Dropping Acid: The Reflux Diet Cookbook & Cure | Blog

This blog is a companion to Dropping Acid and it allows us to continually publish new material.

Transitioning from the Induction Reflux Diet to Maintenance

In the few months since the publication of Dropping Acid: The Reflux Diet Cookbook & Cure, we have received hundreds of notes, inquiries, and questions about specifics. In my own medical practice, patients usually return to see me following the 2-3 week Reflux Induction Diet with big smiles, saying that they feel much better … asking, “now what?” Some patients think that you can go from the Reflux Induction Diet back to eating anything they want, anytime, but nothing can be further from the truth. Once you start down the road of self-monitoring and dietary self-maintenance for reflux disease, you will have to always be responsible for what, how much, and when you eat.

In reality, after a few months of thoughtful and planned analytic eating, it becomes second nature. For example, I always order sauces and dressings on the side; I always ask, “Is this baked, grilled, or steamed, but not fried?” It is marvelous that one can eat out without problems. In its most elemental form, the Reflux Maintenance Diet is a low-fat, low-acid (not no-fat, no-acid) diet, with an emphasis on using fats as flavorings and on pH balancing foods and beverages.

Remember to pH-Balance

Sometimes people are surprised that there are ingredients such as orange juice in some of our recipes. Let me assure that a few ounces of orange juice does not cause reflux, and that orange juice used as a flavoring in a recipe is not a problem. In other words, as an ingredient in a pH-balanced recipe, orange juice is just fine. Here is another example of pH balancing: I used to snack on raisins all the time. I would eat two or three little boxes of raisins at a sitting, but by themselves raisins are acidic and not good for someone who has acid reflux, particularly LPR. There is, however, no problem eating raisins in Raisin Bran cereal with milk (preferably low-fat milk) or in oatmeal. Why? Because of pH balancing … the milk will buffer the acidity of the raisins as will oatmeal.

So how do you go from Induction to Maintenance? Without question at the beginning of the transition, the worst-for-reflux foods still have to be completely avoided, including carbonated and other acidified beverages, all citrus, chocolate, and fried food. You may want to look again at the chapter “Notoriously Bad Reflux Foods” on pages 55-64 of the book. And for sure, late-night eating remains strictly off-limits.

Use Tasty Fats as Flavorings and Avoid Your Trigger Foods

What about a sautéed dish? How about grilled fish with a lemon-butter-caper sauce? What about a glass of wine or a cocktail? The answer to these questions is in moderation and with some vigilance. But the moderation is crucial. Have the fish dried on a paper towel, and the sauce served on the side. Put one tablespoon of acidic sauce on the fish max. For alcohol, it’s one beer, one glass of wine, or one cocktail, and not every day or not late in the evening. One glass of orange juice with Sunday morning brunch. One teaspoon of butter or cheese. Each of these things are permissible, particularly within the context of a generally low-acid, low-fat dish or meal. But all the while, you must self monitor. If every time you have wine, your throat burns, beware!

Here’s the thing – there is no hard and fast one-size-fits-all formula. Our book gives guidance, but your trigger (“idiosyncratic”) foods have to be identified by you. I have patient for whom even a small amount of tomato or wine causes problems. Unfortunately, a doctor alone can not identify your idiosyncratic foods for you. It takes a good deal of trial and error.

Another example of smart maintenance eating: I love eggs. I buy Jumbo eggs, because the yolk (the fat in eggs) is the same size in the different sized eggs. That’s why I get the Jumbo eggs, much more egg white. I make myself omelets with one whole egg and two eggs with the yolks discarded. My omelets taste as good to me as regular three-egg omelets.

Is Barrett’s Esophagus Curable?

About two years ago, a medical colleague called, “Jamie, I have Barrett’s Esophagus; what should I do?” That was before the book had been published, and he lived far away so I could not monitor his progress via examinations here in New York. For many people, the throat, which can be examined by an otolaryngologist, is an excellent barometer for reflux disease, and it can easily be examined in the office.

Barrett’s Esophagus is a pre-cursor to esophageal cancer, and is thought to be irreversible, but I have seen Barrett’s go away on our low-acid, low-fat diet. Make no mistake about, I encouraged him to take his PPIs (e.g., Nexium, Prilosec, Prevacid, Protonix, Zegerid, Aciphex) twice a day (30-60 minutes before breakfast and dinner) with a third pill, an H2-antagonist like Zantac or Pepcid just before bed with a sip of water. And here’s what I told him about his diet:

“My friend for one year this is it: No Carbonated beverages. No fruit except for melons and bananas. No alcohol, chocolate, or fried food, and nothing out of a bottle or can, except water. ‘Eat close to the ground.’ Grains, cereals, fish, poultry, and vegetables should be the mainstay of your diet.”

