That “Lump in Your Throat” Might Not Be Anxiety: Dr. Juna discusses "Silent Acid Reflux: Prevention and Treatment" with renowned author and ENT specialist, Dr. Aviv

I remember the exact moment, 'cause I'm a radiologist, so I think everything's cancer. I was at my daughter's birthday party and I was like swallowing her birthday cake and I felt this lump. I mean, the reason we care so much, I mean, yes, the hoarseness, the jump-ups, those are all bad. And if you aspirate, I guess you could get pneumonia eventually. And then the sinus issues are also real. But in the end, the most scariest thing that we wanna prevent is cancer. And can you talk a little bit about that and like these chronic conditions that can instigate cancer?

Hello and welcome to the Mind Body Space Podcast. I'm Dr. Juna Bobby MD. I'm a mom, NYU-trained medical doctor, and Harvard-trained educator. I started this podcast to help you go from stressed to focused and to boost your resilience. Our Relax to Soar method and planner helps teens and adults reduce stress, overcome procrastination, and build the mental and physical resilience needed to reach your highest potential. You can find out more at mindbodyspace.com. Now let's get into today's episode. I'm so excited to have here today my own doctor, Dr. Jonathan Aviv. He is the clinical director of the Voice and Swallowing Center at ENT and Allergy Associates. He's a clinical professor of otolaryngology at Icahn School of Medicine at Mount Sinai, and he's the professor of ENT and neck surgery at Columbia University. He's the inventor of the endoscopic air pulse laryngeal sensory testing technology. He's also a pioneer of the awake, non-sedated upper endoscopy technique called transnasal esophagogoscopy, TNE. He has authored over 60 scientific papers in peer-reviewed journals, and he's also the author of the book entitled The Acid Watcher Diet, which I have right here, a 28-day reflux prevention and healing program. He's also the co-author of The Acid Watcher Cookbook, 100+ delicious recipes to prevent and heal acid reflux disease. As you can see, I have all these little stickies in there because I use it and it's awesome. He's also the author of textbooks, Flexible Endoscopic Evaluation of Swallowing with Sensory Testing and An Atlas of Transnasal Esophagogoscopy. He's the past is president of the American Bronchoesophagological Association and the New York Laryngological Society. He was the former chair of the Speech, Voice, and Swallowing Disorders Committee, American Academy of Otolaryngology, Head and Neck Surgery. Dr. Aviv is a developer of Project Wellness with Atlantic Records, featuring the creation of a video on vocal health, and he has been named to Best Doctor in New York magazines for many years, as well as acknowledged by the Best Doctors in America. Dr. Aviv has written for Forbes, MindBodyGreen, and has been featured in many articles in the New York Times, the Wall Street Journal, Boston Globe, and U.S. World News and Report. He has appeared on Good Morning America, The Dr. Oz Show, NBC Nightly News with Lester Holt, CNN, Inside Edition, Good Day New York, The Better Show, Bloomberg Television, SiriusXM Doctor Radio, and the Discovery Channel. He's also been my doctor for over a decade, and he's taken such great care of me. I can't recommend him enough. I recommend him to all my friends and family.

Thank you so much for being here, Dr. Aviv. Dr. Aviv has been my doctor for for so many years, right? I came to you first over a decade ago when I felt that lump in my throat, and like, I felt a lump right here when I swallowed. I remember the exact moment because I'm a radiologist, so I think everything's cancer. I was at my daughter's birthday party, and I was like swallowing her birthday cake, and I felt this lump, and it was just so frightening to me. And when I went to see you, you told me about something that I don't think I learned this in medical school, but you told me that I had silent reflux, or LPR, which you're going to tell us all about. And I did have heartburn and like regular kind of reflux that people think of when they think of reflux way back in medical school, but I hadn't known that I had this other kind of reflux. So maybe you can tell us a little bit about LPR.

