Findings point towards a dietary approach using alkaline water and a plant-based, Mediterranean-style diet as comparable to pharmacological regimens used to improve symptoms of a condition affecting around 10 - 20% of the Western population.
“Although effective in some patients, I felt medication couldn't be the only method to treat reflux," said study lead author, Dr Craig Zalvan, chief of Otolaryngology and medical director of The Institute for Voice and Swallowing Disorders at Northwell Health's Phelps Hospital in New York.
"I saw a lot of studies using plant-based diets to treat patients for many other chronic diseases, so I decided to develop a diet regimen to treat my laryngopharyngeal reflux patients. The results we found show we are heading in the right direction to treating reflux without medication."
Rich in bioactive compounds, vegetarian and vegan-based diets are a cost-effective, low-risk intervention that may contribute to lower body mass index, blood pressure and cholesterol levels.
Although there is an emphasis on meat and dairy, a Mediterranean diet has been held in high-esteem as an effective lifestyle choice that addresses risk factors contributing to obesity, diabetes and cardiovascular disease.
The study compared two groups totalling 184 individuals. One group consisted of 85 patients from 2010 to 2012 with Laryngopharyngeal reflux (LPR) that were treated with proton pump inhibition (PPI), the first-line method of treatment, and standard reflux precautions (PS).
From 2013 to 2015, 99 patients that were treated with alkaline water (pH higher than 8.0) were identified. These patients ate a 90% plant-based, Mediterranean-style diet, and standard reflux precautions (AMS).
Dr Zalvan’s diet consists of mostly fruits, vegetables, grains and nuts with avoidance of dairy and meats including beef, chicken, fish, eggs and pork.
Foods that aggravated acid reflux like coffee, tea, chocolate, soda, greasy and fried food, spicy foods, fatty foods and alcohol were also avoided.
The outcome was based on change in Reflux Symptom Index (RSI), a nine-item self-administered outcome questionnaire designed to document and rate (0-5) LPR symptoms and severity.
Results indicated patients achieving a clinically meaningful (over six points) reduction in RSI was 54.1% in PS-treated patients and 62.6% in AMS-treated patients. The mean reduction in RSI was 27.2% for the PS group and 39.8% in the AMS group.
‘A novel strategy’
"Dr. Zalvan's approach of challenging assumptions in treatment norms epitomises our view of medical research at the Feinstein Institute and Northwell Health," said Dr Kevin Tracey, president and CEO of the Feinstein Institute.
"We are committed to developing novel strategies to benefit our patients in a way that positively impacts medical practice globally."
Whilst proton pump inhibitors (PPI) are the most effective drug therapeutic approach for LPR, their use is not without disadvantages. Patients treated with PPIs often have a high rate of erosive lesion healing.
Dr Zalvan observed that some of his patients on a plant-based diet also experienced weight loss and a reduction of symptoms and medication use from other medical conditions like high blood pressure and high cholesterol.
He advised a plant-based diet approach with alkaline water and standard reflux precautions should either be carried out before the use of medication or with the short-term use of medication for more severe needs.
Source: JAMA Otolaryngol Head Neck Surgery
Published online ahead of print: doi:10.1001/jamaoto.2017.1454
“A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux.”
Authors: Craig Zalvan, Shirley Hu, Barbara Greenberg et al