Acid Reflux? Try Going Vegetarian

Amy Norton wrote . . . . . . .

A mostly vegetarian diet may provide relief similar to widely used medications for people with acid reflux, a new study suggests.

The study looked at close to 200 patients at one medical center who had been diagnosed with laryngopharyngeal reflux.

It’s a condition where stomach acids habitually back up into the throat, and it’s distinct from the much better-known gastroesophageal reflux disease (GERD) — or what most people call heartburn.

People with laryngopharyngeal reflux usually don’t have heartburn, explained Dr. Craig Zalvan, the lead researcher on the new study.

Instead, they have symptoms like hoarseness, chronic sore throat, persistent coughing, excessive throat clearing and a feeling of a lump in the throat.

Still, the problem is often treated with GERD drugs known as proton pump inhibitors (PPIs). PPIs include prescription and over-the-counter drugs like Prilosec, Prevacid and Nexium, and they rank among the top-selling medications in the United States.

PPIs do help some people with laryngopharyngeal reflux, said Zalvan. He’s chief of otolaryngology at Northwell Health System’s Phelps Hospital, in Sleepy Hollow, N.Y.

And Zalvan, himself, used to prescribe them regularly.

However, it became clear that the medications were not effective for many patients, Zalvan said. At the same time, he noted, studies began raising concerns that PPIs are not as safe as thought.

Research has linked prolonged PPI use to slightly increased risks of heart attack, kidney disease, dementia and bone fractures — though it’s not clear whether the drugs are the cause.

For Zalvan, it all led to a new direction: prescribing a “dietary approach.”

Based on research into diet and various chronic ills, Zalvan began advising patients to take up a mostly vegetarian diet that he describes as “Mediterranean style.”

He encouraged patients to go 90-percent plant-based — eating mainly vegetables, fruits, legumes, whole grains and nuts. Meat and dairy were to be limited to two or three modest servings per week.

In addition, Zalvan gave his patients the standard reflux-soothing advice to avoid coffee, tea, alcohol and fried or fatty foods.

For the new study, Zalvan’s team looked back at patient records to see how that diet approach compared with the old PPI way.

The investigators focused on 85 patients who’d been treated with PPIs and standard diet advice between 2010 and 2012, and 99 who’d been advised to go mostly vegetarian.

When it came to treating the patients’ symptoms, “the diet was as good, if not better than, PPIs,” Zalvan said.

After six weeks, 63 percent of patients on the diet were showing at least a 6-point drop on a scale called the reflux symptom index. That’s considered a “clinically meaningful” improvement, Zalvan noted.

That compared with 54 percent of PPI patients, according to the report.

The findings were published online in JAMA Otolaryngology–Head & Neck Surgery.

According to Zalvan, patients in the diet group typically lost eight pounds — which may help explain their symptom improvement. But it’s not possible to tell how much credit goes to the weight loss, versus the diet itself.

Sonya Angelone is a registered dietitian and spokesperson for the Academy of Nutrition and Dietetics. She also recommends a largely plant-based diet for managing acid reflux.

What’s critical is picking healthy plant foods, Angelone said — creating a diet high in beans, vegetables and nuts, not pasta and bagels.

Healthy plant foods tend to calm inflammation in the body, Angelone explained, whereas a diet heavy in processed foods does the opposite.

And there’s been a growing understanding of acid reflux as an inflammatory disorder, Angelone said. That is, the acid itself might not do the real damage; the body’s inflammatory response may.

“I think this study offers more evidence that you should aim to eat more plants and fewer processed foods,” Angelone said.

Zalvan acknowledged the study’s limitations. It was not a clinical trial that specifically tested the vegetarian diet against medication, which is considered the “gold standard” for proving a treatment works.

Plus, it’s not clear whether patients have to rigorously stick with the 90-percent vegetarian plan — or whether more-moderate changes would do the trick.

What’s important, Angelone said, is that people make healthy changes they can live with for the long haul.

“Your diet choices matter,” she said. “They matter in your risk of chronic diseases down the road, and in more-immediate symptoms like acid reflux.”

Source: HealthDay

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Study: Vegetarian Diets Almost Twice as Effective in Reducing Body Weight

Dieters who go vegetarian not only lose weight more effectively than those on conventional low-calorie diets but also improve their metabolism by reducing muscle fat, a new study published in the Journal of the American College of Nutrition has found.

Losing muscle fat improves glucose and lipid metabolism so this finding is particularly important for people with metabolic syndrome and type 2 diabetes, says lead author, Dr. Hana Kahleová, Director of Clinical Research at the Physicians Committee for Responsible Medicine in Washington DC.

Seventy-four subjects with type 2 diabetes were randomly assigned to follow either a vegetarian diet or a conventional anti-diabetic diet. The vegetarian diet consisted of vegetables, grains, legumes, fruits and nuts, with animal products limited to a maximum of one portion of low-fat yoghurt per day; the conventional diabetic diet followed the official recommendations of the European Association for the Study of Diabetes (EASD). Both diets were restricted by 500 kilocalories per day compared to an isocaloric intake for each individual.

The vegetarian diet was found to be almost twice as effective in reducing body weight, resulting in an average loss of 6.2kg compared to 3.2kg for the conventional diet.

