Thursday, in my interview with Dr. Jonathan Aviv—a world-renowned ENT physician and surgeon, as well as author of Killing Me Softly From Inside—we explored the surprising link between acid reflux and the rise in esophageal cancer. In addition to talking about the use of sulfuric acid to make high fructose corn syrup, we discussed the mid-1970s legislation that requires acidifying any food in bottles or cans, including baby food, which introduces additional acid into our bodies from infancy. Today, we’ll take a look at foods that people with acid reflux should flat out stay away from, identify which acidic foods can be neutralized and share which ones can help heal acid reflux.
When looking at acid reflux disease, Aviv said foods are looked at in physiological terms—what they do to the muscle that protects the esophagus from acid in the stomach, the LES. Food is also categorized how much acidity it contains.
Six Common Foods That Contribute to Acid Reflux
Foods that loosen the esophageal barrier and foods with high acidity play a major role in acid reflux disease. “It’s these kind of substances we urge patients to stay away from them in the quest of healing their acid reflux naturally,” said Aviv. “In other words, using food as medicine, as opposed to medicine.”
Avid said there are six very common foods we eat that are not especially acidic, but they loosen the LES muscle:
Caffeine is on the list for loosening the LES and for its nature of increasing hydrochloric (HCL) acid production in the stomach.
“Not only does it de-activate the protective muscle, it takes stomach acid and increases it,” said Aviv. “So the stomach produces more acid, that muscle doesn’t work or is deactivated, and stomach material is going to come up the wrong way.”
Chocolate is on the list for its caffeine content, which comes in varying amounts in different types of the candy.
“Very often, chocolate can be a trigger food in my patients,” Aviv said. “People will really feel, if not heartburn, what I call throat burn. They’ll feel the coughing, clearing, lump-like sensations.”
Alcohol, mint, onion and garlic all in general loosen that LES muscle. People cook with a lot of onion and garlic, so in developing his Acid Watcher® Diet, Aviv came up with a list of alternatives to use so people can still have flavor in their food.
What About Other Triggers?
Aviv said that, after a while, patients get a feel for what they can and cannot have. They can also take a proactive role in identifying foods that trigger acid reflux specifically for them.
One reader brought up how dairy also causes the stomach to produce more acid. Her acid reflux symptoms were eliminated simply by cutting out all dairy–milk, cheese, yogurt, etc.
"Some people come in and say, 'I was having a banana and it was like someone was stabbing me in the heart.' You know what I say to that? Don’t eat bananas," Aviv said. "When you've identified things that trigger your symptom, whether it’s a throat burn symptom or a heartburn symptom—let’s stay away from that."
The Power of pH and Pepsin
“There’s a sort of magic number when looking at pH, which is a scientific term for relative acidity,” Aviv explained “You want substances above pH 5 as you’re beginning to heal very vigorously, and then you can ease back to above pH 4.”
The pH numbers in food is critical (find the pH of common foods, fruits and vegetables here) because pepsin gets activated below pH 4. Pepsin is a type of enzyme that normally gets activated in the stomach to break down food when acid is present. Pepsin only is activated in a very acidic environment.
“But with acid reflux, pepsin receptors can float up into esophagus, into the chest, vocal chord and throat area, and they sit there,” Aviv said. “When something acidic comes by, these receptors get activated and it starts basically eating you.”
This is why he cautions against the lemon and apple cider vinegar remedy for reflux disease. “When you pour acid down that area, those receptors—think of them like Pac-Man—get activated. They start inflaming the tissues.”
Soda, one of the most acidic substances we consume, activates pepsin receptors, attacking the throat. Aviv finds it ironic that voice competition shows, like The Voice or American Idol, have their judges with a cup of branded cola at their tables. “So the thing that can destroy voices sponsors the voice shows. It’s sort of like the tobacco companies sponsoring the Olympics,” he said.
