3 Habits To Prevent Acid Reflux — Dr. Peter Belafsky MD PHD Director of Voice & Swallowing

Swallowing and speaking. These are essential functions that we kind of take for granted, and it runs in the background until something goes wrong. We're going to talk about some of the things that can go wrong with your swallowing and voice, but more importantly, how to take those little steps every single day to prevent serious problems that can affect your voice and swallowing. So I'm so excited to have here today Dr. Balofsky, who has dedicated his whole career to helping people keep their swallowing and voice functions as long as they can, making products and treating people so that they can Regain the quality of life. Hi, welcome to the MindBodySpace podcast. I'm Dr. Juna, your host. This is where you're going to get your science-backed information that keeps us resilient and well. Recently, I've been working really hard on Relax to Soar Resilience System. It's an analog planner, actually a system that will help you cognitively offload all of those micro habits you need to stay well. And it's based on over 10 years of experience teaching at schools like the Juilliard School, NYU School of Medicine, Columbia Law School, and as well as tens of thousands of people online. You can head over to mindbodyspace.com/resilience It has 6 months undated, and you'll get email support to get you started on your biggest goals and even your smallest goals. Hi. Hi.

It's good to see you. My wife has just said such amazing things about you. So I've really been looking forward to this. She's a fan.

Oh my gosh. That's amazing.

Cool.

If she has any questions or requests, please tell her to just reach out to me.

You got it.

Put me in touch.

You got it.

Is she also in the healthcare profession?

She is, yeah. She's a critical care nurse.

Amazing. Peter, Dr. Belofsky, I'm so excited to have you here. You are an MD and a PhD.

That's right.

And a PhD, what we call Mudd Fudd, right? And a master's in public health. So what is your PhD in?

Doctorate is in epidemiology and biostatistics.

So you're a professor and you're the director of the Voice and Swallowing Center at the University of California, Davis, at the Department of Otolaryngology, Head and Neck Surgery. You're also the vice chair of academic affairs for the department.

Correct.

You have a bunch of patents, right? And you've been involved in laryngeal transplants. I mean, you have an incredible career already and developing reflux score which is one of my favorite products. I don't have a lot of things on subscription from Amazon, but I have Reflux Gourmet on subscription, and I have given it to my whole family. I have it on my nightstand. So does my husband.

It's always nice to get feedback. It warms my heart.

You're helping all of us.

Are any of your kids in medicine?

Neither of them wanted to become doctors.

None of my 3 children wanted to go into medicine either. And I think ours will be the only generation that doesn't have our children going into the profession, which is kind of sad when you think about it.

Because you're multi-generational. Generational, right?

My grandfather was a surgeon. My father was a surgeon. My sister's a physician. My cousins, I mean, it's kind of like the family business. And my kids wanted nothing to do with healthcare.

So. Well, we'll see. I mean, there's many ways to contribute to society, right?

Absolutely.

But I just want to say, I want to thank you for doing what you do, because first of all, I discovered RxGourmet from Dr. Jonathan Aviv, who is my ENT doctor in New York City. I had never heard of silent reflux or LPR. And we did a whole episode on it, so I'll put a link to that here.

Awesome.

You know, you really don't think about things like swallowing or your voice until something goes wrong with it. As a radiologist, that whole area to me, we have head and neck specialists, obviously, you know that, but it's one of the most difficult anatomy areas. And also everything is so tightly packed in. There's such important structures. It's our breathing, it's our swallowing. Your lungs are right there. Your aorta is right there, the biggest artery in your body. So For me, what you do, especially with all of the procedures you've invented, you invented a dilator, right, for the esophagus?

We do, yeah. We've had a bunch of innovations over the years, some more successful than others.

So some of the things that you do is work with swallowing, right? So that's your esophagus, which is the tube that connects your mouth to your stomach. And you have created some procedures as well as some patents. Can you tell us a few things about one of your most successful?

