Voicing a new approach to acid reflux

The “Voice Doc” says diet, not drugs, may be the answer to treating a form of acid reflux.

Swallowing is something we take for granted.  The average healthy person swallows hundreds of times a day, or more, and never gives it a single thought.

But for those with a form of acid reflux disease that affects the throat, called laryngopharyngeal reflux, or LPR, swallowing becomes an uncomfortable and annoying experience.

Dr. Craig Zalvan. Courtesy New York Medical College.

Dr. Craig Zalvan — chief of otolaryngology and medical director at the Institute for Voice and Swallowing Disorders at Phelps Hospital in Sleepy Hollow and an associate professor of otolaryngology at New York Medical College, Westchester Medical Center in Valhalla — says he has become “a specialist within a subspecialty.” 

 He and his colleagues at New York Medical College recently released a new study, published in September in the Journal of the American Medical Association (JAMA), which indicates this particular type of acid reflux may respond better to diet than drugs.

Reflux is a common health complaint among Americans today and the drugs prescribed to relieve it, known as proton pump inhibitors or PPIs, both prescription and over the counter, are in wide use, fueled in part by ubiquitous advertising on television. (In addition to LPR, reflux can be triggered by too much acid in the stomach and lower esophagus, causing a burning pain the chest and discomfort in the gut.  This is known as GERD, or gastroesophageal reflux disease.)

LPR is triggered by pepsin, a digestive enzyme from the stomach that affects the tissues in the throat. The excess pepsin can damage tissue and cause symptoms like constant throat clearing, hoarseness, a feeling that something is stuck in the throat and trouble swallowing. According to Zalvan, the delicate tissues in this area have poor protection against stomach acid and pepsin.


“I decided to do the study, because I was frustrated with getting a stream of referrals from colleagues who sent me people they were treating with PPIs who were just not getting any better,” Zalvan says. “These people were not suffering from standard GERD and had symptoms concentrated in the throat, voice box and pharynx.”

Zalvan had an intuition that maybe diet was a causative factor in LPR.

“I looked into the literature and found a huge amount of information about the benefits of consuming a plant-based diet.” After having treated his LPR patients in the past with the standard drugs, Zalvan decided to switch them to his version of what is called the Mediterranean Diet, low in red meat and animal fat and high in grains, vegetables, olive oil and a moderate amount of fish.

“I realize that this type of diet is hard for meat-loving Americans to sustain, so I recommend that they take a break from it with three or four meals a week where they can have three to four ounces of chicken, lean meat or fish,” he says. “The important thing to remember is you can get all the protein you need from a plant-based diet.  For example, most of my meals are vegetarian.”

Another component of the regimen is drinking only alkaline water, which can neutralize excess stomach acid.  Patients are also told to avoid the traditional reflux triggers, such as coffee, tea, chocolate, soda, fatty foods, spicy foods and alcohol.


“Many of my patients are initially very resistant to all of this, saying they just can’t give up their meat, But most of them are willing to give it a try.  When they begin to see their symptoms decrease, lose weight and have a rebound in energy, they come around. The effort needed to eat a plant-based diet is not that much greater than a meat-based diet and I provide them with plenty of tips, recipes and information.”

Zalvan says if you incorporate the small amount of nonplant protein he recommends on a weekly basis, the diet is not that strict. “And if people cheat, they see their symptoms come back and are motivated to try harder.”

Zalvan says he believes it is important for patients using PPIs to get off the drugs as they can be damaging over time. “No one needs a lifetime on Prilosec or Nexium.” he says of the drugs, which have not always proven to be effective in treating LPR. “Studies have shown an increased risk of heart attack if these drugs are used longterm. And it’s important to remember that no one needs to be eating all that meat. Excess protein goes into the colon and can create inflammation with long-term consequences.”

The alkaline water recommended by Zalvan is readily available and is an important part of the diet. “Alkaline water is natural and reduces the stomach acids that are creating the symptom my patients are experiencing.”

In the study, published in JAMA Otolaryngology-Head & Neck Surgery, Zalvan and his colleagues compared 85 people with LPR who were treated with PPIs and 99 people with LPR who were told to switch to a Mediterranean Diet and drink alkaline water.

After six weeks, the patients who changed their diet reported similar declines in their symptoms.

Zalvan says the results show you can treat people for LPR using the Mediterranean Diet-based approach. “When put on a plant-based diet along with drinking alkaline water, the majority gets better and they stop using drugs that lead to dangerous side effects in the future.”

Now Zalvan plans to study the effect of the Mediterranean Diet on people with GERD to see if the diet can help relieve their set of related reflux symptoms as well.

For more, visit westchestervoicedoc.com.

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