Mediterranean Diet Can Halt Need For Reflux Medications

A plant-based diet is just as effective, if not more, for common gastrointestinal conditions, such as GERD and laryngopharyngeal reflux, according to a new study by Craig Zalvan, MD.

Proton pump inhibitors (PPIs) are the go-to therapy for many forms of reflux, including GERD and laryngopharyngeal reflux (LPR). Yet, these common medications — used by as many as 15 million Americans — may have serious side effects, ranging from nutritional deficits to dementia.

“We didn’t evolve to be put on drugs,” said Dr. Zalvan, chief of otolaryngology and medical director of Phelps Hospital’s Institute for Voice and Swallowing Disorders. “But as a laryngologist, I see many patients who have been struggling with throat-related symptoms that don’t get better. They’ve tried many physicians and treatments. Often, I discover that these patients have laryngopharyngeal reflux, which is different from GERD.”

LPR can cause throat-clearing, a lump-in-the-throat sensation, trouble swallowing, cough, post-nasal drip sensation and hoarseness, Dr. Zalvan said. He had typically treated LPR the same way — with PPIs.

“Then, some initial data said [PPIs] might cause problems with bone metabolism, fractures and increased risk of pneumonia,” he said. Moreover, the success rate was not impressive. “Probably about six years ago, I really started becoming disillusioned about PPIs. Only about 50 or 60 percent of people were getting better. And I was having a lot of patients who described side effects that caused them even more discomfort.”

Dr. Zalvan started looking more broadly at reflux disorders in a continuum with other chronic diseases: heart disease, diabetes and cancer. His research convinced him that these tend to be lifestyle diseases, “caused [and] propagated by the American-style, high-animal-protein diet.” He hypothesized that reflux might be a similar disorder — with similar causes.

Specifically, he considered the role of the digestive enzyme pepsin in LPR.

“LPR is a reflux of the stomach contents, including acids and pepsin, onto the larynx,” he said. “In these patients, we often find pepsin in the structures of the throat, where it becomes activated when exposed to acid. So when the patient eats or drinks acid, or it regurgitates from the stomach, the pepsin is activated.

“In an animal-based diet, the second someone starts chewing on meat, he or she starts digesting it. Eating meat produces highly bioavailable protein, or amino acids. The amino acids stimulate the stomach to release more gastrin, which is the hormone that releases more pepsin. It sets up a positive feedback loop. By contrast, a plant-based diet, while still containing protein, is less easy to digest. It bypasses the stomach and mostly digests in the small intestine, instead of activating more pepsin.”

Dr. Zalvan’s suspicions fell in line with earlier studies showing eating patterns could be effective frontline treatments for LPR and/or GERD. For instance, high-calorie diets have been associated with increased symptoms in GERD patients, while high fiber intake has been found to reduce symptoms. Since GERD and LPR often appear together — up to 60 percent of GERD patients also experience laryngopharyngeal symptoms, according to a review of literature in Therapeutic Advances in Chronic Disease — treatments effective against GERD may well hold promise for LPR.

Testing the plant-based theory

To test his hypothesis, Dr. Zalvan created a study to compare the effectiveness of a plant-based diet versus PPIs for treating LPR. The diet was 90 to 95 percent plant-based, with no dairy products. The diet also included alkaline water with a pH greater than 8, and standard reflux precautions, such as avoiding spicy foods and caffeine. Eighty-five participants took PPIs and 99 followed the plant-based diet. At the end of the study, 62.2 percent of the dieters found that they experienced significant reduction in reflux symptoms, according to the Reflux Symptom Index, compared to 54.1 percent of the PPI group who experienced the same success.

“I found the plant-based approach did as well, if not better than the PPI group,” Dr. Zalvan said. “Some participants have stopped taking medications for other diseases.”

Since the end of the study, Dr. Zalvan adds, research has demonstrated further problems with PPIs.

“We see substantially more problems in people taking them for a long period of time, including possible increases in the rate of heart attack, stroke, dementia, kidney damage and, most recently, increased risk of death from all causes,” he said. He’s concerned enough that he wants other physicians to consider prescribing plant-based diets for chronic conditions such as LPR and GERD.

“There is a wealth of data about chronic disease that should have people starting to realize that pills are not the answer,” Dr. Zalvan said. “Diet should clearly be attempted — but a real attempt; you can’t do it halfway. I refer patients to available literature on diet and chronic disease. Often, when they don’t succeed, they haven’t read or followed an important part of the diet.”

What's next for reflux?

Dr. Zalvan isn’t finished investigating. He plans to look at variables in the original study more narrowly and also examine biological factors.

“We’re applying for an NIH R01 grant for a prospective study,” he said. “We’ll divide patients into a variety of groups: those on PPIs, those on PPIs and diet, and those on diet alone. We’ll also compare those with standard precautions, those on a plant-based diet and those on alkaline water alone. We also plan to look at the levels and activity of pepsin in the subjects, both in the stomach and throat, and at acid levels and at a variety of parameters associated with the microbiome and how diet affects it. We’re hoping to achieve a larger picture.”

Dr. Zalvan recommends a similar course of treatment — plant-based eating habits and alkaline water — for GERD sufferers.

“The mechanism is the same,” he said. “GERD is a diet-based disease; by eating properly, it can be prevented and even reversed. That even holds for esophagitis and Barrett’s esophagus. With the proper eating habits, we can reverse those conditions and even prevent related esophageal cancer.”

This post is sponsored and contributed by a Patch Brand Partner. The views expressed in this post are the author's own.

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