I'm a laryngologist by training, which is really a 3-centimeter 3-centimeter part of the body that revolves around the voice box. And you've sort of touched on that to a certain extent, because it's the gateway to the lungs, it's gateway to the esophagus, it's a lot of our senses concentrated in this 3-centimeter part of the body. My passion in life is to take care of complex swallowing problems. And we've sort of started a field. It crosses so many different subspecialties, because you may see a gastroenterologist if they think it's your lower esophagus, and an ENT if it's your upper esophagus. You may go see a radiologist for a swallow study, and a neurologist if there's a neurologic component. For the benefit of the patient, we sort of sidestepped all that, created our own specialty called deglutology. We named it. Our goal is to take care of complex swallowing problems from stem to stern, or more appropriately, from gums to bums. It's how we got in the reflux business, because acid reflux is one of the most common causes of swallowing problems. So that's how I sort of became a specialist in reflux along the way.

Mm-hmm.

Swallowing problems Symptoms, even outside of reflux, are extremely common. And like you touched on, you don't even think about it until it's sort of challenged or taken from you. So we've been very fortunate to have a lot of innovation in this area. We developed an esophageal dilator specifically for the upper esophageal sphincter. Esophageal dilators haven't changed shape. They've all been cylindrical since the use of a whalebone to dilate a patient with achalasia in the 1600s.

Oh my gosh.

Same size dilators for 400 years.

We've come a long way.

Exactly.

So for those who are listening, there's a little sphincter up here. Do you want to explain why you would need to be dilated?

Yeah, so—

And hopefully nobody needs this procedure.

Thankfully, it's a pretty straightforward procedure, but a lot of people point to their neck and say food or pills get stuck. Imagine sort of pointing to the base of your neck. So one of the most common things we would see would be a little web or scar tissue in that part of the body. We call them cricopharyngeal webs. Would be one of the most common things. Also, not infrequently, somebody could actually point to their base of their neck and say, food's stuck here, but the vagus nerve is playing tricks on them and the obstruction is further down the esophagus. It could be at the middle part or even the lower part of the esophagus, and it's being referred to the neck. So it's kind of like, the metaphor we give is like the, the toilet's overflowing, but the pipes are clogged further down the line, and all the patient's sensing is that the toilet's overflowing and stuff's getting caught in their throat. Wow.

Okay. Mm-hmm. Could it be like down even into their gut area or is it— Or is it really just the esophagus?

Um, it could be, I mean, it could be a gastric outlet obstruction. Solid food in general, take a little step back, problems swallowing solids is typically something obstructive. Not always, but usually. So it's like a web, ring, stricture, inflammatory, you know, esophagitis from GERD. But the obstruction could be, you know, anywhere along the foregut really.

And they're just, That's why you said gum to bone.

Gum to bones, yeah.

Okay. So if somebody's having what you're saying with webs and things like that, some of that could even be congenital, right? So it could be something you're born with, but then maybe it flares up eventually in your older age. Is that—

And there was, I'd actually just reviewed a manuscript from a colleague of mine that suggested that there's a pretty high prevalence of these webs in younger adults and even kids. So like you said, some of these things can be congenital. Which can be make for a more difficult diagnosis because imagine if you always thought you had to mince your teeth up to a fine, you know, consistency. You don't know any better. Where other people, you know, just has always taken somebody an hour to eat. Where other people can, you know, wolf down a hamburger in in five minutes, you know. But typically, in a healthy ambulatory patient with solid food dysphagia, it's typically something obstructive, which is really treatable. Typically, a quick dilation, whether it's a Esophageal ring, or a ring in the junction between the throat and the upper esophagus.

And you could even have that from— we used to diagnose those anomalous veins or things, arteries that go around the esophagus. So sometimes people have different anatomical versions of arteries or veins, and then that could actually cause a stricture in your esophagus, and then you can start having swallowing issues.

Absolutely, yeah.

We used to call them rings and things.

Yes. I think I gave a lecture once called Rings and Things.

But it's so interesting because you can have no problems and then all of a sudden it starts to become a problem, right? So by the time somebody sees you, so maybe they have taken longer eating, and then all of a sudden one day it becomes a problem. So for me, when I saw Dr. Aviv, this was like over 15 years ago, I had a feeling like I had a lump in my throat, and then I felt like bread or solid foods would feel like it was getting hard to swallow. So he diagnosed me with that silent reflux, which is laryngopharyngeal reflux, which is reflux that comes all the way up into your throat. I was fine for a decade or more, and then I went back to him. I had this weird jump-up thing which I described with him in the last podcast, but it was, you know, when you wake up with reflux and you feel like you're choking. And I thought I was having a panic attack, but it all turned out to be the same reflux thing. So that's when he introduced me to RxGourmet.

