All – 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. Tue, 16 Aug 2016 22:42:33 +0000 en-US hourly 1 Exciting New Book Sun, 27 Sep 2015 17:42:03 +0000 DrKoufmansAcidRefluxDiet300dpi

New Book — Order Now!

ACID REFLUX? Beware of Bottles and Cans Sun, 22 Jan 2012 22:36:18 +0000

Things are not always what they seem.  If you have acid reflux, there probably is a nasty stomach enzyme, called PEPSIN, attached to your throat, esophagus (swallowing tube), and possibly even to your vocal cords, sinuses, and lungs. This powerful digestive enzyme is the actual cause of tissue damage, but the confusion in “acid” reflux comes from the fact that pepsin requires acid for its activation.

When there is no acid around, the pepsin just waits. But when you drink or eat something acidic, the pepsin springs back into action, and starts digesting your throat, esophagus, etc. That’s right, what you eat may be eating you. The biggest risk factor for reflux in our experience is soda pop, carbonated beverages.

More acidic than stomach acid, these 5 are the most acidic carbonated beverages at pH 2.4-2.5

If you have acid reflux, particularly if you have “airway reflux” or “silent reflux,” you should never drink these acid bombs. BTW, people with airway reflux have hoarseness, chronic cough, trouble with food getting stuck, choking episodes, shortness of breath, asthma, and sinusitis. AND you can have those symptoms from acid reflux without knowing it, because sometimes acid reflux occurs without indigestion or heartburn!  This may be because it happens at night while you sleep of just in small amounts during the day. Silent reflux is often associated with breathing problems.

Carbonated beverages are bad for you for many reasons, but the acidity is the most damaging for many reflux sufferers.  The pH scale is tricky, because lower numbers are more acidic. pH 7 is neutral, that is not acidic at all. Stomach acid is usually pH 1-4. Here’s a surprise though, pH 3 is ten times more acidic than pH 4, and pH 2 is ten times more acidic than pH 3. Thus, pH 2 is 100 times more acidic than pH 4 … and that’s the pH level of stomach acid. Coke and Pepsi (shown here) are pH 2.4-2.5


JUST AS BAD: Five Worst non-sodas, with the same pH as Coke and Pepsi, pH 2.4-2.5.

Today, almost every bottled and canned beverage today is acidic. That is the law !!??!! See The Missing Link post. Since 1973, the FDA (Food and Drug Administration) has mandated that acid be put in almost everything bottled and canned to kill bacteria and prolong shelf life.

Unintended consequences” …. REALLY! This acid in all of our beverages is a big factor in the reflux epidemic.  It is one of the biggest causes. We recommend that the acidity (pH) of everything be placed on the nutritional label in the future … like soon. Here are some beverages that you probably think are healthy. Guess again, all have a pH of 2.9, that is, less than three!

These five drinks are also very, very acidic, that is pH 2.9 -- AVOID THEM!

Incidentally, why do young people have acid reflux, too these days? The average 12-29-year-old drank 160 gallons of soft drinks last year; that’s almost a half-gallon a day!

And the “common beverage bad news” just keeps on coming; energy drinks like Gatorade are the same … acid, acid, acid. If you have reflux, you are going to have to think about what you drink. The nutritional label will tell you if there is acid inside . Look for ascorbic, acetic, and citric acids; those are the big three. For some alternatives, see Water Water Everywhere But Nothing Left to Drink.  BTW, we drink alkaline water. Good Luck!

]]> 78 Think Heartburn Means Acid Reflux? Think Again! Tue, 10 Jan 2012 00:53:55 +0000

Columbus of Columbus Circle and the Time-Warner Building

This  website, that goes along with our book: DROPPING ACID: The Reflux Diet Cookbook & Cure, has  a poll.  After a year, almost 9,000 people have responded, and the results are surprising.

THINK YOU MIGHT HAVE REFLUX? Which symptom(s) do you have?

Percent             Votes

Post-nasal drip                                                    14.1%              1,231
Chronic throat clearing                                    14.1%              1,212
Hoarseness                                                           12.1%             1,039
Sensation of a lump in the throat                13.0%             1,119
Heartburn                                                              11.2%                969
Sore throat                                                            11.1%                957
Chronic cough                                                       9.0%                 779
Difficulty Swallowing                                         8.3%                 717
Choking episodes                                                7.0%                 599

Total Votes: 8,822  as of January 9, 2012

Heartburn (chest pain after eating) may not be the most common symptom of acid reflux. We polled thousands of people on this website and found that postnasal drip, chronic throat clearing, hoarseness, and a lump-in-the-throat sensation scored higher than heartburn. We now recognize that airway reflux (involving the nose, throat, sinuses, and lungs) may be more important than esophageal reflux, so-called GERD. The symptoms? See above  … AIRWAY REFLUX WINS!

P.S. If you want to vote, go ahead; the poll is right over here →

]]> 32
New York Times article about Dr. Jamie Koufman’s Low-Acid Diet treatment For Acid Reflux Wed, 09 Nov 2011 11:40:35 +0000

]]> 5
Aloe Vera Is Super Thu, 21 Jul 2011 03:08:03 +0000 Dropping Acid: The Reflux Diet Cookbook & Cure

Known to the Egyptians 6,000 years ago as “the plant of immortality,” the aloe vera plant is again gaining a place of distinction amongst health conscious people, and not just as a topical gel to treat wounds, skin infections, burns and other skin conditions.1-4 More and more this plant’s spiky leaves can be found popping up among the other mixed greens at local markets and health food stores. A properly prepared inch or half-inch section of aloe vera (see below) can be added to juices,  salads, soups, etc. We can attest that it is good for reflux and it is great in our smoothie.

Aloe vera is used for the treatment of reflux and heartburn. In addition, proponents of culinary aloe claim that it has benefits as a natural antibiotic and for the treatment of ulcers, irritable bowel, diabetes, kidney disease, and bladder problems.1,3 Scientific research has yet to refute or substantiate those claims.2 There are some preliminary research studies that suggest that aloe may lower blood glucose in diabetic patients and reduce blood lipid levels in patients with hyperlipidaemia.4 Yes, more research is needed, but it looks like aloe vera may be a very beneficial “superfood.”

  1. Aloe Vera Not Just for Sunburns The Food Channel Online.  Retrieved 2010-2-17.
  2. Eshun Kojo, Quian He. Aloe Vera: A Valuable Ingredient for the Food, Pharmaceutical and Cosmetic Industries—A Review. Critical Reviews in Food Science and Nutrition, Volume 44, Number 2, March-April 2004, pp. 91-96(6).
  3. Root, Jessica.   Forty Amazing New Uses for Aloe Vera. Planet Green: Discovery Online.   Retrieved 2010-2-17.
  4. Vogler BK, Ernst E. Aloe Vera: A Systematic Review of its Clinical Effectiveness. British Journal of General Practice 1999;49:823-828.

Aloe has a beautiful glistening texture and appearance.

It is easy to handle, is relatively tasteless, but makes a great thickener.

It isn't all that pretty when you remove it from its green covering.

Recipe: Silky Pear Smoothie with Aloe Vera


2 pears (peeled, cored, seeds removed and diced
2 tbsp brown sugar
½ tsp ginger
2 Tbsp aloe (cut in half a leaf of aloe and scrape the rich clear cream from leaf)
1 cup of yogurt
1 cup of ice

In a blender, place the pears, sugar, ginger, aloe, yogurt and ice.
Blend until it becomes smooth.

They grow 'em big on the Upper West Side!

