents of the stomach flow backward up the esophagus and may reach all the way to the mouth. Symptoms include heartburn, chest pain, regurgitation of food, sore throat, hoarse voice and cough. Although acid suppressors are commonly prescribed, GERD is not caused by excess production of acid. It is caused by failure of the valve that separates the esophagus from the stomach (the LES or lower esophageal sphincter valve).
The good news is that there are natural remedies for these GERD problems that work even better than drugs and without the side effects:
* Don’t stuff yourself. When you eat a lot at one time it causes stomach distension, which triggers relaxation of the LES.
* Avoid high fat foods such as fried foods and cream sauces. These weaken the LES.
* Don’t smoke. This also weakens the LES.
* Don’t eat for three hours before lying down. When you’re upright, gravity works with you.
* Maintain a normal weight. Being overweight increases your risk of GERD.
* Don’t eat just before strenuous exercise. Strenuous exercise increases the tendency to get GERD.
* Avoid foods that you know cause you discomfort until you’re better. So-called “acid” foods, like oranges and tomatoes, do not cause GERD, but they may irritate an already inflamed esophagus
These simple steps prevent symptoms of GERD in the majority of people and may allow you to avoid the use of acid-suppressing drugs. If not, try:
* Calcium. Calcium tightens the LES valve. This is not an antacid effect. In fact, the best type of calcium, because it is the most soluble, is calcium citrate, which is itself mildly acidic. The most effective preparation is calcium citrate powder. Take 250 mg, dissolved in water, after every meal and at bedtime (for a total daily dose of 1,000 mg). Swallowing calcium pills does not prevent reflux because the calcium is not instantly dissolved.
* Digestive enzymes. These appear to work by decreasing distension of the stomach. The enzymes should be acid-resistant, so they work in the stomach itself, not in the small intestine. A powdered enzyme preparation (1/2 teaspoon) can be mixed together with the calcium powder above and taken after each meal. Digestive enzymes are available in health food stores and pharmacies.
Add comment July 6th, 2007
A two-year test authorized by the 2007 National Defense Authorization Act allows Tricare beneficiaries to substitute over-the-counter versions of certain prescription drugs without a copayment.
For now, the test includes the Tricare mail order pharmacy only. Plans call for expansion to retail network pharmacies once program details are ironed out.
“The drugs included in this test initially are among the most widely prescribed, those treating gastro-intestinal disorders,” said Army Maj. Gen. Elder Granger, the deputy director for Tricare Management Activity.
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Known as “proton pump inhibitors,” this class of medications includes the prescription drugs Nexium, Prevacid, Aciphex, Protonix, Zegerid and Prilosec.
Under the test, beneficiaries receiving a prescription proton pump inhibitor are eligible to receive Prilosec OTC, the only proton pump inhibitor available over the counter. The Department of Defense Pharmacy and Therapeutic Committee found there is no significant clinical difference between Prilosec OTC and its prescription-only counterparts.
“By requesting that their doctors prescribe the OTC version, beneficiaries can save money on their copay, and there is the additional potential to save the government money as well,” said General Granger.
OTC drugs are generally less expensive, by as much as 400 percent in some cases.
Once the OTC test works its way to retail pharmacies, beneficiaries, however, should not expect to walk into any drug store and get OTC products for free at the register, caution Tricare officials. Beneficiaries will still have to get a prescription from their doctor for the OTC drugs.
Beneficiaries already taking the selected prescription proton pump inhibitors through the mail order pharmacy will get a letter telling them about the new program whenever they order medications that qualify them to participate in the OTC test project.
Add comment July 2nd, 2007
Dear People’s Pharmacy: I suffer from leg cramps. Recently while attending a basketball game, I had to leave my seat and try to walk off a severe inner-thigh cramp.
A security guard, seeing that I was grimacing in pain, approached me to see if I needed first aid. When I said it was only leg cramps, he took me to the concession stand and suggested I try yellow mustard. I asked if I was supposed to eat it or apply it. He said it was an old-time remedy his grandmother used.
I ate the mustard. By the time I walked to the end of the concession stand, and to the surprise of all who were watching me eat plain mustard, my leg cramp was gone!
I have since used this remedy repeatedly, especially in the middle of the night when my cramps seem to most often occur. It works. I don’t know why, but I sure am glad it does.
Answer: You are not the first to share the secret of yellow mustard. Some readers keep little packets of this condiment on their night stands to ease leg cramps.
Q: You wrote recently about selenium and said three or four Brazil nuts daily supplied enough selenium to cause toxicity. I’m taking 100 micrograms of selenium daily to ward off prostate cancer. Is this dosage of selenium safe?