Absolutely. I'm an ear, nose, and throat doctor. I'm the director of the Voice and Swallowing Center at ENT and Allergy Associates. What you experience, this sensation of lump in the throat, is, is very disconcerting. You feel like you're gonna choke. Sometimes you feel like you can't breathe. Look, you know more than most as a physician, as a radiologist, you've seen a lot and you worry a lot. Understandably. But the notion of laryngopharyngeal reflux, where stomach acid flies up and burns the throat, causing all sorts of symptoms, actually, as it turns out, is rather rare. What is much, much more common, and finally it's getting more attention, is acid influx, which is the acidity of what you eat and drink causing that irritation. And it's actually far, far more common. I call it the pepsin story. So pepsin, P-E-P-S-I-N, is an enzyme that lives in the stomach. Pepsin gets activated to break down food below pH 4, which is a very acidic level. If you remember from high school chemistry, there's a pH scale from 0 to 14, 7 in the middle, neutral, think Water, plus minus. Above it is alkaline, below it acidic. However, what's meaningful for the body is below pH 4 because that's what activates this enzyme. That's part 1. Part 2, and this is something we didn't learn in medical school, and frankly they still don't teach it. About 12, 15 years ago, it was shown that that enzyme pepsin can float out of the stomach and it can sit in the throat. Mouth, teeth, nose, sinus. And when you eat or drink something less than pH 4, it turns on like activating a sleeper cell. And then what you eat starts eating you. And that's where this starts, right? The good news is this is not a gloom and doom story. Actually, this is a story of hope, which dovetails with your whole concept of mind-body space and using your body natural holistic ways to deal with these things.

Mm-hmm.

But at first we have to acknowledge it scares the crap out of us.

Yeah.

And, and we lose the space and we lose our mind.

And also you get, you have a lot of these symptoms that you don't want where you have like constant clearing of your throat and like maybe you have some sinus issues and you don't sound so great. I know you take care of a lot of singers, so.

Yes, that, that's all true. But so if we just And this will be very beneficial. Your listeners are attuned to healthy diet, and this is where it gets a little tricky because there are only 6 foods less than pH 4. Not— that's not a lot, right?

Yeah.

I'm not a big believer in draconian reflux diets. Frankly, I'm not a big believer in draconian diets of any sort. And you know this from your experience, and we have talked about it. The more draconian a diet, the fewer people can do it, meaning compliance is less. And you end up with a situation where someone does something for a week, 2 weeks, maybe a month if they're feeling saucy, and then they curse you out and they go back to their bacon cheeseburger and a 6-pack of Coke and they give you the finger. So that doesn't help anybody. That's why I drill this down. Once we find out what your symptoms are, If you're telling me I have severe, unrelenting heartburn, okay, but you're saying I got a lump. Well, so let's talk about what I call the dirty half dozen.

Mm-hmm.

Right. And think about it. So pepsin, this enzyme that wants to break down food, just sits here relaxing. It's on its proverbial Barcalounger in your throat.

Well, yeah.

Then you decide to have one of these 6 dirty dozen. So what are they? We divide them. 3 unhealthy, 3 healthy. Okay. Very symmetric. The unhealthies, and they have little to no health benefit. In fact, they're all health detrimental flavored beverages in a can or a bottle. So we have the classics, Coke, Diet Coke, Snapple. I'm not singling out a brand, but we can say regular sodas, diet sodas, and bottled iced tea.

Mm-hmm.

And then what I call the new classics, the flavored sparkling waters like LaCroix, Spindrift, Bay, Bubble Bang, Olipoppy. As soon as I'm finished talking to you, another one of these is gonna come to the market and they'll say they have probiotic, they have prebiotic that helps you run a 4:4:40. All right. Well, I've turned kitchens into food labs with my co-author Samara, my spouse, and we've tested all these things. They're all pH 3. It's not the bubbles, it's the flavoring. It's not the bubbles, it's the flavoring. I should have a t-shirt.

I didn't know that about Olipop, but that's what got me last time. I love Olipop. I got addicted to it and I don't even think you're supposed to drink more than one a day, but I was drinking like maybe two, sometimes three. You get so addicted and the calories were very low and I still love Olipop, but I think that incited my last time of coming to you because I started having these issues again.