Photos by Jamie Koufman

]]> 58
It’s Manuka, Honey! Thu, 02 Jun 2011 23:10:17 +0000

Manuka Honey May Be a Great New Superfood for Reflux Sufferers

Manuka honey may be the next great food for reflux sufferers. Manuka is a mono-flower honey that comes primarily from New Zealand. Because the bees feed solely on the uncultivated Manuka bush, Leptospermum scoparium,1 also called the “tea tree,” the honey has a unique taste. Indeed, the popular name, “tea tree,” reportedly came about because Captain Cook used the leaves to make “tea.”1 We find that less than a teaspoon of the honey in a cup of hot water makes an absolutely delicious drink, loaded with exceptional flavor, which tastes rather like sweet tea.

These days, there is a lot of internet buzz about Manuka honey suggesting that it has real medicinal properties, that is, that it can cure many medical conditions and ailments. The benefits of Manuka are just beginning to be understood by modern science. But what is being discovered is good news for refluxers. Many New Zealanders have believed for centuries that Manuka is good for dyspepsia (indigestion from acid reflux) and for other digestive problems as well.

Here are the purported benefits of Manuka honey: It is an effective treatment for skin infections, burns, throat infections, gastrointestinal infections, and acid reflux.1-4 As Professor Peter Molan of University of Waikato’s Honey Research Unit has reported, Manuka honey is superior or equal to conventional treatments in managing burn wounds, skin ulcers, and Fournier’s gangrene.3 In addition, Manuka honey has been shown to eradicate H. pylori, the bacteria responsible for most stomach ulcers.2,4

One website that sells Manuka honey claims that it is good for many disorders of the aero-digestive tract, including, “sore throat, cough, sinus infection, the flu, canker sores, fever blisters, acid reflux, esophagitis, GERD, heartburn, upset stomach, peptic ulcer, gastritis, diverticulitis, and irritable bowel syndrome.

What Makes Manuka Honey Special?

All honeys have some antibacterial activity due to the hydrogen peroxide formed by breaking down the enzyme glucose oxidase, but the potency of this antibacterial activity can fluctuate up to 100-fold and varies upon the honey’s floral source.2,4 Researchers at the University of Waikato believe that what makes Manuka honey special is the presence of a stable, non-peroxide type of antibacterial activity.4 Whereas the enzyme that produces hydrogen peroxide in all honey is unstable (it is destroyed when the honey is exposed to heat and light), the non-peroxide antibacterial activity of Manuka honey is unaffected by heat, light, and storage.3 What this means is that Manuka honey’s healing qualities can be bottled, preserved, and shipped around the world when other honeys would lose this antibacterial strength.

In addition, University of Waikato’s Honey Research Unit reports that the enzyme in most honeys that produces hydrogen peroxide is inactive in the acidity of the stomach while the non-peroxide antibacterial agent in Manuka Honey remains active.1,3 For this reason, Manuka honey is suspected to be affective at inhibiting the bacteria Helicobacter pylori.1

To ensure product quality, we recommend to purchasing only Certified Organic Active Manuka Honey. There is honey being sold as Manuka honey without a measurable amount of non-peroxide antibacterial activity. This is likely because it is produced from non-Manuka nectar sources.3 We purchase Premium Organic Manuka Honey from The Wild Bee. While at first blush, this looks very expensive ($35/bottle), the bottle contains 500 grams of honey or about 225 servings for honey tea — at a cost of about 16 cents per cup.

Manuka Honey for Acid Reflux

We believe that Manuka may be great for reflux sufferers. It may also potentially help heal Barrett’s esophagus. Some of our patients have reported improved stomach and reflux symptoms after eating the honey or drinking it in hot water as tea. For our patients who can afford it, we presently recommend a — half-teaspoon of Manuka honey — cup of the “honey tea” after the evening meal. In the future, especially for reflux patients with Barrett’s, we may recommend Manuka after each meal. Based upon what is now known, it is possible that this honey as an adjunctive reflux treatment might make a big difference.


1. Leptospermum scoparium. Wikipedia.

2. Al Somai N, Coley K E, Molan P C, Hancock BM.  Susceptibility of Helicobacter pylori to the Antibacterial Activity of Manuka Honey. J. Royal Soc. Med. 87: 9-12, 1994.

3. Molan, PC. Manuka Honey as a Medicine. Global Bioactives Summit. Hamilton, New Zealand. July 2001.

4. “What’s Special about Manuka honey?” Waikato Honey Research Unit. Department of Biological Sciences University of Waikato. Published: 9-3-2009. Retrieved: 4-11-11

]]> 31 The Good Egg: Omelets for Acid Reflux Sun, 01 May 2011 19:11:59 +0000

Good ‘ole (chicken) eggs. I love them. They’re a delicacy and there are a lot of different things that a creative cook can do with eggs for the refluxer. Meanwhile, if you exclude the small, but high-fat yolks, what’s left are egg whites, one of the best sources of protein. But alas, egg whites aren’t as tasty as whole eggs. What to do?

By the way, there is not all that much fat (about 5 grams) in a yummy egg yolk. And eggs are pretty well tolerated by most people with reflux. It’s often the eggs’ partners in breakfast crime – butter, bacon, sausage, hash browns – that cause problems. So what’s an egg lover to do?  I’ll address that in a moment.

Jumbo eggs have a lot more egg white than "large" or "extra large" eggs.

Note: Eggs come in different sizes, large, extra large, and jumbo. Assuming that they are about the same price as all the others, buy the jumbo eggs. Here’s why. The yolks are very close to the same size in all of the different size eggs. So when you purchase jumbo eggs, you are getting a lot of extra egg white for free.

Jumbo and "large" eggs have about the same size yolks.

Getting back to the idea of the versatility of eggs, they keep well in the refrigerator for weeks; and egg dishes are a great time-saving dish, as eggs can cook very quickly; and, they are good both cold and hot. With a couple of admonitions and tricks, this author believes that eggs are a great food for people on a reflux diet. Mind you, this is for people on the Maintenance Reflux Diet, not the Induction (“detox”) Diet.

How to Make a Reflux Friendly Omelet

Start with three jumbo eggs. You will throw away two of the three yolks, using one yolk. This won’t significantly compromise the favor of the omelet, but it does improve the flavor over the traditional-for-reflux egg white omelet. One yolk make a delicious, good-for-the-refluxer, low-fat (not no-fat) breakfast item. In other words, your omelet can be made with all egg whites, but it isn’t as tasty. This is an example of low-fat-not-no-fat cooking with the Dropping Acid: The Reflux Diet Cookbook & Cure.

Get everything ready and close-by before you start.

Here are the ingredients and technique for making a great three-egg omelet: I set out everything I need in about three seconds, and you should too before starting to cook. You’ll need: (1) a non-sick omelet pan, (2) plastic spatula, (3) regular dinner fork, (4) paper towels, (5) a paper plate or two, (6) salt, and (7) Pam spray all within an arm’s reach of your stove  top. (I have a great pot rack that I love; about everything I need to cook is up there.) And don’t forget a preferred omelet filling. I saved a little bit of lobster salad from my dinner last night for my Sunday morning omelet, today … yum. You don’t need much more than a couple of tablespoons of filling for an individual omelet.

To start, turn the heat on medium-high, and then when the pan is hot, spray with the Pam. Alternately, you can use a small amount (1/2 tsp.) of butter. The 3 jumbo eggs are on a paper plate with the knife and spatula. Over the heated pan, strike the top of each egg sharply with the knife so that there are no fragments of shell; then, separate the egg yolks and throw two of them away, on the paper plate. Chef Bauer shows how to separate egg yolks on YouTube.

When you’ve got all three eggs (with the one yolk) in the pan cooking, lightly scramble with a fork. Cook the eggs most of the way through, adding some salt to taste, and then add the omelet filling. Lastly,.

fold the omelet; let it brown on one side; then, flip and serve. You may want to make one omelet like this for each person whom you are serving. My lobster omelet was so good that my kitten wanted some.