A year later, I saw my colleague at a medical convention. He eagerly took me aside and with a big smile announced, “Guess who’s Barrett’s is gone? …MINE!”

So, how do you go from Induction to Maintenance? Slowly. Take a look at the recipes in the book. Look at some of the things we substitute for bad reflux foods. Prosciutto, for example, is a great substitute for bacon and other high-fat meat products. I often get a single slice of prosciutto (less than a ¼” thick), trim the fat, and cube it fine to add to soups, salads, and sauces. Lemon zest is a great substitute for lemon. It has the entire flavor and none of the acidity. Ginger, capers, olives, sesame seeds, rosemary, cilantro, basil, and parmesan cheese are some of my favorite flavorings. These are used as flavorings.

Here are a few more reminders and tips. Don’t exercise after eating; exercise on an empty stomach or have some antacids like Gaviscon before, if exercising makes you reflux. Beef is okay once a week, but not every day, and lean cuts are preferred. Try not to combine fatty foods at the same meal. When eating something acidic think about pH balancing. Orange juice is not quite as acidic when consumed with oatmeal, pancakes, egg whites, etc. (all non-acidic foods). Generally, low-fat products should be selected when it comes to dairy products, e.g. milk, ice cream, yogurts, and snack foods as well. Remember, The Reflux Maintenance Diet is less concerned about sugar and salt as some other diets. Obviously, if you have diabetes or hypertension you may have to restrict sugar and salt.

Here are other examples of my personal “good reflux practices.” For breakfast, the three best choices are cereals, oatmeal, and whole-grain low-fat bakery products. And remembering the concept of pH balancing, it’s okay to have fruit in your muffins or with your cereal. Try to have a similar lunch everyday. I like a salad with chicken, turkey, shrimp, mushrooms, and other vegetables. For dinner, the best choices are fish, poultry, vegetables, grains, rice, and tubers … with sauces on the side. Limit the amount of bad fat – Remember fats are flavorings! Last night, for example, I ordered endive salad with blue cheese and asked for the blue cheese on the side. The piece of blue cheese that came with the salad looked like 4 ounces of cheese. I took one spoonful and sent the rest back to the kitchen, enjoying my endive salad very much. For many people, learning trigger foods, fat moderation, and dietary restraint takes time. But over the long haul, low-fat and low-acid eating is the potential cure for your reflux disease. If you already have our book, the ball is in your court.

Bon Appétit! Dr. Jamie Koufman

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37 Comments

  1. Thank you for posting this page. I am transitioning to the maintenance diet tomorrow, and this is helpful.

  2. We recommend that you continue to stay away from the really very acidic foods and beverages. You might consider taking soda pop (all carbonated and highly acidic beverages) and citrus fruit out of your diet for at least six months. Also, go slow adding back any known trigger foods, especially chocolate, tomatoes, onions, and garlic. In time, you’ll know what you can “get away with.” Meanwhile, late night eating is also still a big no-no. Good luck!

  3. I just ordered your book and could not be more excited. I have horrible acid reflux since I was 7 and have just lived with it for the past 20 years. Reading through this site, it feels like you are talking directly to me! I can’t wait to get started on this diet and start feeling better!

  4. Is the Induction Reflux Diet something that is covered in the book? I’m seeing this term used a lot but can’t seem to find a definition. My wife was diagnosed with acid reflux about six months ago and has been suffering with having a healthy relationship with food that tastes like cardboard so I’ve ordered your book to give her something to look foreward to.

  5. I have a couple of questions. My husband has silent reflux. He also has to watch his intake of sodium and Vitamin K (he’s on a blood thinner). Thus, using soy sauce for flavor is not an option.

    So, as I try to make something that tastes good but accommodates his various needs, I am confused about the ban on onions and garlic. The pH levels for most onions fall between 5 and 6. So does a banana.

    If he had some sort of trigger response to eating something on the list of idiosyncratic foods, we could figure things by trial and error. I understand how sauteing them in oil or butter can be a problem. I’d like to carmelize them and add small bits to season a sauce or use as a garnish.

    But if he has no symptoms to monitor and the onions are not even cooked, why could he not eat as many raw onions as bananas?

  6. Thank you for writing a very helpful and encouraging book!

    I cook fish and chicken in a combination of canola and olive oil in
    a pan on the stove. Am I sautaing or frying?

  7. Is there any noticeable difference to the addition of mild-mix coffee to maintenance diet, especially when some acid reflux symptoms no longer appear? I still want my coffee in the morning and during work hours if its possible of course.

