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I get a lot of questions about GERD (gastroesophageal reflux disease). Many people have it and I wrote it very recently in this section. But what about laryngopharyngeal reflux, or LPR?
This is a variation of GERD. This is what happens when the stomach acid boils to the throat because the muscle that should keep the stomach tight and keep the acid where it should be is not doing the job. It does not close and the acid content goes up into the esophagus, causing irritation.
Symptoms include excessive shortness of breath in the throat, persistent cough, difficulty swallowing and feeling full in the mouth and throat. Google this condition to know more if you think you have it.
The first line of treatment for RAPP is the same as for GERD: Lose weight; lift the head of the bed 6 to 8 inches; avoid foods that aggravate symptoms such as coffee, chocolate, alcohol, fatty foods and peppermint; reduce alcohol, especially at night; stop smoking; and avoid lying down within three hours after eating.
Yet for many, this has not been enough. This is where PPIs (Protein Pump Inhibitors) such as Prilosec OTC have been a boon. They healed the problem for many.
But as I wrote recently, PPIs have some potential side effects, including fractures, pneumonia, diarrhea, vitamin B12, iron or calcium deficiency, and chronic kidney disease. Some even think that there may be a risk of dementia badociated with PPIs.
These risks are low and are not proven conclusively, but if you use a PPI, you must take this into account. Americans spend $ 15 billion on drugs each year.
Can you treat LPR without pill? Recent research published in the Journal of the American Medical Association point the way, but a little bit of science first. Let's talk about pepsin, the main digestive enzyme in the stomach that breaks down proteins into polypeptides.
Reflux is thought to occur primarily by exposure of the laryngopharynx, the region located at the back of the throat, to an acidic environment in the presence of pepsin. It is pepsin which, with the acid, plays a key role in the damage of the back of the throat.
Pepsin is activated by amino acids in the stomach, which increases the secretion of gastrin and stimulates the production of pepsin by the vagal nerve. The typical American diet is rich in animal protein, over a third of our calories from animal products. Reduce them and you reduce the activity of pepsin.
An alkaline environment deactivates pepsin. Studies show that the exposure of pepsin to alkaline water of a pH greater than 9 l 'inactive.
Now let's move on to the study. The researchers took nearly 200 patients and asked them to clbadify their reflux symptoms early – without any intervention, but only in their normal diet.
They found that many patients had good control when they followed the first line suggestions that I mentioned above while drinking alkaline water throughout the day. But even better control came when they began to follow what I call the king of diets, the Mediterranean diet – which contains far less animal protein than the typical American diet of meat and potatoes.
My turn: Medications for reflux definitely have a place. They work for a lot of people. But this study shows that diet plays an important role. For those who do not want to take medication or whose symptoms are not controlled, these are important data. Try it and stay well.
This column provides general health information. Always consult your personal health care provider about concerns. Dr. Paster does not indicate or propose any permanent relationship with people who ask him questions. The opinions expressed by Dr. Paster in his columns are personal and are not intended to represent or reflect the views of SSM Health.
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