]]> 17 Water Water Everywhere, But Nothing Left to Drink Tue, 29 Mar 2011 19:50:16 +0000

Over the past decade, specialty drinks such as enhanced teas, exotic juices, flavored waters, “superfood,” probiotic and sports drinks, have become popular alternatives to traditional carbonated soft drinks.. Unfortunately, most of these new beverages are just as acidic; and thus, just as unsuitable for refluxers as their predecessors. This is not good news. So what can a refluxer drink?

We hope that readers of Dropping Acid: The Reflux Diet Cookbook and Cure (and of this blog) already know that soft drinks (all carbonated beverages), bottled or not, are bad for reflux and most every other bottled thing is NOT okay either. It is the acid that is added to kill pathogenic bacteria and prolong shelf-life.

So, what can a refluxer drink? Our first advice is to read labels carefully and avoid the acids. If you’re going to control your reflux, you are going to have to learn to read labels and look out for ascorbic acid, acetic acid, citric acid, “vitamin C enhanced,” and “100% Vitamin C.”  These are all code words for VERY ACIDIC!

How We Did the Testing (Materials & Methods): With hundreds of drink choices on the market, and seemingly more and more appearing every week, it is beyond our capacity to test the pH (acidity) of every variety and every drink brand. What we did do is test the most available drinks with an eye towards beverages refluxers might possibly be able to drink. We did not test carbonated, caffeinated, or chocolate-flavored drinks, because we already know these beverages are bad for refluxers.


More than one cup a day of caffeinated beverages, like coffee, green and black teas are not okay on The Reflux Diet. Some herbal teas, like chamomile, are terrific. Beware of other herbal teas. Though many herbal teas are good, we found that herbal teas infused with a fruit flavor are extremely acidic (as low as pH 2.8). Anything infused with orange, raspberry, lemon, or other citric flavor should be a red flag. As for the variety of bottled teas on the market, refluxer stay away. None that we tested had an acceptable pH for The Reflux Diet.

Bottled Smoothies

We are big advocates of homemade, pH-balanced smoothies, but what about those bottled smoothies that are so easy to grab in the grocery store? Well, the answer is some are acceptable and some are not. As you can guess, anything with a citric-fruit base is bad. Of the rest, vanilla flavored, high-protein drinks seem to be best.

Slim-fast Vanilla and Slim-fast Strawberry N Crème are both great (pH 6.9 and pH 6.8 respectively), as is Odwalla’s Vanilla Monster Protein Drink (pH 5.8) while Naked’s Green Machine (pH 4) and Odwalla’s Superfood Juice (pH 3.9) might seem okay but are bad.

Specialty Waters

Specialty waters, in most cases, are vitamin enhanced and not okay because the vitamin enhancement adds acid. A few exceptions exist. We have found that all tested brands of coconut water with no acids added are above pH 4.7, for instance, and unflavored Pedialyte is pH 5.4 and therefore, acceptable. With specialty waters especially, check the labels and look out for acids. Specialty waters that seem innocent (Vitamin Water, pH 3.1 – 3.6; Hint Unsweetened Essence Water, pH 3.9) can be deceptively acidic.

Probiotic Drinks

Probiotic drinks, like kombucha and kefir, are too acidic. Always steer clear.  If you need probiotics, take the pills.

Bottled Juices

The rule with bottled juices is fruit juices are not okay and with vegetable juices you must be wary. A case in point is two carrot juices we tested. Odwalla Carrot Juice is all natural and pH 6.3; however, Ralph & Charlie’s Everyday Carrot Beverage was pH 3.9. Looking at the two bottles side by side, you would not notice a difference in appearance. Only when analyzing the label would you see that Ralph & Charlie’s Everyday Carrot Beverage is enhanced with acids and other preservatives and flavorings.


Brand Description pH
Slim-fast Low Carb Vanilla 6.9
Slim-fast Strawberry N Creme 6.8
Traditional Medicinals Herb Tea: Echinacea Plus 6.4
Odwalla Carrot juice 6.3
Twinings Pure Chamomile 6.2
Traditional Medicinals Herb Tea: Organic Breathe Easy 6
The Republic of Tea Rooibos 5.9
Odwalla Vanilla monster protein drink 5.8
Twinings China Oolong 5.8
Adagio Rooibos: Organic Vanilla 5.6
Traditional Medicinals Herb Tea: Organic Gypsy Cold 5.5
Pedialyte Unflavored 5.4
Traditional Medicinals Dandelion Root 5.3
Bigelow Constant Comment 5.2
VitaCoCo 100% Natural Coconut Water 5.2
Bigelow Toffee 5
Naked Plain 5
Naked 100% Natural Coconut Water 5
Naked Protein Zone 4.9
Odwalla Original Super Protein 4.8
Bigelow Apple Cider Tea 4.8
Zico 100% Natural Coconut Water 4.7

Click here for a complete list of beverages tested

]]> 67 Transitioning from the Induction Reflux Diet to Maintenance Thu, 27 Jan 2011 18:35:58 +0000

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

]]> 90
Q & A: Readers’ Questions & Comments Tue, 25 Jan 2011 13:29:02 +0000

]]> 537
Kim Kardashian’s Esophageal Cancer Question to Dr. Oz Thu, 18 Nov 2010 23:38:09 +0000

This photo shows the endoscopic appearance of  an early and  easily treatable esophageal cancer. In this case, endoscopy was done through the nose, with the patient awake, comfortable, and without anesthesia using a relatively new technique called transnasal esophagoscopy (see reference below). When detected early, this stage of esophageal cancer is curable. Obviously, endoscopy is a must for early detection.  Patients with significant reflux symptoms (even people without heartburn) should have screening esophagoscopy performed.

Recently, Kim Kardashian was on the Dr. Oz show to ask him about the relationship between acid reflux and esophageal cancer. Her father, Robert Kardashian, had indigestion all of his life, and he died of esophageal cancer in 2003. Here is the clip from the “Dr. Oz” show.

Acid reflux is epidemic and esophageal cancer, which is caused by acid reflux, is currently the nation’s fastest growing cancer with an incidence rate that’s jumped an astounding 500% in the last 30 years. As Kim Kardashian told it, her father suffered from reflux all of his life and took over-the-counter medications 5-7 times daily.  Dr. Oz suggested that the medicines Mr. Kardashian took may have disguised the disease by taking away his pain. Sometimes, however, people with severe reflux don’t have indigestion or any pain at all. In fact, people with cough, hoarseness, and sore throat who have “silent reflux” (no chest pain, heartburn, or indigestion) are just as likely to develop esophageal cancer as those who have classic GERD (gastroesophageal reflux disease).

Incidentally, people who are rightfully worried about cancer deserve to be checked. The technology has changed. Doctors can now look inside while patients are awake, comfortable, and without pain, using a technique called transnasal esophagoscopy. The idea that you can only be checked for cancer in a special facility and under anesthesia is archaic.

During the TV segment,  Dr. Oz asked how many people had acid reflux, and a lot of the audience raised their hands.  We now know that 40% of the American population has acid reflux disease. Of those 22% have classic GERD and another 18% have silent reflux. That’ translates to about 122 million Americans.  It’s remarkable!

While Dr. Oz did well to explain how reflux affects and harms the esophagus, he did not delve into the issue of diet, which we feel is at the core of the reflux epidemic.  It’s acid, acid, acid. On this website, and in our book, Dropping Acid: The Reflux Diet Cookbook and Cure, we explore the dietary elements in a way that might potentially save the lives of people like Robert Kardashian. Through treatment and diet, we have healed many people who have suffered from reflux-related esophageal disease. Our hope is to heal many more. Have a look at the “Dropping Acid” book trailer.

]]> 25 The Missing Link Wed, 17 Nov 2010 22:55:41 +0000 Almost all of these foods and beverages are acidic. Surprised?

Almost all of the above items are quite acidic, surprised?


