Download essence of the reflux diet

DROPPINGACID
DROPPINGACID
THEREFLUXDIET
COOKBOOK&CURE
DroppingAcid:TheRefluxDietCookbook&Cure
Copyright©2010TheRefluxCookbooks,LLC
ISBN:978-0-9827083-1-6
PrintedintheUnitedStatesofAmericabyG&HSoho,Inc.(ElmwoodPark,NJ)
Allrightsreserved.Nopartofthispublicationmaybereproducedortransmittedinany
formorbyanymeans,electronicormechanical,includingphotocopying,recording,or
anyotherstorageandretrievalsystem,withouttheexpresswrittenpermissionofDr.
JamieKoufman(www.KoufmanReflux.com).
NoticeandDisclaimer
Thisbookisintendedasareferencevolumeonly,notasamedicalmanual.The
informationgivenhereisdesignedtohelpyoumakeinformeddecisionsaboutyour
health.Itisnotintendedasasubstituteforanytreatmentthatmighthavebeenprescribed
byyourdoctor.Ifyoususpectthatyouhaveamedicalproblem,weurgeyoutoseek
medicalhelp.Anyuseofthisbookisatthereader’sdiscretion,astheadviceand
strategiescontainedwithinmaynotbesuitableforeveryindividual.
Mentionofspecificcompanies,organizations,orauthoritiesinthisbookdoesnot
implyendorsementbytheauthorsorthepublisher,nordoesmentionofspecific
companies,organizations,orauthoritiesimplythattheyendorsethisbook.
Measurementsofacidity(pH)ofthefoodsandbeverageslistedinthisbookweredone
bytheauthorsusingaMinilabISFETpHmeter(ModelIQ128pHmeterwithSilicon
ChipSensor,PulseInstruments,Carlsbad,CA).ThepHmeterwascalibratedbeforeeach
useandcleanedbetweenmeasurements,anditwasnotedthatthedevicereturnedto
neutralpHbeforetakingthenextmeasurement.Nevertheless,werecognizethatsampling
errorcanoccur,andthatanyparticularmeasurementmightshowsignificantvariance.In
addition,aparticularfooditemcanvarysignificantlyinpHfromdaytodayandfrom
batchtobatch,anddependingonripeness,growingconditions,handling,andprocessing.
Designedby:RogersSeidmanDesign
AllphotographsinthisbookweretakenbyJamieKoufmanandJordanStern.
Cover:CrunchyCucumberandFennelSalad(page90);photobyJordanStern.
Note:Thegreenslicedvegetablesinthedishareslicedgreenbeans,notjalapeñopeppers.
TherearenojalapeñosinTheRefluxDiet.
Dedicatedtoourpatients
whoaskedforthisbook
“Ihaveneverdevelopedindigestionfromeatingmywords.”
WinstonChurchill
“Isawfewdieofhunger;ofeating,ahundredthousand.”
BenjaminFranklin
“It’sdifficulttothinkanythingbutpleasantthoughts
whileeatingahomegrowntomato.”
LewisGrizzard
Contents
Preface
TheAccidentalChefs
THECURE
WhatYouEatCouldBeEatingYou
HowDoIKnowIfIHaveReflux?
MaintainingHealth:TheRefluxCure
THEDIET
GettingStartedontheRefluxDiet
BestFoodsforaRefluxer
NotoriouslyBadRefluxFoods
AvoidingAcidicFoodsandBeverages
DeliciousLow-FatCooking
THECOOKBOOK
Breakfast
Salads
Soups
Entrées(Lunch&Dinner)
Horsd’Oeuvres&Snacks
Desserts
THESCIENCE
RefluxScienceYouCanDigestbyJamieA.Koufman,M.D.
References
Acidity(pH)ofCommonFoodsandBeverages
AbouttheAuthors
Acknowledgments
Index
Preface
Acidrefluxisepidemic,andyouprobablydon’tevenknowyouhaveit.
Doyoucoughorclearyourthroatalotaftereatingameal?Orwakeupinthemiddle
ofthenightcoughingorshortofbreath?Isyourthroathoarseorsoreinthemorning?Do
youhavethesensationofalumpinyourthroatordifficultyswallowing?Areyouplagued
bypost-nasaldrip?
