Is what we eat eating away at us? Millions of Americans have reflux disease, with symptoms ranging from annoying to dangerous, and experts believe our diet is a major factor.
Reflux is partly a matter of stomach acid moving upward to where it doesn't belong. But a leading researcher, Dr. Jamie Koufman, says an even bigger threat is the digestive enzyme pepsin, which lingers in the esophagus and throat where it is activated by acidic foods and beverages. She preaches that we need to change what, how and when we eat.
Koufman, the director of the Voice Institute of New York, says many people have no idea that reflux is behind their health problems.
Some sufferers have classic digestive symptoms, such as heartburn; others have "silent" reflux, which can progress into chronic cough, hoarseness, asthma, difficulty swallowing and even cancer.
"Esophageal cancer is the most rapidly expanding cancer in the Western world, and the No. 1 cause is reflux," says Dr. Peter Belafsky, medical director of the Voice and Swallowing Center at UC Davis.
Medications quell stomach acid, but they do not target pepsin, which can damage whatever tissue it touches. In one study Koufman conducted, 19 out of 20 patients with reflux (who did not respond to medication) improved on a low-acid diet.
In 2010, Koufman teamed with Dr. Jordan Stern and French master chef Marc Bauer to publish "Dropping Acid: The Reflux Diet Cookbook and Cure." The book rates foods -- for example, in the negative column are tomatoes, citrus and strawberries, all acidic. Others, such as chocolate and alcohol, are poor choices because they relax the stomach valve that keeps acid from bubbling up. At the top of Koufman's worsts are soft drinks, which she blames for the dramatic rise in reflux among young people.
One of her patients, personal finance expert and author Suze Orman, grew up thinking she had asthma. Despite being on medications, her condition worsened. "On my 60th birthday, I am telling you, I could barely breathe," says Orman, now 62.
While working on an episode of "The Oprah Winfrey Show," Dr. Mehmet Oz observed the trouble Orman was having catching her breath. He thought she might be suffering from reflux.
Medication did not help, and eventually Orman made her way to Koufman, who referred her to a surgeon.
"When I look back, a lot of it was related to what I ate," Orman says. "If you were to ask me, did I ever have asthma? I would say, 'No. I had reflux. Period.' "
Dr. Eric Esrailian, co-chief of the Division of Digestive Diseases at UCLA, concurs that sometimes there is a diagnosis of asthma, "but it's the reflux that actually triggers it. The vocal cords and the airways do not like to have acid."
Changing one's diet may sound more challenging than popping a pill. But Koufman warns that relying on drugs alone, such as widely used proton pump inhibitors (such as Prilosec, Prevacid and Nexium), is not the answer.
Certain habits contribute to reflux, such as late-night eating. Koufman jokes that a law requiring kitchens to close at 8 p.m. would improve the nation's health: "The idea of nighttime snacks is as American as reflux."
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The do's and dont's for reflux sufferers
Symptoms of reflux, such as heartburn, hoarseness, chronic cough or the feeling of a lump in your throat, should be evaluated by a doctor, says Dr. Peter Belafsky, medical director of the Voice and Swallowing Center at UC Davis: "The important thing is to get screened, to make sure there isn't something serious contributing to the symptoms. If the exam is normal ... the first line of treatment for this should be diet modification, exercise, weight loss. You can do a lot to help yourself." In "Dropping Acid: The Reflux Diet Cookbook and Cure," by Dr. Jamie Koufman and Dr. Jordan Stern with French master chef Marc Bauer, 10 foods are cited as typically bad for most people with reflux:
Soft drinks (including diet soda)
Fatty meats (such as bacon, sausage and ribs)
Hot sauces and barbecue sauce
Citrus fruits and juices
Potatoes and sweet potatoes
Whole grain breads
The book also offers five tips
* No eating within three hours of bedtime.
* Eat smaller meals.
* Raise the head of your bed.
* If you smoke, quit.
* Drink lots of water.