A: Selenium is a fascinating mineral. Preliminary studies suggest that when people get adequate amounts in their diet, they have better immune function and reduce their risk of developing osteoarthritis. Several studies hint that selenium may help ward off prostate cancer (Harvard Men’s Health Watch, March 2007).
Too much selenium, however, can be toxic. Symptoms may include rash, hair and nail brittleness, garlic breath, upset stomach and nerve damage. The tolerable upper limit for adults has been set at 400 micrograms per day, so your dose is safe.
An ounce of Brazil nuts (about half a dozen or so) contains roughly 800 micrograms of selenium. That’s why we suggest not eating more than a couple of Brazil nuts three or four times a week.
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Q: What is the best thing to do for daily, embarrassing gas? I eat high-fiber foods during the week, but I eat various things on the weekends, and it doesn’t seem to make a difference. I have gas all week.
A: A record of what you eat and how your gut responds might be helpful in pinpointing whether you are reacting to a specific food. Dairy products, bagels and pretzels can have an effect, for instance. Once you identify a likely culprit, avoiding it should tell you if you were correct.
Another reader found a simple solution: “Activia yogurt is excellent in stopping flatus. One small carton a day stopped most of the problem.” Activia contains probiotics (good germs) that can aid digestion.
Q: I heard that people on acid-reflux drugs like Prilosec may need extra vitamin B-12. How much vitamin B-12 do you need when taking Prilosec on a daily basis? Some days I take two pills of Prilosec if my acid reflux is acting up.
A: Acid-suppressing drugs (Aciphex, Nexium, Prilosec, Protonix) can make it much harder to absorb vitamin B-12 from food.
This can eventually lead to a deficiency of this crucial nutrient. Symptoms may be subtle and include loss of appetite, constipation, depressed mood, confusion, and weakness in arms and legs.
People who take these strong acid-blocking drugs for four years or more should have their vitamin B-12 levels monitored.
If your doctor finds that your B-12 level is low and your homocysteine and methylmalonic acid levels are high, an oral supplement of 1,000 micrograms (1 mg) of vitamin B-12 daily may correct the problem.
Add comment June 30th, 2007
Health care products company Perrigo Co. said Wednesday the Food and Drug Administration gave tentative approval to Dexcel Pharm Technologies Ltd.’s generic heartburn treatment - omeprazole delayed-release tablets.
Perrigo is the exclusive marketer and distributor for the 20-milligram, over-the-counter tablets. The branded version, Prilosec, is made by AstraZeneca (nyse: AZN - news - people ).
AstraZeneca has filed a patent infringement lawsuit against the companies. Full approval will be granted after the expiration of a 30-month period, as provided under the Hatch-Waxman Act, which halts the market entrance of drug if the drug company files a lawsuit against a generic manufacturer.
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Final approval can be granted sooner if either the patents in the lawsuit expire or are held invalid by the court.
Perrigo shares fell 34 cents to $19.25 in afternoon trading. The stock has traded between $14.63 and $20.65 over the last 52 weeks. Shares of AstraZeneca fell 8 cents to $51.79.
Add comment June 25th, 2007
June 20 (Reuters) - Perrigo Co. (PRGO.O: Quote, Profile, Research) said its partner, Israel-based Dexcel Pharma Technologies Ltd., got U.S. health regulator’s tentative approval for a generic version of AstraZeneca’s (AZN.L: Quote, Profile, Research) (AZN.N: Quote, Profile, Research) heartburn drug Prilosec.
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Once final approval has been granted by the Food and Drug Administration, Perrigo will be the exclusive marketer and distributor of the product for the store brand over-the-counter market in the United States. (Reporting by Anup Roy in Bangalore)
Add comment June 23rd, 2007
“Acid reflux popularly known as heartburn is a disease that is very dangerous to man and can lead to cancer of the oesophagus.” We hear and see all these everyday in the ads which want us to buy one or two of their products to cure heartburn. Well, it is possible that all these effects of heartburn can be highly overrated and can be marketing strategies devised to just sell us their drugs and medicines. This is because even doctors do not agree on the causes, treatment methods, and long-term effects of heartburn.
That said, heartburn is the painful, burning, pepper-like sensation felt in the chest as a result of acid reflux or gastroesophageal reflex disease GERD( Pretty jaw-breaking. eh?). It can also be a feeling of pressure in the chest which is the reason it is sometimes mistaken as heart attack symptoms. Acid reflux happens when the acidic contents of the stomach move back into the oesophagus as a result of the weakening of the stomach muscles; and since the oesophagus unlike the stomach, does not have protective covering, the acid burns the oesophagus.