Refluxisnotjustindigestionandheartburn.Wenowknowabout“silentreflux”—a
termcoinedbyDr.JamieKoufman—inwhichyoumayexperiencemanyoftheabove
symptomswithoutindigestion.
DroppingAcid:TheRefluxDietCookbook&Cureisthefirstbooktoacknowledge
thatrefluxcomesinmanycolors—aconceptthatisjustnowcomingtothepublic’s
attention.Ifyouareoverforty,there’sa50–50chanceyoualreadyhaveit.Refluxisone
ofthemostimportant,misunderstood,andpreventablediseasesofWesterncivilization.
Weestimatethat100millionAmericanshavereflux,manyofthemunawareofit,
andmanyofthemincorrectlydiagnosed.
Notonlyisrefluxamazinglywidespread,itsincidenceisontherise.Why?Webelieve
ithaslargelytodowithexcessiveacidinourdiets.
Yousee,it’snotjustaboutobesityandovereating,asmanypeoplethink.Reflux
increasinglystrikesthethin,theathletic…andtheyoung.Agenerationago,almostall
therefluxpatientswesawwereintheir40sand50s;today,they’reaslikelytobeintheir
20sand30s.Dr.JamieKoufmanremembersapatientwhohadjustgraduatedfromNYU
withherheartsetonbecomingaBroadwaystar,butperpetualhoarsenesswasinterfering
withhersinging.Shewasonly21,butitwasalreadysofargonethatsheneededsurgery.
Perhapsmoredisturbingwasthatallherfriendswereexperiencingthesamesymptoms!
They’renotthefirstgenerationofcollegegradstogooutforabeeronaSaturdaynight,
butthey’rethefirstgenerationtopayforitsodearly.
Notonlyareweseeingrefluxinayoungerpopulation,we’reseeinglessoftheclassic
symptomofheartburnandmoreofthesymptomslistedatthestartofthischapter.Reflux
ischangingandadaptingwiththetimes,andsomustwe.
Refluxiscomplicated.Itmakescertainfoodsyourenemy.Thesymptomsthatare
stirredupbylate-nighteatingcanaffectyoursleep,andpoorsleepeatsawayatqualityof
lifeandotheraspectsofyourhealth.
Refluxispernicious.Webelieveitisamajorcauseofcanceroftheesophagusand
throat,andpossiblyothercancersaswell.
Fortunately,formanypeoplethereisacure.Itisrighthereinthiscookbook,where
twodoctorstakeeverythingtheyknowaboutrefluxandjoinforceswithacreativechef.
Butthisisnotjustacookbook.Wecertainlyhopeyouwillprepareandenjoythe
delicious,healthfuldishesFrenchMasterChefMarcBauerdevelopedforthisbookusing
cutting-edgemedicalresearchonfoodsthatare“safe,”butwealsoencourageyoutoread
thechaptersonthesciencebehindreflux,whereweexplainwhatcausesrefluxandits
symptoms,andwhythisposessuchaserioushealthriskforyou.
Inpart,wepresentandexplainthesciencebecausewerealizehowcontroversialreflux
hasbecome,withmanypointsofviewonittiedtomanydifferentandsegmentedmedical
specialties.Asexpertsinthefieldforalongtime,wehaveworkedconscientiouslyto
provideafairandaccurateoverviewofamostmisunderstoodcondition.Inthechapter
“WhatYouEatCouldBeEatingYou”(page21),weexplainrefluxintermsanyonecan
understand.Ifyou’reofamorescientificbent,thechapter“RefluxScienceYouCan
Digest”(page159)presentsamorecomprehensiveanddocumentedaccountofthe
medicalresearch—muchofitdonebyDr.JamieKoufman—thathelpsfillthegap
betweenrefluxasitmaybeunderstoodbyyourlocaldoctorandrefluxasitaffectsyour
everydaylife.
Theresearchinthisbooklendsscientificvalidityandauthoritytothesensiblehealth
concernsofthoseconsumers,organizations,andpoliticalleaderswhoareinterestedin
monitoringthequalityandsafetyofourfood.Byreadingoneorbothofthescience
chapters,youwillbetterunderstandwhyandhowtherecipesinDroppingAcid:The
RefluxDietCookbook&Curecanhelpyoufeelwellandgethealthier…notjustwhen
you’reinneedofaquickfix,butforgood.
re·fluxn[Lre-back+fluxusflow]
1:aflowingback2:aprocessofrefluxing
COMMONTERMSFORREFLUX
GeneralTerms
Acidreflux
Gastricreflux
Indigestion
Heartburn
TermsforEsophagealReflux
Gastroesophagealrefluxdisease(GERD)
Gastro-oesophagealrefluxdisease(GORD)(U.K.)
