Identify – Treat – Drop the Acid
Acid reflux is epidemic today, and it is the cause of esophageal cancer, which has become the fastest growing cancer in the United States. It has increased 850% since the 1970s!
Reflux affects 125 million Americans 22% with typical esophageal reflux, the symptoms of which are heartburn and indigestion, and another 18% with airway reflux, the symptoms of which are hoarseness, post-nasal drip, chronic cough, asthma, sinusitis, lump-in-the-throat sensation, and difficulty swallowing. Sometimes airway reflux is called “silent reflux” or “LPR” (laryngopharyngeal reflux).
Remember, our goal here is not just early detection of cancer, but rather cancer prevention. For this, there are three key steps for people with reflux symptoms: (1) esophageal screening to indentify those at risk for developing esophageal cancer (EC); (2) effective medical treatment; and (3) long-term, antireflux dietary (and lifestyle) modification, which means truly healthy eating—with the addition of a couple of supplementary esophageal superfoods. And yes, healthy eating appears to be the single most important factor in EC prevention.
STEP I: Esophageal Screening for People with Any/All Reflux Symptoms
It is important to note that people with airway reflux, even without any heartburn, are at equal risk to develop esophageal cancer and its precursor, Barrett’s esophagus. Indeed, today about 8% of people with reflux have Barrett’s. That converts to over ten (10) million people. All of these people need early screening examinations of the esophagus by transnasal esophagoscopy (TNE). TNE is quick, well-tolerated by people, and requires no sedation. It is done in the doctor’s office, and right after this kind of endoscopy, people can return to normal activity. And yes, it is as effective as sedated endoscopy (EGD) to diagnose trouble in the esophagus (www.TransnasalEsophagoscopy.com).
There may come a time when all adults should have routine TNE esophageal screening, but in the meanwhile, at present we recommend that all people with esophageal and airway reflux symptoms undergo TNE examinations. Then, people who are found to have Barrett’s esophagus (EC pre-cancer), pre-Barrett’s (an irregular Z-line), and esophagitis are all at risk for the development of EC; and therefore need to be on antireflux medication and learn about esophageal health. What does esophageal health mean? It’s a low-acid, low-fat, pH-balanced diet.
When we do a TNE, we may or may not perform a brush biopsy to get preliminary histologic information. If there is any question about the findings, the diagnosis, or the biopsy on TNE, we send the patient to a gastroenterologist for EGD with Seattle Protocol biopsy and potential ablation if in fact there is dysplasia, especially high-grade dysplasia. (See also, Save Money: Throw Out the Baby.)
STEP II: Effective Medical Treatment
For people who have airway reflux, we almost always recommend twice-daily (before breakfast and before the evening meal) PPIs (proton pump inhibitors), such as Prilosec, Protonix, and Nexium, as well as an H2-antaonist, such as Zantac, before bedtime. Sometimes this regimen is called “maximum” medical treatment. Meanwhile, we recommend this dosing for any patient with Barrett’s esophagus or an irregular Z-line (pre-Barrett’s).
The visual in the ads on television that show little acid pumps (in the stomach) giving up at the sight of a purple pill simply isn’t so. None of the acid-suppressive medications, regardless of dose, actually turns the acid off. At best, it cuts the acid in half. That is why we recommend the higher dose for really “at risk” people, at least at the beginning of the treatment program. The idea is to try and produce around the clock acid suppression. Most of the drugs that claim that once-daily is enough actually work well for about sixteen hours. What about the other eight? By the way, “beginning of the treatment program” usually means 6-12 months or until the tissue heals.
STEP III: Healthy Low-Acid Low-Fat Eating
It may come as a surprise to you, but what you eat may be eating you. Here’s the scoop. When you reflux, acid and pepsin (the powerful digestive enzyme of the stomach) comes up. When the pepsin attaches itself to your tissues (in your throat, esophagus, lung, etc.), then it’s off to the races. Pepsin is the cause of tissue damage. The clincher is that pepsin requires acid to activate it. In other words, without acid, pepsin can’t wreak its havoc.
In the last few years, we have discovered that acid in the foods and beverages that we consume causes most of the trouble. The single greatest risk factor for the development of reflux disease is the consumption of soft drinks. According to the American Beverage Association, in 2010 the average 12-29-year-old consumed 160 gallons of soft drinks; that is almost one-half gallon per day; and all are very acidic. BTW, I recently diagnosed Barrett’s in two 28-year-old heavy soda-drinkers. Barrett’s used to be a problem only seen in middle-aged people.
Does diet make a real difference? We are now seeing reversal (cure) of biopsy-proven Barrett’s esophagus in some of our patients. What does it take? (1) maximum antireflux treatment (all the meds); (2) a strict low-acid, low-fat, pH-balanced diet; (3) alkaline water (Evamor is the very best and is recommended); and (4) Manuka honey twice a day (after breakfast and before bed).
Our book is Dropping Acid: The Reflux Diet Cookbook & Cure. Our reflux diet is the healthiest, most sustainable diet in the world. It is like an extension of the healthy-heart diet that emphasizes the additional element of low-acid. This, we believe, is the key to esophageal health.
Next: The Four Phases of Dr. Koufman’s Low-Acid Barrett’s Diet