Sometimes the Best “Prescription” is a Supplement

 

Ten or fifteen years ago, if someone had told me that I would be writing fewer prescriptions than ever before and having greater success in managing chronic conditions, I would be skeptical if not incredulous. But I will admit that I have undergone significant changes in my practice patterns as my career has progressed and I have learned to individualize care for each patient in a manner that is effective, cost-sensitive, and acceptable to patients. 

 

I have had the pleasure of medical school, otolaryngology (ear, nose, throat, head and neck surgery) residency, and complex otolaryngology fellowship training in 3 of the 4 corners of the continent, as well as completing a Master of Public Health through a university in the UK. I have served as a pediatric ENT attending at a preeminent institution in the south and have transitioned to private practice in California. All of this to say, I have treated a variety of patients around the continent and have become attuned to a reality: Patients may not want to commit to making big changes in diet or activity, and they may accept a prescription, but they want to avoid costly, cumbersome, risky or mandated daily medications.

 

One condition that all otolaryngologists learn about in their training is “reflux.” While most non-clinicians equate reflux to the classic gastroesophageal symptoms, or GERD, with heartburn and indigestion being typical symptoms, ENT doctors learn about laryngopharyngeal reflux, or LPRD, where patients may not have any typical GERD issues but may suffer from sore throat, throat-clearing, hoarseness, postnasal drip, or a perception of something stuck in the throat known as globus. We are taught that typical medicines like Tums or Rolaids won’t treat this and that H2-blocking medicines, like famotidine, aren’t sufficient. We are instructed that often the “stronger” proton pump inhibitors (PPIs) are needed to manage LPRD.  Some patients are prescribed PPIs for months or years or indefinitely – and can’t come off the medicine because of rebound symptoms when the medicine is abruptly stopped. There are also many concerns about the long-term use of such medicines, such as impacting calcium absorption and the patient’s bone strength.  

 

While trying to find methods to help patients avoid draconian and impractical dietary restrictions in reflux (ANY vice you can think of can lead to increased reflux, including caffeine, alcohol, spicy food, fatty food, and even dairy), I happened upon information about an alternative to manage reflux that didn’t involve medicines to block acid production or overly restrictive diets. Learning about what alginate products could do for reflux sufferers with minimal side effects was exciting, but it seemed like most products would have to be purchased from overseas or have unpalatable flavors like anise or overwhelming mint. I read articles about the benefits of alginate products in infants with reflux issues and was intrigued – imagine a way to manage reflux in the most vulnerable population without the adverse effects seen in traditional medical options. Enter alginate therapy. After hearing about this approach, I was very curious. A seaweed derivative that is a physical blocker of acid, usable for all ages, with minimal side effects? I wanted to learn more. 

 

Over the past couple of years, along with sensible but not overly restrictive dietary changes, I have used alginate therapy in patients of all ages, from infants to senior citizens, with remarkable success. It has helped to manage everything from typical postprandial heartburn to chronic throat clearing, decreasing reflux in infants with laryngomalacia or recurrent croup, managing annoying coughs in school-age children, and being a lifeline for pregnant patients suffering from severe reflux. 

 

Due to its development by physicians, all-natural formula, and yes, the taste (I do see lots of pediatric patients!), I recommend Reflux Gourmet’s products. Because I want my patients to start as soon as possible, I keep a stock in my clinic. The “proof” of success, in my mind, is how often patients will return to my clinic to request more of the product for their own parents, or spouses, or friends. We have a hard time keeping Reflux Gourmet around because patients want to share it with others they know. That is incredibly rare and incredibly special – patients don’t just drop by clinics for products, in my experience.  

 

Until I started to offer alginate therapy, my number one most common prescription was a PPI. Now, I prescribe that class of medicine once a week at most. Alginate therapy, along with some dietary changes like limiting dairy, avoidance of alcohol or eating before bed, and possibly cutting back on afternoon caffeine, has made all the difference. It gets people off the PPIs or prevents them from starting them, and it can serve as a daily supplement or an as-needed option for situational reflux. I am grateful that this option exists and can offer my patients safer alternatives than what I was taught to prescribe. I love that a supplement has supplanted prescriptions to manage one of the most common conditions otolaryngologists encounter in my practice, and hope that my colleagues will increasingly recognize alginate therapy as a viable option for their patients as well.