Disclaimer: The author recognizes that she does not treat COVID-19 patients and does not have all the facts; thus, the primary concepts of this blog are admittedly conjectural ― they are, however, an experience-informed hypothesis and some related recommendations and conclusions.
About The Type of Acid Reflux Most Americans Have
The most commonly-understood type of acid reflux is signaled by heartburn and indigestion, but that’s just GERD (gastroesophageal reflux disease), which only occurs in about 20% of people with reflux. The far more common types of reflux are LPR and RR (which is similar to LPR, but more broad).
Let's talk about both of these briefly. If you want a deep dive of knowledge, read "Dropping Acid."
About LPR: Affecting 80% of people with reflux, LPR (laryngopharyngeal reflux) literally translates as “backflow into the voice box and throat.” LPR is often also called silent reflux because LPR-sufferers (without heartburn or indigestion) may not know that they have it. Also, for many people with it, LPR may be silent because it happens during sleep and does not wake them.
About RR: Affecting tens of millions of people with reflux, Respiratory reflux is a relatively new term that I coined to hopefully replace LPR. RR is a broader and more accurate term for LPR that includes breathing and lung problems like asthma, COPD, chronic bronchitis and cough. RR occurs when acid reflux comes into any part of the respiratory system, including the lungs. And it is very common.
Allergists, lung specialists (pulmonologists), ear, nose, and throat doctors (otolaryngologist), and gastrointestinal (GI) specialists are all clueless when it comes to respiratory reflux. Millions of Americans are diagnosed with asthma and other conditions, when the real culprit is reflux.
Who Usually Has This Type of Acid Reflux?
Who gets respiratory reflux? In my opinion, pretty much everyone in America. Whether Trump knew he had reflux or not, it would be shocking if he didn't. And if you don't deeply understand reflux and haven't known what to look for as signs (asthma, allergies, cough, breathing issues, COPD, sleep apnea), you may have it and not realize it. The great news is it's fixable.
The problem is food: it’s what we eat and when we eat it. So many people go to bed soon after eating, and this wreaks havoc on our bodies.
- People in nursing homes are some of the most obvious examples. They often die of “community-acquired” pneumonia, which means there’s no bacterial or obvious underlying cause. Interestingly, it is a law that people in nursing homes must be offered a bedtime snack. Here is what I think happens: an old man in a nursing home has a tasty snack of chocolate pudding and ginger ale just before bed, and at two o’clock in the morning that ginger ale and chocolate pudding refluxes into his throat and then into his lungs. This man inevitably dies of ginger-ale-chocolate-pudding pneumonia, even though there’s no obvious medical sign of it. Really, the bedtime snack of chocolate pudding and ginger ale killed him!
- In homes all across America, every night this is happening. Over the years, the evening meal has gotten bigger and bigger and later and later, so that most people go to bed with a full and active stomach. During the night, some of this material ends up in the throat – remember, this is called LPR (laryngopharyngeal reflux). Unfortunately, once the reflux gets in the throat, it can go north into the nose and sinuses or south into the vocal cords, trachea, bronchi and lungs. Once reflux gets below the vocal cords, LPR becomes bona fide Respiratory Reflux.
- A weekend dinner reservation is often for 8 pm or later. For the first hour, you have appetizers and drinks. Next comes a main meal of rich food with more drinks, and you might even add on a rich dessert. You push back from the table at 10 or 11pm, and you’re in bed within an hour or two. Nearly every person in that restaurant with you – and those seated after you – likely have respiratory reflux. And as it turns out, one has sinus disease, another allergies, another has asthma, and another sleep apnea. And how sad, one man dies at 40-something from esophageal cancer (caused by reflux), and everyone is so surprised - it came without warning, and he didn’t smoke!
The American diet and lifestyle is responsible for most of our chronic diseases ― obesity, diabetes, heart disease, osteoporosis, allergies, asthma, sinus disease, sleep apnea, sinus disease, chronic bronchitis, cough and most other lung diseases.
Once you have reflux, it becomes self-sustaining. So if you go into the hospital with reflux, you have reflux while you are in the hospital, even if you are just fed by an IV tube. This is still a big problem.
If I Have Reflux, Am I More Likely to Get COVID-19?
Over the course of many years of clinical practice, I’ve seen a correlation between frequent viral upper respiratory infections (URIs) and LPR. I believe that the reflux sickens and weakens the lining membranes of the nose and throat, making viral penetration more likely.
Case example: I had a patient with LPR who used to get up to five respiratory infections every year, but after his reflux was cured, he stopped getting respiratory infections (none in the past five years).
It is not my purpose to scare people. I want to educate and inform. However, the combination of reflux and COVID-19 is a bad one.
I’m willing to bet having reflux makes you more likely to get COVID-19.
I’m Home with COVID-19 ― What Should I Do About Reflux?
If you get COVID-19 and you are still at home, pay attention to diet and lifestyle variables that might make reflux worse. Actively combat acid reflux ― it may save you.
I have written a best-selling book on the self-diagnosis and self-management of acid reflux. However, here are the most important pieces of advice I can offer:
- No eating or drinking within five hours of going to bed
- Sleep on an incline no less than 45-degrees (gravity helps)
- Eat five small meals
- No fried or high-fat foods
- No alcohol, chocolate or soft drinks (including fruit juice) of any kind
- Take Pepcid 20 mg. before each meal and before bed
- Take a tablespoon of Gaviscon Advance Aniseed after each meal and before bed (not available in stores in the U.S., but available online)
- Drink alkaline water as much as you conveniently can, especially after more acidic food/drink - buy bottled water and/or an alkaline pitcher (and test it with pH paper or a pH tester to make sure it's 8.0 or greater)
If you've read one of my books and you're following this guidance and you still need help, you can book a consultation with me.
Hospitalized COVID-19 Patients Should Be Aggressively Treated for Reflux
When a patient is admitted to the hospital with COVID-19, the treating physicians almost surely have no idea whether or not the patient has reflux. This is likely true of President Trump, unless his reflux has been recently diagnosed (it wasn't in his recent physicals).
For patients with COVID-19 on ventilators, death is usually caused by pneumonia. Once someone is hospitalized with coronavirus pneumonia, respiratory reflux into the lungs would be a very bad thing. For the treating physicians, it would be like fighting fire with water in one hose and gasoline in the other. I believe that anti-reflux measures might make the difference between life and death for some patients.
I believe that all patients with COVID-19 pneumonia should be assumed to have reflux as an accelerant and routinely treated for reflux as aggressively as possible on the assumption that silent respiratory reflux is a potentially deadly cofactor.
It is interesting that Pepcid (famotidine) given in high doses intravenously appears to be helpful in some Covid patients. Indeed, its mechanism of action may not be so much to anti-viral action, but rather due to its acid-suppressive (anti-reflux) effects.
- I would recommend IV famotidine (Pepcid) for all intubated patients.
- Patients should not be left in head-down positions for “drainage” any longer than necessary – they should be in the most upright position that their respiratory system will tolerate.
- They should be suctioned regularly, if possible.
No per oral feedings