Using magnetic resonance imaging, Dr. Kahleová and colleagues then studied adipose (fat-storage) tissue in the subjects’ thighs to see how the two different diets had affected subcutaneous, subfascial and intramuscular fat (that is, fat under the skin, on the surface of muscles and inside muscles).

They found that both diets caused a similar reduction in subcutaneous fat. However, subfascial fat was only reduced in response to the vegetarian diet, and intramuscular fat was more greatly reduced by the vegetarian diet.

This is important as increased subfascial fat in patients with type 2 diabetes has been associated with insulin resistance, so reducing it could have a beneficial effect on glucose metabolism. In addition, reducing intramuscular fat could help improve muscular strength and mobility, particularly in older people with diabetes.

Dr. Kahleová said: “Vegetarian diets proved to be the most effective diets for weight loss. However, we also showed that a vegetarian diet is much more effective at reducing muscle fat, thus improving metabolism. This finding is important for people who are trying to lose weight, including those suffering from metabolic syndrome and/or type 2 diabetes. But it is also relevant to anyone who takes their weight management seriously and wants to stay lean and healthy.”

Source: Taylor & Francis

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Position of the Academy of Nutrition and Dietetics: Vegetarian Diets


It is the position of the Academy of Nutrition and Dietetics that appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes. Plant-based diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources and are associated with much less environmental damage. Vegetarians and vegans are at reduced risk of certain health conditions, including ischemic heart disease, type 2 diabetes, hypertension, certain types of cancer, and obesity. Low intake of saturated fat and high intakes of vegetables, fruits, whole grains, legumes, soy products, nuts, and seeds (all rich in fiber and phytochemicals) are characteristics of vegetarian and vegan diets that produce lower total and low-density lipoprotein cholesterol levels and better serum glucose control. These factors contribute to reduction of chronic disease. Vegans need reliable sources of vitamin B-12, such as fortified foods or supplements.

Position Statement

It is the position of the Academy of Nutrition and Dietetics that appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes. Plant-based diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources and are associated with much less environmental damage.

Vegetarian and vegan dietary patterns can be quite diverse because of the variety of food choices available and the different factors that motivate people to adopt such patterns. People choose to adopt a vegetarian diet for many reasons, such as compassion toward animals, a desire to better protect the environment, to lower their risk of chronic diseases, or to therapeutically manage those diseases. A well-planned vegetarian diet containing vegetables, fruits, whole grains, legumes, nuts, and seeds can provide adequate nutrition. Vegetarian diets are devoid of flesh foods (such as meat, poultry, wild game, seafood, and their products). The most commonly followed vegetarian diets are shown in Figure 1. The adoption of a vegetarian diet may cause a reduced intake of certain nutrients; however, deficiencies can be readily avoided by appropriate planning.

Types of vegetarian diets

  • Vegetarian – May or may not include egg or dairy products.
  • Lacto-ovo-vegetarian – Includes eggs and dairy products.
  • Lacto-vegetarian – Includes dairy products, but not egg products.
  • Ovo-vegetarian – Includes eggs and egg products, but no dairy.
  • Vegan – Excludes eggs and dairy products, and may exclude honey.
  • Raw vegan – Based on vegetables, fruit, nuts and seeds, legumes, and sprouted grains. The amount of uncooked food varies from 75% to 100%.

Vegetarian Diets in Perspective

Trends among Vegetarians

According to a nationwide poll in 2016, approximately 3.3% of American adults are vegetarian or vegan (never eat meat, poultry, or fish), and about 46% of vegetarians are vegan. The same poll revealed that 6% of young adults (18 to 34 years) are vegetarian or vegan, while only 2% of those 65 years or older are vegetarian. Sales of alternative meat products reached $553 million in 2012, an 8% increase in 2 years. It was observed that 36% of survey responders sought vegan meat alternatives, largely from among the 18- to 44-year-old age group. While whole plant foods serve best as dietary staples, some processed and fortified foods, such as nondairy beverages, meat analogs, and breakfast cereals, can contribute substantially to the nutrient intake of vegetarians.

Plant-based diets, including vegetarian and vegan diets, are becoming well accepted, as further evidenced by many nonprofit and government institutions highlighting this dietary choice. The American Institute for Cancer Research encourages a plant-based diet, suggesting Americans consume two-thirds of their dietary intake from vegetables, fruits, whole grains, and beans. In the 2015-2020 Dietary Guidelines for Americans, vegetarian diets are recommended as one of three healthful dietary patterns, and meal plans are provided for those following lacto-ovo-vegetarian and vegan diets. The National School Lunch Program, while not requiring vegetarian options per se, requires schools to increase availability of fruits, vegetables, and whole grains in current meal patterns in the school menu.

Those following a vegetarian diet now have technological support. To date, while no online nutrition food tracker exists strictly for vegetarian diets, some allow clients to select vegetarian and vegan plans. These applications for mobile devices allow vegetarians to discover nutritional needs, track intake, and locate restaurants and markets where vegan foods are available. The online tracking tool at is a part of the US Department of Agriculture Choose My Plate program.

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Read the full paper of the Journal of the Academy of Nutrition and Dietetics . . . . .

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