The acid test
Q: I've stared getting the most awful heartburn - often in the middle of the night. During the day I burp frequently. The other day, I let out a huge burp in a crowded lift at work, and wanted to die of embarrassment. I feel so bloated that none of my trousers or skirts do up. I've tried a glass of milk at night, and hot water after my meals, but it hasn't helped at all. Any advice?
A: You are not alone. Around 40% of the British population get heartburn and acid regurgitation (known in medi-speak as gastro-oesophageal reflux disease or GORD). The problem occurs because the sphincter that lies at the bottom of the oesophagus relaxes temporarily and lets acid from the stomach flow back up the oesophagus. This causes burning behind the breastbone as it washes up the oesophagus, an acid taste in the mouth and excess gas, which accounts for the burping and bloating.
The first step is to cut down excessive alcohol, fatty foods and smoking, all of which can exacerbate the reflux. A lot of people find out the hard way which foods to avoid; tomatoes, citrus fruit, pickles and hot curries are common culprits. Stress triggers heartburn in some people and stress management techniques such as yoga may be very effective. You can buy drugs that neutralise acid, such as Gaviscon, and others that block acid, such as Tagamet or Zantac over the counter. But the drugs that switch off acid production in the stomach, such as Losec, are only available on prescription, so a visit to the GP may be worthwhile. If you don't get better with treatment, or have additional symptoms such as weight loss, difficulty swallowing, or passing blood in your stool, you'll be referred for a test to look inside your oesophagus and stomach (endoscopy).
Q: My toenails are disgusting; discoloured, crumbly, yellow and thick. I'm embarrassed to take my socks and shoes off even in the height of summer and have stopped going swimming - which I used to enjoy. My GP gave me some stuff to paint on the nails which didn't do anything at all. Is there any hope?
A: The first step is to head back to the GP and ask for nail clippings to be taken and sent to a good lab to see which fungal strains you're harbouring in those nails. The drugs terbinafine (Lamisil) or itraconazole (Sporanox) daily for three months can work wonders. Your GP can also refer you to a podiatrist for nail care, and a dermatologist to confirm the diagnosis and advice about treatment.
Q: I've been on a strict but well-balanced diet since January. I have lost 10lbs and everyone tells me I've never looked better. But I feel totally fed up. Could I be missing out on some vital vitamin?
A: Researchers in Oxford have recently published a controlled experiment showing that dieting makes everyone unhappy even if they've never been depressed before. Women who have been depressed in the past get particularly low if they diet. In answer to your question, it seems to be the dip in blood levels of the chemical trytophan that makes you miserable when you diet. Tryptophan is processed in the body to make serotonin, the chemical in the brain that transmits "happy" messages. Many antidepressants, such as Prozac, work by increasing levels of serotonin in the brain. There doesn't seem to be any evidence as to whether you get used to the tryptophan dip if you maintain your diet over a long period, or whether taking trytophan supplements would counteract the depressing effects of dieting. Perhaps just knowing about the tryptophan effect will make you feel less miserable.
These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email firstname.lastname@example.org or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.