Nice.

I mean, I try not to eat at night 3 to 4 hours before I lie down, but if I eat something or if I, you know, have something bubbly like seltzer or something, then I will take Reflux Gourmet. And it like actually works. At first I was scared to, um, eat it because I thought maybe I could reflux that, you know? But it really works. I mean, I've noticed the difference between taking it and not taking it.

The magic of seaweed. Yeah, it's amazing.

Can you tell us about what it is and how you came upon that? And did you see people down the road when they actually develop strictures like me? I hope I don't get that. Oh no.

See it all the time. So like I said, thankfully that stuff's really, really treatable for the most part. The, yeah, so we, I had a, the sort of the origin story behind Reflux Gourmet. We had a patient who's a Michelin-rated chef in Napa who's a patient of mine. And I've been working with alginates for years. We were working on a product that's only available overseas. And it has a nasty carcinogen in it. We wanted to see if we could make an all-natural alginate product that was 100% safe, tasted good, and still as efficacious as the one that's been available for a couple of decades. I don't think Ken ever— I think he just has a high school degree, but is really the most sophisticated chemist That I have ever met, with no science background, just with his kitchen chemistry, is a wizard. He really was able to come up with something that was not just efficacious, but actually tastes good. And our primary charge was to keep it all natural. So, because some of our patients are really the most vulnerable patients, like pregnant women, young kids, people with renal disease who rely on us, so we needed to— Really, that was our primary concern, which is keeping it safe so our most vulnerable patients couldn't enjoy it and try and get off the medications if they didn't need to be on.

So a lot of times pregnant women have that obviously the baby in their abdomen and it's pushing up and you're getting more reflux, right?

Absolutely.

And you don't want them on PPI as you can take it, but you don't you'd rather not, right?

Yeah. PPIs are Extremely effective acid blockers. They are very effective chemicals that increase the pH of the stomach. For patients that need to be on them, they are extremely effective. The reality is that the majority of the population doesn't have consequences of acid reflux. It's a symptom-driven disorder or disease. So they're getting heartburn, regurgitation.

Mm-hmm.

Globus, the throat burning. problems with sleep, but don't have strictures, cancer, precancer, all the other complications that acid reflux can cause. So for the majority of people, they don't need to be on the chemicals, and we try and get them off if we can. But for those people that need it for life-saving indications, you know, there really are remarkable drugs.

I love that you're talking about that, and also that you want to protect the vulnerable patients like kids, because a lot of kids can have reflux, right, as develop. Tell us a little bit about that, because I know kids who are on PPIs as well, but maybe, you know, they could have less if they use something like RxQuartz.

Were any of your kids GERD babies? Like my son was, you just tip him over and he just poured out whatever he ate. It's like his sphincter was, was not developed. No, thank goodness. But we used to think that like the GERD child didn't necessarily become the GERD adult.

And we're saying GERD is gastroesophageal reflux disease.

We used to think that they've Kids that had a, really had a bad as a child would grow out of it. Uh-huh. But there is some data now to suggest that GERDy kids, refluxing kids become GERDy or refluxing adults.

Well, that would make sense, right? 'Cause long-term acid reflux, just loosening that sphincter down there.

Yeah, it does appear to be, like you're saying, in some people, a lifelong problem that they need to address.

Mm-hmm.

Um, and if you're talking about like a lifetime of chemicals, we'd rather, if we can avoid it, we try.

And you're talking about the anti-reflux drugs. But what about lifestyle? Do you talk about eating smaller meals or less ultra-processed foods, for example? Because that was the other thing Dr. Aviv did for me was, you know, he wrote those awesome books. So I used his recipes to help the reflux calm down.

Yeah. What are some of your, his favorite recipes for you?

Well, the initial thing was that watermelon juice that he has a recipe for, and that really calms down, you know, all the inflammation. But I want to prevent the flare-ups in the first place because I'm so deathly afraid of anything.

Yeah, I know what you're talking about.

You know.

Yeah, there is a lot of data to suggest that a plant-based diet is very beneficial.

Mm-hmm.

