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If five people sit down to dinner, one of them will suffer from indigestion afterwards. That, at least, is what the medical statisticians say and since a total of some £20 million a year is spent on antacid preparations it is difficult to argue with them.

Nearly half of all households have one of the dozens of available indigestion remedies in a cupboard somewhere. Since sales have risen by an average 27% each year since 1972, it seems likely that the number of indigestion remedies on the market is likely to continue rising. Selecting the right remedy will, therefore, become more and more difficult.

Milk of Magnesia and Kennies are currently among the market leaders, and sales of Alka Seltzer, Andrews, BiSoDol, Macleans and Setlers are also significant.

Before discussing the values of these and other medicines I’ll explain what indigestion is, what causes it, what you can do to prevent it developing and when you must see a doctor about it.

The pains are usually confined to the centre of the chest and they often occur a short while after eating. They may be accompanied and even relieved by burping or bringing up wind. It’s important to say right away that it is possible to confuse the pains of angina (early heart pain) with the pains of indigestion. Any chest pains which are brought on by exercise rather than eating, which are accompanied by breathless- ness, or which also affect the arms and shoulders need to be treated by an expert.

There are several possible causes of indigestion. Sometimes the pains can be caused by simply eating or drinking too much or too quickly. Very spicy or fatty foods are particularly likely to cause indigestion.

Too much alcohol, tea or strong coffee can also cause indigestion as can smoking on an empty stomach. Worry is another causative factor which is often overlooked, although it is, of course, often accompanied by poor eating habits: if you’re worried you may eat too quickly or forget to eat at all. Aspirin tablets, particularly the non-soluble variety, can also cause indigestion.

You can prevent the onset of indigestion, simply by avoiding the causes I’ve outlined.

It is important to visit a doctor if your indigestion pains persist for more than five days, if they recur regularly after fairly small and ordinarily digestible meals, or if they occur between meals or at night when you are asleep. Persistent or recurrent indigestion suggests the development of some sort of peptic ulceration and that needs to be properly investigated and treated. If your indigestion pains are accompanied by weight loss, persistent loss of appetite, or severe vomiting, then you need to see a doctor without delay. If the pains are severe or if the vomiting involves obvious blood or any dark brown material (old blood) then a doctor’s immediate attention is needed.

It is fairly well known that you can avoid indigestion by avoiding certain foods, by eating small, regular meals, by nibbling between meals and by taking indigestion remedies regularly. If you do any of these things to avoid indigestion pains then you need your doctor’s advice. Your indigestion may well involve some ulceration of the stomach or duodenum and that ulceration may require treatment rather than symptomatic relief.

It is the stomach’s job to turn the vast variety of foodstuffs it receives into a movable thick soup. To facilitate this the cells of the stomach lining produce something like three litres of gastric juice a day. Gastric juice production is increased by stress, alcohol, hunger and nicotine. The most important constituent of the gastric juice is hydrochloric acid: an acid strong enough to burn holes in your carpet. It is that acid which helps to produce the pain associated with indigestion, gastritis and ulceration. And that is why indigestion remedies provide only symptomatic relief. They don’t interfere with the production of excess acid or have any effect on the stomach lining – they simply neutralize some of the acid.

Most popular indigestion remedies consist of nothing more or less than antacids. Proprietary medicines are often available as liquids, powders and tablets. Liquids and powders usually work better than tablets, which need to be sucked or chewed thoroughly before being swallowed, but it is obviously easier to carry tablets around in your pocket or handbag than it is to carry a huge bottle of medicine! If you do suffer from occasional, mild attacks of indigestion it is probably best to keep tablets with you or in the car and a bottle of medicine in the home medicine cupboard.

There are a great many antacids available and no one is obviously superior. Each compound has its disadvantages, producing side effects which affect different people in different ways. It is to overcome these side effects that manufacturers mix together two or more antacids in their medicines, although since side effects usually take a day or two to appear, while indigestion is for most people a fleeting problem, cheaper, non-branded versions are usually quite suitable.

Sodium bicarbonate is one of the best-known and most easily available antacids. This is found in baking soda, which is a useful temporary stand-by, and although it isn’t suitable for long-term treatment (because of the side effects it can have) it can be used to provide relief on a Saturday evening when the chemists’ shops are all shut.

Most of the other products which are sold contain aluminium, magnesium or calcium compounds. All of these compounds have their own particular problems and may therefore be suitable for one sufferer but not for another. Magnesium compounds, for example, tend to have a laxative effect and are, therefore, suitable for people who tend to be rather constipated. Aluminium compounds tend to have a constipating effect and so they are more useful for people whose bowels tend to be ‘on the loose side’. For a non-branded antacid choose from Aluminium Hydroxide Tablets BP, Magnesium Hydroxide Mixture BP or Magnesium Trisilicate Mixture BPC. Non-branded mixtures are also available as Compound Calcium Carbonate Powder BPC (which contains calcium carbonate, sodium bicarbonate and magnesium carbonate) and Compound Magnesium Trisilicate Tablets BPC (which contain magnesium trisilicate and aluminium hydroxide).

These five products are likely to be as effective as many of the much more expensive, widely advertised brands.

