Patients with laryngopharyngeal reflux who adhered to a plant-based Mediterranean-style diet paired with alkaline water achieved similar or better symptom improvement as those treated with PPIs, according to new research.
“Although effective in some patients, I felt medication couldn’t be the only method to treat reflux and recent studies reporting increased rates of stroke and heart attack, dementia and kidney damage from prolonged PPI use made me more certain,” Craig H. Zalvan, MD, FACS, chief of otolaryngology and medical director of The Institute for Voice and Swallowing Disorders at Northwell Health’s Phelps Hospital, and researcher at the Feinstein Institute, said in a press release. “I did research and saw a lot of studies using plant-based diets to treat patients for many other chronic diseases, so I decided to develop a diet regimen to treat my laryngopharyngeal reflux [LPR] patients. The results we found show we are heading in the right direction to treating reflux without medication.”
Zalvan and colleagues reviewed the medical charts of 85 patients treated with PPIs and standard reflux precautions between 2010 and 2012 (median age, 60 years; 56.3% women), and 99 patients treated with a 90% to 95% plant-based Mediterranean-style diet paired with alkaline water (pH > 8) and standard reflux precautions between 2013 and 2015 (median age, 57 years; 61.7% women).
The diet consisted of replacing all beverages with alkaline water and eating mostly fruits, vegetables, grains and nuts while eliminating most dairy and meat, including beef, chicken, fish, eggs and pork. A plant-based diet “may indirectly lead to decreased activity of pepsin,” which is presumed to play a key role in LPR, “by decreasing gastrin secretion,” Zalvan and colleagues wrote. Similarly, alkaline water has been shown to inactivate pepsin, they added.
Both the diet and PPI treatment were paired with standard reflux diet precautions like avoiding coffee, tea, chocolate, soda, greasy and fried food, spicy foods, fatty foods and alcohol.
Change in Reflux Symptom Index (RSI) at 6 weeks served as the primary endpoint, with a reduction of at least 6 points defined as a clinically meaningful improvement.
Overall, 62.6% of patients treated with the diet experienced at least a 6-point reduction in RSI compared with 54.1% of those treated with PPIs, for a difference of 8.05% (95% CI, –5.74 to 22.76).
The average reduction in RSI was 39.8% for those treated with the diet vs. 27.2% for those treated with PPIs, for a difference of 12.1% (95% CI, 1.53-22.68).
While the proportion of patients in each group who achieved a 6-point reduction in RSI was comparable, the percent reduction in RSI was significantly greater in patients treated with the diet intervention. However, “the clinical significance of this difference requires further study [as] the relationship between percent change and response to treatment has not been studied,” Zalvan and colleagues wrote.
“Nevertheless, this study suggests that a plant-based diet and alkaline water should be considered in the treatment of LPR,” they concluded.
Patients should try the diet intervention before the use of PPIs, or with the short-term PPI use if their LPR is severe, Zalvan added in the press release, which also noted that these findings have implications for treating patients with GERD.
These findings “may help to alter the challenging treatment of patients with LPR with a dietary approach if the findings are reproduced in future prospective studies,” Robert T. Kavitt, MD, MPH, of the Center for Esophageal Diseases at University of Chicago, wrote in a related editorial. “In this era when patients frequently raise concerns regarding the chronic use of PPIs owing to the potential adverse effect profile, it would be of great benefit to be able to offer additional options beyond acid-suppressive medications to patients with LPR.” – by Adam Leitenberger
Disclosures: Zalvan reports he serves on the scientific advisory board of Restech Corporation, for which he receives no financial compensation. Kavitt reports no relevant financial disclosures.