  8. Hi, I’m on day two of the induction diet…so far, so good! I noticed in the article above, in the boldface quote, it says “…nothing out of a bottle or can, except water.” Is that true for the maintenance diet, or just the induction diet, or just for this specific patient?

    I’m wondering if canned tuna, for example, is OK on the maintenance diet, as when I read the label, it doesn’t seem to have any acidic additives. Also, in your cookbook, some of the recipes call for canned beans.

    Can you clarify please? Thanks so much!

  9. I have recently found out that I have GERD. I have been clearing my throat for about 3 yrs. Trying to do away with foods, drinks etc that I, at fist thought was part of the cause. I have been to 3 different Dr.s and all three told me it is GERD… until I recently read some of your comments and also ordered the Cookbood I had little hope. True, the medications I am on and the anticids have done little good.
    Now I am very excited after reading the articles in the cook book and have a new hope of getting some major relief of this throat clearing. I was very concerned re: developing throat cancer.
    Dr. Kaufman you have actually given me hope I did not have before.
    God bless you for you hard work and study re: this dreadful disease.

  10. Along with having a LPR I am also a diabetic. I have followed diet as closely as possible but I am not seeing any relief except for voice hoarseness not as severe. As a diabetic I cannot eat many of the foods on the induction diet. They are to high carbed….rice pasta mellons etc…. I am at a loss as to what to do. My blood glucose levels are elevated as it is because I am trying to balance the two totally different diets for each disease as it is. Please help me..I have the book on Dropping Acid by Dr. Kaufmann. It was helpful but it does not address the issue of how to eat if you have lpr and diabetes and there is no info on the web either. I can’t even find a restaurant to eat at that can cater to my health issues as far as eating goes. I am miserable and feel very isolated from friends and family since treating this condition. I want to feel half way decent and I try very hard to take care of myself but never seem to get relief. I am on prilosec 20 mg 2xd and a 150mg Zantac before bed. I also take a digestive enzyme with each meal. My stomach burns most of the time and I can feel the burn up my esophagus to the lump in my throat ( not as painful in the esophagus area as it was before meds). I still constantly have to clear my throat and the cough never ends. The only time I am not in discomfort is when I am asleep. Help Help Help!!!!!! I also have asthma by the way.

  11. I was diagnosed with acid reflux this past February. It seems like everything triggers it even water at times. I had an endoscopy which showed little irritation on the esophagus. Just last week, I went to an ENT; and, he checked my throat and vocal cords; and, noted that everything looks fine; but, there is a little irritation in the throat. I bought your book; and, I should be finishing the induction diet this Friday; however, I’m still having the constant post-nasal drip, clearing of the throat, and coughing. Should I consider staying on the induction diet for another week. Also, I know it must be a pain getting all these food questions; but, what spices are okay. I noticed in your book that the recipes use ginger, nutmeg, allspice, cumin, and coriander. Are these okay on the induction diet? Also, on your Q&A section of the blog, someone asked about paprika; and, it was indicated that it was okay?! I thought paprika was from peppers so I’m getting very confused. Are egg beaters okay? I’m sorry this is long; but, I’m so frustrated at this point. I feel this blog is a lifesaver because you know what I’m going through. Thank you for listening.

  12. I don’t know the acid content of chicory (perhaps someone else here does) but it makes a great coffee substitute. I sometimes pass my chicory through a filter with one teaspoon of ground coffee cup. The French drink a blend of 80% chicory to 20% coffee.

  13. As I have been researching acid-reflux on the web, I have come across many people who are using Apple Cider Vinegar to cure their symptoms. The idea behind using it is that we acually have too little acid in our stomach…obviously this does not fit with the Dropping Acid protocols…I am curious about your thoughts on this…..thanks for your insights.

  14. The book does not recommend Apple Cider Vinegar as a remedy. I can’t remember the exact wording but ACV affects the flap. Buy the book, the amount of information is wonderful.

  15. Did you ever get an answer to whether canned tuna (or salmon) is OK when there aren’t any other ingredients listed i.e. American tuna from Whole Foods Market

  16. I do was wondering about the use of apple cider vinegar. How do you know if the cause is too much or too little acid?

  17. Coffee is often a trigger food, but some people find they can introduce a small amount back into their diet.

  18. The idea that apple cider vinegar can cure reflux is a myth, and is not supported by scientific or medical research. Apple cider vinegar is very acidic and is likely to make your reflux symptoms worse if consumed straight.

  19. Canned tuna, as long as it contains no acid, is a good food for people who suffer from reflux.

  20. Chicory is a reflux friendly food, so this method could be a great way to make coffee less of a trigger. Nonetheless, we still recommend drinking any beverage containing coffee in moderation.