Okay. So we talked about the flavored bevies. We talked about the new classic. You're sports drinks, Gatorade, Powerade, C4, Celsius.

Mm-hmm.

You want an alternative? Pedialyte, pH 6. Not very sexy. Not sponsoring the NCAAs, but pH 6.

Okay.

Very little sugar. So again, the flavoring is what gets you.

Mm-hmm.

Finally, the third in that category, and everyone's gonna be upset because for years we were told we should go drink 2 glasses of wine a day. So alcohol. Now, the notion that alcohol is a health food, I don't think so.

The latest literature, as you know, latest literature says that there's maybe no level that's safe of alcohol.

Yeah, but let's talk why, right? Lowers your immune system, gives you risk for 8 different organ cancers, and is, you know, very acidic and inflammatory. We can talk about all that stuff.

I used to have all those CT scans where there's atrophy of the brain and, you know, it's like a lot of alcohol use. Go on with the reflux. Okay.

As it turns out, the only alcohol less than pH 4 is wine. So Scotch, beer, tequila, rum, vodka, gin, not a problem in terms of acidity. You have to watch out for the mixers, right? Tonic is very acidic. Obviously juices are very acidic. Okay. So we can debate the alcohol thing. And then the other thing by alcohol, by the way, is arrhythmogenic. That means it can give you an arrhythmia. Well, that's fun. And there's an entity papers about, it's called Holiday Heart. You go on a little vacation, you finally get away with your sweetheart and a margarita. I'll have a gin. And next thing you know, you're in atrial fibrillation.

Ooh.

Gotta go home quickly. Not a health food, but okay. Wine is, is pH 3 or lower, sometimes a little higher, but it's below 4. So let's go into the, to the healthies. There are only 3. And each one of them can be neutralized, which is our big point, right? The Acid Watcher diet concept is acid neutralization through diet. It's a simple concept. The execution, so the food tastes good, is what makes it difficult. And that's what Samara Aviv is unbelievable at accomplishing. But let's go through these because these are incredibly common. Your listeners are using these right now. Citrus vinegar. That's it. So let's go through each one. Lemon, lime, orange, grapefruit, pineapple. You can cook with it. You can put it on your meat, fish, or poultry, or the plant-based versions.

Mm-hmm.

You can use the rind, the zest. The zest is okay. In fact, on the Acid Watcher Cookbook site on Amazon, there's a 15-second video of Samara making a pico de gallo just using the zest. You know, a lot of the flavoring is really in the oils of the skin.

Mm-hmm.

Vinegar can be neutralized by dairy or dairy substitutes. So think Caesar, ranch, blue cheese, no problem. Avocado vinaigrette is no problem. So it's not like, oh my God, I can't have salad anymore. That's not true. You just have to modify a little bit. Now let's say you're dying for a vinaigrette. Some Italian dressing or Greek dressing and you have it, will you explode like a Ford Pinto? No. When you come in with a lump and you're worried as hell, it'll be your last meal on earth. You want to have some tools that very quickly and easily start the healing process. Finally, there's tomatoes. Tomatoes are no problem. Tomatoes are 4.2 to 4.8 acidic, but not so bad. Not a huge activator of pepsin. The issue with tomatoes is sauce. Dr. Bobby's famous homemade tomato sauce from your garden tomatoes, no problem. But when you go to restaurants, they say homemade. What really happens? There's a jar of San Marzano somewhere. There's a can of paste, and that's what acidifies it. Again, will you rupture like a volcano if you have a slice of pizza on Bleecker Street? No. But you come to me with a lump and it's swollen and you have cobblestoning and tiger striping and all the signs that we see in the larynx of swelling. You want to— you want some guides that you could do right away. And that's all there is. It's really not draconian. It's totally— I love when people say, oh, I can't eat anything. I said, what, you live on vinegar and wine? They don't have to drink vinegar and wine. That's utter nonsense. Come on.

I mean, wine and coffee, maybe.