Please note this post is an excerpt  from the book chapter “Reflux Science You Can Digest”

Why is reflux epidemic? Why is esophageal cancer one of the fastest growing cancers in America? Why do so many people with reflux fail medical treatment? We believe that the answer is related to high levels of dietary acid. How and when did this happen?

While the story of the reflux epidemic is going to focus on acid, we should point out that since the Second World War there have been four interrelated and unhealthy dietary trends: (1) increased saturated fat; (2) increased (low-glycemic index carbs) sugar; (3) increased preservatives, stabilizers, thickeners, artificial sweeteners; and (4) increased acidification of prepared foods and beverages.  From a historical perspective, here’s what happened.

Landmarks and Milestones in the American Diet

1886    Coca-Cola invented; Pepsi Cola invented in 1898

In 1886 Coca-Cola was invented by a pharmacist in Atlanta and Pepsi Cola two years later. These were fountain drinks and they weren’t actually bottled in the 20th century.  Coca-Cola really rose to prominence as an American drink during and then after the Second World War. While the components and ingredients have changed over the years, the drink (and beverages like Coke) have always been very acidic. The current pH (acidity) of Coca-Cola is 2.8, as acidic as stomach acid itself. Perhaps of interest; see article: The History of Soft Drinks Timeline

1919    American Bottlers of Carbonated Beverages formed

In 1919, the American Bottlers of Carbonated Beverages was formed.  The significance of this group wasn’t clear in 1919, but as you will see later on (with a couple name changes), it became a national lobby.

1952    First diet soda pop sold (Kirsch No-Cal Ginger Ale)

In 1952, the first diet soda pop was sold. This represented a new potential market for the soda industry. That is it gave people something to drink that wasn’t fattening, but it also introduced a whole host of new additives and chemicals. In some cases, these diet drinks are/were more acidic than their non-dietary counterparts.

1955    McDonalds Corporation formed; fast-food is born

In 1955, Roy Kroc started the McDonalds Corporation.  Most baby boomers remember when they first encountered McDonalds.  For most of us, it was actually in the 60s.  Personally, the senior author (JK) recalls buying a hamburger in Dedham, MA for 13 cents in 1963.

1962    Instant foods become common in American homes

By 1962, instant foods were common in almost every American household, including things like instant milk, instant pudding, and other foods. Again this implied new ways of processing foods and some new ingredients. These products were essentially carryovers from WWII rations made palatable for the consumer (after the war, SPAM surpluses were sold to the general population). Incidentally, it was also about 1962 that the term “mystery meat” was coined.

1963    McDonalds begins marketing meals for families

This was a milestone for marketing and public relations, the idea that this type of fast food was appropriate for family; it was a paradigm shift.  That one could get an inexpensive meal outside of the home in a fast-food restaurant was new. Until this people looked at fast food as an inferior food, but through McDonald’s marketing, fast food became an acceptable part of the American diet. As a consequence, we began consuming more hamburgers, fries, and more saturated fat … and more soda pop, too.

1965    Canned soda first distributed in vending machines

Canned soda pop appears in vending machines.  Diet and regular and different flavors as well began popping up everywhere in 1965. This probably represents the greatest increase in soda consumption because now it was everywhere.  You didn’t have to buy it at a soda fountain or store, and it was available 24 hours a day 7 days a week.  After this, soda pop was available to anybody who had a dime and a nickel. Soda machines could just as well be at the library, golf course, in the hair salon, or in the workplace.

1966    The National Soft Drink Association was formed

In 1966, the American Bottlers of Carbonated Beverages changed their name to the National Soft Drink Association (NSDA). Since then, the NSDA has become a powerful lobby that has often been successful in fighting consumer groups that have attempted to limit access to soda pop in places like public schools. In 2004, they again changed their name to the American Beverage Association (ABA). Last year, the ABA spent over $19 million on marketing, promotion and lobbying, employing 25 lobbyists at 7 different firms, a 1000% increase in spending from the previous election cycle.  Recently, their efforts have been able to defeat laws raising taxes on high-sugar drinks.   See: Lobbying: American Beverage Association. Only recently, have consumers begun to gain the upper hand; see Pepsi to pull high calorie drinks from schools around the world.

1967    High-fructose corn syrup was introduced

In the late 60s, high-fructose corn syrup was introduced.  Within two decades, it found its way into use in American soda products and sweetened beverages almost ubiquitously.  HFCS is more fattening and less expensive than sugar.  Since its introduction, the public’s consumption of it has grown to an equal level as cane and beat sugar.  It’s recently become a target in America’s battle against the obesity epidemic. In other words once this became an ingredient in soda, soda became more fattening and higher in low-glycemic sugar.  See table:  USDA Sweetener Timeline

1973    Title 21: Law was response to outbreak of botulism

In response to an outbreak of botulism, Congress passed Title 21, a law giving the Food and Drug Administration (FDA) the power to regulate canned and bottled goods that were crossing interstate lines.  Title 21 underwent major revisions and was expanded in 1979 with the creation of “Good Manufacturing Practices.” These practices specified specific food additives and acidity levels in pre-packaged food to discourage bacterial growth and reduce the likelihood of bacterial contamination in prepared foods and beverages.   The idea that acidification of the food supply might have adverse consequences was never considered in any of the documented discussion about food safety.  See full-text: Code of Regulations Title 21: Food Acids

1985    “New Coke” introduced with high-fructose syrup

The introduction of “New Coke” was meant with loud boos and great disdain by angry “Coke-aholics,” who complained that it was a syrupy drink without any kick.  At the time, the senior author (JK) knew that this was simply a rouse to substitute high-fructose syrup for sugar.  Indeed when Classic Coke was “returned” to the market and “New Coke” disappeared, high-fructose syrup had been successfully substituted for real sugar, completing one of the most brilliant cost-saving ploys in marketing history. It appears that the whole thing had been planned

1990    Nutrition Labeling and Information Act Passed

A significant movement in Congress that suggested consumers had a right to know what was in the food that they were consuming.  It was designed to help consumers make healthy choices about the food they purchased and also encourage manufacturers to produce more healthy products.  See article: The Nutrition Labeling and Information Act of 1990

2003    Report: Junk food Mote than 1/3 of American calories

By 2003, the obesity epidemic became national news and the focus was on saturated fat and low-glycemic sugar.  Meanwhile despite all labeling efforts, Americans continued to consume a large portion of their calories from “junk food.”  In 2009, the average annual sugar intake was 142 lbs, the average sodium intake per day was 4500 mg, and the average daily saturated fate intake was approximately 20 grams.

The FDA’s “Good Manufacturing Practices”

The acidification of food has long been used as a means to preserve food, but it wasn’t until the modern era that the process evolved to meet transnational needs.  In order to prevent and regulate bacterial growth on food traveling long distances to sit on a store shelf, the FDA implemented a system of “Good Manufacturing Practices” through Title 21 regulations. Title 21 does not regulate which acids and preservatives within a broad group are used, but it does require the pH to be below 4.6, a level that is low enough to discourage most bacteria.  In fact, Title 21 encourages acidification of foods and beverages to 4.0 in below:

“Acidified foods should be so manufactured, processed, and packaged that a finished equilibrium pH value  of 4.6 is achieved.  If the finished equilibrium pH is 4.0 or below, than the measurement of acidity of the final product may be made by any suitable method.” Title 21, 2002.

What this says is that the manufacturer only needs to use a pH meter, a very inexpensive device if their product is below pH 4.

Food and Drug Administration (FDA) Approved Food Additives

A corollary question when considering how FDA regulated food is acidified is wondering, what does the FDA allow to be used as food additives to achieve these lower pH levels?  As it turns out there are 373 substances that are FDA approved, referred to as GRAS “Generally recognized as safe” food additives.

