LPR: what works for me

If you've been following this blog, you know I've been suffering from a relapse of GERD and LPR. I've dug myself out of the hole over the past four weeks, and I'm not there yet. But it's pretty clear to me now what helps and what doesn't. The information about LPR on the web is scattered and inconsistent, and from an academic point of view, we really only have Jamie Koufman's template to draw from. So I thought it would be of some use to someone to summarize what helps me and what doesn't.

FOODS

Generally speaking, I find a low-acid, low-fat, small-meal regimen to be most useful. Low acid because the Koufman diet works for me. Low fat because fats slow down digestion , which increases acid production, and increases bile production since bile is released to break down fats- which can cause problems too.

I don't snack much, usually a piece of fruit or some RAW almonds if at all. Rather I stick to five small meals a day. By "small" I mean a cup of grain, a cup of veg, sometimes a small amount of meat; a half sandwich with one slice of turkey and lots of vegetables; a small bowl of salad.

Fennel- very useful. Lowfat and alkaline. Chop up the bulb and use in stir fries and salads; add the fronds to eggs, potato and pasta salads, etc.

Ginger- use this very carefully. It does bother some people. But personally it settles my stomach, so less gas- less acid in the esophagus.  Goes great in stir fries, sweet breads, squash soup.

Avocado- Very alkaline. High fat, but fat also adds to satiety. If you are drastically decreasing how much you eat, avocado can see you through. Add to salads, beans, tofu burgers, etc.

Eggs- the yolks do have fat and cholesterol, but eggs in general are easily digested and well tolerated when you have active LPR symptoms. Soothing on the throat, filling and nutritious.

Water with baking soda- just put a scant 1/8 teaspoon and tepid water in a water bottle and take SMALL sips all day. Keeps you from getting dehydrated, which is as irritating  as much as ice water can be (ice cold beverages actually aggravate the lump in your throat, so be careful).

Steamed vegetables and rice- one of my staple dishes. Snow peas, bamboo shoots, lotus root, fennel bulb, spinach, green beans, even lettuce. Steam or saute in water and serve with soy sauce and a tiny bit of sesame oil.  Five spice powder seems ok too. When you are feeling better, add broccoli and use HOMEMADE BONE BROTH for flavor. Do NOT use commercial broths- most have dangerous additives like citric acid as a preservative or garlic and onion.

Roast chicken and bone broth- roast a chicken, stuffing the chicken with parsley, fennel and sage.  Serve the roast chicken with green beans or peas, mushrooms, steamed or mashed potatoes or rice. Take most of the meat off the bones, then simmer the carcass in sufficient water to cover with fresh parsley and savory, if you have it. low and slow for about an hour an a half. Let it cool in the fridge overnight. Skim the fat off in the morning (easy- it will be solid). The stock should be gelatinous. Pour into ice cubes and freeze, then put cubes into plastic bags. Use a cube of broth when you in the past might have used oil to saute something. Gives it a lot of flavor and the collagen helps heal your stomach lining.

Artichokes and olives- add a little fiber and zest to your dishes. Rinse olives thoroughly and don't use the marinated artichokes.

Rice. All kinds. Wonderful stuff.

Whole grain breads- make yourself a turkey sandwich with lettuce for lunch. Fennel is nice on there, too.  I have never had problems with mayo, but be careful, some have more vinegar than others. Either way use only very little mayo.

As Jamie Koufman suggests, Get a loaf of artisanal whole grain bread and cut it into slices of half slices. have some all week.

Rycrisp and similar rye crackers- these are the ONLY crackers I can eat. Serve with a salad or a smooth, gently herbed chicken broth potato or pea soup.

Squash- all kinds. Seed and bake spaghetti squash acorn squash or butternut squash in the oven- put water in the cavities. Low fat and delicious. make into soup or serve with roast potatoes and chicken, salmon or turkey. Bake strips of zucchini dipped in egg white and bread crumbs for delicious "fries."

Melons and apricots- THE best fruits for LPR and GERD sufferers. Alkaline. Soft. Soothing on the throat and tummy.

Red apples- seems a bit counterintuitive when you are suffering- but they do help. In the acute phase, you probably want to peel and chop the apples to avoid getting the skin stuck in your throat. Avoid green or sour apples.

Parsley, Cilantro, dill- alkaline herbs. Helps alter ph of meals. OK in acute phase, chop very finely though.

Oregano, Rosemary, Thyme- I would not use until your severe symptoms have subsided. But they are alkaline and relatively safe.

Beans- as long as you don't over-season them, they are a vital source of fiber and minerals. Don't overdo, though, as beans can cause gas- which leads to burping- which leads to acidic vapor in the esophagus, which can re-damage you.