And there's nothing wrong with coffee, by the way. Coffee and chocolate are not acidic. Yes, they loosen the lower esophageal sphincter. Yes, they bring acid up. But if heartburn is not your main complaint, you can probably get away with your morning coffee. I just wouldn't have it late. You know, Godfather style, late. I just finished a 9-course meal. I had my chocolate cake. Now let's have an espresso and now I'm gonna lie down. Then you will explode.

Okay. So I just wanna reel back and say that when you talked about the pepsin, which sits in your throat or even in your sinuses, cuz I did get that nasal drip. Then what happens is when you get that silent reflux and you get the acid back up there, that's activating the pepsin and that's what we are worried about, right? Cuz that could irritate your mucosa. Which is like the lining of all of your soft tissue back there. And that's what causes the problems, right? All those symptoms.

Exactly. You're causing an inflammatory response. By the way, the latest data is showing it's not just a local response. It's a body-wide inflammatory response. The patient group that was initially so adherent to our diet, believe it or not, was our Crohn's disease patients, our inflammatory bowel disease patients, because as their inflammation went down, their need for The medications that they used to control their symptoms diminished because their inflammation went down.

Would you recommend like the diet for anyone who's pregnant as well? Just because you're going to get some reflux or like LPR is a different mechanism than the regular heartburn, or is it all— is it all washing? It's my guess.

Again, what really is much, much more common, and I'll give you a simple example. Americans consume 800 million cans of soda a day. Mm. There are only 240 million adults. So that's influx. That's influx. Pepsin activation at its finest. If you have pressure here, pregnant, yes, it's a— but it's a different mechanism. And again, any dietary issues that Dr. Bobby MD and I discuss on this podcast, don't run out and do it. Speak to your doctors. Okay. I don't know your medical history. We don't know what's going on. We don't know your hemoglobin A1C. We know nothing about your medical story. So before you run out and treat yourself and become your own general contractor of your own body, speak to your doctor. That's very important. You gotta speak to your doctor. This is informational. This information, especially about the flavored beverages, it's really the flavoring, not the bubbles. That's the big issue most folks don't know. And the bottom line is very, very few clinicians can look at the larynx, as you know.

Right.

So we're getting a perspective and an actual view. You've seen your larynx in action.

Yeah, I have.

Many times, both when it's swollen and when it returns to normal, usually within 100 days. That view is a rarefied view. Most people can't get it. So the information that you read online is woefully inaccurate.

Mm-hmm. Oh. Mm-hmm.

And then the thing that really gets us all, everything happens at night. All the reflux action or the influx action is nighttime. So everything's gonna come up and that's where we're most vulnerable, right? We're most vulnerable at night. When you cook for yourself in general, I don't worry. It's when someone else is doing the cooking, when you dine out, order in, travel, you really don't know what you're eating. And I love when people say to me, oh no, no, no. I know exactly what I eat when I go out. I said, yes, you go up to Jean-Georges in his kitchen and say, Jean, don't put that in my food. Well, we'll see how far you get. So we don't know. Well, anytime there's a sauce, chefs will put chili flake or chili powder in the sauce. Chilies have a chemical in it called capsaicin. Many people have heard about capsaicin. When I mentioned capsaicin in the office, people say, oh yeah, capsaicin. But what people don't know about capsaicin is that it paralyzes the stomach. It impairs gastric peristalsis for 4 hours.

Wow.

So what does that mean, right? 8:00 PM dinner out. Your stomach's not moving till midnight. You go out Barcelona style and you are screwed. Gastric peristalsis that we're talking about. And when the stomach's not moving and you lie down, it's coming up. So what do we do about that? As it turns out, there's a natural substance that prevents that. It's new. It's called alginate or algae. The product I like most is called Reflux Gourmet.

I love Reflux Gourmet. I have subscriptions to them. I gave it to everybody, my husband, my kids, and natural, right?

Good.

My son was like, this tastes really good. I have a subscription and I, I've been using it ever since you told me about it. And it's amazing. I talked to my doctors up at Mass General too, and they, they thought it was great. And yeah, so I've been using that and now I actually collaborated with them recently for one of the—

Oh, it's beautiful.

Emergency room doctors out at UCLA. Love this product.