In February 2010, the Government Accountability Office (GAO), a non-partisan group appointed by Congress to investigate federal agencies, published a scathing report entitled Food Safety: FDA Should Strengthen Its Oversight of Food Ingredients Determined to Be Generally Recognized as Safe (GRAS). The first paragraph of the report reads:

“FDA’s oversight process does not help ensure the safety of all new GRAS (“Generally Recognized as Safe”) determinations. FDA only reviews those GRAS determinations that companies submit to the agency’s voluntary notification program—the agency generally does not have information about other GRAS determinations companies have made because companies are not required to inform FDA of them. Furthermore, FDA has not taken certain steps that could help ensure the safety of GRAS determinations, particularly those about which the agency has not been notified. FDA has not issued guidance to companies on how to document their GRAS determinations or monitored companies to ensure that they have conducted GRAS determinations appropriately. Lastly, FDA has yet to issue a final regulation for its 1997 proposed rule that sets forth the framework and criteria for the voluntary notification program, potentially detracting from the program’s credibility.”  

This states that not only was there inadequate oversight of the approval process; indeed food manufacturers themselves and not the FDA were left to determine the “safety” of the additives they chose to employ in their products.  For all intents and purposes, this process is all industry self-regulated as long as the food additives comply with the list of 373 approved GRAS (“Generally Recognized as Safe”) substances.  It is reasonable for a concerned consumer to assume self-regulation could mean no oversight.  This would be like asking tobacco manufacturers to tell us whether or not cigarette smoke was harmful or not.

Furthermore, no consideration is, was, or has ever been given to the potential downside of acidification. At least not until now. Amazing as it may seem throughout the entire scientific community and in the literature and published reports dealing with food safety and food additives there has never been an expressed concern about the possible adverse health consequences of acidification.  By the way, 13% of the GRAS substances are acids, including hydrochloric acid, and every item in the photo shown  at the front of this post has been acidified to pH 4.6 or less.  This is what many of us eat much of the time … ouch!

In an recent report published by the Ohio State Medical Center on the Amish in Ohio, it was found that the cancer rates among Amish adults was 60% of the age-adjusted cancer rates in Ohio.  For “tobacco-related” cancers, including pharynx, larynx, and esophagus, the Amish cancer rate was only 37% of the Ohio population. Although the authors never consider the possibility, we offer this interpretation:  Pharynx, larynx, and esophagus cancers are reflux-related cancers.  One possible explanation for the lower rates of those cancers in the Amish is that they don’t eat highly acidified and preservative-ridden food; in stead they consume mainly homegrown and home-made food.   See the complete study: Low cancer incidence rates in Ohio Amish

Connection between Reflux Disease and Acid in the Diet

We know you’re not scientists and we don’t want to overwhelm you with complicated science; however, cell biology holds the key to understanding the consequences of excessive dietary acid.

LPR is different than GERD in fundamental ways

It is important to remember that reflux causes many different symptoms and that heartburn and digestive symptoms like indigestion represent one group of symptom manifestations.  Believe it or not, “Silent Reflux,” which affects the voice box, throat, and lungs, is an even bigger problem than “indigestion” that everyone seems to know about.  If you look at the most common symptoms for which people see doctors in America other than injuries and pregnancies, cough, sore-throat, hoarseness, asthma, etc., all common symptoms of reflux.  Thus, it is important to recognize differences in the GERD pattern of reflux and silent reflux. By the way, classic reflux is called gastroesophageal reflux disease GERD, silent reflux is usually called laryngopharyngeal reflux (LPR). A thorough discussion of manifestations and mechanisms of GERD and LPR is beyond the scope of this blog, but suffice it to say what makes silent reflux silent is that when reflux occurs it does not stay in the esophagus long enough to produce problems there; however, it does cause problems above. For further information,  see the sample chapters “What You Eat May Be Eating you” and  “How Do I Know If I Have Reflux” on this website.

Tissue injury is caused by active pepsin (not acid)

One of the great surprises for most people when we talk about reflux disease is that it is not all about acid.  In the stomach there is a very important digestive enzyme called “pepsin,” in addition to the well-known acid.  Scientific studies have shown that pepsin actually causes the problem and that confusion results from the fact that pepsin requires acid to activate.  For further information about this particular bit of science, see the sample chapter “What You Eat May Be Eating You” on this website.

How pepsin causes problems

Research has shown that people who have reflux disease have pepsin in the tissue.  Furthermore once pepsin is in the tissue, it can be activated and re-activated by acid of any cause.  The pepsin molecule is very stable and once it is attached to tissue in the throat, esophagus, or elsewhere, it tends to remain for days or weeks.  In the past, it was believed that this pepsin was inactive above pH 4, but that is incorrect.  Scientific experiments have shown that pepsin remains active, although weakly, up until pH 6.  Furthermore, we know that tissue damage can occur in the throat at pH 5 or less.

The Reflux Diet works

As clinicians, we have been restricting acids such as soda pop and citrus in our reflux patients for years, and we have found that it has been an extremely important part of medical treatment. Within the past year, we have tested the strict two-weeks-with-no-acid “pepsin detox” diet in our patients.

In a recent pilot study, the authors put twenty patients with recalcitrant reflux — still having symptoms of hoarseness, cough, and sore throat on twice-daily proton pump inhibitors like omeprzole, pantaprazole, and lansoprazole with an H2-antagonist at night (ranitidine 300 mg. q.h.s.) — on “pepsin detox,” a strict acid-free diet with nothing below pH 5, and found a statistically significant improvement in the patients’ symptoms and laryngeal findings.  These data will be presented at the annual scientific meeting of the American Broncho-Esophagological Association in Las Vegas on Wednesday, April 28th.

Summary and Conclusions

Why is reflux epidemic and why are esophageal cancer rates soaring? The cell biology (basic science) of reflux in conjunction with clinical experience has shown that a highly acidic diet is harmful for people with reflux. Amazing as it may seem until now no one has investigated this problem, but even more amazingly no one has ever considered the possibility that there might be adverse health consequences of systemic acidification of America’s food.

We believe that acidic food is indeed the reason reflux is epidemic and the reason that esophageal cancer (and pre-cancer, i.e., Barrett’s esophagus) is increasing in prevalence so dramatically. From our point of view, we try to eat fresh, organic, non-processed foods and generally avoid acids.  For most people, there is probably a middle road —  having a glass of orange juice or soda pop once in a while doesn’t cause reflux disease — but if that’s all you drink day in and day out, it’s likely to be a big problem. For people with known reflux disease, a period of “acid/pepsin detox” makes good sense.

People will ask if we have proven these claims beyond a reasonable doubt — that dietary acid causes disease. We respond that we have sited here sound scientific evidence and the state of the art of clinical medicine. We believe that our data are compelling and speak for themselves. It is likely that we are dealing with a huge public health issue. Yes, we are worried about the implications of all this,  aren’t you?


Amin MR, Postma GN, Johnson P, Digges N, Koufman JA.  Proton pump inhibitor resistance in the treatment of laryngopharyngeal reflux. Otolaryngol Head Neck Surg 125:374-378, 2001

Amin MR, Postma GN, Setzen M, Koufman JA. Transnasal Esophagoscopy: A Position Statement from the American Bronchoesophagological Association (ABEA). Otolaryngol Head Neck Surg 138:411-13, 2008

Axford SE, Sharp S, Ross PE, Pearson JP, Dettmar PW, Panetti M, Koufman JA.  Cell biology of laryngeal epithelial defenses in health and disease: preliminary studies.  Ann Otol Rhinol Laryngol 110:1099-1108, 2001

Belafsky PC, Postma GN, Koufman JA.  Transnasal esophagoscopy (TNE). Otolaryngol Head Neck Surg 125: 588-589, 2001.

