Alkaline water
August 29, 2023

Why a Low-Acid Diet for Acid Reflux?

Alkaline water


  • Acid reflux? Your doctor may have prescribed an acid-suppressive medication. But when it comes to inflammation from reflux, the real villain is the digestive enzyme pepsin, not acid, so an antacid won’t do a thing for many reflux symptoms.
  • What you eat could be eating you. Pepsin causes swelling and inflammation wherever it lands and sticks; and when you consume acidic foods or beverages, pepsin is activated and does its thing.
  • Today, many prepared foods and beverages, especially soft drinks, are as acidic as stomach acid; so if you want to beat your reflux, as part of your treatment program ― to get rid of the pepsin ― you should be on a low-acid diet.

Note: Respiratory Reflux (RR) and Laryngopharyngeal Reflux (LPR) are synonyms and the terms can be used interchangeably. Going forward, I prefer the term RR and so should you; it is easier to pronounce, more intuitive, more comprehensive, and implies that RR can affect any and all parts of the respiratory system, which it does.

Here’s a surprise: “Acid reflux” should probably be called “peptic reflux,” because the stomach enzyme pepsin ― that comes up along with the acid when you have reflux ― causes all the inflammation, swelling, tissue damage, ulceration, even cancer. Pepsin is the bad actor in reflux disease.

If you have hoarseness, post-nasal drip, sinus symptoms, a feeling of a lump in your throat or any other respiratory reflux symptom, it is usually due to inflammation and swelling caused by pepsin. So, I have studied for 40 years, so let me tell you a few things about it. First, pepsin attaches itself wherever it lands; one of the most common places is the vocal cord(s). Second, pepsin doesn’t just sit on the surface, it penetrates to do damage deep in the tissue. Third, pepsin is most active, does the most damage, at pH 1-5. And finally, pepsin is denatured, dies, falls apart at about pH 8 or greater.  

Shown here is a vocal cord biopsy from a patient with severe hoarseness and reflux. Every bit of the brown color in this photo is pepsin. (The tissue is stained for pepsin; normally in this biopsy the tissue would be mostly light and dark blue.) That’s a lot of brown pepsin, and it causes a lot of inflammation. BTW, in this case, the patient was addicted to diet Coca-Cola that has a pH of less than 4. Imagine trying to get rid of all that pepsin!

Obviously, with pepsin on and in your tissue, if you have another reflux event, more acid will come up and activate the waiting pepsin. On the other hand, and perhaps more likely, is that you consume something that’s acidic, and that can turn on the pepsin, too.

That’s why soft drinks (almost everything in a bottle or can) are really bad for refluxers; they have the same acidity (pH 1-5) as stomach acid, and really ger pepsin going. In my reflux diet, all soft drinks including seltzer and fruits juice are forbidden as well as lemon, lime, all citrus, as well as apple cider vinegar.

In a landmark cell biology study, we took biopsies from the larynx of people with (pH-documented) respiratory reflux, and then examined the tissue under the microscope for the presence of pepsin, so-called immunohistochemistry. Eureka! We found pepsin in the tissue in every case, including patients with laryngeal cancer as above. We have also shown that throat tissue is damaged at pH 5 or less, and the esophagus, pH 4 or less. (If you need a refresher on the pH scale, it is explained in the first paragraph of the Is Alkaline Water Safe? Post.)

Principles of Dr. Koufman’s Low-Acid Diet

Assume that you’ve got a pepsin everywhere from respiratory reflux; it’s your job is to wash out, kill the pepsin. That’s why I recommend an alkaline diet, drinking alkaline water (pH 9.5 or higher), and using alkaline water throat spray. This is covered in my last post on Alkaline Water.

Personally, I use and recommend the Cerra Water pitcher (pH 9.5) and these small cobalt blue throat spray bottles. The alkaline water throat spray is particularly important for treating the vocal cords — if you’re a singer, actor or any type of professional voice user, this is for you, because if you spray the vocal cords with alkaline water pH 9.5, the pepsin dies (pH 8).

Dropping Acid: The Reflux Diet Cookbook & Cure was the first book, and remains the anchor book in the reflux category, to reveal the principles, importance, and the how-to of a low-acid diet. (And Dropping Acid is a New York Times best-seller.) Very interesting is the fact that it has been the number1 best seller in the Asthma category for a year now. I guess people are figuring out the causal relationship between reflux and asthma (and reflux-caused pseudo-asthma), even if their doctors aren’t … see Is My Asthma Really Asthma?

In a nutshell my reflux-detox, my starting-point dietary plan:

— Nothing out of a bottle or can except still water

— The only fruit you can eat is melons and bananas

No alcohol

— No onions, peppers, garlic, or tomatoes.

The complete detox diet, how to get rid of pepsin, is in the vegetarian post on this blog, as well as in Dropping Acid and Dr. Koufman’s Acid Reflux Diet with gluten-free recipes.

For more information about diagnosis and treatment, see my books on Amazon: Dropping Acid: The Reflux Diet Cookbook & Cure and Dr. Koufman’s Acid Reflux Diet. And if you would like to schedule a virtual consultation with me, you can book online.

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