Pepticesophagitis/Esophagealerosions
TermsforThroatReflux
Laryngopharyngealreflux(LPR)
Extraesophagealrefluxdisease
Supraesophagealrefluxdisease
Atypicalrefluxdisease
Refluxlaryngitis
Silentreflux
TheAccidentalChefs
Thisbookcameaboutthroughacombinationoffriendshipandcommonpurpose.Two
oftheauthorsaremedicaldoctors(trainedasear,nose,andthroatspecialists),andthe
thirdisaFrenchMasterChef.Drs.JamieKoufmanandJordanSternwereurgedtowrite
thisbookbytheirrefluxpatients,forwhomthestandardtwo-pagebrochurewasn’t
enoughtohelpthemfigureoutwhattoeatonadailybasis.ChefMarcBauerwas
interestedinmakinghisdeliciouscuisineaccessibletopatronswithreflux.
Whenwesetouttowritethisbook,wealreadyhadexperiencetreatingthousandsof
patientswithreflux.Weknewallaboutthenotoriousbad-for-refluxfoods.Weknewthat
somefoodscauserefluxbydisablingesophagealdefenses,theequivalentofspringing
openatrapdoor.
Wealsoknewthatacidicfoodscauserefluxsymptoms.Thislastpointisarecent
discovery,andthekeytoTheRefluxDiet.
Refluxmanagementhastraditionallybeenaboutminimizingtheimpactofacidfrom
thestomachbelow,butourresearchandclinicalexperiencetaughtustobejustas
concernedwith“acidfromabove.”Wefoundthatformanyrefluxpatients,adietthatwas
tooacidicwasjustasbadashavingcontinualgastricreflux,acidcomingupfromthe
stomach.
WetestedtheacidityofmanyfoodsandbeveragesusinganISFETpHMeter.
Asaresult,TheRefluxDietCookbook&Cureoffersnewideasabouthealthful
eatingandcooking.Thisisthefirstdietcookbooktosystematicallyaddresstheproblem
ofdietaryacid.
Theauthorstalked,cooked,andatetheirwaythrougheveryrecipeinthisbook,and
webelievethatourcollaborationhonestlyreflectsthestateofthemedicalartandour
combinedyearsofexperience.
Bepreparedtoconsidersomenewideas.Whole-grainbreads,forexample,arevery
goodforavoidingreflux,andasliceortwomakesagreatsnack.Justrememberthat
almosteverythingwerecommendisgoingtobebadforsomeone,somewhere.That’sthe
wayitisintheworldofreflux.Oatmealandbananasaregreatitemsformostrefluxers,
butnotallsufferers.Wewelcomequestions,suggestions,andrecipes;youcanaddyour
comments,etc.,toourblogatwww.refluxcookbookblog.com.
DroppingAcid:TheRefluxDietCookbook&Curehasbeenaworkinprogressfor
25years.That’sbecausetheprinciplesandrecommendationsherehaveevolvedasa
directresultofclinicalandbasicmedicalscienceresearch.Untilrecently,noone
understoodenoughabouthowrefluxcausessymptomsanddiseasestocounselpatientson
exactlywhattoeatandwhatnottoeat.
Naturally,therearefoodsyouwillhavetolearntoavoid.Barbecuedribs,Frenchfries,
andchocolatecakewillnevermakeagoodmealforarefluxer.Still,wefeltthatthe
conventionalanti-refluxdietwasoverlyrestrictiveandfocusedonlyonwhatyoucouldn’t
eat—nofriedfood,nochocolate,nosoda—sowecameupwithrecipesthatexpandedon
whatyoucouldeat.Waittillyoutryouroatmeal-crustedsalmon!
TheRefluxDietCookbook&Cureintegratesscience,medicine,andculinaryartina
boldway.Andwhilethefocusofthebookisself-directedrefluxmanagement,thebasic
principlesaremorebroadlybeneficial.Whenyoumaintainthiswayofeating,youalso
loseweightandbecomeleanerandfitter—becausethesedishesarelowinfat.Inthepast,
“lowfat”meant“nofat,”leadingtofoodwithnotaste.ChefBauer’sideatousetastyfats
asflavorings,notasmainingredients,representsaparadigmshiftinrefluxcooking.
