In the 19^th edition of the Gut Reaction series, I suggested that patients with Laryngo-Pharyngeal Reflux (LPR) may consider an alkaline water & plant-based Mediterranean style diet. As discussed in that blog, a paper published in JAMA Otolaryngology (October 2017) suggested that diet and consumption of alkaline water might be as effective as treatment with a PPI. The main outcome of the study was a change in Reflux Symptom Index (RSI) – the 1^st group were treated with PPI and standard anti-reflux precautions (PS) and the 2^nd group with alkaline water, a plant-based Mediterranean-style diet and standard anti-reflux precautions (AMS). Results from the study showed that the percentage of patients achieving a clinically meaningful reduction in RSI was 54% in PS-treated patients and 63% in AMS-treated patients.

How alkaline water and dietary change help the symptoms of LPR is unclear but it may change the biodiversity of the gut bacteria (microbiome) in the oro-pharynx, gullet (oesophagus) and stomach.

In this blog, I will provide some further information regarding alkaline water and what the Mediterranean-style diet involves.

First of all, the “alkaline” in alkaline water refers to its pH level. The pH level is a number that measures how acidic or alkaline a substance is on a scale of 0 to 14. Alkaline water has a higher pH level than regular drinking water. Because of this, some advocates of alkaline water believe it can help maintain balance by neutralising the acid in your body. Drinking water generally has a neutral pH of 7 while alkaline water typically has a pH 8-9.

It is relatively straightforward to make your own alkaline water at home. Here is a suggested recipe:

• Pour a half-gallon of the filtered water (preferable to tap water) into a gallon jug with a lid. If using tap water, a filtration system is recommended.
• Add one teaspoon each of baking soda, sea salt and coral calcium powder to the container.
• Wash a lemon and slice it in half. Squeeze the juice into a small bowl.
• Pour the juice into the water/baking soda/coral calcium mix.
• Secure the container lid and then shake it vigorously to thoroughly mix all the ingredients.
• Add the rest of the distilled water to the container, being sure to leave an inch of space at the top of the container for air.
• Close the container tightly and shake it to mix the water.
• Use pH strips to test the water to see the level, ideally around level 8 or 9. If that is not the case, add another ¼ teaspoon of baking soda and mix again until the proper pH level is reached.

Equally, many supermarkets stock alkaline water along with other specialty waters in the bottle water aisle. It can also be ordered online from a number of retailers.

Here is some basic information about the plant-based Mediterranean style diet:

• Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts.
• Replace butter and other dairy with healthy fats such as olive oil and canola oil.
• Use herbs and spices instead of salt to flavour foods.
• Limit red meat to consume no more than a few times a month.
• Eat fish and poultry at least twice a week.

If you have any questions about alkaline water or a plant-based Mediterranean style diet, please do not hesitate to contact Dr. Harris.