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BackTable / ENT / Article
The Role of Alginates in the Contemporary Management of Reflux
Julia Casazza • Apr 4, 2024 • 38 hits
Reflux is a common condition that causes bothersome ailments ranging from heartburn to sinusitis. While proton pump inhibitors (PPIs) decrease stomach acid production, providing patients relief, recent data connects these drugs to increased risk of dementia and kidney disease. Thus, interest in alternative treatments for reflux continues to mount. BackTable ENT recently sat down with University of Virginia rhinologist Dr. Spencer Payne, whose interest in functional medicine inspired his approach to reflux treatment and his leadership of RefluxRaft, an alginate-based solution to reflux.
This article features excerpts from the BackTable ENT Podcast. We’ve provided the highlight reel in this article, but you can listen to the full podcast below.
The BackTable ENT Brief
• Reflux is the retrograde passage of stomach contents into the esophagus.
• Reflux’s effects aren’t limited to the gastrointestinal tract. When the sinuses are affected, recurrent sinusitis and post-nasal drip can result. When the larynx is affected, dysphonia, chronic cough, and dysphagia result.
• A functional medicine approach to reflux might include a combination of lifestyle / dietary modifications, natural supplements, and conventional therapies.
• Alginates treat reflux by cross-linking inside the patient’s stomach to form a physical barrier between the stomach and the esophagus. Unlike proton pump inhibitors (PPIs), they have no known side effects.
• Dr. Payne launched RefluxRaft, an alginate-based solution to reflux, to give patients a natural, good-tasting alternative to traditional treatments for the disease.
Table of Contents
(1) Otolaryngologic Manifestations of Reflux
(2) The Functional Medicine Approach to Reflux
(3) Alginates: A Natural Treatment for Reflux
(4) The Birth of RefluxRaft
Otolaryngologic Manifestations of Reflux
Reflux is movement of stomach contents backwards into the esophagus. Classically, symptoms include heartburn and difficulty swallowing. When stomach acid moves further upward, otolaryngologic complaints result. Laryngopharyngeal reflux results from the action of gastric acid on the larynx, manifesting as dysphonia, chronic cough, and dysphagia. Dr. Payne, a rhinologist, will sometimes evaluate patients with post-nasal drip, post-nasal chronic cough, recurrent sinusitis, or sinusitis refractory to surgical treatment whose symptoms are due to reflux.
[Dr. Ashley Agan]
Oh, that's fascinating. As the sinus surgeon in your group, how do patients with reflux usually present for you? Are they having more nasal symptoms or post-nasal drainage? What are you seeing in your clinic?
[Dr. Spencer Payne]
Yes. The thing I always joke with people about is they just come in, and they say, "Doc, I got sinus." Then you've got to dive down into like, "What does that mean?" It's a lot of post-nasal drip or post-nasal drip chronic cough. It must be my sinuses or patients with a lot of grand negative, like recurrent sinusitis or failing to improve with standard therapies after sinus surgery. We dive down into, "Do you have heartburn? Do you have reflux?"
For a lot of these patients, it's silent reflux. It's the laryngopharyngeal reflux. They don't have the heartburn. Then you've got to talk to them about like, "Well, you don't have heartburn. That doesn't mean you don't have reflux." "I didn't get better on a PPI. I don't have reflux." You're like, "Well, okay, but that only stops one aspect of the reflux." I work with a lot of them on that type of thing.
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The Functional Medicine Approach to Reflux
Functional medicine seeks to determine the etiology of the patient’s symptoms, then apply conventional treatments and lifestyle changes to counter the underlying cause. Potential causes of reflux include hiatal hernia, dietary indiscretion, obesity, bile salts, and problems with stomach acid production. Patients with reflux benefit from adhering to a whole food (minimally processed) diet. Particular trigger foods to look out for include chocolate (which is acidic), coffee (whose caffeine reduces lower esophageal sphincter tone), and acids. Furthermore, patients should wait 3-4 hours between their last meal and when they lie down for the evening.
[Dr. Spencer Payne]
I think a big thing I try to first get them to is much more of a whole food type diet as opposed to processed food, something out of a box or a can. Then reading labels. It's amazing how many people don't read the labels, have no idea what's in the food. It was the one study that looked at Mediterranean diet and alkaline water being as symptomatically beneficial as a PPI.
I do try to steer more towards a Mediterranean diet and then counsel them. That doesn't mean all the pasta you can eat, just more fish-based and vegetable. As one show I had seen on one of the streaming platforms, it was always this like eat a healthy diet, mostly plants, sometimes meat, that type of thing. With AERD patients, they actually benefit from studies from really high omega-3 type diets because of the anti-inflammatory component of that.
Let's get rid of the processed food. Let's get rid of the added sugar. Let's get rid of a big source of red meat and omega-6s and start there. Then it's just a matter of portion control and timing. You can eat certain things but maybe not at 10 PM. We dig in with some people about like, "Well, could there be dairy issues or gluten--" We could have a whole other podcast on non-celiac gluten sensitivity, but that's beyond that scope today. We dig into that stuff, though, too.
…
[Dr. Ashley Agan]
Why are coffee and chocolate a no-no?
[Dr. Spencer Payne]
Coffee because it's acidic, and then the caffeine interferes with the lower esophageal sphincter tone. Then chocolate is mildly acidic as well and then has the caffeine in it. They do make low-acidity coffees. Those are out there. For that person who needs that cup of coffee, it's an option. Milk, chocolate might be less acidic, but it's going to be, now you've got processed sugars in that as well as opposed to your darker chocolates and that kind of thing. There's something sneaking behind.