TheRefluxDietCookbook&Cureoffersahealthydietaryfoundationonwhichyou
canbuild.Ourrecipesareoriginal,healthful,anddelicious.Theymakegoodsense.And
giventhatreflux-relatedesophagealcanceriscurrentlyoneofthefastestgrowingcancers
intheU.S.,thisdietjustmightsaveyourlife.
the
cure
WhatYouEatCould
BeEatingYou
Almosteveryonehassomereflux,theupwardbackflowofthestomach’scontents.
Managingitwillalwaysrequirethought,creativity,andattentiontowhatyoueatand
when.There’snoone-size-fits-allstrategyforbeatingit.
Thischapterdescribesthesciencebehindrefluxinawaythatwillhelpyouunderstand
howandwhyTheRefluxDietworks.Tounderstanditfurther,thechapter“Reflux
ScienceYouCanDigest”laterinthisbook(page159)containsamorein-depthlookat
thescientificstateoftheartandresearchinthisfield,includingmanyoftherelevant
referencesfromthemedicalliterature.
ThingsareNotWhatTheySeem
Acidrefluxhasbeenpoorlyunderstooduntilrecently,evenbydoctorsincloselyrelated
fields.Forexample,yourfamilydoctororevenaspecialistmighthavetoldyouthatit’s
asthma,sinusitis,orallergy,wheninfactyouhadreflux.Orperhapsyourdoctor
prescribedanover-the-counterantacid.Therealvillain,however,isthedigestiveenzyme
pepsin,notacid,andanantacidthereforewon’tdoathingformanyrefluxsymptoms.At
present,thereisno“anti-pepsin”medication,sothediseasethatisliterallyeatingawayat
youkeepsongoing.
Whyshouldyoucare?Becauserefluxisnotonlyuncomfortableandinconvenient,it’s
dangerous.Ifleftuntreated,refluxcanwreakhavoconyourthroat,airways,lungs,and
digestivesystem.Itcanevencausecancer.
TheAmericandiethaschangeddramaticallysinceWWII,buttherehasbeenno
captainsteeringtheship—nooverarchingbodytomonitorallaspectsofthesafetyofthe
foodsupply.Thismayexplainwhyrefluxandmanyreflux-relateddiseasesareincreasing
inAmerica.
Here’swhathappened.Inthe1960sand1970s,fastfoodandpre-packagedfood
becamepopularandmanypeoplestoppedeatinghome-cookedmeals.Ingeneral,the
obesityepidemichasparalleledtheincreaseinthesaturatedfatcontentofourdiets,but
therehasbeenasecond,moreinsidioustrend:Preparedfoodshavebeenincreasingly
acidifiedtopreventbacterialgrowthandaddshelflife.Today,manypreparedfoodsand
beveragesarejustasacidicasstomachaciditself.
Computer-generatedimageofthehumanpepsinmolecule.Pepsinistheprincipal
digestiveenzymeofthestomach,andit(notacid)isresponsibleforthetissuedamage
causedbyreflux.Peptideswereusedtomakeantibodiesforpepsinassays,whichformthe
basisfornew,non-invasivetestsforreflux;seewww.KoufmansRefluxTestStrips.com.Dr.
JamieKoufmanistheinventorofthesediagnosticmethods(USPatentNo.5,879,897).
Untilthisbook,noonehasinvestigatedtheadverseeffectsoftoomuchacidinthe
foodsandbeveragesweconsume.Everyoneworriesaboutequalizingthestomach’s
naturalacid,yetwecontinuetopourevermoreacidifiedfoodsanddrinksintoit.Again,
it’snotstomachacidthat’sthemainproblem.Theterm“acidreflux”ismisleading,since
itisthedigestiveenzymepepsin,notacid,thatcausesmostofthetrouble.Theconfusion
isbecausepepsincanonlydoitsjobwhenacidisaroundtoactivateit.Thenitgetsbusy
breakingdownproteinsintosmaller,moreeasilydigestibleparticles.Withoutacidto
superchargeit,pepsincan’tdoitsthing.
