Koufman Diet Review: Does the Dropping Acid Diet Work for LPR?

The Koufman diet — also called the Dropping Acid diet — is a low-acid, alkaline-focused eating plan developed to reduce laryngopharyngeal reflux (LPR) and GERD by limiting foods and drinks that reactivate pepsin in the throat. It runs in two phases: a strict healing phase that eliminates anything below pH 5, followed by a more flexible maintenance phase where you reintroduce foods and identify personal trigger foods.

I’ve read both of her books, followed the diet personally, and spent years researching the science behind it. My short verdict: it’s genuinely one of the better reflux resources out there — particularly for people with classic GERD symptoms — but it has some real limitations for LPR (silent reflux) sufferers that are worth understanding before you dive in.

Here’s everything you need to know.

Key Takeaways

• The Koufman diet restricts foods below pH 5 because low-pH foods reactivate pepsin in the throat, the primary driver of LPR damage.
• It runs in two phases: a 2–4 week healing phase (strict, pH 5+ only) and a maintenance phase (gradual food reintroduction).
• Alkaline water (pH 8.8+) is a core part of the protocol — research confirms it can permanently deactivate pepsin in vitro.
• A 2017 study in JAMA Otolaryngology found that a plant-based, alkaline-water approach produced symptom reductions comparable to — and potentially better than — PPIs in LPR patients.
• The diet is more effective for GERD/heartburn than pure LPR, though it’s the closest thing to a science-backed LPR diet most people will find.
• A few foods in the healing phase (like honey, pH ~3.9–4.5) technically fall below pH 5, which can reactivate pepsin in LPR sufferers.
• Both books are worth reading; the 2015 edition (Dr. Koufman’s Acid Reflux Diet) is the more refined version I’d recommend starting with.
• If you have LPR specifically, the diet benefits from a small but important layer of refinement around pepsin-sensitivity thresholds.

The Two Books: Which One Should You Get?

If you didn’t already know, the Dropping Acid diet comes from two books. The first — Dropping Acid: The Reflux Diet Cookbook & Cure — was published in 2010 and became a New York Times bestseller, essentially putting the concept of a low-acid diet for reflux on the map. The second — Dr. Koufman’s Acid Reflux Diet — came out in 2015 and is a refined, updated version of the same core framework.

Both books cover the same fundamental science and diet structure. The 2015 version is simply more polished, with clearer explanations and updated guidance. If you’re only buying one, get the 2015 edition. If you already own the original, there’s value in the newer one but you won’t be starting from scratch in terms of the core principles.

It’s also worth noting that she updated her recommended healing phase from 2 weeks to 4 weeks in more recent guidance — the 2010 book said 2 weeks, but her current recommendations lean toward a full 4-week induction period for more stubborn cases.

What’s Actually in the Books?

The structure is well thought out. The first section covers everything you need to understand about reflux — what causes it, why the standard Western diet is so problematic, and how LPR symptoms develop differently from the typical heartburn picture. She explains the pepsin mechanism clearly: pepsin is the digestive enzyme that travels up with reflux, binds to throat tissue, and gets reactivated every time acidic food or drink reaches it. This is why pH matters — it’s not just about reducing stomach acid, it’s about not reactivating the pepsin that’s already sitting in your throat.

She also covers the role of medications and when surgery becomes relevant, though the focus of both books is squarely on dietary intervention. Once the science is explained — which she does without unnecessary filler — you move into the actual diet phases. About a third of each book covers the core principles and food lists; the remaining two thirds are recipes.

I personally appreciate how concise it is. You can read the explanatory section in a day or two and actually get started quickly. The recipes are detailed with portion sizes and preparation instructions, which makes practical implementation easier than most diet books.

How the Koufman Diet Actually Works

Phase 1: The Healing Phase

The healing phase is the stricter of the two stages. The core rule is eliminating all foods and drinks with a pH below 5. The reason is direct: pepsin in your throat is activated by acid. Foods below pH 5 will keep triggering that activation, preventing the tissue inflammation from settling down. By removing them entirely for the healing period, you give the aerodigestive tract a chance to clear pepsin and start recovering.

Foods eliminated in this phase include: all citrus fruits and juices, tomatoes and tomato-based products, vinegar, most sodas and carbonated drinks, coffee, alcohol, and anything else in the highly acidic category. She’s also clear about fatty and fried foods, which increase LES (lower oesophageal sphincter) relaxation and worsen reflux mechanically, not just through pH.

Alongside food restriction, the healing phase emphasises alkaline water with a pH of 8.8 or higher. This is backed by Koufman and Johnston’s own research, which demonstrated that pH 8.8 alkaline water can permanently deactivate (denature) human pepsin in vitro — unlike tap or regular bottled water, which sits at pH 6.7–7.4 and has essentially no effect on pepsin stability [Koufman & Johnston, Annals of Otology, Rhinology & Laryngology, 2012]. This is one of the more important pieces of science underpinning the whole protocol.

In her more recent guidance she recommends running the healing phase for 4 weeks for best results, though 2 weeks can be sufficient for milder cases.

Phase 2: The Maintenance Phase

Once the healing phase is complete, you move into maintenance. This is where more foods gradually come back into your diet. The key process here is systematic reintroduction — you add one food back at a time, observe how you respond, and if you get reflux symptoms, you’ve found a trigger food. Remove it. Continue with the next candidate.