Belafsky PC, Postma GN, Koufman JA. The association between laryngeal pseudosulcus and laryngopharyngeal reflux.  Oto Head Neck Surg; 126:649-652, 2002.

Belafsky PC, Postma GN, Reulbach TR, Holland BW, Koufman JA.  Muscle tension dysphonia as a sign

Belafsky PC, Postma GN, Amin MR, Koufman JA. Symptoms and findings of laryngopharyngeal reflux. Ear Nose Throat J. 81: 10-3, 2002.

Belafsky PC, Postma GN, Daniels E, Koufman JA. Transnasal esophagoscopy. Otolaryngol Head Neck Surg;125:588-589;2001.

Belafsky PC, Postma GN, Koufman KA.  Laryngopharyngeal reflux symptoms improve before changes in physical findings.  Laryngoscope 111: 979-981, 2001.

Belafsky PC, Postma GN, Koufman JA.  The validity and reliability of the reflux finding score (RFS).  Laryngoscope  111:1313-1317, 2001.

Belafsky PC, Postma GN, Koufman JA.  Validity and reliability of the reflux symptom index (RSI). J Voice 16:274-277, 2002.

Birchall MA, Bailey M, Gutowska-Owsiak D, Johnston N. Inman CF, Stokes CR, Postma G, Pazmary L. Koufman JA, Phillips A, Rees LE. Immunologic response of the laryngeal mucosa to extraesophageal reflux. Ann Otol Rhinol Laryngol. 117:891-5, 2008.

Blot WJ, McLaughlin JK.  The changing epidemiology of esophageal cancer. Semin Oncol. 26(5 Supple 15): 2-8, 1999.

Brown, LM, Devesa, S, and Chow, W.  Incidence of Andenocarcinoma of the Esophagus among white Americans by sex, stage, and age.  J Natl Cancer Inst 100(16): 1184-1187, 2008.

Carrau RL, Khidr A, Gold KF, Crawley JA, Hillson EM, Koufman JA, Pashos CL. Validation of a quality-of life instrument for laryngopharyngeal reflux. Arch Otolaryngol Head Neck Surg 131:315-20, 2005.

Cohen JT, Bach KK, Postma GN, Koufman JA. Clinical manifestations of laryngopharyngeal reflux. Ear Nose Throat J. 81:14-23, 2002

Duke SG, Postma GN, McGuirt Jr. WF, Ririe D, Averill DB, Koufman JA.  Laryngospasm and diaphragmatic arrest in the immature canine after laryngeal acid exposure: a possible model for sudden infant death syndrome (SIDS).  Ann Otol Rhinol Laryngol 110:729-733, 2001.

Halum SL, Postma GN, Johnston C, Belafsky PC, Koufman JA. Patients with isolated laryngopharyngeal reflux are not obese. Laryngoscope 115:1042-5, 2005.

Halum SL, Postma GN, Bates DD, Koufman JA. Incongruence between histologic and endoscopic diagnoses of Barrett’s esophagus using transnasal esophagoscopy. Laryngoscope. 116:303-6, 2006.

Gill GA, Johnston N, Buda A, Pignatelli M, Pearson J, Dettmar PW, and Koufman J. Laryngeal epithelial defenses against laryngopharyngeal reflux (LPR): investigations of pepsin, carbonic anhydrase III, pepsin, and the inflammatory response.  Ann Otol Rhinol Laryngol 114:913-21, 2005.

Knight J, Lively MO, Johnston N, Dettmar PW, and Koufman JA.  Sensitive pepsin immunoassay for detection of  laryngopharyngeal reflux. Laryngoscope 115:1473-8, 2005.

Johnson PE, Koufman JA, Nowak LJ, Belafsky PC, Postma GN.  Ambulatory 24-hour double-probe pH monitoring: the importance of manometry.  Laryngoscope 111: 1970-1975, 2001.

Johnston N, Bulmer D, Gill GA, Panetti M, Ross PE, Pearson JP, Pignatelli M, Axford A, Dettmar PW, Koufman JA.  Cell biology of laryngeal epithelial defenses in health and disease: Further studies. Ann Otol Rhinol Laryngol 112:481-491, 2003.

Johnston N, Knight J, Dettmar PW, Lively MO, Koufman J. Pepsin and carbonic anhydrase isoenzyme III as diagnostic markers for laryngopharyngeal reflux disease. Laryngoscope 114:2129-34, 2004.

Johnston N, Dettmar PW, Lively MO, and Koufman JA.  Effect of pepsin on laryngeal stress protein (Sep70, Sep53, and Hsp70) response: role in laryngopharyngeal reflux disease.  Ann Otol Rhinol Laryngol 115:47-58, 2006.

Johnston N and Koufman JA.  What are the compared mechanisms of cellular defense in the esophagus and at the laryngeal level?  The duodenogastroesophageal reflux.  125 questions and 125 answers (Proceedings from the World Organization for Specialized Studies on Diseases of the Esophagus, Paris, France, September 2003).  R. Giuli and C Scarpignato Eds. 15-23, 2006.

Johnston N, Dettmar PW, Lively MO, and Koufman J.  Effect of pepsin on laryngeal stress protein (Sep70, Sep53, and Hsp70) response: role in laryngopharyngeal reflux disease.  Ann Otol Rhinol Laryngol. 115:47-58, 2006.

Johnston N, Dettmar PW, Bishwokarma B, Lively MO, Koufman JA. Activity/stability of human pepsin: implications for reflux attributed laryngeal disease. Laryngoscope. 117:1036-9, 2007.

Johnston N, Dettmar PW, Lively MO, Postma GN, Belafsky PC, Birchall M, Koufman J. Effect of pepsin on laryngeal stress protein (Sep70, Sep53, and Hsp70) response: Role in laryngopharyngeal reflux disease.  Ann Otol Rhinol Laryngol 115:47-58, 2005.

Koufman JA, Wiener GJ, Wu WC, Castell DO.  Reflux laryngitis and its sequelae:  the diagnostic role of 24-hour pH monitoring.  J Voice 2:78-89, 1988.

Koufman JA.  The Otolaryngologic manifestations of gastroesophageal reflux disease (GERD):  A clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 101 (Suppl. 53):1-78, 1991

Koufman JA, Burke AJ. The etiology and pathogenesis of laryngeal carcinoma.  Oto Clin N A 30:1-19, 1997.

Koufman JA, Amin M, Panetti M.  Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head Neck Surg  123:385-388, 2000.

Koufman JA, Aviv JE, Casiano RR, Shaw GY.  Position statement of the American Academy of Otolaryngology-Head and Neck Surgery on laryngopharyngeal reflux. Otolaryngol Head Neck Surg 127:32-35, 2002.

Koufman JA. Laryngopharyngeal reflux is different from classic gastroesophageal reflux disease. Ear Nose Throat J. 81:7-9 2002.

Koufman JA, Belafsky PC, Daniel E, Bach KK, Postma GN.  Prevalence of esophagitis in patients with pH-documented laryngopharyngeal reflux.  Laryngoscope 112:1606-1609, 2002.

Koufman JA, Block C. Differential Diagnosis of Paradoxical Vocal Fold Movement. American Journal of Speech and Hearing. 17:327-34, 2008.

Knight J, Lively MO, Johnston N, Dettmar PW, and Koufman JA.  Sensitive pepsin immunoassay for detection of  laryngopharyngeal reflux. Laryngoscope 115:1473-8, 2005.

Little JP, Matthews BL, Glock MS, Koufman JA, Reboussin DM, Loughlin CJ, McGuirt Jr. WF.  Extraesophageal pediatric reflux: 24-hour double-probe pH monitoring of 222 children.  Ann Otol Rhinol Laryngol Suppl 169: 1-16, 1997.

Loughlin CJ, Koufman JA. Paroxysmal laryngospasm secondary to gastroesophageal reflux. Laryngoscope 106:1502-1505, 1996.