Here’sthecatch:Atacertainpoint,pepsindoesn’tgoawaymeeklyafterdigesting
yourmeal.It’sstillhangingaroundlikethebullyataplayground.Allitneedsissome
acidtowakeitupagain.Yourstomachproducesacidwhenyoueatameal,butpepsin
doesn’tcarewheretheacidcomesfrom;anyacidwilldo.Anyfoodsyoueatthatarehigh
inacidareperfectlysufficientforactivatingpepsin,andifthere’snoproteinaroundthat
needsdigesting,thepepsinwillgnawonwhateverishandy—suchastheliningsofyour
throatandesophagus.Theoldadage“Youarewhatyoueat”mightinthiscasebe
rephrased:“Becarefulwhatyoueat,becausewhatyoueatcouldbeeatingyou.”
Imaginethatyourstomachisfullofseawaterandlobsters.Theseawaterisacid,and
thelobsters(big,aggressiveoneswithmightyclaws)arethepepsinmolecules.Whenyou
reflux,theseawatersplashesaround.Someofitsplashesupwardintoyourthroat.The
lobstersridethiswaveofseawaterandattachthemselvestotheshorewherevertheyland
—theshorebeingthedelicatetissueandmembranesliningyourthroat,larynx(voice
box),esophagus,andlungs.
Thelobstersarehangingonbytheirclaws.Itdoesn’treallymatternowwhetherthe
seawatertheyneedforsurvivalsplashesupfrombeloworpoursdownfromabove.To
theselobsters,it’salljustadelicious,rejuvenatingsplash.Onceapepsinmoleculeis
boundto,say,yourthroat,anydietarysourceofacidcanreactivateit:Sodapop.Salsa.
Strawberries.
ThepHscale,usedtomeasureacidity,issomewhatcounterintuitive.pH7isneutral;
pH1isveryacidic,andcausticslikebleachhavevaluesfrompH8-14.Forexample,
distilledwaterandmosttapwaterispH7(neutral),butvinegaratpH2.9andlemon
juiceatpH2.7areacidic.ThenormalrangeofstomachacidispH1-4.Alsonote
thatthepHscaleisalogarithmicscale,sopH4istentimesmoreacidicthanpH5,
andpH4.9istwiceasacidicas5.0.That’swhysimplydilutingacidicbeverages
doesn’tmakethemnon-acidic.
WesuspectthatDroppingAcid:TheRefluxDietCookbook&Curewillnotbe
popularwithFederalregulatoryagenciesandtheCongressthatfundsthem.Orwithsome
ofthecompaniesthatproducecommercialfoodsandbeverages,becausemanycommon
productsareasacidicasstomachacidandjustaspotentiallyharmful.The
acidificationofpre-packagedfoodsandbeveragesextendstheirshelflifeanddiscourages
bacterialgrowth,whichisgood.Butitisalsolikelythatthisacidificationofourfoodis
oneofthereasonsrefluxisapproachingepidemiclevels.
Thisbookmightalsoirritatecertainmembersofthemedicalcommunity.Afterall,
differentmedicalspecialtieshavedifferentperspectives.However,theprevailingclinical
modelofrefluxdiseaseisaboutaswrongastheancientbeliefthattheworldisflat.
Foronething,thereisahugemisconceptionabouthowpepsinworks.Manydoctors
mistakenlybelievethatpepsinisonlyactivebelowpH4.Nothingcouldbefurtherfrom
thetruth.Pepsin,thoselobsters,cancontinuetobesomewhatactiveuptopH6.
Theoldthinkingwasthatpepsinwasn’tactiveabovepH4,butthischartshowsjusthow
wrongthatis.(Reference:JohnstonN,etal.Activity/stabilityofhumanpepsin:
Implicationsforreflux-attributedlaryngealdisease.Laryngoscope117:1036-9,2007.)
PepsindoesmaximumdamageatpH2(100percentactivity),butitcanstilldosome
damageuptopH6(10percentactivity).Thispepsinactivationcurvehasimportant
implicationsforreflux,becauseproteincanbedigested—andtissuedamaged—tosome
degreewheneveranyacidispresent.(Incaseyouwerewondering,Coca-ColaispH2.8.)
