Silent Reflux May Respond Better to Plant Dietby Sophie Ramsey Health Writer
If you're one of the millions of Americans who has a stomach acid problem called silent reflux, a new study suggests that switching to a mostly plant-based diet might help your symptoms as much as — if not more than — drug treatment.
What is silent reflux?
Silent reflux — also called laryngopharyngeal reflux (LPR) — happens when acid, enzymes, and other contents from your stomach come up into your throat, causing irritation and damage. Acid from what you eat and drink can also add to the problem.
LPR is often called silent reflux because it doesn't usually cause the classic symptoms of acid reflux, such as heartburn and indigestion. Instead, common symptoms of LPR include coughing, trouble swallowing, frequent throat clearing, hoarseness, and a feeling of having a “lump” in your throat.
The main treatments for LPR are proton pump inhibitors (PPIs), such as esomeprazole (Nexium) and dexlansoprazole (Dexilant). These drugs can work well for LPR symptoms, but they can sometimes cause side effects, such as abdominal pain, nausea, diarrhea, and constipation. They are also recommended for only short-term use. However, many people end up taking them for years.
Rethinking treatment of silent reflux
The small study was published in October 2017 in JAMA Otolaryngology — Head & Neck Surgery. Its lead author, Craig H. Zalvan, M.D., says he — like many doctors — used to routinely prescribe PPIs to his patients with LPR. However, about six years ago, Zalvan, who is the medical director for The Institute for Voice and Swallowing Disorders at Phelps Hospital in Sleepy Hollow, N.Y., began to reconsider this approach.
“At some point it just stopped making sense that I'm constantly prescribing drugs for people and then drugs for their side effects,” he said in a phone interview with HealthCentral. “We didn't evolve to be on drugs.”
He was also troubled by the growing body of research suggesting that longer-term use of PPIs increases the risk of a wide range of serious health problems. “Papers keep coming out showing that PPIs are now linked to significant increased risk of things like stroke, dementia, kidney damage, and stomach cancer,” he says.
In his search for a different approach to treating LPR, Zalvan came across extensive research linking many common chronic diseases — such as heart disease, diabetes and cancer — to the American-style diet, which is mostly animal-based, with lots of meat and dairy products. “All these data show that much of those chronic problems would be gone if we all switched over to a more plant-based diet,” he says.
Zalvan realized LPR might be another chronic condition that could be improved by a similar dietary approach. A digestive enzyme called pepsin causes much of the irritation and tissue damage in LPR, he explains.
When you eat foods with animal protein — such as meat, eggs, and cheese — the stomach makes pepsin to digest it. Most plant-based protein, in contrast, is digested in the small intestine. So, a mostly plant-based diet means there's less pepsin in the stomach to reflux up into the throat and cause LPR symptoms.
A diet-based approach to silent reflux
Zalvan began recommending that his patients with LPR try a Mediterranean-style diet, with lots of fruits, vegetables, grains, and nuts, minimal dairy, and meat only two to three times per week. He calls it a “cheater’s vegan” or “cheagan” diet.
He also asked his patients to drink alkaline water instead of other beverages to neutralize any acid in their throat. The idea was to help prevent any pepsin that entered their throat from causing damage, as pepsin needs an acidic environment to become active. He recommends people look for a brand of alkaline water with a pH of 8 or higher that is naturally occurring (i.e., not made in a lab). Alkaline water is often available in grocery stores, he says, as well as online.
The results among his patients who tried the cheagan diet plus alkaline water were striking. “What I found was patients were really getting better — much better,” Zalvan says.
So, he and his co-authors decided to take a more formal look at the effects of the treatment by comparing the medical charts of 184 people with LPR: 99 (average age of 57) had been treated with the diet plus alkaline water and 85 (average age of 60) had been prescribed PPIs.
Despite using different treatments, the two groups were similar in other respects including the severity of their LPR symptoms, which was rated using a scale called the Reflux Symptoms Index (RSI).
Overall, people in the diet and alkaline water group were just as likely to have improved after six weeks as those taking PPIs, with more than half of the people in both groups having had a substantial reduction in their reflux symptoms score.
The study also found that people in the diet and alkaline water group had a greater improvement in symptoms, on average, than those in the medication group, with their symptoms score decreasing by an average of nearly 40 percent, compared with around 27 percent for those taking PPIs.
What's next for silent reflux treatment?
These findings are quite promising. However, it's worth noting that this is only a preliminary study, so we can't yet draw any firm conclusions about how well this dietary approach works.
Meanwhile, Zalvan and his colleagues are applying for a grant through the National Institutes of Health to fund a large clinical trial, in which people will be randomly assigned to use the different treatments and then be compared over time.
For now, however, Zalvan hopes this preliminary study will prompt more people with LPR — and their doctors — to consider a dietary approach to treating this condition. In his experience, the benefits of adopting a mostly plant-based diet go far beyond improving people's reflux symptoms, with many people also losing weight and seeing improvements in their other chronic conditions.
“It's an exciting time because I think there's a lot more acceptance of the fact that drugs are not the answer for all of these diseases,” Zalvan says. “We have to change the problem, which is the diet.”