Know. Better. Updates.

Dr. Koufman’s Two-Week Induction Reflux Diet

October 5, 2012

Listen to an expert with 35+ years in aerodigestive studies. Nice recommendation on the alkaline water too.


The medical establishment has missed the boat by a mile. The purple pill does not fix acid reflux for most people, especially people with silent reflux. And, if the medication does help, do they have to stay on it for life?

Acid Reflux Is Caused by What You Eat and When You Eat It

For most people with reflux, “cleaning up” their diet and their lifestyle is the essential therapeutic action for defeating it. This post isn’t about all four phases of my reflux diet—(1) Induction, (2) Transition, (3) Maintenance, and (4) Longevity—it’s sole focus is Phase I, the two-week Induction Reflux Diet. It is strict like a “detox,” no cheating. The purpose of the induction diet is to wash out pepsin and restore more normal function of the aerodigestive tract, which is a combination of the breathing passages (from the nose to the lungs) and the upper digestive system (from the tongue to the stomach). These components of the aerodigestive tract are intimately integrated.

When your acid reflux is bad, you have a downward vicious cycle going on. The more you reflux; the more you reflux. This is because reflux causes inflammation of the esophagus and its valves, and that inflammation further compromises the esophageal and valve function. Thus, the more you reflux, the more you reflux.

The opposite is true for most people going in reverse, that is, as inflammation and reflux lessens, function improved and there is less reflux. This idea behind the induction reflux diet is simple: Reduce acid and a potent digestive enzyme, pepsin, from coming up from the stomach for two weeks AND reduce damaging acid (that activates pepsin) from above during that same two week periods, with no alcohol, no night eating, avoidance of certain foods known to cause reflux, and consumption of the best-for-reflux foods and beverages.

Acid, Pepsin, and All That Jazz

Pepsin and not acid actually does most of the esophageal and throat damage from reflux, but pepsin requires acid for its activation. With reflux disease, the inflamed tissue has pepsin on it and in it. That’s why acidic foods and beverages cause trouble.

Imagine that your stomach is full of seawater and lobsters. The seawater is acid, and the lobsters (big, aggressive ones with mighty claws) are the pepsin molecules. When you reflux, the seawater splashes around. Some of it splashes upward into your throat. The lobsters ride this wave of seawater and attach themselves to the shore wherever they land—the shore being the delicate tissue and membranes lining your throat, larynx (voice box), esophagus, and lungs.

The lobsters are hanging on by their claws. It doesn’t really matter now whether the seawater they need for survival splashes up from below or pours down from above. To these lobsters, it’s all just a delicious, rejuvenating splash. Once a pepsin molecule is bound to, say, your throat, any dietary source of acid can reactivate it: Soda pop. Salsa. Strawberries. For more about the science behind the Induction Reflux Diet see the chapter “Science You Can Digest” in Dropping Acid: The Reflux Diet Cookbook & Cure, and for more about acid in food, see the blog post “The Missing Link” on

SIDE BAR: The pH scale, used to measure acidity, is somewhat counter intuitive. pH 7 is neutral; pH 1 is very acidic, and caustics like bleach have values from pH 8-14. For example, distilled water and most tap water is pH 7 (neutral), but vinegar at pH 2.9 and lemon juice at pH 2.7 are acidic. The normal range of stomach acid is pH 1-4. Also note that the pH scale is a logarithmic scale, so pH 4 is ten times more acidic than pH 5, and pH 4.8 is twice as acidic as 5.0. That’s why simply diluting acidic beverages doesn’t make them non-acidic. During the Induction Reflux Diet, nothing is allowed to be consumed that is below pH 5.

Dr. Koufman’s Induction Reflux (Detox) Diet in a Nutshell*

Grilled/baked/broiled/boiled fish, shell fish, and poultry

All veggies except (onions, tomatoes, garlic, and peppers)

Breads, rice, grains (low-sugar cereals), oatmeal, and tofu

Melons, bananas, ginger, agave, honey, chamomile tea

Low-fat soy, almond, coconut or cow milk, and alkaline water

Finally, one cup of coffee or caffeinated tea per day is allowed

That’s it! The list above is what you can eat—nothing else—nothing fried, no high fat foods like cheese, no alcohol, no condiments, no snack foods, and nothing out of a bottle or can except water, preferably alkaline water. That means pH of 7.8 or more; I recommend Evamor water and the Islandic waters as the best; any water that is pH 7.8 or greater kills those lobsters, that is, helps wash out pepsin. (Oh yes, * no nuts.)

Close the Kitchen Early

Finally, no eating anything within four hours of bed. Even if you eat healthy, eating too late can be a problem. It actually takes 4 hours for the stomach to empty completely.

I had a patient named Frank who was a restaurant manager. Frank would get off work at 11 p.m., and by midnight, he’d have eaten dinner and already gone to bed. He was frustrated that his reflux medication wasn’t helping as he awoke every morning with terrible heartburn and sometimes in the middle of the night, too. To make matters worse, he also told me that dinner was usually his biggest meal of the day.

When he told me his story, I registered a silent, “DUH.” And when I explained that he didn’t have a chance of beating his reflux as long as he was eating dinner before bed, he replied,” I pretty much knew that you were going to say that; I guess that I am going to have to make some big changes, huh?” “Not really,” I told him, just take a break to eat your dinner before 8 p.m.”

Night eating is a major cause of reflux, obesity, diabetes, hypertension, snoring, and sleep apnea If you go to bed with a full stomach, you are probably going to reflux. Just as bad, by the way, is lying on the sofa after dinner. Actually, the best thing you can do after dinner is take a walk.

People ask me all the time how long they should wait after eating before going to bed. In truth, it’s four hours during the Induction Reflux Diet. Later on, two hours may suffice.

See blog post on “How to Transition From the Induction Reflux Diet to Maintenance,” and the post, “The Good Egg,” is an excellent example of low-fat (not no-fat) maintenance eating.

If you want to be seen as a patient, go to

comments powered by Disqus