Whenpepsinbindstotissue,itremainsstableforalongtime.Thequestionisnot
whetheritisactive,buthowactive.Allthosepopularandexpensiveantirefluxmedicines
don’tactuallyturnofftheacid,theyjustturnitdown,reduceitsomewhat.Ontelevision,
you’llseethoselittleacidpumpsinthestomachgiveupatthesightofapowerfulpurple
pill,butthat’snotwhatreallyhappens.Despitethestrongestanti-refluxmedications,the
protonpumpinhibitors(e.g.,Prilosec,Protonix,Nexium),everyone’sstomachstillchurns
outsignificantamountsofacid.About10percentofpeoplewhotryprotonpump
inhibitorsdonotrespondtothem,andanother15–20percentgetsideeffectssuchas
nausea,gas,bloating,diarrhea,andabdominalpain.
Westilldon’thaveauniversallyeffectiveanti-refluxmedication.Thebestmedications
wehaveareonlyprettygood,andthey’reonlyprettygoodforabouttwo-thirdsofthe
peoplewhoneedthem.
Bynowyou’reprobablywondering:“Whynotforgettheacidandjusttreatthe
pepsin?”
Thereisnotyetaneffectiveanti-pepsinmedication.However,whathasbeenmissing
fromthetreatmentequationuntilnowisanunderstandingoftheprofoundimpact
ofdietaryacid.Tocorrectthismisunderstanding,hereisasummaryofexactlyhow
refluxcausesproblemsforyou,thesufferer:
•Acidandpepsinworktogethertocausereflux-relatedsymptomsanddiseases.
•Noneoftheavailableanti-refluxmedicationsturnsacidoffcompletely.
•Whenpepsinattachestohumantissue,diseasemayresult.
•Dietaryacidcanactivatepepsinalreadyinorontissue.
•Sickfromreflux,thattissueneedsaperiodofrecovery.
WhyDoesn’tMyDoctorKnowAboutThis?
Patientsfrequentlyaskus,“Whydoesn’tmydoctorknowaboutthis?”Partoftheanswer
isthatspecialistsaretoospecialized.Manyrefluxsymptoms(hoarseness,thesensationof
alumpinthethroat,post-nasaldrip,chronicthroatclearing,cough,chestpain)cross
medicalspecialtylinesandarenon-specific.Thecorrectdiagnosisisoftenconfusedwith
otherdiagnoses,includingupperrespiratoryinfections,allergies,andsinusitis.
Patientswithreflux-relatedchroniccough,forexample,oftenseeanumberof
physicianswithoutreceivingproperdiagnosisandtreatment.Theymightfinda
knowledgeablespecialistonlyafterbrowsingtheInternetandstumblingacross
informationabout“silentreflux,”alsoknownaslaryngopharyngealreflux(LPR).These
frustratedpatientsmayfindreliefonlyafterbeingdisappointedbyvisitstodoctorsin
otolaryngology,allergy,immunology,gastroenterology,andpulmonaryandinternal
medicine.
FromthecasefilesofDr.Koufman
ArespiratorytherapistItreateddowninNorthCarolinawasabigman:6-foot-4,280
pounds.Evenhisvoicewasbig,butitwasalwayshoarseinthemorning.At38,he
waskeepingthatweightupbychowingdownonhisfavorites—gritsandahalf-pound
ofbaconforbreakfast,friedchickenalmostdaily.Infact,hedividedhispatronage
equallyamongthefourbigchickenchains:K&WCafeteria,KFC,Church’s,and
Popeye’s.Youdon’tgettobe280poundsfornothing.
Ihelpedhim,butthiswasaverysadcase—becauseheleftCaliforniatobecomea
respiratorytherapistonlyafterhispromisingcareerasanoperasingerfizzled.That
career,itturnedout,hadbeendestroyedbysomethingassimple(andascomplicated,
too)asreflux.Heneverknewwhattheproblemwaswithhishoarsevoiceandwas
neverproperlydiagnosed,soheabandonedacareerheloved.
Istoppedhislate-nightfoodbingesandall-frieddiet,andIsenthimtoagym.The
morninghoarsenessclearedupandhegothisweightdownto215pounds.He
actuallywentbacktosinging,butitwastoolateforaprofessionalcareerinopera.
Bytheway,youshouldnotbewakinguphoarse.It’snotnatural!Ingeneral,voice
problemsgetworseasthedaygoeson,soifyou’restartingthemorningwith
hoarsenessorasorethroat,itprobablymeansyou’reanighttimerefluxer.
