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Another study finding that diet (what one eats) can work just as well as medications for a health condition - this time for one form of acid reflux disease. The researchers found that a Mediterranean style diet worked just as well as, and actually worked better, than medications for laryngopharyngeal reflux (LPR). They think these beneficial results will also work for gastroesophageal reflux disease (GERD). The plant-based Mediterranean diet (lots of fruits, vegetables, legumes, whole grains, seeds, nuts, olive oil, more fish and less meat) in the study has lots of other health benefits, while common medications (proton pump inhibitors - PPI) for reflux have many side effects, including very serious ones with prolonged use (stroke, heart attack, dementia, kidney damage).

It must be noted that the Mediterranean style diet group was also told to drink alkaline water, and both groups were told to follow "standard reflux precautions" (no coffee, tea, chocolate, soda, greasy, fried, fatty and spicy foods, and alcohol). However, the researchers point out that " prior studies have demonstrated little clinical change in reflux incidence with these lifestyle approaches" - meaning both groups in this study were told to follow standard reflux precautions, even though prior studies showed there was no benefit in doing so. (So why did they have the people follow them?)

Many studies have found numerous health benefits from a Mediterranean style diet, but it is unclear whether alkaline water has any health benefits, and the only study the researchers mention about alkaline water and GERD was done in laboratory tests (on cells), rather than in humans - so we really don't know (need studies!). Perhaps only a Mediterranean style diet is sufficient to treat acid reflux disease? Bottom line: dietary changes work best, benefits occur quickly (within a few weeks), and have many health benefits - therefore try them first in treating reflux symptoms. From Medical Xpress:

Mediterranean-style diet may eliminate need for reflux medications

A plant-based, Mediterranean-style diet has been shown to provide the same medical benefits for treating laryngopharyngeal reflux as popular reflux medications. .... When compared to patients who took the traditional reflux medication, proton pump inhibitors (PPI), those patients who consumed a 90-95% whole food, plant-based, Mediterranean-style diet paired with alkaline water had the same if not better reduction in reflux symptoms. 62.6 percent of patients treated with a plant-based diet and alkaline water saw a six point reduction in their Reflux Symptom Index (RSI - a measurement for the severity of reflux symptoms), compared to 54.1 percent reduction in patients taking PPI's.

Though this research only focused on those with laryngopharyngeal reflux, this same diet regimen has implications to help patients with gastro-esophageal acid reflux (also known as GERD). Lead author of the study, Craig H. Zalvan, MD, FACS, chief of Otolaryngology and medical director of The Institute for Voice and Swallowing Disorders at Northwell Health's Phelps Hospital and researcher at the Feinstein Institute, said he was formerly one of the largest prescribers of PPI's in the region. Feeling that there had to be a better approach to treating reflux conditions like laryngopharyngeal reflux, he started to research alternatives. "Although effective in some patients, I felt medication couldn't be the only method to treat reflux and recent studies reporting increased rates of stroke and heart attack, dementia and kidney damage from prolonged PPI use made me more certain," said Dr. Zalvan. 

The diet suggested by Dr. Zalvan consists of mostly fruits, vegetables, grains and nuts with near complete cessation of dairy and meats including beef, chicken, fish, eggs and pork. This is in addition to standard reflux diet precautions like avoiding coffee, tea, chocolate, soda, greasy and fried food, spicy foods, fatty foods and alcohol. Along with relieving reflux symptoms, Dr. Zalvan noted that many of his patients who were treated with a plant-based diet also experienced some weight loss and a reduction of symptoms and medication use from other medical conditions like high blood pressure and high cholesterol. Dr. Zalvan said that a plant-based diet approach with alkaline water and standard reflux precautions should either be attempted prior to the use of medication or with the short-term use of medication for more severe needs. [Original study.]

 Uh oh - once again a drug taken for a common problem (heartburn) is linked to an unexpected negative health effect (higher risk of strokes). Millions of Americans take proton pump inhibitors  (PPIs) to treat acid reflux and heartburn. They are among the most prescribed drugs in the United States, are frequently taken for long periods of time, and are available over the counter. But according to preliminary research presented at a 2016 American Heart Association conference, these medications may also increase the risk of ischemic stroke. Ischemic strokes, which are the most common type of stroke, occur when a blood clot cuts off blood flow to the brain.

Earlier research has linked proton pump inhibitors to increased risk of dementia in older patients, disruption of gut microbes, increased risk of C. difficile infections, and kidney disease. Stomach acid seems to play a role in the normal balance of microbes in the digestive system. When someone takes PPIs it lowers their amount of stomach acid, and so disrupts the gut microbial community (and these changes last for at least a month after discontinuing the drug).

The research was conducted in Denmark among a quarter-million patients who suffered from stomach pain and indigestion, and were taking one of four PPIs: Prilosec, Protonix, Prevacid or Nexium. Overall, they found that ischemic stroke risk increased by 21% among patients who were taking a PPI. The researchers found either no increased risk or minimal increased risk of stroke when taking low doses of PPIs. But at the highest doses of PPIs, they found that stroke risk increased from 30% (Prevaacid) to a high of 94% (Protonix). Another group of medications used to treat heartburn - called H2 blockers - were not linked to increased stroke risk.

Hey, what this research suggests is that not everything should be treated with pills. Medical professionals agree: the safest and best way to reduce heartburn is by making some lifestyle changes. Eat smaller meals (and not right before bedtime), lose weight if needed, don't eat very fatty meals, drink less alcohol, and don't smoke. From EurekAlert:

Popular heartburn medication may increase ischemic stroke risk

A popular group of antacids known as proton pump inhibitors, or PPIs, used to reduce stomach acid and treat heartburn may increase the risk of ischemic stroke, according to preliminary research presented at the American Heart Association's Scientific Sessions 2016.

"PPIs have been associated with unhealthy vascular function, including heart attacks, kidney disease and dementia," said Thomas Sehested, M.D., study lead author and a researcher at the Danish Heart Foundation in Copenhagen, Denmark. "We wanted to see if PPIs also posed a risk for ischemic stroke, especially given their increasing use in the general population." Ischemic stroke, the most common type of stroke, is caused by clots blocking blood flow to or in the brain.

Researchers analyzed the records of 244,679 Danish patients, average age 57, who had an endoscopy -- a procedure used to identify the causes of stomach pain and indigestion. During nearly six years of follow up, 9,489 patients had an ischemic stroke for the first time in their lives. Researchers determined if the stroke occurred while patients were using 1 of 4 PPIs: omeprazole (Prilosec), pantoprazole (Protonix), lansoprazole (Prevacid) and esomeprazole (Nexium).

For ischemic stroke, researchers found:Overall stroke risk increased by 21 percent when patients were taking a PPI. At the lowest doses of the PPIs, there was slight or no increased stroke risk. At the highest dose for these 4 PPI's, stroke risk increased from 30 percent for lansoprazole (Prevacid) to 94 percent for pantoprazole (Protonix). There was no increased risk of stroke associated with another group of acid-reducing medications known as H2 blockers, which include famotidine (Pepcid) and ranitidine (Zantac).

Authors believe that their findings, along with previous studies, should encourage more cautious use of PPIs. Sehested noted that most PPIs in the United States are now available over the counter. Doctors prescribing PPIs, should carefully consider whether their use is warranted and for how long: "We know that from prior studies that a lot of individuals are using PPIs for a much longer time than indicated, which is especially true for elderly patients."