A new study looked at close to 200 patients at one medical center who had been diagnosed with laryngopharyngeal reflux.
It’s a condition where stomach acids habitually back up into the throat, and it’s distinct from the much better-known gastroesophageal reflux disease—or what most people call heartburn.
People with laryngopharyngeal reflux usually don’t have heartburn, explained Dr. Craig Zalvan, the lead researcher on the new study.
Instead, they have symptoms like hoarseness, chronic sore throat, persistent coughing, excessive throat clearing and a feeling of a lump in the throat.
Still, the problem is often treated with GERD drugs known as proton pump inhibitors. PPIs include prescription and over-the-counter drugs like Prilosec, Prevacid and Nexium, and they rank among the top-selling medications in the United States.
PPIs do help some people with laryngopharyngeal reflux, said Zalvan. He’s chief of otolaryngology at Northwell Health System’s Phelps Hospital, in Sleepy Hollow, N.Y.
And Zalvan, himself, used to prescribe them regularly.
However, it became clear that the medications were not effective for many patients, Zalvan said. At the same time, he noted, studies began raising concerns that PPIs are not as safe as thought.
Research has linked prolonged PPI use to slightly increased risks of heart attack, kidney disease, dementia and bone fractures—though it’s not clear whether the drugs are the cause.
For Zalvan, it all led to a new direction: prescribing a “dietary approach.”
Based on research into diet and various chronic ills, Zalvan began advising patients to take up a mostly vegetarian diet that he describes as “Mediterranean style.”
He encouraged patients to go 90-percent plant-based—eating mainly vegetables, fruits, legumes, whole grains and nuts. Meat and dairy were to be limited to two or three modest servings per week.
In addition, Zalvan gave his patients the standard reflux-soothing advice to avoid coffee, tea, alcohol and fried or fatty foods.
For the new study, Zalvan’s team looked back at patient records to see how that diet approach compared with the old PPI way.
The investigators focused on 85 patients who’d been treated with PPIs and standard diet advice between 2010 and 2012, and 99 who’d been advised to go mostly vegetarian.
When it came to treating the patients’ symptoms, “the diet was as good, if not better than, PPIs,” Zalvan said.
After six weeks, 63 percent of patients on the diet were showing at least a 6-point drop on a scale called the reflux symptom index. That’s considered a “clinically meaningful” improvement, Zalvan noted.
That compared with 54 percent of PPI patients, according to the report.
The findings were published online in JAMA Otolaryngology—Head & Neck Surgery.
According to Zalvan, patients in the diet group typically lost eight pounds—which may help explain their symptom improvement. But it’s not possible to tell how much credit goes to the weight loss, versus the diet itself.
Sonya Angelone is a registered dietitian and spokesperson for the Academy of Nutrition and Dietetics. She also recommends a largely plant-based diet for managing acid reflux.
What’s critical is picking healthy plant foods, Angelone said—creating a diet high in beans, vegetables and nuts, not pasta and bagels.
Healthy plant foods tend to calm inflammation in the body, Angelone explained, whereas a diet heavy in processed foods does the opposite.
And there’s been a growing understanding of acid reflux as an inflammatory disorder, Angelone said. That is, the acid itself might not do the real damage; the body’s inflammatory response may.
“I think this study offers more evidence that you should aim to eat more plants and fewer processed foods,” Angelone said.
Zalvan acknowledged the study’s limitations. It was not a clinical trial that specifically tested the vegetarian diet against medication, which is considered the “gold standard” for proving a treatment works.
Plus, it’s not clear whether patients have to rigorously stick with the 90-percent vegetarian plan—or whether more-moderate changes would do the trick.
What’s important, Angelone said, is that people make healthy changes they can live with for the long haul.
“Your diet choices matter,” she said. “They matter in your risk of chronic diseases down the road, and in more-immediate symptoms like acid reflux.”