Laryngopharyngeal reflux (LPR), also known as silent reflux, airway reflux, or respiratory reflux, is a condition that many people struggle with. Dr. Jamie Koufman is a pioneer in treating LPR, and her work has brought the topic of silent reflux into the public eye. Without Dr. Koufman, LPR patients would find it much more difficult to find treatment. Her books, including "Dropping Acid: The Reflux Diet Cookbook & Cure" and its updated version, "Dr. Koufman's Acid Reflux Diet," have become widely accepted resources for managing this condition. This article delves into the principles of Dr. Koufman's approach, its strengths and weaknesses, and how it compares to other dietary strategies.
Who is Dr. Jamie Koufman?
Dr. Jamie A. Koufman is a physician and researcher renowned for her work on acid reflux. She is credited with coining the terms "laryngopharyngeal reflux" and "silent reflux." Koufman is the founder and director of the Voice Institute of New York, a center specializing in voice and reflux treatment, and a Professor of Clinical Otolaryngology at New York Medical College. A past president of the American Bronchoesophagological Association, Koufman has lectured and published extensively on laryngology and acid reflux research for 25 years.
Understanding LPR and the Dropping Acid Diet
Dr. Jamie Koufman's books about LPR start with an introduction into the causes, diagnosis, and treatment of the disease, however, this part about the disease is very short. Koufman's diet advice against silent reflux is a combination of factors. This is a unique factor that differentiates the diet from others.
The Core Principles of the Dropping Acid Diet
Dr. Koufman's diet focuses on two key principles: reducing acid intake and limiting fat consumption.
Minimizing Acid Intake
Dr. Koufman's diet forbids everything below pH 5. The pH is a way to measure acidity. All sodas, most canned foods, and fruits are below pH 5. Once your symptoms are better, you can try to reintroduce foods down to pH 4. The core of the diet involves avoiding foods with a pH below 5, as measured by sticking a pH meter probe into the food. This includes many common items like sodas, canned goods, and certain fruits. The reasoning is that processed foods often have increased acidity to extend shelf life. It is recommended that processed foods have a pH of 4.6 or lower. The authors speculate that this is part of the cause of the rise in reflux disease in younger patients and also contributing to the increase in esophageal cancers. As symptoms improve, foods down to pH 4 can be gradually reintroduced.
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Limiting Fat Intake
Another core component of Dr. Koufman's diet focuses on limiting fat intake. The explanation is simple: fat relaxes the lower esophageal sphincter (LES). The LES is the valve which sits above the stomach. Fat causes that valve to be looser. That is why fat promotes reflux. You will be able to reintroduce moderate amounts of fat back into your diet after a while. The diet also emphasizes limiting fat intake because fat relaxes the lower esophageal sphincter (LES), the valve between the stomach and esophagus. A looser LES allows stomach acid to reflux more easily. Moderate amounts of fat can be reintroduced later.
Avoiding Trigger Foods
There are foods which are known causes of reflux. Typical examples are garlic and onions. Others are coffee, tea, and chocolate. Some of those trigger foods produce gas in the stomach. The resulting pressure forces the sphincter up above the stomach. Other foods simply relax the sphincter so that anything opens it easier. People's reactions to trigger foods vary. One patient might not tolerate the smallest amounts of chocolate while the next does not feel a bit of reflux. The goal is to avoid all those trigger foods until symptoms improve. Then you can reintroduce them into your diet one after the other. Certain foods are known to trigger reflux. Common examples include garlic, onions, coffee, tea, and chocolate. These foods can either produce gas, increasing pressure on the LES, or directly relax the sphincter. Individual tolerance to these foods varies, so the diet recommends avoiding them initially and then reintroducing them one by one to identify personal triggers.