Obviously avoiding the processed stuff. There's some data to suggest that a low acid diet can be beneficial. Did you and Jonathan talk about that? 'Cause that's a big, one of the big things I got from Jonathan was trying to keep, keep—

Yes. What about—

The importance of keeping the acid down.

Yes. And what about like alcohol?

Alcohol's horrible.

Obviously, right? The alcohol.

Alcohol's horrible, but you know, the goal is, like you said, if you're having a flare-up, I think it's time to tighten everything up. But, you know, this, our journey is short. There's no reason why people shouldn't be able to enjoy a glass of wine every now and then, especially, you know, we live in the middle of wine country up here in Northern California. So I think in moderation, as long as your symptoms are under control, is fine.

If you were going to give somebody the top 3 things you can do to prevent reflux, what would those top 3 things be as far as lifestyle?

Okay, so just behavioral modifications, right?

Whatever you think is like the biggest lever.

The biggest lever is, you know, Taking alginate after meals and before bedtime, because that's going to not only coat your esophagus, but actually form a physical barrier to prevent regurgitation. Whereas the acid blockers don't prevent regurgitation, they just increase the gastric pH. So that'd be number one.

Okay.

Number 2, you touched on it, is really going to bed on an empty stomach.

Okay.

The healthy stomach takes between 4 to 5 hours to empty. And people with diabetes can have delayed gastric emptying. Some other medications can cause delayed gastric emptying. But if food's sitting in your stomach and not being processed in your small intestine, it's going to be regurgitated. So going to bed on an empty stomach is essential. And one of the key things that I have my patients do to promote gastric emptying is just take a walk after dinner. So even just walking for 10 or 15 minutes can help promote gastric processing and improve gastric emptying. So taking a walk after dinner really helps speed up the emptying of the stomach. And then the third one would be elevating the head of your bed is really essential. So you want to get gravity on your side. Reflux needs to move uphill at night when you're sleeping, and that's really essential.

Would you lie on your left side or right side? Because I was reading all these radiology articles about which side you can lie. I mean, I used to do upper GI swallows, and to empty the stomach, we would roll people around on their right And then, but then some of the studies I read that was lie on your left side because then it would stay in the antrum, the food, and it wouldn't come back up into your esophagus.

Yeah.

Do you have any preferences or just, just don't eat a lot before you lie down?

The key is elevating the head, elevating the head of your bed. You know, for me, it's like lying on my right side is better for me. And I just kind of trust your body. I think there may be intricacies per individual why there's conflicting data, because I don't think in terms of the best sleeping position at a one Right, right.

'Cause everybody has different anatomy, different body habitus.

But for me, without a doubt, it's lying on my right side is, is beneficial for me.

Okay. I love that advice. So the alginate is actually a part of seaweed, right? Yeah.

So the magic behind Reflux Gourmet is it forms a foamy raft in the stomach and it reacts with the acidic stomach contents, forms a foamy raft. And then floats on top of the gastric contents. So if you do regurgitate, it's the alginate that's going to regurgitate into the esophagus, which is not only harmless, but protective, and not the food. So it forms a sort of a cork on top of the esophagus to prevent regurgitation.

And it's kind of like slippery if— and it— I love the caramel one, so that's my favorite. And kind of plugs up your stomach so that the content doesn't come back up, but it's really safe and it's natural. It's like a natural product.

100%.

Do you have any GI distress from it? Like, can anybody have GI problems if you eat too much of it?

You know, if you drink too much water, it can be fatal, right? So— Oh, okay.

So just follow instructions.

A teaspoon after meals and before bedtime. Mm-hmm.

Don't eat it like it's dessert.

Yeah. I mean, there's nothing in Repellex for Men that's not in your kitchen. There's really nothing in there that could harm you outside of, you know, drinking too much water. Just going crazy and having too much of them.

