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Consider plant-based diet for treating reflux symptoms

PPIs no better than plant-based Mediterranean diet plus alkaline water at improving LPR symptoms, research suggests

Louise Prime

Friday, 08 September 2017

Laryngopharyngeal reflux (LPR) symptoms improved at least as much among people who tried dietary interventions as they did in those taking proton pump inhibitors (PPI), in a small US study* published in JAMA Otolaryngology-Head & Neck Surgery. The study’s authors suggested that a plant-based diet and alkaline water should be considered in the treatment of LPR, because there are many other benefits to non-pharmacological treatment, but they also called for more research into the effectiveness of this approach.

The researchers pointed out that treatment of LPR is controversial because there has been little study evidence to support the superiority of PPI therapy over other treatment methods, even though this is the current predominant regimen in the US – costing the US more than $13 billion in one year (2009) alone. So, they set out to investigate a possible alternative.

They recruited patients with LPR and divided them into two treatment groups. One group of 85 people with LPR were treated with PPI and standard reflux precautions (PS group); and the other group of 99 patients were treated with alkaline water, 90% plant-based, Mediterranean-style diet, and standard reflux precautions (AMS group). The researchers then compared outcomes between the groups, based on change in the reflux symptom index (RSI).

Almost two-thirds (62.6%) of patients in the AMS group experienced a clinically meaningful reduction in RSI (i.e. of at least 6 points), compared with just 54.1% of those in the PS group; this difference between the two groups did not, however, reach statistical significance. The mean reduction in RSI was 39.8% in the AMS group, significantly better than the 27.2% achieved in the PS group.

The authors of the study acknowledged that it had some important limitations, including the inherent biases of retrospective chart reviews, such as selection, information, and exclusion group biases. They said that as rigorous as exclusion criteria were, patients with dual diagnoses might still have been enrolled in the study, confounding its results.

They concluded: “Because the relationship between percent change and response to treatment has not been studied, the clinical significance of this difference requires further study.

“Nevertheless, this study suggests that a plant-based diet and alkaline water should be considered in the treatment of LPR. This approach may effectively improve symptoms and could avoid the costs and adverse effects of pharmacological intervention as well as afford the additional health benefits associated with a healthy, plant-based diet.”


* Zalvan CH, Hu S, Greenberg B, et al. A comparison of alkaline water and mediterranean diet vs proton pump inhibition for treatment of laryngopharyngeal reflux. JAMA Otolaryngol Head Neck Surg. Published online September 07, 2017. doi:10.1001/jamaoto.2017.1454.

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