And it—

you told me that some mylants will have alginate, but it has all of those other chemicals with it. Yeah.

Well, it's, it's really Gaviscon, right?

Oh yeah.

American Gaviscon doesn't have enough algae. The UK Gaviscon, excuse me.

And while you drink, I'm gonna say, cuz you were talking about sleep. One of the most frightening things that happened to me was that I woke up in the middle of the night feeling like I was having a panic attack. And this was the first time I saw you was over a decade ago, and that resolved. You treated me and everything was good. And then just recently, 3 or 4 years ago, I woke up in the middle of the night thinking I had a panic attack. I've never had a panic attack before. Like maybe once when I was in medical school, the first week of school, I had a panic attack. Like, I don't belong here. What am I doing here? But anyway, so I woke up in the middle of the night. I thought I was having a panic attack. I couldn't breathe. And then when I saw you, you told me it was actually what's called jump up, which is what this reflux thing does, which is so frightening. And that's why I really, I just ate like melons, no alcohol, nothing. That was the scariest thing and I haven't had it since. So thank you so much. And when you scope me, it's so quick and painless. So, and you show me everything that's going on.

So I really want to thank you for having taken care of me for so many years.

It's my pleasure. And the thing about the jump up, I'll deal with the jump up and then we'll finish with the alginates. The reason it's a, it's a jump up. What happens when acid comes up, it can hit the larynx, the airway, and as a protective mechanism, it shuts. So suddenly you can't breathe. That happened to me. We talk about it in my first book. I was director of head and neck surgery at Columbia in the middle of the night. I woke up choking and I thought, well, That's it. 4 years into the campaign, I'm done.

So scary.

When it does happen, if you have the wherewithal to think of it, is to close your lips and sniff. When you close your lips and sniff, it tells the brainstem to open the airway. We can get very technical, the muscle that does that, but that's what happens. It has to be a closed lip. If you open your mouth, it actually makes it worse, but a closed lip. Sniff helps open the airway.

What's the name of the muscle?

The posterior cricoarytenoid muscle.

Nice. So it's not open or use, use a paper bag. Like you think you're having a panic attack. Don't use a paper bag because, well, no, you, it's just the opposite. You want to close, you want to, but you got to know what's happening because if you think you're having a panic attack, then you're just like, yeah, then you wake up.

What are all these paper bags around here? So getting back to alginate. So what algae does, right, it floats to the top of the stomach. It acts like a raft, prevents acidic things from coming up. As I said, likely the most important advance in the holistic management of reflux in the last 40 years. Reflux Gourmet itself has no preservatives, so it's so safe I could give a half a teaspoon to my 7-year-old if need be. I personally have been taking 1 teaspoon before I brush my teeth for bed, 4 years running. If I forget, and the last time I forget was last summer, I fell asleep watching the MLB All-Star Game. It happens. I wake up choking. I have a jump up.

Sometimes I use it before I work out also.

I mean, that's, that's wise. But by the way, I keep it at my bedside because if I forget, I then, you know, and it happens, I squirt it in my mouth. I don't start measuring a teaspoon at 2:00 AM. I just squirt it in my mouth. It's a syrup. It's, it's very tasty. And, you know, 10 minutes later I'm asleep. That's anecdotal, but the science behind it is very consistent. So that has become part of how we work this up and treat, really treat more than investigate. And it's, it's been an unbelievable help. If you think about it, for years we're given when we have heartburn-type symptoms or even the throat-type symptoms, we're given one thing. We're given an acid reducer, a pat on the back, and it's via congiost. The thing is, you have to do more than that, right? You have to prevent the stuff from coming up. That's where the alginate is so effective. And then the other thing is you want to actively reduce swelling. And as you know, we're huge fans of watermelon cucumber as a blendy. We don't wanna juice it, we wanna keep fiber. So we blend it. And that combination of foods readily available will actually shrink the throat swelling, reduce your big globus from a golf ball to less than a pea over a 100-day period. And I call it the watermelon cuke blending. If you don't have time to blend it, people say, Doc, I don't cook. I said, okay. I said, is buying watermelon considered cooking? They said, no, I can handle that. I said, okay, 8 ounces a day, 1 cup, 4 weeks in a row in the morning, in addition to whatever breakfast you have. And it works. This is what we give a lot to our performers in lieu of systemic steroids. When they're on tour or in the recording studio. Now, I'm not saying if someone has an emergency, an airway emergency, you're going to throw watermelon at them. That's not what we're saying.