Like you said, alginate has been in other products, like medical products that help with reflux, but it had all of those chemicals with it, right? Parabens you were talking about, and maybe preservatives. So the second thing you mentioned was walking after a meal, which is awesome because that's great for your insulin levels also, like your blood sugar, right? So that's a great habit to have after every single meal. The eating 3 to 4 hours before you lie down is a little bit tougher for some people, and I used to be a big night eater. So that was something that I had to really get adjusted to. I replaced it with a habit of walking or doing something else so that I wouldn't lie down right after, you know, or just drinking tea. So drinks would help me not snack on things. For a while, I was drinking a lot of probiotic stuff, like the, the bubbly stuff, and that really got me. The last time I had to see Dr. Avi was because I was drinking all those fun probiotic drinks, and he was like, no, don't do that, because it was causing havoc. It was And you think it's a healthy drink, but you have to be careful. You said elevate your head. I have tried everything. I have bought wedges, you know those wedges put under your— I would just slide off of them, slip off of them. And then also you just kind of want to keep your head not too elevated because you do want the glymphatic system working while you're sleeping. It like your blood flow and the glymphatic system gets rid of all the waste products out of your brain. So I think that that convinced me that I really just need to stop eating four hours before. And if I do eat, I definitely take RX Gourmet.

Yeah. Then the other thing we have to be concerned about with healthy sleep and reflux is sleep apnea, because that can really— the pressure required to overcome breathing obstruction pulls gastric contents up with the change in pressure. So the sleep apnea really does make reflux worse.

And, you know, and then when you have those— the reflux come up, it could go into your lungs and you literally get pneumonia. Usually you have the reflex that shuts it down. Which is why I thought I was having a panic attack when it was actually just the reflux.

Yeah, it's terrifying.

Yeah, I guess I wasn't getting enough oxygen. Now I want to talk to you about the entrepreneurship side of this.

Sure.

Because you're a doctor, you have a big job. How did you meet this chef? I mean, you said he was one of your patients, right?

Yeah, Chef Ken was one of my patients who had a horrific— he had bad reflux. He's extremely open with his journey, but that's his journey. Yeah, so he was, you know, not only the inventor, but a longtime user of Reflux Gourmet. And he was really able to— alginate tastes horrible. It's very difficult to mask the flavor of it. You know, so he was able to really— the magic is in his flavor profile, which not only made it taste palatable, but actually, like, a lot of people enjoy the taste of it.

How do you juggle everything? Like, when you're getting patents or you're inventing something new, which must be so satisfying. I mean, I love that whole idea, but As a physician, how do you juggle all of this? Do you hire people? Do you know how to delegate?

Kind of what's the secret to innovation? Entrepreneurship?

What's your secret?

Entrepreneurship?

Yes. It's kind of rare to find an ENT guy who's a head and neck surgeon, head of a department, like doing all of this stuff. So how do you do it all?

So, I mean, the most important thing is as busy clinicians, you know, we need to work in teams. So you can't, you can't do everything.

Mm-hmm.

So you really need to surround yourself with a like-minded team that can help you achieve your, your mission of improving health, is sort of our overreaching mission. But you really need to have a long-term curiosity mindset for successful entrepreneurship and having a lifetime of curiosity, just being a curious person. The entrepreneurship is the action behind the curiosity. So one of the great advantages we have as clinicians in terms of our ability to innovate is that we're in the trenches. So we know where the knowledge gaps are. We know where the treatment gaps are. We know where the innovation is most needed and where we can make our highest impact. Because people who just do innovation or people who just do medicine, they're sort of missing the opportunity. As a busy clinician, we know where our treatment failures We know the people we can help. We know where those knowledge gaps are. So we're really in a unique opportunity to transform our curiosity into action. And then the other big one is you just can't be afraid to fail.

Mm-hmm.

So we've had some really, some epic failures that have really been remarkable learning opportunities. Some of our, my greatest successes are actually kind of have been some of the failures along the way. It's the failure that the failures were What was your favorite failure? My favorite failure was we developed a feeding tube that was placed on an ultra-thin endoscope for transnasal transjejunal endoscopic feeding tube placement.

So that's going through your nose, down your stomach, into your jejunum, which is part of your small intestine.

Right.

Using a camera. To deliver it. Yes.

Because there are about 4 deaths a year from failed deaths at every major medical center a year from feeding tube misadventures. And it was just missed on an X-ray, or no one ever got an X-ray, or the nurse started feeding the patient before the X-ray results ever came back. And the, you know, it's in the chart as like the patient died of pneumonia or pneumothorax or something else.

Oh, wow.

So it doesn't get a lot of press, but it's 4 deaths a year from feeding tube complications at every major medical center. So we developed a very elegant solution for this. We had a clinical trial. It was the most successful clinical trial ever published on a feeding tube. We raised about $500,000, couldn't get it through the FDA with the resources we had, and our business just kind of went belly up. That was a wonderful idea.