Loughlin CJ, Koufman JA, Averill DB, Cummins MM, Yong-Jae K, Little JP, Miller Jr. IJ, Meredith W. Acid-induced laryngospasm in a canine model. Laryngoscope  106:1506-1509, 1996.

Postma GN, Cohen JT, Belafsky PC, Halum SL, Gupta SK, Bach KK, Koufman JA. Transnasal esophagoscopy revisited (over 700 consecutive cases). Laryngoscope 115:321-3, 2005.

Postma GN, Tomek MS, Belafsky PC, Koufman JA.  Esophageal motor function in laryngopharyngeal reflux is superior to that of classic gastroesophageal reflux disease. Ann Otol Rhinol Laryngol  110:1114-1116, 2001.

Rees CJ, Halum SL, Wijewickrama RC, Koufman JA, Postma GN. Patient tolerance of in-office pulsed dye laser treatments to the upper aerodigestive tract. Otolaryngol Head Neck Surg. 134:1023-7, 2006.

Rees LE, Pazmany L, Gutowska-Owsiak D, Inman CF, Phillips A, Stokes CR, Johnston N, Koufman JA, Postma G, Bailey M, Birchall MA. The mucosal immune response to laryngopharyngeal reflux. Am J Respir Crit Care Med. 177:1187-93, 2008.

Reavis, K, Morris, C, Deepak, G, Hunter, J and Jobe, B. Laryngopharyngeal reflux symptoms better predict the presence of esophageal adenocarcinoma than typica gastroesophageal reflux symptoms.  Ann Surg. 239(6): 849-858, 2004.

Reulbach TR, Belafsky PC, Blalock PD, Koufman JA, Postma GN.  Occult laryngeal   pathology in a community-based cohort. Otolaryngol Head Neck Surg 124:448- 450, 2001.

Smoak BR, Koufman JA.  Effects of gum chewing on pharyngeal and esophageal pH.  Ann Otol Rhinol Laryngol  110:1117-1119, 2001.

Weiner GJ, Koufman JA, Wu WC, Cooper JB, Richter JE, Castell DO.  Chronic hoarseness secondary to gastroesophageal reflux disease:  Documentation with 24-H ambulatory pH monitoring. The Amer J of Gastroenterol 84:12, 1989.

Westcott CJ, Hopkins MB, Bach KK, Postma, GN, Belafsky, PC, Koufman, JA. Fundoplication for laryngopharyngeal reflux. J American College of Surgeons 199:23-30, 2004.

FOOD SAFETY: FDA Should Strengthen Its Oversight of Food Ingredients Determined to Be Generally Recognized as Safe (GRAS). United States Government Accountability Office Congressional Report.  February 2010.  Retrieved 2010-3-17.

Westman J, Ferketich A, Kauffman R, et al.  Amish Cancer Rates in Ohio. Ohio State Medical Center.  September 2009.  Retrieved 2010-3-17.

CFR – Code of Federal Regulations: Title 21. U.S. Food and Drug Administration (FD. April 2009.  Retrieved 2010-3-17.


]]> 11
How to Keep Acid Reflux Under Control During the Holidays Wed, 10 Nov 2010 18:53:17 +0000

Acid reflux is epidemic. Today, 125 million Americans have reflux—that is 4 in 10 people—and half of them do not even know they have it. That’s because acid reflux symptoms include hoarseness, chronic cough, a lump-in-the-throat sensation, difficulty swallowing, choking episodes, shortness of breath, asthma, postnasal drip, and even sinus. That’s right! All of those symptoms are associated with acid reflux into the esophagus (the swallowing tube that joins the stomach and the throat), and sometimes even into the throat and lungs.

You may be surprised to learn that the holiday season is the worst reflux time of the year. There are many reasons for this: stress, travel, parties, and lots of rich food. When it comes to the holidays, many people with reflux just forget about moderation and overeat and over-drink. They think that they can eat their cake and have it too! In truth, if you have acid reflux, the holiday season is a time for you to be especially vigilant and to exercise more restraint than any other time of year.

Preventing Holiday Reflux: Top 10 List of What to Avoid

  1. No carbonated beverages (all carbonated beverages, particularly those with caffeine)
  2. No bottled fruit or energy drinks (unfortunately, these are acidified to prolong shelf life)
  3. No more than one glass of eggnog or wine a day
  4. No chocolate (sorry!)
  5. Avoid garlic and onions, particularly if they are in a greasy sauce
  6. No bacon, barbecue, or sausages
  7. Avoid fried food (foods sautéed in olive oil are okay, but no deep fried food)
  8. Just one plate of food from the buffet (big-time overeating = asking for reflux)
  9. No late-night eating (if you eat before bed, you are going to have reflux while you sleep)
  10. Avoid holiday cookies

Actually, just kidding about number 10 — sugar cookies are probably one of the better holiday treats for people who have reflux, as long as they are not also high in fat or made of chocolate. There is lots that is good to eat for you with reflux. Turkey, potatoes, green beans and other veggies are great foods for refluxers, but do limit cranberry and gravy, just use a little bit for flavoring the other foods. Pumpkin pie is also pretty good, but stay away from the whipped cream.

No matter what time of year it is, the healthiest reflux foods are: grains (cereal, breads, etc.), rice, poultry, fish, and vegetables. These do not change no matter what time of year it is. Remember, excessive amounts of alcohol are to be avoided! And if you do have nighttime reflux or will be eating late, you may want to consider taking an antacid, Gaviscon, or an over-the-counter medicine like Zantac or Pepcid before going to your party and before bed, especially if you have cough or heartburn symptoms.

Dropping Acid: The Reflux Diet Cookbook and Cure is available on Amazon and in Barnes & Noble bookstores.  In addition, “Dropping Acid” on Facebook is very useful to people with reflux as it is very interactive.

]]> 3
“Dropping Acid” Book Launch Mon, 27 Sep 2010 16:39:02 +0000

The authors of “Dropping Acid: The Reflux Diet Cookbook & Cure” celebrated the launch of their new diet book September 16, 2010 at the William Bennett Gallery at 65 Greene Street in SoHo with over 200 guests in attendance. Recipes from the book were served. Students from the French Culinary Institute and co-author Master Chef Marc Bauer prepared the menu, which included  Banana Ginger Energy Smoothie, Asian Tuna Tartare, Chicken South-of-the-Border style, Sweet Potato Bites, and Creamy Hummus and Rich Garbanzo Bean Spread.

The party marked the official sales date of the “Dropping Acid”‘ hardcover edition and celebrated the launch of Dr. Jamie Koufman’s Voice Institute of New York Research Foundation, a non-profit institute which will perform specialized research in reflux, nutrition, and the America diet.

Guests enjoy hors d'oeuvres prepared by French Culinary Institute students

Dr. Koufman and book cover designer, Gene Seidman of Rogers Seidman Design

Master Chef Marc Bauer signing a book for a guest

The authors thank the crowd

The authors addressing the crowd


]]> 11
Navigating the Grocery Store if You Suffer from Acid Reflux Sun, 20 Jun 2010 19:50:30 +0000

This guest post written by Maggie Badore, staff writer for; see her article here.

I have been undergoing treatment for acid reflux for about two months, with the guidance of Dr. Jamie Koufman, one of the authors of Dropping Acid: The Reflux Diet Cookbook & Cure. Like many people who suffer from heartburn, I had a pretty clear idea of my worst trigger foods before seeking medical attention. Coffee, citrus, alcohol and tomato sauce all had me reaching for the Tums.

What I learned from Dr. Koufman is that acid as a food additive is also a contributor to reflux. Acid is added to foods because it prevents the growth of bacteria, but few consumers are aware of the potentially negative consequences of this practice. Things containing ascorbic acid, citric acid, and acetic acid should all be avoided by people suffering from reflux. You should also look out for foods and beverages that are “vitamin C enriched” or “vitamin C enhanced,” which is usually done through the addition of citric acid.

