When patients come to see Dr. Jonathan Aviv complaining of a hoarse throat or allergy-like symptoms, they’re often perplexed when he returns with his diagnosis: acid reflux. But the ear, nose, and throat doctor and clinical professor of otolaryngology at Mr. Sinai says that misinformation about acid reflux is abundant, and that it’s far more common, and potentially serious, than you might think. On top of that, the traditional “solutions” we turn to (we’re looking at you, TUMS) aren’t solutions at all. In fact, the ultimate solution comes down to — you guessed it — diet and lifestyle.
The first misconception Dr. Aviv wants to clear up is that there are actually two types of acid reflux. There’s the one everyone thinks of, the burning feeling coming up your chest from your stomach, which is called gastroesophageal reflux disease, or GERD. But there’s also a type that can happen to any of us: when you eat something acidic, it causes inflammation as you swallow, affecting the throat, sinuses, ears, lungs, and vocal cords.
This second type is where people get confused, as the symptoms don’t manifest like traditional acid reflux. Instead, you might have a cough, post-nasal drip, or a hoarse throat. That means that acid reflux cases go undiagnosed. What’s worse, uncontrolled acid reflux of either type can lead to esophageal cancer.
This is a big deal, as esophageal cancer has been the fastest-growing cancer in the U.S. and Europe since the mid-1970’s. So, what happened in the mid-1970’s? Well, two things:
First, in an effort to prevent food poisoning from Botulism, the government enacted a law called Title XXI, requiring that every food in a can, bottle, or box needs to be acidified. Food producers continued to lower the pH of food by adding ingredients like ascorbic acid and citric acid.
Second, the food industry began to shift how they added sweeteners, switching from cane sugar and beet sugar to a much less expensive sweetener derived from crop corn, known as high fructose corn syrup. This is a very inflammatory sweetener that can loosen the lower esophageal muscle, making it easier for the acidic cells in the stomach to make their way up.
This combination of more acidic food and looser esophageal muscles is a one-two punch that causes a lot of inflammation — or worse.
Today, 75 million americans have GERD, and “we’re all at risk,” according to Dr. Aviv. “The scary thing is that a lot of people don’t have the traditional symptoms.” So when patients come to Dr. Aviv complaining that they need to clear their throat all the time, they’re quite confused when he responds by asking about their diet. “They look at me like I have nine heads,” he says.
Dr. Aviv is laser-focused on how diet and lifestyle affects the acid response, and he should know — he has personal experience. When he was at Columbia, he woke up in the middle of the night and couldn’t breathe. Eventually he realized that it was because of what he was eating. “You know, that 32-ounce Big Gulp of, I don’t know how many milligrams of caffeine were in this thing,” he says. “My diet was giving me symptoms and it took a long time because the science really wasn’t there.”
Today, he asks all his patients detailed questions about their diets, and he recommends that if your doctor isn’t asking you these questions, you should volunteer the information — or better yet, bring in a food diary, including not only what you ate (and drank) but when. This latter part is important because if you’re lying down shortly after eating, you take away gravity, and acidic enzymes make their way up into your esophagus. By providing this information, Dr. Aviv says, “You’re giving your clinician the keys to a lot of these symptoms.”
Addressing the issues in your diet is incredibly important, because as was discovered in 2016, eating acidic foods causes a body-wide inflammatory response — which means it can affect a lot of things besides acid reflux. This is pretty sobering, but on the flipside, it means that switching to an anti-inflammatory diet can help a whole bunch of other things as well as acid reflux. After putting patients on his acid watcher diet, Dr. Aviv has had patients come back reporting that conditions like IBS, psoriasis, and Crohn’s disease have improved.
His book goes into detail on how to use diet to replicate acid-reducing medication (since a lot of those medications have some serious side effects), but here’s a quick primer on the 12 foods to avoid (the “Dirty Dozen” as he calls them):
6 foods that loosen the muscle that separates the acidic stomach from the non-acidic esophagus:
6 extremely acidic foods/food groups:
sugary or diet soda
sugary or diet bottled iced tea (According to Dr. Aviv, even having these first two items once or twice a month isn’t okay. He equates it to “pouring battery acid down my throat twice a month.”)
tomato sauce (not tomato)
In terms of what you should eat, he recommends organic, non-GMO produce, non-dairy milks, cucumber, watermelon, flax seeds and lots of whole foods: “The more whole, natural foods you have, the better it is for your body, meaning less chemicals, less inflammation.”
Watch Dr. Aviv’s full interview to learn about how smoking and vaping affects acid reflux, how to tell the difference between acid reflux and allergies, and the role weight plays in all of it.
Cold-Pressed Watermelon Juice
The Acid-Watcher Diet: A 28-Day Reflux Prevention and Healing Program