Remember,whatmakessilentrefluxinsidiousanddifficulttodiagnoseisthat
peoplewhohaveitDONOThaveheartburnandindigestion.Tomostpeople(and
theirdoctors),refluxandheartburnaresynonymous,sotheymissthebigpicture.
Silentrefluxhasmuchincommonwithotherrelativelyrecentmedicaldiscoveriesthat
wereatfirstmisunderstood,butitistimetogivesilentrefluxitsdue.Itisthemost
importantdiseaseofthebreathingpassages,anditcontributestothedevelopmentof
manydiseasesoftheear,nose,throat,lungs,andesophagus—includingthedevelopment
ofcancer.Atpresent,reflux-relatedesophagealcancer(mostcommoninwhite
males)isoneofthefastestgrowingcancersintheUnitedStates.Inaddition,research
onthecellbiologyofLPRhasshownthatlaryngealcancerandrefluxexhibitsimilarcell
damageprofiles.
We,theauthors,believethatrefluxmaybeoneofthemostimportantriskfactorsfor
thedevelopmentofbothesophagealandlaryngealcancers.
ESSENCEOFTHEREFLUXDIET
1.Beginwithtwoweeksonaverystrict,acid-freediet(TheInductionReflux
Diet).(See“GettingStartedontheRefluxDiet,”page45.)
2.Inthethirdweek,gotothe“maintenance”phaseofthedietbychoosingyour
foodsandbeveragesfromthe“good”and“bad”foodlistsonpages62–64.
3.Eatsmallermealsmorefrequently,insteadoflargemeals.
4.Donoteatanythingthreehoursbeforebedtime.
PrinciplesofTheRefluxDiet
Asitturnsout,thestoryofacidandpepsin(themaindigestiveenzymeofthestomach)
makesacompellingcaseforanewapproachtorefluxmanagement.
First,asyoumighthaveguessed,werecommendthatyoulimityourintakeofacidic
foodsandbeverages,whichwewilldescribeandlistlaterinthisbook.
Second,therearefoodsthatcauserefluxinanentirelydifferentwayfromthelobstersin-seawateranalogy.Thesefoodsrelaxthestomachvalvethatnormallykeepsthings
downtherefrombackflowing(refluxing)upward.Thatvalveiscalledthelower
esophagealsphincter(LES),anditcantemporarilyrelax,orloosen,inthepresenceofthe
chemicalcompositionofsuchfoodsaschocolate,caffeine,alcohol,andmanyhigh-fat
delicaciesfromfriedfoodstofattymeats.
Third,therearefoodsthatincreasepressureinsidethestomach,resultinginabackflow
thatovercomestheLESvalve.Thisgroupoffoodsandbeveragesincludesanythingthat
expandsinthestomach,suchascarbonatedbeverages(beerandsoda).
Bydesign,TheRefluxDiethastwolevels:(1)induction(start-up)and(2)
maintenance.Forthefirsttwoweeks,werecommendaverystrictdiet.Wecallthisstartupperiodtheinductionrefluxdietor“pepsinwashout”phase.Theideaistogivethe
membranesliningyourthroat,esophagus,etc.,achancetoheal.
Nextisthemaintenancediet,whichislessstrictandcanbesustainedforalifetime.
Onefinalobservationfornewlydiagnosedrefluxers:Itmaytakeayearormorefor
youtoacquireanunderstandingofallthevariablesthatmakeyourrefluxbetterorworse.
Trytobepatientwiththeprocess.Refluxisgenerallyintermittentanyway,soyou’llhave
plentyoftimetoexperiment.Youwill,however,havetochangethewayyouthink.From
nowon,youwillalwaysneedtofocusonwhatyoueatandwhen.Nomoresnackson
autopilot!
TheRefluxDietCookbook&Cureisintendedtohelppeoplewithreflux,nottobea
substituteformedicaltreatment.Thatsaid,thereisnoquestionthatformanypeoplewith
reflux,dietandlifestylechangeisthekeytosuccessfultreatment.Hereareafewother
stepsyoucantaketoreducerefluxandbringsomerelief:
•Ifyouusetobacco,quit.Smokingcausesreflux.
•Don’twearclothingthatistootight,especiallytrousers,corsets,bras,andbelts.
•Avoidexercisingrightaftereating(especiallyweight-lifting,jogging,andyoga).
•Donotliedownrightaftereating,anddonoteatwithinthreehoursofbedtime.