So you raised money also?

Yeah.

Too bad. I mean, too bad.

Yeah.

Why? That's terrible.

I'm just thinking about it.

Yeah.

It's just gonna get me, you know, get me sad, but—

So when you came up with the Reflux Gourmet idea, did you raise funds? Or did you take it up as your own company bootstrapping?

So one of the primary reasons that startups fail is not because of a bad product. Like I was talking about my feeding tube example, it's, that's rarely the case is a bad product. It's insufficient funds. So you just don't raise enough money to get, you know, the regulatory out of the way and marketing and everything else you need to, for a successful product. So I was extremely fortunate. I'm very close with Our business partner in Reflux Gourmet, Ramon Franco, who is just a brilliant human who has experience and successful, other successful ventures and passionate about voice and swallowing problems. And between the two of us, we were able, and the chef, we were able to have enough resources on our own to sort of bring this to market. And because of the success of the product, we've never really had to raise more money because people, we, our biggest problem with reflux For me, it's just keeping it in stock because—

Wow, that's awesome.

So many people are benefiting from it. But yeah, but it's not that way for all of our other products.

So yeah, that's a challenge that's special for medical products, I think, because you do need that cash because you do have regulations that you wouldn't have with other products. And people would say, if you are bringing a product to market, a lot of times the failure is no product market fit, like no demand, or you can't create a demand. But for medical products, it's more about regulatory and like, because you're the doctor, you know what patients could use and where that gap is, like you said. So that's a different interesting problem. GLPs, because of GLPs, you were talking about that motility, moving the gastric emptying and stuff. So I would imagine that your product is going to be in more demand because GLPs really slow down the motility of your bowels, right?

People with reflux. You know, one of our vulnerable population, you know, the obese population, is extremely vulnerable in our healthcare system.

I think everybody's taking it, even people who need to lose like 10 pounds. Yeah. Yeah.

Yeah. So, I mean, but like you said, those medications work by slowing GI motility. And we all reflux, you know, it's the body needs to vent gas. You know, we're swallowing 3 liters of air a day.

Wow.

So, you know, anywhere from 30 to 50 reflux episodes per day is Oh my gosh.

It's normal for everybody.

It's normal for everybody, yeah. They're called transient lower esophageal sphincter relaxations, which is just the body, the stomach gets distended, it vents gas, you burp. Sometimes it brings up gastric contents, sometimes it's just air. Sometimes you notice it, it makes a sound, sometimes you don't even notice it. So, but the stomach needs to vent gas, so reflux is a normal physiologic mechanism.

Interesting. I never thought about it that way.

Yeah. So that's why your reflux disease could really mean anything. Anything, right? Because some people have 3 reflux episodes per day, and they feel every single one, and they're miserable. Other people don't get any symptoms for whatever reason. They're just not as sensitive, and they may have a lifetime of bad reflux and never get heartburn, and they present with obstructing cancer later in life.

Wow, that's so scary. I mean, there's no screening study then, right? We don't do upper GIs for an ENT, You can scope down into the larynx, like your voice box area and your maybe the upper esophagus. But we don't normally get esophageal scans all the time or scopes where they put the camera in. So how can somebody prevent this in their lives? Like how can you prevent regular reflux from becoming a problem, like a stricture where it gets narrowed or cancer? Anything, all those things. Okay, don't drink alcohol, don't smoke cigarettes, and then all those things out the three.

Take everybody's fun away. No, no.

See, I— people say that all the time, but you know, you have to reframe fun. Is it really fun? Like, you have to really question what is fun, right?

I mean, a giant cheeseburger with bacon and avocado and such.

Yeah, but it's only what you're—

That's fun every now and then.

With a beer?

With a beer, yeah.

But that is something that I've never thought was fun.

Yeah.

It just depends on the person, right?

Yeah, no, absolutely.

For me, it's potato chips and those probiotic Seltzer.

Some people, it's no problem giving up alcohol completely, and it's no problem not eating before bed and, you know, making, you know, fresh watermelon juices, you know. But for other people who are, you know, working 2 jobs and don't have the opportunities to make their own food and exercise, like, if we told everybody that we, they had to give up, you know, all the sweets and alcohol and everything else, we'd be pretty lonely because I don't, I think it's the unusual person in my experience that can give up all those things, but has the willpower to do that at least.

