Could a Plant-Based Mediterranean-Style Diet help Acid Reflux?

A study has found that a plant-based Mediterranean-style diet could help people with acid reflux when paired with alkaline water. The diet was compared with the usual treatment for laryngopharyngeal reflux (LPR) which are a group of drugs known as proton pump inhibitors and standard reflux precautions. The study was published in JAMA Otolaryngology (Head and Neck Surgery) and the abstract can be read online.

Could a Plant-Based Mediterranean-Style Diet help Acid Reflux?

The study was based on a retrospective medical chart review of two cohorts of treatment for the disease. The first set of patients were identified from 2010 - 2012 and were treated with proton pump inhibitors and standard reflux precautions. 85 patients were identified for this review. The second batch of 99 patients were identified from 2013 - 2015. They were treated with alkaline water, which had a ph value under 8.0, with standard reflux precautions and with a plant-based Mediterranean-style diet. The scientists measured results using the Reflux Symptom Index.

Laryngopharyngeal reflux can also be known as the silent reflux, because it can be accompanied by no symptoms. It is caused by the ring of muscle or sphincter at the end of the oesophagus failing to work correctly. A healthy sphincter will keep stomach contents in the stomach, but a damaged muscle can cause stomach acid to pool into the back of the throat or pharynx, the voice box or larynx or into the back of the nasal airway. This can cause inflammation in areas that are not designed for gastric acid exposure. The disease can be common in infants because their oesophageal sphincters are immature, they are frequently lying down and they have a shorter oesophagus. 

There is a lack of research in the cause for adults. Symptoms for infants can include hoarseness, a chronic or backing cough, asthma symptoms, noisy breathing or apnea (pauses in breathing), problems gaining weight or problems feeding. Adult symptoms include heartburn, or a burning sensation at the back of the throat, however symptoms are less common than if they had gastro-oesophageal disease. They may also persistently clear their throat, or have a cough, hoarseness of the voice or a lump in their throat that persists despite swallowing. There may also be excess throat mucus, breathing or swallowing problems or a sore throat.

The study found that over 62% of patients, who were on the later study which treated them using alkaline water and a plant-based Mediterranean-style diet, had a six point reduction in their Reflux Symptom Index. This compared very favourably to just over 54% of patients, who were being treated with proton pump inhibitors. The scientists pointed out that although the research reviewed was focussing on the treatment of laryngopharyngeal reflux, their findings could also help patients who suffer from gastro-oesophageal acid reflux, as the results were statistically significant. The Mediterranean-style diet also carried other side effects such as weight loss for those patients who followed it.

One of the reasons that the scientists carried out the study, was the concern that the medication currently used to treat oesophageal problems have been linked with increased risk of stroke and heart attack, as well as the possibility of dementia and kidney damage. The plant-based Mediterranean-style diet excluded dairy and meat such as chicken, fish and eggs, and was mostly based on fruits, vegetables, nuts and grains. Standard reflux diet precautions were also recommended, including the avoidance of coffee, tea, fizzy drinks, chocolate, fried, spicy or fatty foods and alcohol.

Alkaline water contains a neutral ph value, but there are no studies which can prove its health benefits. Although data has indicated that consuming alkaline or ‘hard’ water can help to increase the alkalinity of the body, there is no proof that this is beneficial to everyone. People with a kidney condition or who are taking a medication to alter kidney function would not find this helpful, as some of the minerals could accumulate in the body.

Patients considering changing their diet are recommended to discuss this with their GP before doing so.

Craig H. Zalvan, Shirley Hu, Barbara Greenberg, Jan Geliebter. A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux. JAMA Otolaryngology–Head & Neck Surgery, 2017; DOI: 10.1001/jamaoto.2017.1454

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