- Filed under: Reflux
Confessions of a Refluxing Physician
As a physician, my patients with reflux never kept me up at night. It seemed like everyone had it (at least 1 in 5 US adults do), and the solution was to prescribe a proton pump inhibitor, let the GI docs handle the ones who didn’t get adequate relief, and the usual things I tell my patients – lose weight, stop smoking, cut down on your drinking. Surely, something in the fully-stocked, overflowing acid-blocker aisle at every pharmacy could help.
Because my patients’ reflux never kept me awake at night, I was never expecting my own reflux to start waking me up from a dead sleep! It started with an epigastric (below my sternum) burning that evolved into a feeling of menthol up my entire throat and into my ears. It wasn’t just uncomfortable; it was completely unsettling. Once I awoke from sleep to the pinching and burning in my gut, it took hours to regain enough sense of self to fall asleep again. I lost about 15 pounds, and I found myself suddenly sensitive to foods that were never a problem before. This made no sense to me — I didn’t smoke or drink, I wasn’t overweight, I wasn’t pregnant (as far as I knew…), and I ate a clean, (mostly) plants-based diet. What I thought was a minor inconvenience for my patients was a huge slice of humble pie for me. Never again would I think reflux was “no big deal because everyone has it.”
Following my own advice, I started with ranitidine, which falls into a class of histamine antagonists, one of the older treatments for reflux. These medications helped a bit, but I was worried about tachyphylaxis, the gradual inefficacy of the drug as the body adjusts to it. These medications seemed to help the “burning” and “acidic” feeling, but I was still getting a rush of fluid at night that would wake me up, what may have been nonerosive reflux.
My next step was a reluctant one; though I prescribe proton pump inhibitors and have so many patients who are prescribed them from other docs, I was also aware of the long list of complications ranging from bone fractures to chronic kidney disease, nutrient deficiencies, gastrointestinal malignancies, and bacterial overgrowth. I remember feeling very stressed about this — unchecked reflux disease can be a precursor to esophageal cancer and ulcers, yet the most popular class of medications is likewise associated with new issues that seemed to be in the news every week. One of my physician mentors, Dr. Lee Lipsenthal, died of esophageal cancer, which hung in the dark parts of my consciousness in an unsettling and existential place, while I lay awake at night thinking of how these new symptoms were robbing me of my sleep, time with my family, and possibly even days in my future.
After trying omeprazole, the prototype proton pump inhibitor, I was devastated when my symptoms worsened. Suddenly, I found myself with a feeling of something stuck in my throat (globus sensation), hoarseness in my voice, a need to clear my throat, and pressure in my ears. Though these accounts are well-represented in professional literature and in patient forums, my gastroenterologist said they didn’t make sense. For me, the proton pump inhibitors would be an unwelcome transition from gastroesophageal reflux (GERD) to full-blown laryngopharyngeal reflux (LPR), when the reflux causes irritation and damage to the much more sensitive tissue of the voicebox (larynx) and throat (pharynx). I learned that the proton pump inhibitors might have been reducing the overall volume of the fluid being refluxed (refluxate), thus concentrating the amount of pepsin, a digestive enzyme made by the stomach that digests proteins. What proteins was it digesting? The proteins in the cells of my throat and voicebox. Ouch!
Feeling totally helpless and discouraged, I did what any 21st century doctor would do: I went to the internet and read patient testimonials and joined several reflux forums on social media. I was surprised to find so many young, healthy people who were affected by reflux, both GERD and LPR. These were not the “typical” cases I learned about in medical school. There were countless athletes and performers, none of whom were overweight or had poor nutrition. I discovered the Acid Watcher Diet by Dr. Jonathan Aviv, overlapping with the work of Dr. Jamie Koufman. I found inspiration in one study from a high-quality journal that introduced diet and alkaline water, tried a bunch of different supplements (some of which made my symptoms much worse), and even imported a device from Sweden that had some evidence of improving lower esophageal sphincter (LES) tone – the muscular and pressure differential valve that is supposed to keep food in the stomach from moving back into the esophagus.
One class that stood out to me were the alginates, derived from kelp/brown seaweed. These natural molecules were demonstrated to inhibit pepsin (that enzyme from the stomach that I could feel digesting my throat) and have an efficacy similar to proton pump inhibitors without the side effects. In the forums, I could see that many in the United States were importing Gaviscon Advance from Europe, which contains alginates and is a totally different formula than the Gaviscon-named products sold in the United States, which are more typical antacids. Alginates are unique in the treatment of reflux because they condense to form a “raft” that blocks the acid from leaving the stomach and entering the esophagus. As someone who has a small hiatal hernia and perhaps a less-than perfect LES, this was of special interest. I ordered a bottle of Gaviscon Advance on Amazon and was pleased with the effect — I could sleep at night! However, I was concerned about the presence of parabens in the formula, as these common preservatives have been linked to endocrine disruption and adverse effects. Oh, and the “aniseed” flavor of the liquid was goopy and gross, and the tablets were just plain chalky. The product and process felt “unnatural,” and I didn’t like the idea of using this every night.
Timing must have been perfect, if there is such a thing as a perfect time to develop reflux symptoms. I met with my trusted laryngologist, Dr. Peter Belafsky. As the original author of the Reflux Symptom Index (RSI), the Director of the UC Davis Center for Voice and Swallowing, Professor in several university divisions, one of the kindest and humblest physicians and surgeons I know, and someone in whom I have total confidence, I couldn’t believe that he was working with a world-renowned chef from Napa on an alginate product — what would eventually become Reflux Gourmet.
Reflux Gourmet addresses a major need, as we have next to no commercially available, safe alginate products available in the United States. I may have been one of the first purchases when Reflux Gourmet was released on September 3, 2019. I was immediately blown away by the product, which came in a beautifully designed tube that opens easily and feels a bit like a shampoo bottle. Reflux Gourmet tastes great with a smooth and easy-to-swallow texture. The flavor – chocolate mint – contains no actual chocolate or mint and therefore is not estimated to be a trigger for reflux (it hasn’t been for me). It’s free of parabens, has just a handful of ingredients, and uses totally safe and water-soluble calcium pantothenate (vitamin B5) as a source of calcium ions to bind with the alginic acid to form the raft. I didn’t know this until I tried it, but the Calcium Carbonate in Gaviscon Advance (and the active ingredient in antacids like Tums) clumps, settles to the bottom over time, and reduces efficacy. I think this change in binding agent is a huge credit to the Reflux Gourmet team.
I’m only a few days into my trial, but this product has already moved to the top of my list after trying countless pharmaceuticals, home remedies, stretches, and more than my fair share of frustration, fear, and discomfort.
Thanks to the Reflux Gourmet team for providing a product that is going to change the lives of so many.
Jonathan Terry, DO, ABIHM, IFMCP
Diplomate of the American Board
of Psychiatry and Neurology