Practical Aspects of the Dropping Acid Diet
Recipes and Food Lists
What is very good about the Dropping Acid Diet books is that they include a huge number of recipes. So even if you say: I do not care about what LPR is or how it is caused - you can just follow the recipes, at least for the first few weeks, and see whether it works for you. Sooner or later you will want to eat something else, so you still need to understand the basics of what causes reflux. The Dropping Acid Diet books include a wide array of recipes to help individuals adhere to the diet. The books also give a list of foods and their pHs, though, to help you when you shop. The recipes are low-fat and low-acid, it repeatedly tells you that those foods are okay some of the time in moderate quantities, especially once you get your reflux under control. These recipes are designed to be low-fat and low-acid, making it easier to follow the dietary guidelines. A list of foods and their pH levels is also provided to guide food choices.
The 2-Week Induction Diet
Koufman also does not go much into what happens after the 2-week induction diet. She only writes that you have to test which foods you can tolerate and which ones you cannot. The diet typically starts with a strict 2-week induction phase, after which individuals gradually reintroduce foods to determine their tolerance.
Strengths of the Dropping Acid Diet
Focus on Dietary Change
Dropping Acid provides a concise plan on how to reduce GERD and silent reflux through lifestyle changes, specifically dietary change. This book changed my life by changing my eating over a decade ago. I have not had a PPI since! The diet emphasizes the importance of dietary changes in managing reflux, which can be a sustainable long-term solution.
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Addresses Silent Reflux
Dropping Acid: The Reflux Diet Cookbook & Cure is the first book to explain how acid reflux, particularly silent reflux, is related to dietary and lifestyle factors. Dropping Acid defines silent reflux and explain in depth what causes reflux. Silent reflux is also known as laryngopharyngeal reflux--it affects the larynx and throat. Silent reflux often goes unnoticed and can cause serious health-related problems, as well as career-related problems if you rely on your voice for a living. Wake up hoarse, with a scratchy throat? You may have it. The book includes a checklist of symptoms. This could be useful if you are not sure and would give you more information to share with your doctors. The diet specifically addresses silent reflux (LPR), which often goes unnoticed and can cause various health issues.
Empowers Individuals
This book made me feel like I can survive a low acid diet. Very empowering and it was helpful to finally read what's been going on in my body (as my PCP has been less than helpful). The diet empowers individuals to take control of their health by understanding and managing their reflux symptoms through dietary choices.
Comprehensive Information
Helpful advice for those with reflux, including real causes and solutions. The book provides comprehensive information on the causes and solutions for reflux, making it a valuable resource for those seeking relief.
Limitations of the Dropping Acid Diet
Lack of Scientific Proof
The short answer is: the diet as a whole is not scientifically proven. However, its individual elements have a scientific basis. Jamie Koufman had to fight an uphill battle in bringing her knowledge to patients. Before the internet, it was very tough for physicians to introduce new concepts and treatments into the medical world. It is a universal phenomenon that the establishment tends to block and slow change by new and innovative thinkers. Do not get me wrong, having a critical establishment is important. There are more fake treatments, hoaxes, modern snake oils and placebos on the market than working therapies. That is why the medical establishment demands hard data to prove that a treatment concept works. How you get that data? Through independent studies from neutral parties. But guess what: Those studies are incredibly expensive. Usually, studies are sponsored by pharmaceutical companies who have an interest to show that their drugs are effective. Getting a neutral party to do a study and providing the necessary funds for a dietary treatment approach is close to impossible. There are no parties with a monetary interest in the diet and deep enough pockets involved. You cannot put a patent on a diet or specific foods. That explains why there is little scientific proof for the effectiveness of the Koufman diet. It is also why Dr. While individual elements of the diet have a scientific basis, the diet as a whole lacks comprehensive scientific evidence due to the difficulty of funding independent studies on dietary interventions.
Individual Variability
Some people will need additional treatment which you will not find much about in these books. One patient might not tolerate the smallest amounts of chocolate while the next does not feel a bit of reflux. The authors do acknowledge that people vary in which foods are the worst triggers, so there is some leeway for experimentation once the GERD symptoms are reduced. People's reactions to trigger foods vary. While the diet provides general guidelines, individual responses to foods can vary significantly, requiring experimentation to identify personal triggers.