Okay. Yeah, I know. You've given me Dr.

Aviv says I have an airway emergency. Give him a watermelon. We're talking about a non-acute situation where we want to keep swelling down over a long period of time in a holistic, very effective way. And it works. And there it is. There's a watermelon cucumber blend.

I did that for, you know, when you gave it to me the first time I did that. And it really would soothe my throat. It was amazing. Yeah. It really works.

Yeah.

And you gave the medication as well, but it helped me get off the medication so much faster because some of the medications have side effects. It affects B12 absorption as well. Some of the meds for me was a problem. Yeah. Meds are great, but all of this food that you talk about, I mean, that is the real medicine that you can use without side effects.

Yeah. And most of our patients, except for our cancer patients, either esophageal precancer or esophageal cancer, most of our patients can handle things with food and occasionally weaker acid reducers like famotidine. It's called an H2 receptor antagonist. It goes by the brand name Pepcid. But again, look, sometimes, you know, you're, let's say you're going to wine country. Let's say, you know, you want to enjoy the local fare, you may have to you know, sort of beef up your program a little with transient use of acid reducers, I see nothing wrong with it. Again, it's not poison. In fact, recent study by Maietti showed that all the issues about bone fractures, dementia, kidney problems have been disproven. And there's very, very good science on that. The observational studies that has worried people for almost a generation, most of those observational studies are very poorly done and really didn't get to the issue. So bottom line is, if you need an acid-reducing medication, again, you discuss it with your doctor, get an endoscopy, get a laryngoscopy, see what's going on in these areas. And if you need it, you take it. But I always feel there's room for a food-based approach, especially something that's so simple, like we discussed, all of which essentially you can neutralize. And again, please don't neutralize wine. If you have a great bottle of wine, don't do anything to it. Have it, you know, if you can. But in general, most of these things can be taken care of by adjustments of food.

Awesome. And I, you know, I'm glad you brought up the cancer thing because that is what we're, we're trying to prevent here. I mean, the reason we care so much, I mean, yes, the hoarseness, the jump-ups, those are all bad, and if you aspirate, I guess you could get pneumonia eventually. It's possible also. And then the sinus issues are also real, but in the end, the most scariest thing that we want to prevent is cancer. And can you talk a little bit about that and like these chronic conditions that can instigate cancer?

Yes. I mean, and in the late '70s, the FDA instituted a law called Title 21. The purpose of Title 21 was quite noble. It was to prevent food poisoning. Or botulism. So the plan was, and it was executed, any food or beverage in a can or a bottle need to be acidified. And they came up with pH approximately 4.3 to 4.4. The food packers dropped everything below 4 to maintain shelf life. And since the late '70s, esophageal cancer has become the fastest growing cancer in America and Europe. There are other things that happened, the sugar tariffs, The, the wheat subsidies, the institute, the initiation and bringing on of high fructose corn syrup, which led to our obesity epidemic and so on and so forth. But that's when it started. And that's what we worry about. Anecdotally, again, we have not published this, but the gastrointestinal doctors that I take care of in the tri-state area, we have diagnosed Barrett esophagus, Barrett, which is potentially potentially can lead to esophageal cancer in almost 200 men and women under the age of 30. And none of them had heartburn, just throat symptoms, cough, hoarseness, throat clearing, phlegm, lump. Exactly what you're talking about. And the only common denominator was not smokables, which is bad enough. It was these flavored beverages. Now, of course, everyone's going to have a connection. Oh no, I've, you know, My friend Sammy has, you know, 9 cans of soda a day and he's, you know, 97 years old and he's fabulous.

Okay.

He's good for, good for Sammy. But we're, we're, we're seeing something else here in the trenches.