In the light of this then, what can be done to reduce the effects or probably cure it completely?
Quite a number of over the counter non-prescription drugs can help reduce the effects of mild to moderate heartburn/ acid reflux. These prescriptions include antacids which neutralize the gastric acids. These include well-known prescription such as Tums and Rolaids, Mist- Mag, Mist suspension. These drugs contain magnesium trisilicate.
Another option of treatment could be the H2 receptor antagonists. These reduce the production of stomach acids. Some examples of these are Tagamet HB, Pepcid AC, and Axid AR et.c. Pepcid complete has been found to a lot more effective because it contains both an H2 receptor antagonist and antacid. Therefore, it is deemed the best treatment as it is better than having at antacid alone, or an H2 receptor alone.
Prescription drugs that can help ameliorate the effect and treat reflux acid are proton-pump inhibitors. These include Prilosec, Aciphex, Nexium, Protonic, and Prevacid. Although all of them are effective in the treatment of acid reflux, Nexium has been found to heal oesophagus sores quicker.
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You can also consider homeopathic remedies and treatments. When combined with this, acid reflux can be treated with less reliance on OTC or prescription drugs. These might just provide the needed answers as combining one or two remedies may cure heartburn faster than if they were used alone.
The natural and herbal treatments that are likely to help in the reduction of heartburn are Deglycyrrhizinated licorice popularly called DGL, which can bring fast relief and heal damaged oesophageal lining. The Aloe Vera juice too also acts quickly to bring relief. And for people who have chronic acid reflux disease, Rice bran oil (Gamma-oryzanol), choline, pantothenic acid and thiamin are useful in the faster cure and healing. Please note that these natural remedies provide more of short term relief than long term.
Quite a number of people opt for these homeopathic remedies because they less expensive and reduce that chance of relying on just a one solution which can be drastic if the solution goes out of circulation. The beauty of natural solutions is that it not only treats the effects, it also treats the causes and can be combined with both over the counter and prescription drugs.
Research on whether acid reflux causes cancer are still being conducted as some studies show that chronic acid reflux increased the chances of oesophageal cancer by as much as eight times. Another one states that the risk of having cancer from acid reflux is not as high as was once thought even though chronic heartburn can result in Barrett’s’ oesophagus which has a high chance of resulting into cancer for quite a few people; not most.
But it is generally agreed by all who have acid reflux, that it is extremely uncomfortable and difficult to live with.
Add comment June 17th, 2007
A court has ruled that generic versions of 10- and 20-mg Prilosec delayed-release capsules produced by Mylan Laboratories and Lek do not infringe on two of AstraZeneca’s formulation patents.
The U.S. District Court for the Southern District of New York also found that the same Prilosec (omeprazole) patents are valid and infringed on by products manufactured by Impax and Apotex, AstraZeneca said. Impax’s product is marketed by Teva in the U.S., the company noted.
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Prilosec patent litigation first began in 1999, according to AstraZeneca. Andrx was the first to challenge Prilosec patents, but it was barred from marketing its product until AstraZeneca’s pediatric exclusivity period expires in October 2007.
AstraZeneca’s two formulation patents expired April 20, according to Impax, which said it believes the company’s pediatric exclusivity period is invalid.
Add comment June 10th, 2007
Aaron F. Barkoff submits: In a lengthy decision released last Thursday, Judge Barbara S. Jones upheld the validity of AstraZeneca’s (AZN) two formulation patents on Prilosec (U.S. Patent Nos. 4,786,505 and 4,853,230) and found that Apotex and Impax (IPXL.PK) infringe the patents, while Mylan (MYL) and Lek, a division of Sandoza (a Novartis Pharmaceuticals (NVS) subsidiary), do not. The defendants had challenged the validity of the patents on grounds of lack of best mode, enablement and written description under § 112; public use and disclosure under § 102(b); and obviousness under § 103(a).
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The decision marks another milestone in patent litigation that began seven years ago, when AstraZeneca filed suit against at least eight companies that filed ANDAs for generic versions of Prilosec. In a 2002 decision that was later affirmed by the Federal Circuit, Judge Jones found that Andrx, Cheminor and Genpharm infringe the same two patents and that Schwarz Pharma does not.
Separately, Judge Jones also recently denied Impax’s motion to dismiss the suit against it for lack of subject matter jurisdiction. Impax argued in its motion that the suit should have been dismissed because the ‘505 and 230 patents expired on April 20, 2007 and AstraZeneca had dismissed its claim for damages against Impax. The court, however, found that AstraZeneca has pediatric exclusivity on Prilosec until October 20, 2007, and therefore the court still has jurisdiction
Add comment June 5th, 2007
HAYWARD, Calif., June 1 (UPI) — U.S firm Impax said Friday it has lost its bid to invalidate AstraZeneca’s recently expired patent underlying Prilosec.
