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Quotations by Jonathan Aviv

Heartburn occurs when gastric acid from the stomach goes the wrong way, or refluxes, up into the delicate tissues of the esophagus, causing a burning sensation at the bottom of the chest and rib cage that can emanate out through the middle of the chest and toward the throat. Regurgitation is the sensation of food coming back up into your chest and throat after you’ve already swallowed it. Over 90% of the people diagnosed with acid reflux disease do not have these typical symptoms. They are more likely to have throat-related complaints such as feeling a lumplike sensation in the throat severe enough to cause dysphagia, or difficulty swallowing. Other common symptoms are chronic cough (cough that persists longer than 8 weeks), hoarseness, frequent throat clearing, and sore throat. [2017] - Jonathan Aviv

Dietary acid is in many of the most commonly consumed foods and drinks, even though you probably don’t know it’s there. It’s in canned and jarred soups and vegetables especially if they’ve been pickled, marinated, or fermented. It is in all carbonated beverages and industrially produced fruit juices. It’s present in every product that contains high-fructose corn syrup, even in items that don’t seem to be sweet at all. This ubiquitous and overused sweetener is produced using sulfuric acid and you’ll find it in the most unexpected places, such as in condiments, barbecue sauces, cocktail sauces, spice mixes, even baby food. You’ll find dietary acid in breads, salad dressings, juices, yogurts, and candy bars. [2017] - Jonathan Aviv

Research has revealed that poor sleep quality and/or insufficient sleep and chronic stress have a direct relationship to weight gain and acid damage. Glucocorticoids (GCs) are a class of steroid hormones released by the body during psychological or emotional stress. When GCs are being produced at a fast clip, the result is greater pepsin production, an increased chance of developing or worsening GERD and stomach ulcers, and a propensity to store more abdominal fat, which is linked to acid reflux and increased chances for developing Barrett’s esophagus. [2017] - Jonathan Aviv

Research shows that foods and drinks with a pH below 5, and especially those below 4 on the pH scale, will activate pepsin. Research links pepsin’s presence in the esophageal lining to increased tumor activity, particularly in the area where the lower part of the esophagus joins the stomach. [2017] - Jonathan Aviv

The clinical name of throatburn reflux is laryngopharyngeal reflux (LPR). Throatburn Reflux Symptoms: • Hoarseness • Frequent throat clearing • Acidic taste in the mouth: acid regurgitation from the stomach can literally bring an acidic taste all the way into the mouth • Globus sensation: feeling a lump in the throat or that something is stuck in the throat • Trouble swallowing • Chronic cough • Aspiration: food or saliva or any other material going into lungs • Waking up at night due to burning in the throat • Waking up at night with a choking sensation • Excessive mucus in the throat [2017] - Jonathan Aviv

More detailed throat exams used to require sedation because of the difficulty in getting any sort of instrument past the powerful gag reflex. However, an exam called the transnasal flexible laryngoscopy (TFL) is now the preferred method for viewing your larynx and the surrounding structures. The brilliance of any transnasal exam is that it involves passing an instrument through your nose, thereby allowing a physician to bypass the gag reflex and view the tissues and structures below. What will typically be examined are the vocal folds—do they look swollen and red, likely to be the source of hoarseness or throat pain? Is there evidence of postnasal drip or accumulated mucus, the possible cause of chronic cough or a lumplike sensation in the throat?  [2017] - Jonathan Aviv

Following a high-fiber, low-acid diet is not only the most powerful prescription for curbing acid damage, it is also essential for true healing and prevention. However, because symptoms often stem from decades of exposure to inflammatory foods, the damage cannot be reversed after just a few days of strategic, low-acid modifications to your diet; in other words, the recovery process can take time: 28 days is the minimal time needed to heal acid-damaged tissue. [2017] - Jonathan Aviv

There are two steps to taking a PPI the correct way: 1. Take a PPI dose thirty to sixty minutes before you eat either breakfast or dinner, or both (allowing it to enter your bloodstream). 2. Eat something to “activate” the PPI within thirty to sixty minutes after taking the medication. In my practice, only 25% of patients with throatburn reflux symptoms improve after 6 weeks of treatment with PPIs, with a larger percentage experiencing relief after 12 weeks of use. Others will require medication for 6 months or longer before they begin to feel better. Numerous studies have suggested that PPIs may give a protective effect against both the precursor to esophageal cancer and esophageal cancer itself. [2017] - Jonathan Aviv

There is no evidence to suggest that macronutrient depletion can help reduce acid damage to the esophagus or other organs in the aerodigestive tract. Only an increase in dietary fiber intake will help extinguish the internal fires lit by acid damage by lessening inflammatory pepsin triggers, improving digestion, and reducing cravings for salty, sugary, and acidic foods. [2017] - Jonathan Aviv

Animal-derived proteins that are good for Acid Watchers include sardines, salmon, tuna, halibut, turkey (light meat, no skin), chicken (light meat, no skin), yogurt, kefir, and eggs. Examples of vegetable-derived proteins include peanuts, oatmeal, cashews, beans (all types), tofu, edamame, walnuts, soy milk (non–genetically modified), hazelnuts, whole grains, quinoa, broccoli, spinach, kale, and spirulina. Beans and eggs, especially egg yolks, can be hard for some people to digest. I recommend that they be consumed in moderation. For best results, animal sources of protein should primarily be eaten in combination with vegetables, ideally prepared raw or steamed, for easier digestion. [2017] - Jonathan Aviv