Well, that's what I'm working on. I believe that it is our environment. We are the product of our environment. So like once you understand what your environment is doing for your brain or to your brain, then we have a lot more control over what we want to think about as fun or rewarding. So what does—

what's your top 5 fun things that you like to do?

I love interviewing you, for example. I'm so— I love going to lectures or like watching documentaries. Or going for a walk, or going to a new town, or reading a book. Sometimes listening to podcasts. I don't know. There's so many things. Hanging out with my kids. But I, I mean, I have issues too. I have the potato chip problem. I stopped drinking alcohol a lot because of the reflux, actually. And it solved a lot of other things for me too. The alcohol, like, you know, we used to drink wine at night, you know. I also stopped drinking because my husband almost died of sepsis. He was on so many antibiotics. It was like appendicitis, and he went into sepsis. So just for For those recovery reasons, he stopped drinking, and then we just stopped.

Good for you.

I mean, I still drink once in a while, but like, not, you know, I don't have to do it to have fun.

Yeah.

But I, maybe I don't have any friends. I don't know. You might be right. You don't have any friends.

I'm not, I'm not push— pushing alcohol on everybody. Everyone believe me. I just like, we deal with, I see a lot of cancer survivors in my specialty. So they have head and neck cancer survivors have some of the worst swallowing problems you can imagine. It's absolutely devastating.

Oh my gosh.

Not infrequently end up dying. Oh my gosh. But they have had so much taken from them. I spend a lot of my time just trying to restore dignity and some semblance of quality of life. So for that, for them, for some people, it may just be, they just wanna be able to enjoy a cup of coffee, you know? Or they may just, for some people who are on a feeding tube, they may just wanna be able to enjoy a glass of water. 'Cause we can sustain, Yeah. you can sustain somebody nutritionally. on a feeding tube. So I'm very sensitive if somebody really enjoys something, whether it's a glass of water, or walking the dog, or getting in the hot tub with a feeding tube, or whatever it is, we really try and optimize the quality of life wherever we can. And if for some people it's a glass of bourbon before bed, well, we're going to help you try and achieve that. So, and everybody's different. So, you know, we're just very sensitive about restoring quality of life and dignity.

Well, that's— So yeah, that's amazing. Like the work you do, that's just incredible stuff that you're dealing with and helping people with. So I'm so grateful for you and for putting Reflux Gourmet out there. That's just awesome.

Yeah.

Thank you so much. Well, I want to give you like 5 speedy questions. Can I ask you a couple of fun things? So what's on your nightstand right now? Like I know Reflux Gourmet is on mine and the book that I'm reading.

What's on my nightstand right now is my mouth guard that brings my jaw Fall forward when I sleep, so I don't obstruct.

So the snoring?

I just obstruct. Yeah, I don't— I don't— my snoring sounds terrible, but yeah, that and a dog toy. So we have dogs everywhere, so it's my mouthguard and the dog toy.

I have a mouthguard too. Who doesn't, right? I have a mouthguard because I grind my teeth.

Oh, yeah.

And I cracked a tooth. Okay, so what is the biggest thing you wish every patient did that costs them nothing and would take 2 minutes to prevent all of these things we're talking about?

Advice for kids, younger people, Anyone go to bed on an empty stomach? Probably the biggest bang for the buck.

Yay! So hard to do, but yes. That's the biggest bang for the buck. Again, like, so, okay. What's your non-negotiable daily habit?

Ooh.

Like a healthy one.

My non-negotiable daily habit. Ooh. I mean, for me, it's probably Peloton would be, that's my 45 minutes of me time.

Awesome. Treadmill or bike?

A bike. Jennifer Sherman.

What?

You know her? She's my favorite Peloton instructor. Oh, I'm gonna have to look her up. Yes.

Send her some Reflux Gourmet. And what about one best throat or voice hack that you would give to patients that they're surprised about? We never think about our voices either, but, you know, your voice can sound icky depending on if you have a lot of stuff in there, inflammation.

Embrace your aging voice.

No.

Really?