Tofu- excellent source of protein. Mild and easy to digest. common  flavorings (soy sauce, sesame, mirin) have been fine for me. Even the mirin which is  sweetened rice wine. Just use it for marinade- the alcohol burns off in baking. Bake cubes of drained, marinated tofu in the oven- it reduces somewhat and takes on an almost cheesy consistency. Does have fat, but it doesn't seem to bother me.

Lettuce- I try to have lettuce with most meals. Sandwiches always have it (unless it's peanut butter!). a small salad with a creamy, low-fat yogurt-based dressing and a rycrisp cracker make a satisfying meal.

Spinach- low acid and chock full of vitamins in minerals. Mild enough, it doesn't bother me whether cooked or raw. Serve raw in salads, or steamed or microwaved, blotted dry, in pasta, on potatoes, with rice.

Note: leafy bits like lettuce, spinach, parsley, etc. can get stuck in your throat if it is restricted. Best to approach cautiously in the acute phase.

Corn- mild, sweet, no problems with corn. I mix with beans, cilantro, cubed jicama, then season with cumin and oregano for a lpr-friendly pico de gallo.

Potatoes- absorb acid, provide potassium and magnesium- these stalwart tubers should be eaten regularly. It fills you up, provides needed nutrients, and calms the stomach.

Carrots- raw and cooked. sometimes I will just munch on a bunch of carrots for a meal. Chew thoroughly, they cause me hardly any problems. Throat feels soothed and I experience almost no gas. Cooked carrots are mild and sweet and go well with fennel and ginger.


SUPPLEMENTS

DGL Licorice- soothes the throat. DGL lines the stomach- along with bone broth, it helps heal the stomach. Suck on them, don't chew.

Slippery Elm tablets- better than even DGL for soothing throat. reduce inflammation too. I take them before and after meals and when my throat feels sticky or dry.

Calcium tablets with Magnesium- typical example being Rolaids. Good for emergencies when you feel a flare-up coming. Chew 2 after a meal on bad days.

Magnesium and Melatonin- I take these at night and they seem to help me calm down enough to rest.

Gaviscon- on bad days I take a swig of Gaviscon before and after meals. really seems to help.

Gaviscon advance- I take a teaspoon of this before going to bed to keep stomach contents in the stomach.

Please reach out to me any time if you have any questions. I moderate all comments, but I get them in emails.

Also consider following me on Instagram- I've started posting #lowacid and #lowfat meals. @michaelsalmons

"The Changing American Diet" suggests important advice for everyone

I've stated more than once on this blog that weight- especially around the middle- exacerbates reflux and affects gut health, organ health, metabolic health, and longevity in various negative ways. The Flowing Data resource called The Changing American Diet has been causing a stir in the health twittersphere, because within it lie clues to the current obesity, metabolic syndrome and diabetes epidemic that afflicts the western world and beyond.

In the data, you'll see two rather glaring changes in our diet. One is the increase of consumption of vegetable oils. It's been observed that high consumption of fats exacerbates reflux. It also drives up caloric values very efficiently. If you have used a calorie tracker for sufficient length of time to be begin seeing patterns, one thing that is very clear is it only takes a couple of teaspoons of oil to throw a diet off track and into the high-calorie weeds.

Try this strategy:

Only eat oils for their flavor. The next time you make pasta, use a teaspoon of extra virgin olive oil to help flavor it. Or make a potent and delicious pesto out of EVOO, garlic, basil, parmagiano (the real stuff, please) and the nut of your choice. It only takes a teaspoon or two to impart incredible flavor to a dish.

On the flipside, stop using oil to cook food. get some essential nonstick pieces- at minimum, a 10" fry pan and an oven sheet. Make roast vegetables, chicken stir fry and eggs with no added fat. Use a little broth or water and a lid when making eggs- if the pan is nonstick, that's all you need. (Or, poach them!) Most vegetables can be successfully sauteed with only a little broth. Add flavorful oils, if the recipe requires it, at the end, and sparingly.

Wheat is one commodity that has always been high- but it is ever on the increase. Baked goods are the most common way industrial food sneaks vegetable oil into our diets. Even bread is a source. Here's a challenge: go to a supermarket bread section. Find two types of bread with no soybean oil. unless you look at the artisanal breads, you will find this to be a difficult task! The solution is to eat bread made the old fashioned way. Did you know baguettes have almost zero fat? Now that was a pleasant discovery!

