Anyone would be very concerned if they received a diagnosis of a pre-cancerous condition - Barrett's esophagus / Barrett's disease - especially when information about the condition is ambiguous and bewildering. Indeed, Barrett’s esophagus is a confusing diagnosis with no clear path towards improvement or resolution… until now.
Barrett’s esophagus is caused by years of acid reflux, and it is not a death sentence. In fact, it can be controlled, even cured. And yes, for many people, the diagnosis and the medical information you’ll read in this blog are a complete surprise.
The Common (Terrible) Barrett’s Disease Treatment Plan
Here is a common story from my practice: a patient was scheduled to have a colonoscopy and the gastroenterologist suggested he undergo an upper endoscopy (esophagogastroduodenoscopy or EGD) at the same time. A week later, the patient received a telephone call: “Your biopsies showed Barrett’s esophagus.” He received a prescription for a PPI and was told to come back for a repeat endoscopy next year.
That was the extent of his medical advice.
As so many do, the upset patient turned to the internet and discovered that Barrett’s is pre-cancerous and that esophageal cancer can be a deadly form of cancer. Terrified, the patient searched for more information and answers, and he eventually found me.
As you will see, the diagnosis of Barrett’s is often a misdiagnosis. Furthermore, impactful treatment is not with PPIs. Believe it or not, data suggest that long-term use of PPIs increase the risk of developing esophageal cancer. You can beat Barrett’s, but not with drugs like Nexium or Prilosec.
The Big Question: Barrett’s Esophagus Reversal / Cure?
Like so many Barrett’s patients who have come to me desperate and afraid, that patient from the story above asked, "If I always eat healthy and alkaline, can I prevent esophageal cancer?" The answer is YES!
I believe that Barrett’s doesn’t cause cancer, but reflux does. As a matter of fact, Barrett’s is not supposed to be reversible, but it is.
Here’s but one example: a patient from Seattle came to see me a year after she had been diagnosed with Barrett’s. She had been enrolled in the Seattle Barrett’s Esophagus Project, having been positively diagnosed. After she read Dropping Acid: The Reflux Diet Cookbook & Cure, she put herself on the strict reflux-detox diet for a full year. At that point, she came to see me and asked that I perform transnasal esophagoscopy. I did, and her Barrett’s was gone — reversed with a low-acid diet and alkaline water!
Before discussing how The Dropping Acid Diet might be modified for people with Barrett’s esophagus, permit me to share my thoughts about Barrett’s. In the past, it was believed that people with Barrett’s had a 1% chance per year of getting esophageal cancer. It is now clear that that estimate is far too high and that progression from Barrett’s to esophageal cancer is uncommon.
The progression from Barrett’s to esophageal cancer is particularly uncommon in patients adhering to a good diet.
In my 40 years of practice, thanks to my patients following my guidance, I have not had a single of my Barrett’s patients develop cancer or even dysplasia (pre-cancer).
And honestly, I think that’s because my patients understand the crucial importance of lifestyle choices, detailed below in “What to Do About Your Barrett’s.”
What GI Docs Don’t Understand About Barrett’s Esophagus
1. Importance of Dietary Choices
While GI doctors usually put patients with Barrett’s on a PPI, they rarely talk about dietary changes. I suspect they don’t understand the role of pepsin in causing esophageal cancer, and are therefore, not concerned about the negative impact of dietary acid. They should be.
BTW, in Dropping Acid: The Reflux Diet Cookbook & Cure there is an actual photo (page 169) that shows a Barrett’s biopsy with pepsin within the Barrett’s tissue. Thus, the purpose of an alkaline diet for Barrett’s is to acid-starve the pepsin-diseased areas and wash out the pepsin.
2. It’s Over-Diagnosed
I have another major concern about the contemporary management of Barrett’s. It is being grossly over-diagnosed. For every three patients who come to me from a GI with a diagnosis of Barrett’s, only one actually has it. This may have to do with the way the endoscopy and the biopsies are being performed by GI doctors.