Branded preparations which contain one or more of aluminium hydroxide, calcium carbonate or magnesium trisilicate as major ingredients, and which should all be effective, include Alka-Mints, Aludrox, Bir/ej’s Antacid Powder, Boots Dyspepsia Tablets, Boots Indigestion tablets, De Witt’s Antacid Powder, De Witt’s Antacid Tablets, Dijex, Droxalin tablets, Eso-Dex Indigestion tablets, Gastrils, Gaviscon, Gelusil, Indi-Go, Maalox, Macleans Indigestion Powder, Macleans Indigestion tablets, Moorland Indigestion tablets, Nniacin, Primes Premiums, Kbuaka Indigestion tablets, Setlers, Titralac and Turns.

Apart from these three compounds there are a large number of other aluminium, calcium and magnesium compounds used in the manufacture of antacids. Aluminium phosphate, magnesium carbonate and magnesium hydroxide are commonly used.

Magnesium hydroxide is the basic ingredient of Boots Cream of Magnesia Tablets and the big-selling Milk, of Magnesia (tablets and liquid). Mil-Par contains magnesium hydroxide together with liquid paraffin . Rennie Digestif Tablets, another big-selling antacid, contain chalk and magnesium carbonate.

Abdine, Abdine Double Strength, Bablets, Boots Alkaline Stomach Powder, Boots Indigestion Mixture, Cox’s Digestive Mints, Dolomite Tablets, Meggeson Dyspepsia Tablets, Opas Indigestion Powder and Tablets, Rodale and Ventos Stomach Powder all contain magnesium, sodium, calcium or aluminium compounds. Again, these products should all help.

Whatever antacid is selected it should be taken in relatively large doses, quite frequently. The maximum dose recommended by the manufacturers may need to be taken every two hours. With non-branded products I suggest doses as follows: Aluminium Hydroxide Tablets BP – 1 or 2 tablets; Compound Calcium Carbonate Powder BPC – up to 5 gm; Magnesium Hydroxide Mixture BP – 10 ml; Magnesium Trisilicate Mixture BPC – 20 ml. Once relief has been obtained the medicine can be stopped or the dosage at least reduced.

Children with indigestion should be given a small amount of warm milk and possibly a small dose of an adult antacid mixture.

Some antacid mixtures also include dimethicone (also known as dimethylpolysiloxane) which helps gases in the stomach escape. It does this by helping small bubbles of air coalesce to form larger bubbles.

The following compounds are therefore particularly suitable for people who have wind they cannot expel: Andursil, Antasil, Asilone, Diloran, Polycrol Gel, Polycrol Tablets, Siloxyl, Sovol Liquid and Sovoi’Tablets.

The final antacid mixture to be mentioned is Alka Seltzer, a unique and, to some people, surprising combination of sodium bicarbonate and aspirin. This famous, big-selling compound is used in the treatment of headaches and indigestion and is particularly recommended for ‘headache with upset stomach’ – the sort of thing you get if you eat or drink too much the night before. The manufacturers have collected a great deal of evidence which shows that this combination is not as dangerous to people with stomach troubles as it might seem to be. Nevertheless, despite their reassurances I find it difficult to recommend this product.

Apart from the antacids I have already mentioned there are other substances used in the treatment of indigestion. Liquorice has long been used in herbal mixtures and is today available in Rabro and Caved-S (which, just for good measure, also contains bismuth subnitrate, aluminium hydroxide, magnesium carbonate and sodium bicarbonate). Charcoal is another long-established remedy which is available as a powder, granule, tablet or biscuit and which is said to help absorb gases. Products which contain charcoal include Bragg’s Charcoal Biscuits, Bragg’s Charcoal Tablets, Carbomucil, Charabs, Darco G-60, Encarbon, Golden Health Indigestion tablets, Lnstjs Charcoal Tablets, Potter’s Acidosis Tablets, and if your dog gets indigestion, Bragg’s Charcoal DogBiscuits.

However, the value of charcoal as an indigestion remedy is, in my opinion, doubtful.

A number of bismuth salts are used in the treatment of indigestion. Bismuth is supposed to have an antacid and protective action, but these effects have not been proven. Bismuth compounds used include bismuth carbonate, bismuth hydroxide, bismuth salicylate, acid bismuth sodium tartrate, bismuth subnitrate, bismuth aluminate and bismuth and ammonium citrate.

Proprietary preparations which include bismuth are Ayrtons Heart Shape Indigestion tablets, Bisrua-Calna Cream, Bismag Powder, Biswa-Rex Antacid Tablets, BiSoDol Powder, BiSoDol Tablets, BM Indigestion Suspension, Boots Frangula Compound Tablets, Ovals Indigestion tablets and Roter Tablets. It is difficult to choose between the antacid products I have listed in this section, but the standard non- branded preparations are probably cheaper than most and just as effective.

There are inevitably a number of herbal remedies available. These include Biobalm, Box’s Indigestion Pills, Heath and Heather’s Indigestion and Flatulence Tablets, Heath and Heather’s Indigestion tablets, Potter’s D4 Special Formula Stomach Tablets and Thompsons Indigestion Remedy. Biobalm is also sometimes recommended for thickening soups, gravies and sauces. I make no further comment.

Health salts are sometimes used by sufferers in the treatment of upset stomachs, but I feel that other products I have mentioned are likely to be more suitable.

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