Think of reflux and chances are you conjure up that feeling of chest pain that can strike after a meal of fried or spicy food—when contents in your stomach leak back up into your esophagus and irritate it, giving you heartburn.
But there is another type of reflux, one that is less well-known than the gastroesophageal reflux disease (GERD) that many people are diagnosed with. Laryngopharyngeal reflux (LPR), also known as “silent” or “atypical” reflux, usually doesn’t involve heartburn and indigestion. And unlike GERD, stomach acid isn’t the main culprit; the digestive enzyme pepsin, which is activated by any kind of acid to do its breaking-down work, is.
When stomach contents back up, pepsin is along for the ride, traveling up to the esophagus and throat, where it interacts with any kind of acid, especially from foods we’re putting into our mouths, and attacks the delicate tissue lining our throat, voice box (larynx), lungs, and esophagus. This is LPR, throat specialist Dr. Jamie Koufman explains in her book “Dropping Acid: The Reflux Diet Cookbook & Cure,” and more often than not it goes misdiagnosed.
“Patients frequently ask us, ‘Why doesn’t my doctor know about this?’” writes Koufman, founder and director of the Voice Institute of New York. “Part of the answer is that specialists are too specialized. Many reflux symptoms (hoarseness, the sensation of a lump in the throat, post-nasal drip, chronic throat clearing, cough, chest pain) cross medical specialty lines and are non-specific. The correct diagnosis is often confused with other diagnoses, including upper respiratory infections, allergies, and sinusitis.”
To combat LPR, she espouses a low-acid diet, which she tested in a study published this year in the Annals of Otology, Rhinology & Laryngology. That research involved 12 men and eight women, whose reflux was not responding to medication and who followed a strict, low-acid diet—foods and drinks with a pH level of less than 5 were eliminated for two weeks. (The lower the pH is, the higher the acidity. Foods and drinks high in acidity include soda and diet soda, strawberries, apple sauce, and barbecue sauce.) Of the 20 participants, the symptoms of 19 improved, and three participants were completely free of symptoms.
This two-week diet, which Koufman details in her book, doesn’t allow fruit except for melons and bananas; carbonated beverages, fruit juice, onions, and alcohol also are no-no’s. However, whole grain bread, fish and chicken (grilled, broiled, baked, or steamed—never fried), pasta, beans, egg whites, and other foods are allowed. Another diet tenet is: no eating after 8 at night because lying prone contributes to reflux.
“The idea here is to reduce the possibility of acid from below and get acid from above absolutely out of the picture for two weeks,” Koufman tells Newsmax Health.
Avoiding processed, canned, and bottled foods also is particularly important because of acidic preservatives added to them since the early 1970s, when federal officials established rules to prevent bacterial growth and enhance shelf life, she notes. Increased consumption of these foods correlates with rising rates of esophageal cancer caused by chronic reflux, she says.
“Everyone is concerned about corn syrup and sugar and saturated fat and no one has questioned acid — and yet it is in everything,” Koufman says.
For many reflux sufferers, the diet requires experimentation. Those who don’t have severe disease may be able to eat foods with no lower than a pH 4, such as peppers, apples, and yogurt. What’s more, getting to know one’s trigger foods is important. Those that are notoriously bad for reflux include ones high in fat like chocolate, bacon, cream sauces, and peanut butter.
The diet, which overall is low in fat as well as being low in acid, is similar to many heart-healthy plans with its emphasis on skinless poultry, vegetables, water, and natural flavorings, such as ginger, brown sugar, and Dijon mustard. Patients often lower their weight, cholesterol, and blood pressure after just a few weeks, Koufman says.
Koufman, who has been working with reflux patients for 30 years, notes that despite “overwhelming clinical evidence, almost no long-term dietary studies have looked at acidity as a factor in reflux management.”
“Critics will argue that we have not done long-term controlled studies and therefore have not proven our case against dietary acidity,” she writes with co-author Dr. Jordan Stern, an otolaryngologist. “That is true. However, we believe that the data are too strong to make our patients wait to get relief.”
In addition to her clinical practice, Koufman is continuing her research by studying the effects of high-alkaline water on reflux patients, and working to bring more awareness around the issue of acidic foods.
“If we required all manufacturers to put the pH on the label of the food—make it the same size font of the major ingredients—the American people would figure out the problem and know what to do,” she says.
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