•Elevatetheheadofyourbedifyou’reanighttimerefluxer;thatis,ifyouhave
symptomsofhoarseness,sorethroatand/orcoughinthemorning.
Therecipesinthisbookhavebeencreatedasawelcomechangefromthetasteless
refluxfoodsofthepastandasthecornerstoneofahealthy,sustainablediet.The
nutritionalprofileofTheRefluxDietisanextensionof“thehealthyheartdiet,”sowe
havenotroublerecommendingthisdiettoeveryone.If,forexample,youshareyourlife
withsomeonewhohasreflux,youcoulddoworsethantocookandeattogetheraccording
toTheRefluxDietCookbook&Cure.
FromthecasefilesofDr.Koufman
OnepatientflewinfromJapantoseeme.At60,hissingingcareerhadbeenupand
downovertheyearsbecauseofchroniccough.WhenIfirstlookedathislarynx,Isaw
thatinadditiontoreflux,hehadcandidalaryngitis—afurryfunguscoatinghis
esophagusandlarynx.
Hewasnotdoingwell.Hecouldn’tperform.Itreatedthefungusandthereflux,but
whenIfoundoutthismanseemedtoeatalmostnothingbutcherries,Ialsoputhimon
TheRefluxDiet.Today,heisagaingivingMasterClassesinsingingandhasstopped
coughingentirelyforthefirsttimein35years.
HowDoIKnowIf
IHaveReflux?
Peoplewithtypicalgastroesophagealrefluxdisease(GERD)haveheartburn—chest
painaftereating,particularlyaftereatingfriedorgreasyfoods.Mostofthetime,adoctor
makesthediagnosisofGERD.Themoredifficultquestionishowtoknowifyouhave
“atypical”or“silent”reflux,alsocalledlaryngopharyngealreflux(LPR).
COMMONSYMPTOMSOFREFLUX
Hoarseness
Chroniccough
Chokingepisodes
Troubleswallowing
Alumpinthethroat
Post-nasaldrip
Heartburn
LPRcanoccurduringthedayornight,butmostpeoplewithLPRdonothave
heartburn.(Hence,“silentreflux.”)Theexplanationforthisisthatrefluxedmaterialdoes
notstayintheesophaguslongenoughtoirritatethatorgan;however,ifevenalittleof
thosestomachjuicescomeupintothethroat,symptomscanoccur.Comparedtothe
esophagus,thethroatandvoiceboxareahundredtimesmoresensitivetoirritationand
damagefromreflux.
ThesymptomsofLPRarehoarseness,toomuchthroatmucus,throatclearing,postnasaldrip,chroniccough,asensationofalumpinthethroat,sorethroat,choking
episodes,shortnessofbreath,asthma,sinusproblems,difficultyswallowing,dental
disease,andevenhalitosis.Somepeoplehaveintermittentorchronichoarseness,while
othershaveproblemswithtoomuchnoseandthroatdrainage,thatis,toomuchmucusor
phlegm,causingchronicthroatclearing.Ifyouhaveanyofthosesymptoms,especiallyif
yousmoke,youshouldaskyourdoctoraboutLPR.
THEREFLUXSYMPTOMINDEX(RSI)
Circle0–5ineachofthe9rowsandaddupthenumberstogetyourRSI
ThespecialistswhomostoftendiagnoseandtreatpeoplewithLPRareENT(ear,nose,
andthroat)doctors,alsocalledotolaryngologists.ThetwoENTauthorsusetheReflux
SymptomIndex(RSI)asatoolforscreeningpatients.YoucanfigureoutyourownRSIby
answeringthequestionsabove.
Generally,themagicnumberforLPRis15,buttheRSIisn’tasurefirewaytoknowif
youhaveLPR,becausesomepeoplewithLPRhavelowRSIs.Ontheotherhand,most
peoplewhohaveLPRhavemorethanonesymptom.TheaverageRSIscoreforapatient
comingfortreatmentinDr.Koufman’spracticeisover20.Ifyouthinkthatyouhave
refluxdiseaseofanykind,goseeyourdoctor.
REFLUX-RELATEDSYMPTOMSANDCONDITIONS(LPR&
GERD)
RedFlagsforReflux
Herearesomewarningsignsandsymptomsofseriousreflux(bothLPRandGERD).
Someofthesesymptomsmightindicatethepresenceofmoredangerousconditionsas
well.