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Limited Scope
The big upside of the books - that they are straight to the point - is also the downside. I believe that having all the information is the best foundation for fixing a problem. Dr. Koufman’s books give you a summary of causes and treatment of LPR, but that’s it. I know that many of my readers on Refluxgate are the severe LPR cases. Most get better with Koufman’s diet, but many do not. Those types of patients need advanced strategies. What helps them is to get a deep understanding of LPR. It enables them to experiment with different diet and treatment approaches. You will not get that in the Dropping Acid books. The books primarily focus on diet and may not provide sufficient information on other treatment options or advanced strategies for severe LPR cases.
Incomplete Food Lists
On the downside, it covers only a limited number of common foods, leaving the reader to wonder about the rest. The authors claim that they can't cover it all. Maybe not, but I wish they had covered more, especially spices and seasonings. The charts showing the ph of different foods are extremely short and just… random. Many everyday foods aren't listed, but we get the ph of several different varieties of apple. There are some random brand names. I tried looking up the foods I regularly eat and couldn't find a single one. The food lists provided may be incomplete, leaving individuals unsure about the pH levels of many common foods.
Other Health Considerations
My main problem with the book is that the recipes might be appropriate for those who have GERD, but they don't take other health considerations, such as diabetes or gluten allergies, into consideration. Some of the recipes seem to be high in sugar and simple carbs. The recipes listed have carb counts that would send my blood sugar through the stratosphere. The assumption seems to be "this is the healthiest diet around and will be good for anyone, no matter what their other issues." The recipes may not be suitable for individuals with other health conditions like diabetes or gluten allergies.
Difficulty Adhering to the Diet
Adhering to it strictly is nearly impossible, so as long as you keep in mind that it is not an exact science - you must still figure out which foods work/don't work for you, then it can be very helpful. Strict adherence to the diet can be challenging, and individuals may need to experiment to determine which foods work best for them.
Comparison with the Fast Tract Diet
There is a competing diet approach to Koufman’s diet out there: the Fast Tract Diet. Many of my readers are confused about which of those two diets they should follow. The diets conflict with each other in some ways. The Fast Tract Diet sees bacteria in the gut as the cause of reflux. Those bacteria produce gas from fermentable carbohydrates. Jamie Koufman’s Dropping Acid Diet includes many fermentable carbohydrates like whole wheat bread, pasta, rice & potatoes. The Fast Tract Diet is a competing approach that attributes reflux to bacterial fermentation of carbohydrates in the gut. This contrasts with the Dropping Acid Diet, which includes many fermentable carbohydrates.
Neuropathy and Reflux
This article would not be complete without mentioning that Dr. The medical term is neuropathy. You might ask: why should I care about nerve damage? I want to know how to treat my reflux! But are you sure that it is reflux that is causing your symptoms? Many people are writing to me that they do not manage to get better with reflux treatment. When I ask them to describe their symptoms, they sometimes sound much more like neuropathy than reflux. Chronic cough is the most common symptom of neuropathy in the throat area. However, tingling, burning, general pain or painful speaking are other signs. Those symptoms can show up in the larynx or pharynx. Even the mouth can be hit. Usually coughing should only happen when something threatens to block the airways. Like slime which is produced as a reaction to reflux. The neuropathy causes nerves to become more sensitive. They start triggering an unnecessary coughing reflux from the slightest stimulation. Some people have reflux and neuropathy. In those cases, even slight reflux can feel very bad. But to come back to Dr. Koufman’s book, I loved the detail of the Chronic Cough Enigma. It explains very well how chronic cough can be caused by damaged nerves. The downside is that Koufman concentrates on only one symptom: chronic cough. She mentions other symptoms of neuropathy like a sore & burning throat or painful speaking only as side notes. However, causes and treatment of all of those symptoms are very similar. If you think you might have both neuropathy and reflux: you will still need to treat the reflux. That is very important, as the nerve damage will multiply the reflux symptoms. Nerve damage, or neuropathy, can also contribute to reflux symptoms. Neuropathy can cause nerves to become more sensitive, triggering unnecessary coughing and other symptoms. It's important to treat both reflux and neuropathy if both conditions are present.