The company said the U.S. District Court for the Southern District of New York ruled that two of AstraZeneca’s patents were valid and infringed by Impax’s generic formulation of the acid reflux drug in 10 mg, 20 mg and 40 g strengths. The Prilosec patent expired in April.
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In making its decision, the court has also asked for additional submissions on the form of the relief, if any, because AstraZeneca had previously dropped its damages claim against Impax to avoid a jury trial and in light of the fact that the patents have expired.
Meanwhile, the companies remain in a dispute over whether the Food and Drug Administration should further delay the marketing of Impax’s generic drug until what AstraZeneca claims is its pediatric exclusivity running until Oct. 20.
Impax’s marketing partner Teva began selling the delayed release capsules in the 20 mg and 10 mg strengths in the fall of 2004, the company said.
Add comment June 2nd, 2007
AMMAN - “It is not enough to understand the laws of Intellectual Property (IP), it must be actively used as a management tool to direct businesses into the future,” Dr. James G. Conley, a faculty contributor in the Kellogg Center for Research in Technology and Innovation and serves as a Faculty Fellow at the Institute for Design Engineering and Application (NU IDEA) in the United States, told ag-IP-news Agency.
Professor Conley was the key speaker at the business meeting held by the Licensing Executives Society-Arab Countries (LES-AC) in cooperation with Abu-Ghazaleh Intellectual Property (AGIP) May 28, 2007 at Talal Abu-Ghazaleh College of Business/German-Jordanian University (TAGCB/GJU).
“One of the results for proactively using IP systems is to bring out the talented and bright individuals, groups and industries in the Middle East,” he added.
Ideas and innovations are a source of competitive advantage when they are protected from imitation. The securest forms of ideas and innovation are the monopoly rights vested in the Intellectual Properties.
The granting of exclusive property rights for innovations and creations by most governments in the industrialized world substantially increases the economic value behind the corresponding ideas; Conley explained during discussion his paper entitled “Articulating the Value of Intellectual Property, an Integrated Approach for Managers”.
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“Portfolio Management is not only for special products or innovation; it is for every innovation and what you can do with it in terms of integrating management function regimes of IP into the innovation that leads to competitive advantage.”
Conley stressed that Ideas and innovation derive economic value from two concepts of securitization:
The first concept of securitization is the actual granting of exclusive rights to the inventors or authors of innovations and creations via the formation of intellectual property rights. These rights allow owners to exclude others from profiting by entering the innovation or idea space protected by the subject of intellectual property. Simply put, a piece of intellectual property such as a method patent impedes competitors from using the same method to compete in the same market space. Hence the granting of the exclusionary right is quite valuable.
The second concept of securitization is the transformation of an innovation or creation from an illiquid idea to a more liquid security. Again, the granting of intellectual property rights achieves this goal. The rights vested in the intellectual property allow for the holder or assignee of the innovation or creation the ability to sell or license that property. This embedded option to sell or license the property also has significant economic value.”
“As the product ages the value of the limited life intellectual property vehicle typically decreases unless the value is actively transferred to a longer life trademark. If this transference is properly managed, the value associated with that idea could be extended to the life of the trademark. Most would agree that the infinite right to exclude others from using your mark translates into a VERY long time and certainly a sustainable form of competitive advantage,” Conley said.
He further shed light on a competitive advantage represented specifically by AstraZeneca pharmaceutical’s business case; the advantage in this case is represented by the company’s purple color used as a medication for gastrointestinal reflux disease (GIRD). AstraZeneca’s patented and very profitable Prilosec medication for GIRD ended its patent protection term in April 2002.
“The Prilosec medication is uniquely purple in color. Much of AstraZeneca’s advertising and public domain literature features Prilosec in its purple packaging or a trade dress protected “purple pill”. It is interesting to note that AstraZeneca’s next generation of GIRD which is called Nexium, covered by a new patent, will also be packaged as a purple pill and hence build upon all of the consumer awareness already captured by the Prilosec purple color,” Conley concluded.
Meanwhile, AGIP Clients’ Relations Manager Suha Al Mahsiri presented a paper entitled “IP Portfolio Management”.
“Integrating intellectual assets into the business plan will on the long run increase profit margins and furthermore increase the overall well-being of the business,” she said.
“Many businesses today are enjoying more profits after implementing IP tool in the assets of their firms,” Al Mahsiri added.
Add comment May 29th, 2007