If you are off your medication for a few weeks and your reflux symptoms have come burning back, Rakel and Kiefer say patients should be evaluated to see why. Some patients may have hiatal hernias or precancerous changes to the esophagus (Barrett’s esophagus), for example, which may mean they need to go back on acid-blocking medication or explore other treatments. What Kiefer and Rakel won’t do is recommend you stay on a regular regimen of herbs to fight reflux. If you have occasional mild heartburn, you can take an herbal remedy, they say, but if your problem is severe and ongoing, you want to find out what the cause is — not just mask its symptoms. “I would be doing a disservice if I just swapped out a drug for an herb,” says Kiefer. Angelucci says he decided to go off his PPI because he didn’t want to be on a drug for the rest of his life; he wanted to see if he could address the reason for his symptoms. In his case, it turned out to be his diet, he says.  In fact some research suggests that starting with a change in diet may be more effective than PPIs in reducing acid reflux symptoms. According to a study published in JAMA Otolaryngology-Head & Neck Surgery, people with laryngopharyngeal reflux — when acid travels up the esophagus to reach the throat — were divided into two groups. More than 60% of those in the group that closely followed a Mediterranean diet saw improvement in reflux symptoms compared to only 54% who in the group that took PPIs.  The Mediterranean diet is plant and whole foods-based and focuses on eating fruits, vegetables, grains and nuts. Dairy and animal products are largely cut out, as are the refined grains and processed foods that Angelucci ditched from his diet.  The study’s lead author, Craig H. Zalvan, MD, medical director of The Institute for Voice and Swallowing Disorders at Phelps Hospital in Sleepy Hollow, NY, used to be one of the biggest prescribers of PPIs in the area. But he thought there had to be a better treatment for reflux and through research, developed a plant-based diet for some of his patients. “Although effective in some patients, I felt acid reflux drugs couldn’t be the only method to treat reflux and recent studies reporting increased rates of stroke and heart attack, dementia and kidney damage from prolonged PPI use made me more certain,” Zalvan said in a statement. “The results we found show we are heading in the right direction to treating reflux without medication.” “My diet was the root cause of my reflux symptoms,” Angelucci says. “But the herbal supplements were a dramatic help during that really difficult roller-coaster period.”