  21. The line between “Sautéing” and “frying” is pretty thin, but typically if something calls to be sautéed it needs less oil. For those who suffer from reflux, it’s best to use just enough oil to cover the pan.

  22. Dear Doctors,

    I love your book. It’s a life saver. Not even the gastroenterologist helped me find what foods were o.k. and which were forbidden. God Bless you both! I have been having shortness of breath associated with my reflux. I take two meds., one in a.m. and Zantac at night. My doctor said I’m getting small amounts of acid in my lungs.

  23. Dear Dr. Koufman, thanks a lot for all the new hope you bring to our lives! I’ve heard that lemon, although an acid fruit, becomes alkaline when it hits the stomach. So, taking water with lemon juice in the morning (20 minutes before breakfast) helps to prevent reflux. Is this true? Thanks a lot,

  24. This is not true, lemon does not become alkaline in the stomach. It will only make the stomach more acidic.

  25. Hiya
    Am 10 days into the induction diet and wondering if you can post a chicken stock recipe?

    Also, I’m having problems managing to include enough iron & calcium in my diet (although a few chicken livers & fortified cereal are helping with the iron). Is this ok for a couple of weeks?

    Do you have any recommendations for good high-calcium foods? I’m not a milk drinker, though I’m managing a bit in my oatmeal.

  26. Dear Doctors,

    I have just purchased your book and I must say among all the books I have read it is the one I like the most.
    I was wondering about the ph of papaya?
    Can we eat papaya after the 2 weeks induction period?
    Also what about probiotics? Do they increase acidity in the stomach?
    Thank you

  27. We’re glad you’re happy with the book. Papaya is OK in moderation during the maintenance phase, but should be avoided during the induction phase. As far as probiotics go, we have not seen significant data to show that they affect reflux.

  28. Any low-fat sock recipe is good for people with reflux. If you are eating plenty of leafy greens, you shouldn’t have a problem with iron or calcium deficiencies. Include broccoli, kale and spinach in your diet. Iron and calcium are also found in beans.

  29. Yes, the Induction Diet is laid out in the book. It is a stricter diet that is only intended to be followed for about two weeks.

  30. Got the book. Hope to start soon. I just have a couple of questions if anyone is able to answer. Is red meat ok to have as often as youd like on the induction diet as long as the meat is very lean? I make a meat loaf out of 93% ground beef, oatmeal, zuchinni, green beans, and carrots. These ingredients really make the meat much more moist. The beef is only 8g of fat for every 4 oz. Is this ok? How many grams of fat does one want to stay under while under the induction diet? Is it ok to have 1/4 of an avocado for breakfast with egg whites?…i think thats only about 6-8 grams of fat and can substitute for the 2 tbsp of olive oil allowed during induction.

  31. Could anyone tell me if it’s okay to drink decaf coffee, and if so, how much?

  32. Love your book. It has helped and I keep it nearby to refer to it everyday.

  33. A cup of coffee per day is fine once you reach the maintenance phase.

  34. I am a 67 yr old male. Have had excess sinus drainage, phlegm and constant clearing of throat and upper chest FOREVER. For some years now I have been taking 2 Omeprazole/day which controls my obvious GERD. ENT says I have LPR so I bought the book and have followed the Induction Diet for two weeks. Feel little difference. Still get excess phlegm with difficulty clearing after nearly every meal and it stays with me into bedtime. Should I see some symtomatic relief at this point?
    Other questions? Is there a broader list of pH levels than those in the book? How about deer meat (low fat)? My wife and I eat mostly canned vegetables for convenience and to avoid waste. Is this something I need to stop? Can I transition to maintenance diet or should I wait until my symptoms subside? I remain hopeful, but a bit skeptical. Thank you for your efforts.

  35. We really recommend that you stay away from beef and avocados during the Induction Phase, but these things are OK in moderation once you reach the Maintenance Phase. However, even lean beef takes the stomach a very long time to digest, so if you reflux at night (as most of our patients do) it’s best to stay away from it at dinner time.

  36. Hi Ken,

    We would recommend that you stay on the Induction Diet for four weeks if you are not feeling any relief from your symptoms before transitioning to the Maintenance diet. Some patients do recover very slowly, for some the process takes over a year.
    We are working on an app that will provide patients with a more comprehensive list of foods, but until it’s available, we’re doing our best to answer all your questions here. Unfortunately, most canned vegetables contain added acid, so if you wish to continue eating these you will have to do some serious label-reading to avoid citric acid, ascorbic acid, ect. Once you reach the Maintenance Phase, deer meat and venison is OK in moderation, but it’s probably better to avoid it at dinner.

  37. We steer clear of onions in our recipes because it is such a common trigger, but if they don’t bother your husband then feel free to cook with them.

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