Mm-hmm. Mm-hmm. And also obviously alcohol, if you're a heavy drinker, that, that increases your risks of esophageal cancer and all those things. And not to scare anybody, but these reflux things, these long chronic issues can lead to an increased risk. And that's what I was afraid of.

Well, and these are reasonable concerns.

Mm-hmm.

The symptom that scares most of us most, believe it or not, is chronic cough. Cough more than 8 weeks.

Oh yeah.

And there's plenty, plenty of literature.

I've had a cat go to you for months now. She's coughing every time she eats.

More than 8 weeks of cough, speak to your doctor, get a chest x-ray. You know, get an endoscopy or at least speak to your doctors about this. Let them, let them get a diet history. That's, you know, one of the things that, you know, we've been talking about for so many years is, and we endlessly talk about this, ask your patients what they eat and drink. And as patients, tell your doctor what you eat and drink. It's so important because once we know what you're putting in, We can make some adjustments still. You can enjoy things tremendously, but let's establish the playing field. That's what I think is so vital. And when people say, oh, I can eat anything, my stomach's perfect. Well, what's happened really, and we know this from our development and inventing of laryngeal sensory testing, we've tested sensation in the throat through a device I developed in the '90s when I was faculty at Columbia. So we know when there's acid injury, the tissues swell to the point where you lose sensitivity. So you lose sensitivity up here, you lose sensitivity here, so you don't feel anything. So it's not that, oh, my heartburn went away. It's just that things got seared and you feel nothing. And that's when you got to give someone a call and find out what's going on.

Almost like a callus.

That's a great way to look at it. Callus is a much nicer term than searing. Okay.

So I want to ask you one more thing, and this is such amazing information. Now that we have GLP-1s, you want to tell me a little bit about how that could affect reflux and how that could be used?

Yes. You have put your finger on the future. So what are GLPs? GLPs and GIPs are the quote unquote miracle weight loss drugs. Mm-hmm. Uh, the flagships are Ozempic and Mounjaro. Mounjaro also goes by the name Treslebepound. Ozempic goes by also by the name Wegovy, but they're GLP and GIP drugs. The good part is they're longevity drugs, and this is what seems to be missing from a lot of people's calculations about these medications. Well, folks, it's arrived. The GLP drugs, the Ozempics and Mounjaros, reduce what I call the four pillars of non- Cancer, death, stroke, heart attack, kidney failure, heart failure, risk of fatty liver and Parkinson's. Other than that, they don't do squat.

And now, is that direct or is it because it's helping people lose weight, which is a problem?

There's a direct effect on the end organs. It not only increases blood supply, it decreases cell death of the brain, of the heart, of the kidneys. And people don't know that. They think, oh, you know, I'll, I'll go on, I'll take my Ozempic that I got on, you know, one of the sites. And, you know, when I lose my 15 pounds, I'll go off it. That's like saying, well, my blood pressure's finally under control on Ramipril. I'm to go off the Ramipril. Now my cholesterol's not 400 because I'm a statin. Now it's normal. Let me go off my statin. Now you have to be on it forever. Well, so what? But what about forever?

So, so you're saying that I should take it to lose my menopausal weight, but like, but what about the fact that it slows down like peristalsis and you could get, I'm always scared of anything with pancreatitis because that's another thing as a radiologist, like you never want to see pancreas involved in anything, just all of those side effects. And what about the slowing down? Doesn't that cause more reflux?

So you bring up something very important. I believe that the incidence of reflux-related issues is grossly underreported. It's actually like the early days of LPR. People would come in with cough, throat clearing, and what do people say? Hey man, your allergies are acting up.

Yeah.