“There is just a little bit of a disconnect, and people probably aren’t aware of that. [Soda] beverages activate these receptors and there’s not a health benefit to consuming them to begin,” said Aviv. “So I join the acidic healthy foods with the acidic, non-healthy foods, which are sugary sodas, which are extraordinarily acidic.”
Citrus foods—like lemon, lime, pineapple, orange, and orange juice—are considered very healthy. However, they are also highly acidic. In people with acid reflux, citrus can wreak havoc on the pepsin receptors in the throat.
Acidic Foods That Can Be Alkalinized
There’s another set of healthy fruits, berries, of which patients with acid reflux should be cautious. While high in fiber, antioxidants and anti-inflammatory, most berries are also rather high in pH and quite acidic. Fortunately, the acidity of berries can be neutralized with something alkaline, like unsweetened almond milk.
“You can combine handful of berries and almond milk in a smoothie You can add banana, hemp protein and spinach, and alkalanize these acidic fruits and eat them safely when you have acid reflux disease,” he said. Any tree nut milk, coconut milk, non-GMO soymilk or rice milks is very alkaline and concentrated, helping to neutralize the acidity of berries.
Honey is another example of an acidic food that can be neutralized. Nut butter can neutralize the acidity of nut butter, according to Aviv.
He says that unfortunately it’s almost impossible to neutralize the substances, like caffeine and alcohol, which cause the physiological effect of loosening the LES muscle. Aviv says alcohol and caffeine are the hardest for most people to give up.
“Yet knowing that if they have less coffee or less alcohol, they will feel better is very empowering,” Aviv added. “While it’s hard to change your diet and lifestyle, knowing you can fix the problem by changing what you eat is very powerful. When people are uncomfortable or worried, they’ll step up and do what they need to do to get better.”
Foods the Help Heal Acid Reflux
So we know which foods harm people with acid reflux. What are foods that can help? “You want to stay with the fruits and vegetables that are certainly above pH 5, if you can, or pH4 as your healing is taking place,” said Aviv.
Fruits like watermelon and banana are well tolerated, helping to heal acid reflux. Yet green vegetables seem to be the food of choice as they are very alkaline. They are also high in fiber, which will fill you up.
Dr. Aviv's Acid Watcher® Diet
Aviv developed the Acid Watcher® Diet, which is a low acid, high fiber diet that has balanced amounts of the three macronutrients—proteins, fats and carbohydrates. He’s had his patients use a modified form of the diet for years, but now he can offer a series of recipes and pH tables with his book, Killing Me Softly From Inside.
The book also has hundreds of foods that Aviv tested and broke down into different categories—fruits, vegetables, commonly consumed liquids, etc. He said that since the book came out, he has about 1200 people on the diet.
Dr. Aviv noticed that more and more patients on his Acid Watcher Diet were having fairly consistent and predictable weight loss, as fiber revs up the metabolism. “We’re seeing anywhere from 4-10 lbs weight loss and an average of about an inch off the waist in the first 2-3 weeks from people on the diet. Then it levels off to about 2 pounds a week,” he said, “If you’re going to rev up metabolism and get rid of processed food, you are going not only feel good but look good.”
As Aviv pointed out in yesterday’s article, getting rid of processed food is key for people with acid reflux, especially as any food substance in a can or bottle is acidified to prevent bacterial overgrowth and food poisoning. Aviv believes that eventually the government will reveal to the public that foods in jars and cans are acidic. He recommends readers continue to read food labels and watch out for sulfuric acids in processed foods–including backing off foods with HFCS.
For now, the key is to raise awareness. “We need to raise awareness that things that you may be eating are acidic and that chronic throat symptoms should be considered alarm symptoms that require a doctor’s attention,” said Aviv.
While he admits that using food as medicine is still considered maverick idea in a lot of medical circles, Aviv feels changing what you eat is key to healing acid reflux and putting a halt to the rise in esophageal cancer.
(Image: pH Chart from MindBodyGreen)