I perform transnasal esophagoscopy (TNE).Unlike endoscopies which are performed with the patient sedated, TNE is performed with an ultra-thin instrument with the patient awake, sitting comfortably, and swallowing normally. Therefore, it is easy to see the anatomic landmarks that allow precise and accurate biopsies to be obtained.
What to Do About Your Barrett’s Disease
I’d suggest getting a second opinion and make sure the biopsies are done correctly. Given a choice of examination procedures, have transnasal esophagoscopy performed by a skilled physician rather than a sedated endoscopy.
And remember, your diet is vital. PPIs are not effective treatment, and research is well-documented that they’re dangerous.
The remainder of this section is devoted to how the Barrett’s patient should adhere to The Dropping Acid Diet with a few modifications:
- You should never drink another soft drink again, including seltzer. Bottled and canned beverages are acid bombs for the esophagus and for your Barrett’s.
- You should always eat an early dinner. I recommend finishing eating by 6:00 p.m., assuming that you will go to bed after 11:00 p.m. This way you go to bed with an empty and quiet stomach.
- You should probably abstain from alcohol.
- You should avoid acidic foods like citrus except on rare occasions, and when you consume acidic foods, you should pH-balance it with low-alkaline food.
- You should consider using Manuka honey lozenges, Manuka honey itself, or Manuka honey tea after meals, or at least after your evening meal. There is anecdotal evidence that Manuka honey is good for reflux and that it helps heal the esophagus. BTW, so is chewing gum.
- Alkaline water should always be your beverage of choice. You should have a steady supply of it available. I recommend a Cerra water pitcher; it makes water pH 9.5. (That’s what I use.) We have proven that alkaline water kills the stomach enzyme, pepsin; and I believe that alkaline water is an important part of the long-term management of Barrett’s. Alkaline water is also sold at grocery stores, or you can pick it up on Amazon bottled or buy a pitcher there, then test the water with pH paper.
Yes, There is Real Science: Acid, Pepsin and All That Jazz
There is real science behind my approach to treatment. It is important science that even your doctor almost definitely doesn’t know, and I’ve linked to the original research publications for easy reference.
For much of my academic career, the main thrust of my basic science laboratory was devoted to the cell biology of reflux.
In other words, I was discovering and documenting how reflux attacks cells.
The focus of my work was LPR (laryngopharyngeal reflux), a term I created, which is acid reflux into the throat, often occurring at night during sleep. LPR is also known as “silent reflux” or “respiratory reflux.”
The research that led to us understanding the real problems that exist for Barrett’s Esophagus patients:
- First, we found that the main stomach enzyme, pepsin, was the bad actor. While it is still called “acid reflux,” it’s pepsin that causes inflammation, tissue damage, and perhaps cancer. The thing is, pepsin needs acid to be activated.
- Second, we found pepsin in every biopsy of laryngeal cancer that we studied.
- And finally, we found pepsin in biopsies of Barrett’s esophagus.
The research that led us to understanding that fighting pepsin can allow you to properly treat Barrett’s:
- Kill the pepsin with alkaline water. The pepsin molecule is denatured / broken / dies at ph 8 or higher. Alkaline water is the only thing in nature that has a high enough pH to destroy pepsin, and, it’s completely safe.
- Fight pepsin by denying it acid (with a low-acid diet). Drop acid from your diet and you can heal your body – this is where the title of my best-selling book Dropping Acid got its name!
This ground-breaking research showed me that it is so important for people with Barrett’s esophagus to have an alkaline diet and drink alkaline water.
If You Have Barrett’s Esophagus, You Must Make Healthy Choices
Reflux and decreased longevity are tied together in many ways. More importantly, a healthy diet and lifestyle that keeps you reflux-free can restore overall health and increased longevity, even if you have been diagnosed with Barrett’s. I recommend that you purchase Dropping Acid: The Reflux Diet Cookbook and Cure as well as Dr. Koufman’s Reflux Diet. They are companion books and they tell the whole story. And eat dinner early!
If you've read at least one of my books and you're following this guidance and you still need help, you can book a consultation with me.