Monounsaturated fats are considered a good type of fat when consumed in moderation. They help increase our body’s HDL levels while lowering LDL levels. They’re found in a wide variety of foods, such as meat, whole milk, olives and olive oil, avocados, almonds, cashews, and peanuts. With the exception of red meat, monounsaturated fats are typically good choices for people with acid reflux disease. However, a subset of monounsaturated fat is not good for those with acid reflux—vegetable oils made from seeds. Cold-pressed vegetable oils are always the best option for people with acid reflux. If possible, choose extra virgin olive oil. [2017] - Jonathan Aviv

The industrialized, processed food that you find in your local grocery store has been acidified, its pH has been lowered, and its micronutrient viability has been significantly reduced. Even cooking some plant-based foods—such as broccoli and zucchini—can strip them of certain antioxidants, such as vitamin C. This is why it’s important to avoid processed foods and replace them with plenty of organic, minimally cooked fruits and vegetables (steaming is my preferred option). I also recommend that whenever you eat eggs, dairy, or meat, it should ideally be organic and come from a grass-fed animal to ensure that your diet is balanced in macronutrients and that you are getting all the micronutrients your body needs. [2017] - Jonathan Aviv

Eat a daily minimum of 1 pound of vegetables above pH 5, half of which should be consumed raw. Consuming both raw and cooked vegetables will help ensure that you get a greater variety of antioxidants. Some vegetables, such as carrots, asparagus, cabbage, mushrooms, and spinach, offer a greater concentration of antioxidants when cooked compared to when eaten raw (if they’re prepared by steaming or boiling, that is). But you’re likely to get more vitamin C from these foods if you eat them fresh out of the fridge. Broccoli is one nutritional powerhouse that you should try to eat raw, at least some of the time, as raw broccoli is higher in sulforaphane, a known anticarcinogen. [2017] - Jonathan Aviv

Eat a daily minimum of ½ pound of raw fruit, above pH 5. Fruits are an essential part of a healthy diet. Just as vegetables provide unique vitamins and minerals, fruits do the same. Plus, fruits are hydrating, are low in calories, and provide plenty of fiber (especially whole fruits eaten with the peel). Approximately one cup of chopped or sliced fruit or one medium-sized piece of handheld fruit is equal to ½ pound and will satisfy your fruit serving for the day. For most handheld fruits, the equivalent will be one medium-sized piece of fruit. [2017] - Jonathan Aviv

You won’t waste time (or money) trying to test your pH because you know that low-acid eating is about reducing tissue damage and inflammation, not about manipulating your blood or urine pH. You also won’t be eliminating valuable macronutrients that can aid, even accelerate, your healing from long-term acid exposure. [2017] - Jonathan Aviv

Simple routine changes, such as music therapy (listening to relaxing classical music for twenty minutes before bed) or engaging in muscle relaxation (breathing exercises) that you can practice in the privacy of your home have been shown to improve the quality of sleep in individuals experiencing extreme manifestations of stress such as post-traumatic stress disorder. And then there is always the power of exercise to reduce stress, improve the quality of your sleep, and help you lose weight. [2017] - Jonathan Aviv

Lycopene is a powerful antioxidant believed to play a role in preventing cancer and heart disease. Red- and rose-colored fruits and vegetables have lycopene, though not all of them are safe for Acid Watchers because of their pepsin-activating properties. Here is a list of items you can indulge in: 1. Guavas; 2. Watermelon ( Research shows that watermelon has 40 percent more lycopene per cup than raw tomato. So whenever you crave tomatoes in your salad, just replace them with watermelon in both phases of the diet, especially in summer when the fruit is dense with natural sweetness.); 3. Papaya; 4. Asparagus; 5. Purple cabbage; 6. Mango; 7. Carrots. [2017] - Jonathan Aviv

Preservation methods in prepackaged, jarred, processed, and canned foods require the use of chemicals that are inherently acidic or have properties that loosen the Lower Esophageal Sphincter (LES). I allow three exceptions in the Acid Watcher Diet: canned tuna, chickpeas, and beans. Canned tuna must be water packed and drained before using. Canned chickpeas and beans must be organic and thoroughly washed to eliminate traces of acidified liquids. [2017] - Jonathan Aviv

Reflux-inducing substances may include condiments and natural products that are pH friendly (pH 5 and higher) but should be avoided by people with acid reflux. Among these are coffee, onions, tomatoes, citrus fruit, vinegar, garlic, mint, and chocolate. But if you have acid reflux, you must also beware of the following items: seed oils, peppers, berries, honey, and organic agave. Berries are allowed if they are balanced by acid neutralizers such as almond milk, non-GMO soy milk, rice milk, and coconut milk. One way to consume berries safely is through a smoothie, which, in combination with nondairy milk, can be an alkalizing, palate-pleasing combo. [2017] - Jonathan Aviv

How to Be an Acid Watcher at a Restaurant: 1. Whether you are at a restaurant, deli, or the prepared food court of your local grocery store, buy only chicken or seafood if you want animal protein. 2. Chicken, seafood, and vegetables should be roasted, seared, broiled, steamed, baked, or grilled. 3. Skip breaded, fried, and sauced options. 4. Keep enjoying sushi, if that’s your pleasure; just stay away from soy sauce and wasabi. [2017] - Jonathan Aviv

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