That telltale fiery pain after a Mexican meal. The volcanic churn in the pit of your stomach at 2 a.m. after red wine. These are common acid-reflux symptoms — ones that often have us popping Tums or Prevacid.
Lesser known but equally worrisome are symptoms such as hoarseness, sore throat, and shortness of breath. These issues can also point to gastroesophageal reflux disease, which affects more than 75 million Americans. Left untended, acid reflux can cause erosion that leads to conditions including esophageal cancer.
Enter Dr. Jonathan Aviv, who made a (non-acidic) splash with his first book, “The Acid Watcher Diet,” becoming something of a legend in the online acid community. Aviv is clinical director of the Voice and Swallowing Center of ENT and Allergy Associates in New York, clinical professor of otolaryngology at Mount Sinai’s Icahn School of Medicine, and former director of head and neck surgery at Columbia University. He’s also a reflux sufferer who writes with humor and compassion. In his book, he warned readers about those vaguer symptoms and offered solutions.
As such, the 2017 book spawned Facebook support groups packed with fans who ruthlessly adhere to his 28-day program, a two-phase eating plan that balances macronutrients (proteins, carbs, and fats) and micronutrients (vitamins, minerals, antioxidants) to neutralize acid and relieve inflammation.
Just one problem: It was restrictive. Goodbye, tacos. So long, pizza, old pal. Cow’s milk? Inflammation city. Aviv realized this. He suffered, too, after all. Now he and his wife, Samara Kaufmann Aviv (also a longtime acid patient) have come out with a cookbook for the millions pining to eat freely again, incorporating previously verboten foods such as tomato-based sauces and soups, desserts with acidic fruits, dairy-free cheesy sauces, and naughty dressings.
The Avivs talked to the Globe about their new book, “The Acid Watcher Cookbook: 100+ Delicious Recipes to Prevent and Heal Acid Reflux Disease,” which shows reflux-prone home cooks how to combine acidic ingredients with alkaline ones to neutralize them. If you thought pizza, eggs Benedict, or tomato soup were forever off-limits, read on. And if you have any of the above symptoms, of course, see your doctor.
Q. What is acid reflux, and how do you know that you’re having problems?
Jonathan Aviv: There are two ways, and a very simple way to visualize it is with two arrows. There’s an arrow coming up from the stomach, and there’s an arrow coming down from the mouth. The arrow coming out from the stomach is what we all traditionally remember as the plop-plop, fizz-fizz era. It’s heartburn and the old Alka-Seltzer commercials: ‘I can’t believe I ate the whole thing!’ Someone’s gripping their stomach, leaning over the edge of the bed. It’s usually a middle-aged individual with male pattern baldness.
But today’s reflux, if you will, is the acidity of what you eat. . . . What are those symptoms? It’s not heartburn and regurgitation. It’s cough, hoarseness, throat clearing, a lump sensation in the throat, sinus drip, post nasal drip. . . . It’s the throat symptoms that fool everybody.
There’s an enzyme in the stomach called pepsin. . . . Pepsin sits in the stomach, and it gets activated in an acidic environment. It gets maximally activated below pH four. [Foods] that are very acidic are below seven; above seven, they’re alkaline. But for the purposes of diet and pathology, below four is where pepsin gets very activated. The stomach is pH two. That’s a hundred times more acidic than what’s baseline necessary to activate the enzyme. So, it’s extraordinarily active in the stomach.
But pepsin can float. It can sit in the esophagus, it can sit in the throat near the vocal cords, it can sit in the lungs, it can sit in the teeth, it can sit in the sinuses, in the middle ear spaces. So, when you eat or drink something less than pH four, what you eat starts eating you. Thankfully, there are only six things that are less than pH four.
Q. What are they?
Jonathan Aviv: Two are unhealthy; four are healthy. The ‘unhealthys’ are flavored beverages in a can, bottle, or box. . . . The four ‘healthys’ are citrus, tomato sauce — not tomato — vinegar, and wine. So you know, on a night where you’re very proud of yourself, you could have a four-colored vegetable salad, pour on the balsamic vinegar, knock back a couple of glasses of wine, and pow.
Q. How do people know what the pH of their food is, if they’re curious?
Jonathan Aviv: Our book has a comprehensive list of the pH of foods, but people sort of go wild with that. What’s the pH of this plum in January? I don’t know. We want to give people very, very basic options and basic tenets. . . . We’re saying, stay away from six things. We give options for almost everything except wine. Having said that, if you want alcohol, [go for] potato and corn vodkas. As long as you don’t put Hawaiian punch or Red Bull in them, you can have them. So, it’s not a deprivation diet.
Q. How did you come up with the concept for the book?
Samara Aviv: I started to explore the food science, this concept of neutralizing acidic foods. . . . I was thinking, ‘You know, what about all the foods and flavors that I’ve been missing? How can I possibly bring those back into my life?’ Because I wasn’t ready to accept never having Mexican food again!
So I got into the kitchen, and I started to explore this concept of neutralization. How can I neutralize the acidity of the vinegar but still have it be a traditional salad dressing? How can I possibly neutralize the acidity of tomatoes and have a classic marinara sauce that resembles or is almost identical to the tomato sauce I’m used to? How can I once again be able to enjoy dessert, enjoy the holidays? So, how can I bring these foods and flavors back into my life while still remaining symptom free, keeping the pH above four?
Jonathan Aviv: We turned two kitchens into food labs. . . . We invested in a highly calibrated pH meter, and that’s what we use. Again, the magic number is four.
Q. How long did it take you to develop all of these recipes, and how did you do it?
Jonathan Aviv: Samara and I put our heads together, and we started with an extensive list of the things that we wish we could have. Can we get a pizza in here? Can we get mac and cheese in here? Can we get a marinara? Can we get some Chinese? Can we get a tostada?
Samara Aviv: In terms of recipe testing, I would make the food for dinner. I have three step-kids, teenagers. I would cook for the family. I would test this out multiple times on our family and our friends, and if everybody loved it, we had a winner, if it tested above pH four.
Jonathan Aviv: If you have experienced dealing with teenagers, if they don’t like food, they don’t exactly hide it.
Samara Aviv: I really was making these foods for dinner. They had to be simple and they had to be easy, on top of being delicious. I would say 90 percent of the recipes in the book really are simple to make and realistic.
Q. What’s the goal for readers?
Samara Aviv: The goal for the readers is … to have their life back. People are saying they feel human again, they can enjoy food again. There’s a positivity to their experience of life again; it’s not about what they’re missing, it’s about what they do have.
Jonathan Aviv: If you have to summarize it in one sentence: We don’t want people to have to choose between their health and the foods they love.
Interview was edited and condensed.