Another not so glaring but telling datum is the continual rise of cheese consumption. Again, it's a matter of caloric density. Cheese is delicious, yes! But try using it for its own flavor. By that I mean don't use it unless the flavor is going to be a star of the dish. Parmegiano Reggiano in pesto. Brie on a baguette. Also you should check out lower fat cheeses- not modern low-fat miracles, just the cheeses that tend to be lower in fat, like real Swiss cheese.

One thing I would like to remind our GERD and LPR-suffering readers: fats are hard to digest and make the body produce extra stomach acid. Best to stick to naturally low-fat foods and eat fat sparingly and for its flavor. Here is a gastroenterologist's take on a GERD-friendly diet. Guidelines we should all be sticking to, as the GERD diet is also a great way to shed pounds.

One thing we already know, but is not reflected in this report, is the rise in our consumption of added sugars. This chart listing the source of calories in the western diet claims the two highest sources added sugars and vegetable oils/dairy fat. How to relate this back to the food groups in our diet? Check out the data about the actual foods that contribute to our calories.

The top categories are:

• grain-based desserts
• pizza
• yeast breads
• soda/energy/sports drinks
• chicken dishes. We eat a lot of chicken, people.

So it comes full circle. Now you see what we are eating most of, and that happens to be what's making us fat. I certainly wouldn't condemn healthy versions of these items, such as skinless chicken breast or whole grain artisanal bread, but that isn't how most of us eat these things.

I would reconsider your consumption of these specific foods and in particular the sources of refined oils in your diet. Think of ways to trim them down or eliminate them completely. The healthy way forward for all of us is a rejection of industrial calories and return to eating real, whole food.

New Year's Morning Casserole

Greetings, readers! Let me begin by wishing you all a happy new year, and apologizing for my very, very erratic posting "schedule." I changed employment this past year, the amenities of which included a learning curve,  so it has made it hard to do much else. I resolve to do better in 2015. But I felt absolutely determined to post today in the wake of the truly sad experience of searching for a breakfast casserole recipe.

I woke up this fine New Year's Day, wanting to feed the crew that had stayed over. I had hash browns in the freezer, and my thoughts turned to  breakfast casseroles. The ideas I found on the web were, let's be honest, pretty sad. Most could be summed up as big chunks of greasy sausage in eggs topped by a bunch of gloopy cheese. It's amazing how much meat these people think is desirable, let alone acceptable. And have none of these casserole assassins heard of quiche? Quiche is an art piece of eggs, milk and cheese held in a velvety, creamy suspension. I'd say that's the perfect base for a eggy casserole. Cheese on the top is ok, but only a small amount, not the "reserve half for the top" nonsense I've been reading.

Also, if you read this blog, you know I have suffer from acid reflux occasionally. I wanted to dial down the fat while not sacrificing flavor.  I'd suggest crumbled turkey sausage. But I've gone even further over the edge by using my favorite sausage substitute, Gimme Lean! When properly browned, it passes the kid test for authenticity, high praise indeed, for no other group of diners are more finicky about weird ingredients and flavors than your own children.

I have two more beefs with the internet casserole cognoscenti. First, why just any cheese? If we're going to eat cheese, we need to get our K2, because studies show it aids in healthy digestion. And that's half the battle with reflux. That's why we are using a grass-fed cheddar and cave-aged gruyere combo. Secondly, where are the bleeping vegetables? Ten casseroles I looked at. TEN. Only two had vegetables of any sort. So I am roasting, then finely dicing some sweet red peppers for this hearty breakfast jam.



I am not going to make you wade through painstaking pictures of every step. Here you can see I've crumbled and browned a cup of Gimme Lean in some (cold pressed sunflower) oil. To that I added two cups of frozen store-bought hash browns. Read labels, some varieties list only one ingredient: POTATOES. Those are the ones you want! I just sauteed until the potatoes became fragrant. Layer them in an oblong casserole dish that has been prepped for nonstickiness.

Then I tossed  four small sweet peppers in that pan and let the outsides char a little. They got finely diced shortly thereafter.

Here is our egg mix: eight egg whites and four egg yolks. I got you covered, acid reflux people. To that I added 1 cup of soy milk- only because it's hard to find milk from grass-fed cows in our area and Abbey can't do the lactose. The peppers go in here, too.

Add approximately 3/4 cup each of gruyere and cheddar. These get mixed into the eggs- not glopped on top. This is not pizza, y'all.

 In a 350 degrees F oven it goes for 20-30 minutes depending on your mileage.

Doesn't the finished product look every bit as good as the fatty alternative? Hell yes it does. And it tastes just as good, if not better.

Enjoy 2015, and may your resolutions be achieved with uncommon ease.