Quotations by Jamie Koufman

We advocate a diet that is lean (not too much red meat, milk, and other unhealthy fats), clean (avoidance of unpronounceable and potentially harmful chemicals), green (organic), and alkaline (low acid and pH balanced, limiting consumption of acidic foods and beverages). We also advocate portion control and consuming the equivalent of five meals a day--breakfast, snack, lunch, snack, and dinner--with dinner being a light meal eaten relatively early in the evening. [2015] - Jamie Koufman

I recently examined data from my reflux patients using the Reflux Symptom Index. Here were the symptoms, in decreasing order of frequency: 1. Too much throat mucus 2. Chronic throat clearing 3. Hoarseness 4. Lump-in-the-throat sensation 5. Chronic cough 6. Heartburn 7. Difficulty swallowing 8. Choking episodes [2015] - Jamie Koufman

Alkaline water can be very helpful in managing reflux because it helps wash out pepsin and is good for pH balancing. Natural alkaline water has trickled through limestone for thousands of years, giving it a pH of between 8.0 and 9.0. Of the brands of alkaline water on the market today, almost half are naturally occurring. Alkaline water with a pH higher than 8.5 is best. [2015] - Jamie Koufman

The Laws of Decompensation: 1st Axiom: Before--the components of a system are in dynamic balance; 1st Corollary: Conflicting elements are held together by function and purpose. 2nd Axiom: Decompensation is preceded by often-ignored warning signs; 2nd Corollary: During early destabilization, imbalance is assessable. 3rd Axiom: Last-straw principle: When threshold is exceeded, collapse occurs; 3rd Corollary: Recovery requires repair and stabilization of all elements. The laws of decompensation apply to many things in life that appear to happen slowly, even silently, then all of a sudden. (Such events even include dissimilar things like divorce and the failure of a business.) [2015] - Jamie Koufman

During the detox phase, we prohibit onions, garlic, tomatoes, and peppers (both the vegetables and the seasonings) because all of those are common triggers. In truth, each individual item is a trigger for less than half of people. During transition, our patients add them back in, but one at a time. Of the four items, onions are the most common trigger food. Interestingly, cooked onions are generally better than raw onions. If garlic is a reflux trigger food, it is usually the "meat" of the garlic. Garlic powder and garlic salt are less likely to trigger reflux than the garlic clove itself. Fresh tomato is probably a trigger food for fewer than one-third of people. Cracked black pepper is a fairly common reflux trigger food. Green peppers appear to be more of a problem than red or yellow ones. [2015] - Jamie Koufman

You should always eat an early dinner. I recommend 6:00 p.m., assuming that you will go to bed after 11:00 p.m. [2015] - Jamie Koufman

You should consider using Manuka honey lozenges. Manuka honey itself, or Manuka honey tea after meals, or at least after your evening meal. There is anecdotal evidence that Manuka honey is good for reflux and that it helps to heal the esophagus. [2015] - Jamie Koufman

Top 10 Best Yogurts for People with Reflux: 1. Stonyfield Plain Organic 2. Dannon Plain (“all natural”) 3. Dannon Light & Fit Blackberry 4. Stonyfield Blueberry Organic 5. Stonyfield Strawberry Organic 6. La Yogurt Probiotic Pina Colada 7. La Yogurt Probiotic Strawberry 8. Dannon Cherry 9. Dannon Lemon (“all natural”) 10. Fage Greek Strained (“all natural”) [2015] - Jamie Koufman

We allow lean beef twice a month, but still prohibit fatty beef, lamb, and bacon. [2015] - Jamie Koufman

Most Common Reflux Trigger Foods: Chocolate, High-fat meats, Deep-fried food, Alcohol, Nuts, Coffee, Onions, Tomatoes, Apples, Garlic, Strawberries, Cracked pepper, Bell peppers (green worse than red), Bread (for some, gluten may be a trigger) [2015] - Jamie Koufman

Abstain from bread, pasta, cookies, cakes, energy bars, doughnuts, and everything else you know that contains added sugar. [2015] - Jamie Koufman

Silent reflux is the single most common cause of difficult-to-diagnose chronic cough, and neurogenic cough is the second most common cause. [2014] - Jamie Koufman

The first step in the diagnosis of chronic cough is to rule out a pulmonary cause. [2014] - Jamie Koufman

Reflux treatment with acid-suppressive medications alone (e.g. PPIs, "purple pills") is not useful as a diagnostic test. If a chronic cougher does not respond to antireflux medication, it does not prove anything. Reflux may still be the cause of the cough. [2014] - Jamie Koufman

GI reflux-testing techniques lack pharyngeal (throat) reflux data and that is why esophageal pH monitoring is virtually useless. [2014] - Jamie Koufman

Two medications are used to treat neurogenic cough and vagal neuropathies: amitriptyline 10 mg. before bed, and gabapentin 100 mg. four times a day. [2014] - Jamie Koufman

Besides cough, there are several other common vagal neurogenic symptoms, such as burning tongue, chronic sore (burning) throat, and painful speaking (odynophonia). [2014] - Jamie Koufman

Telltale and red flags for neurogenic cough: 1. Cough from talking or singing; 2. Cough caused by changes in temperature or air conditioning; 3. Cough caused by perfume or other fumes; 4. Presence of other neurogenic symptoms such as odynophonia (painful speaking) or painful burning throat. (Throat-burn is typically a neurogenic symptom and not a common symptom of reflux). [2014] - Jamie Koufman

For the treatment of neurogenic cough, I generally use just three medications alone or in combination: Amitriptyline (Elavil), Gabapentin (Neurontin), Tramadol (Ultram). [2014] - Jamie Koufman

Besides chronic cough, the most common symptoms of silent airway reflux are chronic throat clearing, hoarseness, choking episodes, trouble swallowing, lump-in-the-throat sensation, shortness of breath and asthma. [2014] - Jamie Koufman