Added acid will always appear on the ingredients list. “In the beginning, think like you are learning a new language,” says Dr. Koufman. “You need to start looking at labels and you should know which foods are unacceptable based upon the acidity and fat content.” It’s best to buy organic poultry, because it will have a lower fat content.

Once you start examining labels you will find that many, many processed foods have added acid, from candy and soups to frozen dinners and salad dressing. This may seem daunting at first, but the best thing for people with reflux is to follow the familiar advice of shopping at the edges of the grocery store. This means buying mostly whole foods, particularly veggies, lean meats and low-fat dairy products. Of course, you will still need to avoid citrus and tomatoes, plus whatever foods are triggers for you.

Another great option is to skip the grocery store all together and check out your local farmer’s market. This can be a great way to discover local produce, and you will often find fresher, more flavorful ingredients. Plus, the prepared foods you will find at a farmer’s market are less likely to contain added acid.

Buying more whole foods does generally mean cooking more at home, but there are still a number of healthy and convenient options for days that are too busy for cooking. “I am always buying bananas, and nowadays every Bodega has bananas,” says Dr. Koufman. Sandwiches are a convenient option that can also be purchased ready-made. “My go-to sandwich has always been turkey breast, preferably organic turkey. If there is something in the sandwich, like excessive amounts of mayonnaise, I get a plastic knife and take it off.” She adds that small amounts of fats are okay. Eating a low-fat, low-acid diet has the added benefit of being heart-healthy.

]]> 11 Whoa Baby! Even Some Baby Food is Acidic! Mon, 19 Apr 2010 20:06:39 +0000

We heard about a baby with reflux who was on antireflux medication and so we wondered — Could there be acid in baby food, too? We tested 30 baby foods (Gerber, Beech Nut, and Earth’s Best brands). We were interested in whether organic baby foods were less acidic than those that were processed, and we were surprised to find that some of the “organic” baby foods had added citric acid as a preservative.

Before telling you the results of the testing, I would like to convey to you an insight  I had relatively recently.  A few weeks ago, I had sitting in my office a beautiful 20-year-old singer who likely will be performing on Broadway someday soon, but her reflux had been so bad that she had to have reflux surgery (just two weeks prior to her visit to me).  When she came in, she was smiling ear to ear, “My voice has never been better.” I thought to myself why would a 20-year-old healthy woman with good habits and a good diet have such bad reflux? Then, she turned and said to me, “ALL my friends have reflux.” At that moment, it hit me that there are generations of refluxers.  I, as a baby boomer, was a “first generation refluxer.”  I didn’t start getting exposed to the food supply acidity, saturated fat, etc. until my college years. This 20-year-old, however, was born in 1990, and all she ever had experienced as a “second generation refluxer” was acid, acid, and more acid in almost everything that she ate and drank.  Now, babies are born as “third generation refluxers.”  For this new generation, virtually everything, including even some of  the “organic” labeled  baby foods have acid added.  What’s organic about adding citric or ascorbic acid?  Is it just that it comes from citrus?  Let’s help  protect our babies by limiting the acidity of their food intake. That’s what prompted this post on the acidity of baby food.

Greg Van Horn, my assistant, testing the pH of baby foods.

We went to three grocery stores, and we were a little surprised that there were only three brands of prepared baby food (Gerber, Earth’s Best, and Beech Nut). We tested 30 bottles/cartons containing fruit, vegetables, pasta, meat, and starches. All of the pH measurements were made using a Minilab ISFET pH meter (Model IQ128 with Silicon Chip Sensor, Pulse Instruments, Carlsbad CA). The pH meter was carefully cleaned between measurements; it was noted that the device returned to neutral pH before making the next measurement.


We tested the pH of the three brands, Gerber, Earth’s Best, and Beech Nut Baby Foods. These were all prepared foods, and thus we were concerned about the “Title 21 effect,” the adding of acid as a preservative to discourage bacterial growth; see “The Missing Link” in this blog for more on Title 21. First, there is acid added to “organic” baby foods. I guess that this is considered organic by the manufacturer, because it is citric acid. It is not, however, in the interest of reflux. To me, organic means the food is unadulterated!  Second, some of the fruit is just acidic by itself. Green apples have a pH below 4.0, so some of the truly organic apple sauce also is acidic. Here’s the message: your baby can have apple sauce sometimes, but it should not be a staple of her/his diet. Feed your baby low-acid foods to the greatest extent possible, especially if she/he has reflux. Finally, there is consideration for fat content. Thankfully, all of the baby foods we tested except for the Beech Nut Macaroni and Cheese were low in saturated fats.

Top 10 baby Foods for Reflux That We Tested (Obviously we couldn’t test them all)

Brand Description pH Acids Added
Gerber Green Beans 5.9 None
Gerber Squash 5.9 None
Beech Nut Turkey Rice Dinner 5.7 None
Beech Nut Mixed Vegetables 5.7 None
Earth’s Best Organic Garden Vegetables 5.4 None
Gerber Chicken Noodle 5.3 Folic Acid
Earth’s Best Organic Spinach & Potatoes 5.3 None
Beech Nut Corn & Sweet Potatoes 5.3 None
Earth’s Best Organic Corn & Butternut Squash 5.3 None
Gerber Sweet Potatoes 5.2 None

Bottom 10 baby Foods for Reflux That We Tested

Brand Description pH Acids Added
Gerber Applesauce 3.7 Ascorbic Acid
Gerber Apple Blueberry 3.7 Ascorbic Acid
Earth’s Best Organic First Apples 3.8 Ascorbic Acid
Beech Nut Applesauce 3.9 Ascorbic Acid
Beech Nut Pears & Raspberries 3.9 Ascorbic Acid
Gerber Pears 4.0 Ascorbic and Citric Acid
Gerber Prunes 4.0 None
Gerber Peaches 4.0 Ascorbic Acid
Beech Nut Rice Cereal and Apples with Cinnamon 4.0 Ascorbic, Citric, and Folic Acid
Beech Nut Oatmeal & Apples 4.0 Ascorbic, Citric, and Folic Acid

In summary, we recommend that babies generally be fed foods with a pH of greater than 5. having more acidic food sometimes is okay, but not as a regular diet.

Click here for a printable PDF listing of the results of all the baby foods we tested

]]> 18
Dr. Koufman on NY1, “Low-Acid diet can stop acid reflux before it leads to bigger health problems.” Fri, 12 Feb 2010 22:40:57 +0000

September 21, 2010 NY1’s Health segment featured “Dropping Acid: The Reflux Diet Cookbook & Cure” author Dr. Jamie Koufman speaking out about the increase in acid reflux prevalence and the rise  of reflux-related cancers in America. On air, Dr. Koufman sounds the alarm for higher reflux awareness in America by explaining how the American diet and lifestyle stimulates the reflux epidemic’s growth. She also explains how a low-acid diet can work to stop it.

If you missed it on TV, you can find the segment and NY1’s recap interview here.

]]> 2
Dr. Jamie Koufman on Good Morning America Health Fri, 12 Feb 2010 17:56:00 +0000  

Dr. Jamie Koufman on Good Morning America Health

Earlier this summer, Dr. Jamie Koufman, founder of the Voice Institute and co-author of Dropping Acid: The Reflux Diet Cookbook & Cure, appeared in an interview with Dr. Tim Johnson on Good Morning America Health.

Through the interview, she discusses the red flags for diagnosing “silent” reflux (chronic throat clearing, chronic cough, excess mucus, etc.) and the difficulties some patients have in finding proper acid reflux treatment.  We thought you guys would like to check it out!

]]> 7