Alkaline Water, Along With a Mediterranean Diet, May Help Symptoms of Laryngopharyngeal Reflux Disease

Written by Angeline A. De Leon, Staff Writer. Of the 184 patients with laryngopharyngeal reflux disease, those on a plant-based Mediterranean-style diet and alkaline water had symptom reduction equal to or better than those who were on a proton pump inhibitor after 6 weeks of intervention.

Laryngopharyngeal reflux disease (LRD) is defined as the retrograde flow of the stomach and upper digestive system’s gastric contents into the back of the throat and nasal airway. Some of the symptoms that may accompany LRD include sore throat, trouble breathing and swallowing, hoarseness, and persistent cough. Current research has determined that LRD may be caused by exposure of the laryngopharnyx to an acidic environment in the presence of pepsin, an enzyme involved in the breakdown of ingested proteins (1). Treatment of LRD, therefore, has primarily focused on countering acid, either through the pharmacological use of proton pump inhibitors (PPI) (2) or through dietary interventions involving a low-acid, plant-based diet with minimal animal protein intake (3, 4). Although only a small sample of pilot studies indicate the promising effects of a wholly dietary approach to treating LRD (5), symptom improvement through a low-acid diet may prove to be at least, if not more, effective than the current gold standard use of PPI (6). In a study conducted by researchers at the New York Institute for Voice and Swallowing Disorders, a comparative investigation was carried out to determine the efficacy of a diet-based approach involving alkaline water and a plant-based, Mediterranean-style diet vs. standard PPI therapy in the treatment of LRD.

A retrospective review was conducted on the medical charts of 184 patients who were diagnosed with LPR. Patients were placed into one of two treatment programs based on the time period of their enrollment: 85 patients (median age = 60 years) were treated with a PPI inhibitor and standard reflux precautions (PS), and 99 patients (median age = 57 years) were treated with a combination of alkaline water, a plant-based Mediterranean-style diet, and standard reflux precautions (AMS). At baseline and following 6 weeks of treatments, the Reflux Symptom Index (RSI) was administered to assess severity of LPR and document any changes in symptoms resulting from treatment.

Using a 6-point reduction in RSI score to signify a clinically meaningful improvement, results indicated that at the end of 6 weeks, the PS group did not experience a response that was significantly better or worse as compared to the AMS group. 54.1% of PS patients achieved improvement in RSI score, compared to 62.6% of AMS patients (between-group difference = 8.05; 95% Confidence Interval: 5.74 to 22.76). The mean percent reduction in RSI was 27.2% for PS group and 39.8% for AMS (difference in means = 12.10; 95% CI: 1.53 to 22.68).

Data suggest that the effect of a plant-based diet, along with alkaline water, is at least equally effective, if not better, when compared to standard PPI treatment for LPR. Given the overall benefits associated with a healthy diet, a dietary approach to LPR management does not only offer far-ranging health benefits for general well-being, it is also more cost-effective than any pharmacological intervention. Randomized clinical trials are still needed to corroborate current findings.

Source: Zalvan CH, Hu S, Greenberg B, et al. A comparison of Alkaline water and Mediterranean diet vs. Proton pump inhibition for treatment of laryngophareyngeal reflux. JAMA Otolaryngology-Head and Neck Surgery. 2017. DOI: 10.1001/jamaoto.2017.1454.

© 2017 John Wiley & Sons, Ltd.

 Posted January 2, 2018.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

References:

1. Johnston N, Dettmar PW, Bishwokarma B, et al. Activity/stability of human pepsin: implications for reflux attributed laryngeal disease. Laryngoscope. 2007; 117(6): 1036-1039.
2. Karkos PD and Wilson JA. Empiric treatment of laryngopharyngeal reflux with proton pump inhibitors: a systematic review. Laryngoscope. 2006; 116(1): 144-148.
3. Guilloteau P, Le Meuth-Metzinger V, Morisset J, et al. cholecystokinin and gastrointestinal tract functions in mammals. Nutr Res Rev. 2006; 19(2): 254-283.
4. Qian JM, Rowley WH, Jensen RT. Gastrin and CCK activate phospholipase C and stimulate pepsinogen release by interacting with two distinct receptors. Am J Physiol. 1993; 264(4 Pt 1): G718-G727.
5. Koufman JA. Low-acid diet for recalcitrant laryngopharyngeal reflux: therapeutic benefits and their implications. Ann Otol Rhinol Laryngol. 2011; 120(5): 281-287.
6. Sheen E and Triadafilopoulos G. Adverse effects of long-term proton pump inhibitor therapy. Dig Dis Sci. 2011; 56(4): 931-950.