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Dr. Jamie Koufman  Reflux

Dr. Jamie Koufman:
Treating Reflux with Diet.
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December 09, 2021  

Dr. Jamie Koufman

Dr. Jamie Koufman: Treating Reflux with Diet

August 22, 2011

Written for Reflux1 by Michelle Alford

Jamie Koufman, M.D., is the Director of the Voice Institute of New York and is a Professor of Clinical Otolaryngology at New York Medical College. In addition, she is an Adjunct Clinical Professor of Otolaryngology at Drexel University, an Adjunct Clinical Professor of Surgery at George Washington School of Medicine, and an Adjunct Associate Surgeon at New York Eye and Ear Infirmary.

Dr. Koufman has been practicing medicine for over 25 years. She’s been listed as one of “America’s Top Doctors” every year since 1994. She has published numerous articles and regularly lectures on reflux. Her book, Dropping Acid: The Reflux Diet Cookbook and Cure, includes detailed patient-friendly information about reflux and 75 original low-acid recipes.

Dr. Koufman’s uncles inspired her to become a doctor. “I actually had two uncles who were surgeons and liked the idea of being able to help people and fix things by doing surgery. I started my career in throat surgery, and then I heard about this guy who was pioneering laser surgery. I had the 4th laser in the United States. I think every patient is like a puzzle we have to solve. It’s important to be able to look them in the eye and say, ‘I’m not going to bail on you.’”

Dr. Koufman coined the term Laryngopharyngeal Reflux (LPR), or Silent Reflux, to draw attention to the fact that there are two populations of people with reflux. “Everyone knows that heartburn is a symptom of reflux, but not everyone realizes that coughing, hoarseness, sore throats, post nasal drip, a lump in the throat, or difficulty swallowing are all symptoms. Only half of patients with reflux actually have heartburn, so a lot of people suffering from the other symptoms don’t realize that they have reflux.”

Those suffering from Silent Reflux usually have several symptoms. “Hoarseness could mean a lot of things—paralysis, infection, nodules—but if you have hoarseness as well as a cough, throat mucus, and trouble swallowing, that’s most likely reflux.”

Dr. Koufman believes that part of the problem with our current medical system is that there are too many specialists. “Americans like to see that someone is ‘the best in lungs’ or ‘the best in throat’ or ‘the best in stomachs.’ So we have specialists for everything as if those diseases would respect the boundaries of the specialties, which is preposterous. As a result, doctors diagnose illnesses looking at only one part of the body instead of comparing notes and finding the root cause. We need more general physicians who understand how everything is connected. I had a patient, a 72-year-old woman, who had been suffering from a chronic cough for 42 years. I was the 34th doctor she came to. Nobody had figured out that her cough could be caused by reflux.”

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Dr. Koufman's Advice

  • Don't eat anything after 8pm
  • Minimize your consumption of carbonated drinks
  • You only need enough sauce or dressing for your tongue to taste; a little works as well as a lot
  • Don't cut out the food you love--eat it in moderation
  • Don't expect medication to completely cure your reflux if you're still consuming a lot of highly acidic foods and beverages
  • According to Dr. Koufman, reflux is usually treated with pills when the root cause for most people is their diet. “Medication reduces the acid in the stomach, but doesn’t impact what you eat and drink. What you consume may be doing damage on the way down as well as on the way up.

    The first step to a healthy diet is reevaluating your eating habits. “Night eating is one of the worst things you can do. If you have reflux, you should close the kitchen at 8 o’clock. It’s also important to consider how often you eat. You don’t have to eat every time you have a pang of hunger. Americans eat when they get home, keep eating until they go to bed, and sometimes they wake up and eat.  We need to not eat as much; it causes obesity and reflux.”

    The percentage of people suffering from reflux has increased significantly over the past two generations.  “4 out of 10 people have reflux, including 37 percent of people between the ages of 20 and 30, which is surprising because it used to be the disease of middle age. It’s because of the acid in the food. In 1973 after a food poisoning epidemic, FDA mandated that companies start putting acid in food to kill bacteria. Everything you eat or drink out of a can or bottle has acid. Acidity in food contributes dramatically to the development of acid reflux. Even baby food has acid in it.”

    According to Dr. Koufman, many people with reflux disease who try a low acid diet get well. “I recommend a strict detox diet for the first two weeks. Low fat food with no acid. That means no carbonated beverages, no citris, nothing out of a bottle or can except water. Bananas and melon are good, but otherwise not much fruit. Eat grains, vegetables, salad, poultry without skin, fish, tofu, breads, cereal with low fat milk, oatmeal, salad with chicken, rice, grains, potatoes, fish. Eating acid free food doesn’t mean you have to suffer. A lot of people worry what they can eat if they go out to a restaurant, but almost every restaurant has grilled fish, salad, and delicious vegetables.”

    After the detox period, there are fewer restrictions on what you can eat. “At this point, it’s all about maintenance, which doesn’t mean that you can’t ever have acidic foods, just that you need to have smaller portions and balance acidic foods with foods that aren’t acidic. For example, strawberries are really acidic so people with reflux may feel like they can’t have strawberries. But if you have strawberries in your cereal with milk, the non-acidic milk will balance out the strawberries and you should be okay.”

    In Dr. Koufman’s experience, one of the most common concerns of reflux patients is that they’ll be on a restricted diet for the rest of their lives. “They worry they’ll never be able to have wine or chocolate, but they should be able to eat anything as long as it’s done in moderation. One glass of wine or one cocktail is fine, but not two. A few bites of rich ice cream instead of a few scoops.  Yes, you can eat what you want. You just have to think about what you eat and when you eat it.”

    The only food you absolutely need to avoid is your trigger foods. “Sometimes people have trigger food that makes them reflux, even when it’s normally good for most people. Bananas, oatmeal, even tuna fish have been trigger foods for patients of mine. There are variations from person to person that make it difficult to have an all encompassing diet, but we can say what works for most people. You just need to avoid your trigger foods.”

    Another concern for patients is being on a lot of medication. “Most reflux medications are effective and safe, but a lot of patients don’t want to be on medication if it can be avoided. Patients come to me because I treat reflux without mediation. A lot of doctors thought that people wouldn’t be willing to moderate their food and beverages and live with a restricted diet, but, in my experience, most people love to be the captain of their own ship.”

    One patient story stands out to Dr. Koufman. “One of my patients was a woman only 27-years-old who came to me with terrible lungs, coughing all over. I treated her, educated her, for over a year.  At the end of that time I said, “Catherine, you graduate. Call if you need me.” Her lungs were clear and she had no reflux. She went from having serious lung disease to perfect health. It’s a process of education, learning about diet. Generally speaking, most doctors don’t talk to their patients about these things. My specialty is rebuilding vocal chords, but I spend 2/3rds of my time talking to people about their diet. Three things resulted in Catherine’s serious condition. One, she was a late night eater. Two, she was a big drinker. She drank all night and fell asleep tipsy. Three, she ate a fair amount of fried food. When she fixed these things, she got better.”

    Dr. Koufman thinks that the current approach to medicine needs to change going forward. “As I said, there are too many specialties. General physicians need to understand that all these things are connected. We need diagnostic tools to weed out people with reflux because it’s the easiest to treat. There are a lot of misdiagnoses. Half of asthma sufferers could become well if they change to a diet for reflux.  I truly believe reflux is the disease of our civilization.”

    Visit the Facebook page for Dr. Koufman’s book, Dropping Acid

    Discuss in the Reflux1 forums

    Last updated: 22-Aug-11

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