No one strategy for indigestion works for everyone

Q. Recently a reader wrote about being able to cease using acid-blocking drugs by controlling his/her diet. This included intermittent fasting. Fasting can trigger acid reflux, too. Some of my worst episodes were from not eating.On the Yom Kippur holiday, one woman at our temple was taken via ambulance to the hospital. The "heart attack" she thought she was having was simply acid reflux from fasting.A. Over the decades that we have been writing about indigestion, we have learned that no one strategy works for everyone. Some people insist that apple cider vinegar eases their heartburn. Others find that it aggravates their symptoms.This may also be the case with fasting. The reader you refer to found that fasting could help control acid reflux. Research is inconclusive.One study noted that people fasting during Ramadan had less severe GERD (gastroesophageal reflux disease) symptoms (Acta Medica Indonesiana, July 2016). Another study reported an increase in reflux disease when people were fasting during Ramadan (European Archives of Oto-Rhino-Laryngology, November 2012). Clearly, there is no consensus on the effects of fasting on heartburn. Cutting back on carbs, however, may be beneficial for some people.Q. My thyroid gland was removed three years ago. I have never felt right on Synthroid. I've also tried a combination of Synthroid and Cytomel and recently Armour Thyroid.Of all three, I've found Armour Thyroid is the best. I split it and take multiple doses throughout the day to avoid heart palpitations.Most endocrinologists, as well as primary care physicians, adjust the thyroid dose based on the TSH test. That will be low when you take T3 (which is a natural part of Armour Thyroid). I've been informed that the blood test should be done in the early a.m., and food and thyroid meds shouldn't be taken for 12 hours before blood is drawn for labs.A. We consulted one of the world's foremost authorities on thyroid function, Dr. Antonio Bianco, professor of medicine at the University of Chicago School of Medicine. He has found that up to 15 percent of patients don't feel good on levothyroxine (Levoxyl, Synthroid) alone (Frontiers in Endocrinology, July 9, 2019). This may be due at least in part to genetic differences in the enzymes that convert T4 (levothyroxine) to the active T3 hormone (triiodothyronine).He points to evidence that a normal TSH (thyroid stimulating hormone) does not necessarily indicate optimal thyroid hormone activity throughout the body. Although most endocrinologists still use TSH as the gold standard and prescribe levothyroxine alone as treatment, Dr. Bianco suggests that treatment should be personalized.The goal is for patients to feel good. For some patients, this will mean using combination therapy or desiccated thyroid extract such as Armour.People who would like to learn more about treating thyroid problems may wish to read our eGuide to Thyroid Hormones. This online resource may be purchased at www.PeoplesPharmacy.com in the Health eGuide section.Q. Do hyaluronic acid injections help knee arthritis pain?A. One study in the Annals of Internal Medicine (Jan. 6, 2015) found that knee injections with this natural compound were more effective than placebo or even corticosteroid injections. However, a more recent meta-analysis did not find this injection beneficial for long-term pain relief (JAMA, Dec. 25, 2018).* * *In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is "Top Screwups Doctors Make and How to Avoid Them."(c) 2019 King Features Syndicate, Inc.Joe and Teresa Graedon