Yes. What if you, you can exercise it? Dr. Aviv gave me something that I love and it helps so much, which is the warm milk. Mist. So good for your vocal cords.

See, I mean, you're, you're young still, but I, I'll probably see 3 or 4 patients a week in their 90s who come in and say, I sound like a little old lady. So you're winning if you're coming to see me and your biggest complaint is your voice at 92 and you sound like a little old lady. Just embrace it. You're winning. You're winning. So it's a wonderful society we're living in when people in their 90s are, I But it's so frequent now. When I graduated medical school, you know, in '94, we never saw people in their 90s come in complaining of voice complaints. Like, like we just, you know, people lived in their 70s and 80s. Yeah. You lived to 76, 77. That's a good run. And now, like I said, I, I'm seeing 3 or 4 patients a week with voice complaints in their 90s.

Great.

When they voice their youth.

So awesome.

Yeah. So when, when you get there, when you get to be a little old lady, I hope. Embrace your voice.

I hope.

This is a, this is a good hack. I think this is important advice for your listeners. Record your voice.

Okay.

Get a 2-minute recording of your voice in conversational speech, because in the near future, if your voice is taken from you from age or Parkinson's or stroke, or no matter what, paralyzed vocal cord, no matter what it is, we'll have ways using artificial intelligence to clone your voice and reconstruct it so you can still communicate, you know, in your normal voice. So, but we won't be able to do that without everyone having banking their voice. So just, there's a voice memos app in your iPhone or whatever it is, just 2 minutes of conversational speech, just have a recording of your your voice. So in the future, if you need it, you have— you'll be able to have utilized the voice of your youth.

That's great advice. I love that. I'm glad I've been doing this podcast and my voice is all over the internet.

You have. Yes, you're good. And you have a wonderful voice.

Oh, thank you so much. So just one last question. What do you think about AI in medicine and in your field? You're just talking about this amazing thing where you could bank your voice and maybe AI could communicate for you. Is there anything else that's going on in ENT that AI is rearing its head? Oh gosh, yes.

I think A lot of different aspects. I think you have a lot of APPs, so nurse practitioners and physician assistants with artificial intelligence will be able to handle a lot of the entry-level ENT complaints. So with the booming aging population, there's going to be a shortage of specialists. So I think a lot of the entry-level care with AI will be able to be done by entry-level nurse practitioners, physician assistants, that type of thing. We already have AI note-takers as part of our electronic medical records that are, I was skeptical about, but are really amazing. I think that the otolaryngologists, in regards to surgical procedures, will be safe for a while. As you know, I just mentored a radiologist last week who switched specialties because, for fear that there will be no more radiologists in the future, it'll all be AI-driven. In terms of the surgical subspecialties— Well, there's a I think the ophthalmologists will be the first ones to go. That'll all be automated and robotic. But yeah, exciting time, but it's changing, right?

I feel like there's always going to be a need for somebody who's good at what they're doing to oversee everything, you know?

Absolutely.

To work with AI, right? You're going to be reading mammograms with AI, which I think is great, actually.

Yeah, no, absolutely.

Yeah.

A good friend of mine, a guy named Al Maradi, who's my counterpart at University of Washington, said, we're not going to lose our jobs to AI. We're going to lose our jobs To clinicians that use AI better than us.

And that's for every field, I think. I feel like. Thank you so much for spending your time with me and for doing all the amazing things you're doing for patients out there and developing these products.

You got it.

Really grateful to you.

My pleasure, Juna. And if you ever need to be dilated, I'm your guy.

No.

I'm your guy.

No, never.

Yes, come to California.

Never. No, I don't need that.

If you ever do, I'm there.

I'm knock on wood. I am, and also I'm going to take reflux garments and do all the other things.

If you got any questions, just feel free to reach out at any time. Okay?

Yes, and people can find you on your website at UCSD. And thank your wife for me. What's her name?

Angela.

Shout out to Angela for listening to Mind Body Space Podcast. Please have her contact me.

You got it. I mean, thanks, Gina.

Thank you for listening. Don't forget to hit subscribe and share, and head on over to Mind Body. Space.com/store to get your copy of the Relax to Source system that will put all of those microhabits of wellness into autopilot for you. Until next time, this is Dr. Juna signing off, wishing you and your loved ones wellness.