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September 12, 2017

Mediterranean Diet Works as Well as Medications in Reflux Treatment

Image courtesy of KEKO64

New York researchers have discovered that a modified Mediterranean diet worked as well as PPI medications in resolving LPR symptoms (laryngopharyngeal reflux) which include globus, chronic cough, phlegmy throat, constant throat-clearing, etc. The comparison study group that used PPI medications utilized esomeprazole (Nexium) twice daily or dexlansoprazole (Dexilant) daily.

In fact, the modified Mediterranean diet group had more patients feeling better (62.6%) than the medication group (54.1%). The symptoms also decreased more dramatically in the modified Mediterranean diet group (39.8%) than the medication group (27.2%).

Improvement typically occurred within 6 weeks.

Given there is a trend to avoid reflux medications due to side effects from long-term use, lifestyle changes are an integral part of any treatment regimen. This research provides welcome news for those wanting to avoid such medications.

So what is this modified Mediterranean diet for LPR symptom control? It is a diet rich in:

• fruits
• vegetables (tomatoes OK!)
• whole grains and nuts
• drink only alkaline water (pH more than 8)

BUT also to...

• near complete avoidance of dairy products (yogurt, ice cream, cheese, pudding, etc)
• near complete avoidance of meats including beef, chicken, fish, eggs and pork.
• avoid ALL caffeine (coffee, tea, chocolate)
• avoid ALL sodas
• avoid ALL greasy and fried food, spicy foods, fatty foods
• avoid ALL alcohol

Essentially, you need to become an alkaline water drinking vegetarian who cheats a little.
Keep in mind that although this diet appears to help with LPR symptoms significantly, it is unclear whether the improvement is specific to certain sub-groups (acid vs non-acid LPR vs both???). It is entirely possible that certain patient sub-groups may not benefit from this diet. More research is needed.

For those curious, the reason for the alkaline water beyond acid neutralization is that it inactivates pepsin, a stomach enzyme, which is thought to play a key role in ongoing mucosal damage independent of acid levels.  [more info]


Reference:
A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux. JAMA Otolaryngol Head Neck Surg. Published online September 7, 2017. doi:10.1001/jamaoto.2017.1454




Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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