Again, any diet that is too restrictive is not going to be able to be maintained by your patients. You have to empower them to make the best choice of the options that are presented with at any time through education and knowledge. If you're going to have chocolate, know what's going to happen, but these are the things. Again, a lot of this reflex is quality of life. I tell patients, I was like, "Look, I know you enjoy your cigarettes. I know you enjoy your coffee. I know you enjoy your chocolate, but you're also here because you've got this problem, and it's not going to kill you, but you have to make the choice and help guide them."
Alginates: A Natural Treatment for Reflux
Unlike other medications used to treat reflux, alginates physically block the movement of stomach contents into the esophagus. Alginates are non-digestible polysaccharides that crosslink in the presence of calcium to form a hydrogel. This hydrogel then interacts with a carbonate (such as that found in stomach acid), aggregating into a “raft” that floats on stomach contents and keeps them from passing into the esophagus.
[Dr. Spencer Payne]
Alginates, as they may sound, actually come from algae, which a lot of people are familiar with what blue-green algae is, the stuff that floats on ponds. Brown algae or brown kelp are the seaweed-type things that in the ocean. Alginates, it's technically a polysaccharide, but in essence, it's such a long chain that's not broken down by the body, so it's actually a fiber.
Then what happens is when you take an alginate along with a calcium source, when it hits the stomach acid, it cross-links, and you get a hydrogel. It actually forms a gel. For the molecular gastronomy fans out there, alginates are what are used to create boba tea and all of the spiracles that float in fancy foods and things. It's a gelling agent in essence. What you get is a gel, but it's not simple enough to have a gel, because if you just swallow a gel, it does nothing.
For an alginate to work, then you also have to have a carbonate source, and then when that interacts with the stomach acid, you get CO2. CO2 becomes incorporated in the gel, and the gel floats or racks on the stomach contents and then serves as a physical barrier so that when reflux is going to occur, it's the gel that either plugs the esophagus or what goes up is this inert substance as opposed to an acid and enzyme or a biosol.
The Birth of RefluxRaft
In bringing RefluxRaft from the kitchen to the market, Dr. Payne drew on his resilience, vision, and business acumen. Wary of the long-term side effects of PPI use (which include osteoporosis, nutrient deficiencies, and infection), Dr. Payne set out to create a natural product to remedy the cause of reflux. At the time, his colleague and co-founder, laryngologist Dr. Jim Daniero, routinely recommended alginate-based products to his patients with reflux. But, many of his patients didn’t like the way these products tasted.
Motivated to create an effective, palatable treatment, Dr. Payne and Dr. Daniero got to work. They began in Dr. Payne’s kitchen, whipping up different combinations of natural ingredients and testing their handiwork. Dr. Daniero’s severe reflux allowed him to serve simultaneously as co-founder and patient number one. Then, they connected with entrepreneur friends at UVA to find companies that could manufacture their supplement using Current Good Manufacturing Practices (CGMP) and market their product. After two years of work, RefluxRaft launched in October 2022.
[Dr. Spencer Payne]
I really started thinking about it. I remember looking at all the information they were providing around treating reflux and problems with PPIs and the associated downstream side effects, which may just be very bad cross-sectional studies of people in nursing homes but take it for what it's worth. As we were coming back out of it, and I was trying to apply a lot of these options to taking care of patients. I remember talking to our laryngologist, Jim Daniero, and he was just like, "Oh, have you tried alginates for your patients? It's really gaining steam in the laryngology community."
I was like, "Oh, yes, they actually mentioned that at that course. It would be really great if we could have something." We talked about some other brands that were on the market. I started recommending a lot of those. A lot of patients were complaining about like, "Oh, there's a lot of sugar in this," or, "There's a lot of sodium in this," or, "This brand tastes horrible, and it's chalky, and it's hard to get," and da, da, da, da.
I was talking to Jim, and I was like, we complain about how PPIs, even when we take the side effects out of it, we're really only addressing one issue, the acid, but we're not addressing the reflux, but these alginates seem great. Again, we're not addressing the reflux, stoppy reflux, but we're not addressing causes with it. It's still a unit-dimensional product. I says, "Wouldn't it be great if we could integrate other holistic therapies into an alginate-based product and create the best option for patients."
…
Then we had this brain trust of people who had run some other businesses, and they introduced us to a marketing company, and they had an intern. Then we just started researching companies that excelled at organic, healthy, that's called CGMP manufacturing standards for liquid processing. Then we found a third party manufacturer and interviewed several places and found one that seemed to be in line with our mission of providing this natural based organic healthy product to help with patients and then got moving. Then it was crazy because I had taken one business course during COVID, too, that was marketing.
At that time, I was like I had no idea marketing was not just advertising. To me, marketing equaled advertising. It was a mind-blowing situation to realize marketing is every step it takes to get your product to market including brand mission, product conceptualization, manufacturing, logistics, sales, all of this stuff. You're like, "Yes, let's make this product." Then all sounds like we've got to make it, we've got a bottle it, we've got a label it with FDA requirements so you've got to dig through all this FDA stuff about—
Luckily, our product is a food supplement, so we're not dealing with pharmacological types of restrictions, but then it's like, "What do you have to put on a label? How much fat? How much sugar? How much of these things is in this stuff? What does your label have to have? You have to have the office or where it's manufactured on the label, and the bottle has to either have a manufacture date or an expiration date on it."
Podcast Contributors
Dr. Spencer Payne
Dr. Spencer Payne is a professor and medical director of otolaryngology head and neck surgery at University of Virginia Health and the co-founder of RefluxRaft.
Dr. Ashley Agan
Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.
Cite This Podcast
BackTable, LLC (Producer). (2024, January 30). Ep. 156 – RefluxRaft: A New Option Beyond Conventional Therapy [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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