Wait, it's December 20th. What allergies? Yes. So it will cause backup and almost everyone's going to experience it. So we have an acute antidote or treatment, and we have a chronic antidote or treatment. The acute reflux gourmet, right? Alginate is gonna prevent acidic things from coming up when you're most vulnerable, which is when you're recumbent and you don't have gravity as your friend. Reflux gourmet becomes your friend. That's the acute antidote to the GLP issue related to the impairment of gastric emptying. 'Cause right, these drugs work two main ways: on the brain to suppress appetite, on the stomach to prevent emptying. So unlike chilies and capsaicin, which is a 4-hour deal, this is more like a 24/7 deal. So we have the acute antidote. When you're upright, I don't worry as much. It's when you're like this and you don't have gravity, we need something like Reflux Gourmet. That's the acute antidote. The chronic antidote is a version of the low acid, high fiber acid watcher type diet where you're trying to keep inflammation down elsewhere. And it's very consistent. It works, but people are coming in. It's the same thing that my doctor said. It was my allergies. I said, well, how long have you had the throat clearing, the phlegm, the horses? They said, well, since I think it was around February of 2025. I said, did anything else happen then? They said no. I said, are you taking GLPs? Yeah. And like January that year, I started my Ozempic. Don't I look great?

So they started having the reflux.

Yeah. I mean, is it immediate? It's sort of gradual. It happens. The next thing you know, it's throat clearing, it's lump. And people just need to be aware. It's not a reason to stop the GLPs and GIPs. It's a reason to continue taking them to get the full benefit. And also be comfortable vis-à-vis acid reflux, throat clearing, the larynx throat complex symptom, and very, very easy to treat, very safe way to treat it. And I don't think just yet— in fact, it's the subject of our next book. It's tentatively called The Acid Watcher Guide to GLP-1 and GIP Therapy. People more and more will be on these medications. Everyone is gonna become more and more aware. You're the tip of the spear as usual, where you're pointing out something that most people aren't aware of. Probably a lot of endocrinologists are not aware of. In fact, if you look at the black box warning on GLPs, you know what it is? It's medullary carcinoma of the thyroid. Okay.

Oh yeah.

Medullary carcinoma thyroid. Let's look into medullary carcinoma of the thyroid. 1,000 cases a year in the United States. So, Exceedingly rare, and it's only been shown in mice, medullary carcinoma, the thyroid. So the whole thing is a little warped. I understand the regulatory issues. They have to say things like that. But really what's gonna happen because of the way it works is it is gonna be coming up and we have two great solutions, acute and chronic, to keep it down. So if you're the right candidate, for these meds, and I believe the indications are going to expand and expand and expand. Yeah, you have a solution. You could take it and it's sort of like having your cake and eating it too.

Well, you're going to be busy. So many people want GLPs. I'm still going to pass on those for now. I'm still doing it the old-fashioned way, trying to do the lifestyle medicine, 6 pillars. You have to be on these things forever. And I'm not committing. I don't like to commit to anything.

I'm glad you committed to this interview though.

Well, thank you so much for being here and you have been an amazing doctor for me. I really want to thank you so much for taking care of me. You have been so cool. Dr. Aviv is being funny today, but when you go see him in the office, he cares so much. I'll be sitting in the waiting room. I hear them talking to your front desk people saying, I love Dr. Aviv.

Where is he?

He's helped me so much. He saved my life. I hear all these things. I mean, It's true. I heard that in the waiting room, people saying that about you. And I feel the same way. So thank you so much for the work you're doing. And, you know, putting this out there that this is about food. It's not about medication or surgery or you're just like putting something out there that could help people so much on their day-to-day life.

Well, I'm grateful to you for the opportunity to let people know. As I say, we toil in obscurity.

We do a lot of laryngoscopies.

And, you know, if it wasn't for Dr. Bobby MD, uh, and you know, your vision, we, we would not be able to help people.

Oh, that's not true, but thank you so much. That's really nice of you. And I should be coming in for a checkup soon, so look, can't wait to see you. All right.

Thank you so much. Talk to you soon, Juna.

That was such an awesome conversation. Thank you so much for listening. And if you wanna bring these tools into your home, BrainBun Plush Doll and Relax2Store System are designed to help your family go from stress to focus, healthy wealthy, and wise. You can find everything at mindbodyspace.com. If you found this helpful, please share it with somebody else who can use more calm, focus, and resilience in their home. Until next time, wishing you and your loved ones wellness.