This article was written by Jonathan E. Aviv, MD FACS, Clinical Director, Voice and Swallowing Center, ENT and Allergy Associates LLP, Clinical Professor of Otolaryngology, Icahn School of Medicine Mount Sinai.
Dr. Aviv has long been established as an authority on the forefront of the fight against reflux. Never one to shy away from any avenue that may provide relief to those who suffer, his newest endeavor, The Acid Watcher Diet: A 28-Day Reflux Prevention And Healing Program, is an elegant exploration of how diet can drastically impact reflux and recovery.
On October 13, 2022 at the JCC Manhattan, Dr. Jonathan E. Aviv and his co-author, Samara Aviv, MA, are giving an in-person presentation (there is a virtual option as well to participate!): “Use Food, Not Medicine, to Prevent and Heal Acid Reflux”
Follow this link to register and take advantage of the opportunity to learn more with the authors themselves: http://bit.ly/AvivJCCfood4GERD
Acid Neutralization Through Diet
Let us begin with some basic facts about acid reflux and the Acid Watcher Diet. We are all quite familiar with the concept of acid reflux, that is, acidic material coming up from the stomach causing the equivalent of an acid “burn” as the acidic material works its way up from the stomach into the esophagus, throat, and mouth.
However, what very few seem to pay attention to, but what “Acid Watchers” pays a great deal of attention to, is the undeniable fact of the damage caused to the mouth, throat, sinuses, and esophagus by the acidity of what one eats and drinks – thus, not acid reflux, but acid INFLUX.
The reason why acid ingestion should have greater attention paid to it has to do with two relatively recent discoveries:
- Pepsin in the upper aerodigestive tract.
- Body-wide inflammation that results from acid injury in the head and neck.
The Pepsin Story
Pepsin is an enzyme located in the stomach which breaks down food when it gets activated. Pepsin gets maximally activated below a pH of 4. However, pepsin can float out of the stomach and sit, not activated, in the entire upper aerodigestive tract. When acidic substances then enter the body via the mouth, pepsin gets activated causing an inflammatory response; simply put, what you eat starts eating you.
Thankfully, very few foods are extremely acidic (defined as having a pH less than 4). There are six foods that fall into this category; two are unhealthy and four are healthy, what I call “the dirty half dozen.”
The two unhealthy foods are flavored sodas and bottled ice teas. The general rule of thumb is that if it is flavored, it is acidic and less than pH 4. Sugary or diet sodas have no discernable health benefits and so should be avoided by anyone conscious of their health, let alone people with acid reflux disease.
The four healthy foods with a pH less than 4 are: citrus – lemon, lime, orange, grapefruit, and pineapple (such as those found in juices, fruits, and dressing), tomato sauce (not raw tomato), vinegar, and wine.
Raw tomatoes are generally okay as they are typically between pH 4 and pH 5. It is the tomato sauce that is the problem since it is generally acidified when it is canned or bottled. Vinegar, including the popular apple cider vinegar, is extremely acidic. Wine is the most acidic alcoholic beverage.
All told, these very acidic “dirty half dozen” are to be avoided when preventing or treating those with acid-related injury to the head and neck.
The Body-Wide Inflammatory Response Story
In 2016, it was shown that acid injury doesn’t just initiate a local inflammatory response where the acid comes in contact with tissues, it also initiates a body-wide inflammatory response. Not only will one actually be able to visualize irritation of the throat, sinuses and esophagus, there will also be systemic inflammatory effects as well.
What I have seen clinically is that my patients with autoimmune diseases such as irritable bowel syndrome, Crohn’s disease, psoriasis, fibromyalgia, and rheumatoid arthritis have commented that their symptoms improved while they avoided foods with a pH less 4, along with reduced requirements for anti-inflammatory medications such as steroids and other anti-inflammatory drugs.
A diet-based approach to acid-related disease is therefore likely to extend far beyond the elimination of one’s reflux symptoms and could ultimately translate to improved quality of life from many diseases of inflammation that plague so many people today.
A Food Based Solution
Working with my spouse, the talented Samara Aviv, we figured out that we can neutralize the acidity of various foods by adding relatively alkaline foods. Thus, effectively neutralizing acid influx.