This is actually a smart approach because trigger foods vary significantly between individuals. What wrecks one person’s reflux is fine for another. The maintenance phase essentially runs a structured self-experiment to map your personal trigger landscape. She also lists the most common triggers (coffee, alcohol, fatty foods, chocolate, mint, onion, garlic) as a starting guide.

Alkaline water remains the drink of choice throughout both phases, with chamomile tea being one of the few exceptions permitted. There’s good reason for that — chamomile has anti-inflammatory properties that may actually support healing in the oesophagus and throat.

What the Research Actually Says

One of the strongest pieces of evidence supporting a dietary approach to LPR comes from a 2017 retrospective cohort study published in JAMA Otolaryngology. Researchers compared 99 LPR patients treated with alkaline water and a 90% plant-based, Mediterranean-style diet against 85 patients on standard PPI therapy. The dietary group saw 62.6% of patients achieve a meaningful reduction in their Reflux Symptom Index (RSI), versus 54.1% in the PPI group — and the mean RSI reduction was actually larger in the dietary group [Zalvan et al., JAMA Otolaryngology–Head & Neck Surgery, 2017]. Diet matched or outperformed medication. That’s significant.

More recently, a 2023 prospective cohort study found that LPR patients with high pre-treatment salivary pepsin levels who also had high compliance with lifestyle modifications had substantially better treatment outcomes — 91.7% achieving a good response versus 53.8% in those with lower compliance [Yun et al., Scientific Reports, 2023]. This reinforces what the Koufman approach is built on: dietary and lifestyle adherence isn’t optional — it’s the treatment.

A 2025 multicenter randomised study also confirmed that dietary modifications alone produced significant LPR symptom improvement, with combination approaches (diet plus mucosal protectors) performing best [Gelardi et al., Frontiers in Medicine, 2025].

The pepsin biology is also well established. Pepsin remains stable and inactive at neutral pH (around 7.4) but gets reactivated by any acid source — food, drink, or stomach acid — with peak activity below pH 4. Research on reflux substances confirms that pepsin, alongside acid, is a primary driver of laryngopharyngeal tissue damage, and that targeting pepsin through diet is mechanistically sound [Lechien et al., Frontiers in Medicine, 2022].

Where the Koufman Diet Falls Short for LPR Sufferers

I want to be honest here because I think this is the most important thing people with silent reflux (LPR) need to understand before buying the book.

The books are excellent resources — but they were written with a broad reflux audience in mind, and GERD is the more common diagnosis. LPR is more sensitive to pepsin reactivation because the throat tissue doesn’t have the same mucus protection the oesophagus does. This means even some foods that technically sit at or near pH 5 can still cause problems for LPR sufferers — the threshold is tighter than the book implies.

The most common example is honey. The healing phase includes honey as an acceptable food, but honey can have a pH as low as 3.9–4.5, well below the pH 5 cutoff. For someone with LPR, this can reactivate pepsin in the throat and cause ongoing irritation during a phase that’s supposed to be about healing. There are a handful of other examples like this scattered through the food lists.

This isn’t a fatal flaw — it’s a nuance. But for LPR sufferers in particular, you may need to be a bit stricter than the book suggests, particularly around pepsin-sensitive items that slip through the pH 5 net.

It’s also worth knowing that the books don’t focus much on foods that specifically help heal reflux-damaged tissue, or on the relationship between gut health and LPR — areas that have seen growing research interest since the books were published. If those topics are relevant to your situation, you’ll need to look elsewhere to supplement what the book covers.

Who Is the Koufman Diet Best Suited For?

The Koufman diet is most effective for people with classic GERD symptoms — heartburn, acid indigestion, regurgitation. For this group, the two-phase approach combined with alkaline water is genuinely well-structured and evidence-supported. It gives you a clear framework, explains the reasoning, and the recipes make it practical to follow.

For people with LPR / silent reflux, the diet is close to ideal but needs minor refinement — particularly around stricter avoidance of borderline pH foods during the healing phase. If you understand the pepsin mechanism well (which the book does explain), you can self-correct for those gaps. Go into it with the expectation that you may need to be slightly stricter than the book’s healing phase food lists suggest, especially in the first few weeks.

For someone entirely new to reflux symptoms, either book is a solid starting point and one of the better structured introductions to the science and dietary approach currently available.

My Overall Verdict: 8/10

After using both books and following the approach personally, my final rating is 8 out of 10. The books are well-written, efficient, and rooted in genuine research — particularly the alkaline water and pepsin science, which Koufman herself contributed to. There’s minimal filler, the structure is logical, and the recipes are practical.

The 2-point gap is for the small number of healing-phase foods that don’t quite hold up to the pH 5 standard when you look more closely at them (particularly for LPR sufferers), and for areas the books don’t cover — like gut health’s role in reflux or specific throat-healing nutritional strategies. These are gaps rather than errors, but they’re worth knowing about.

If you want to buy the book, the 2015 version — Dr. Koufman’s Acid Reflux Diet — is the one to get. You can read the explanatory section in a day and get started almost immediately, which is more than most reflux resources offer.

For more in-depth reading on LPR specifically, also check out LPR foods to avoid and my overview of the LES valve and how it relates to LPR.

Final Thoughts

The Koufman diet is one of the most credible and well-researched reflux eating plans available, and for most people it’s a very solid place to start. The core principles — eliminating low-pH foods, drinking alkaline water, running a structured two-phase protocol — are backed by real research, not just dietary theory. The books explain the why clearly, which makes it much easier to stick to and adapt as you learn your own triggers.

That said, managing reflux — particularly LPR — long-term is rarely as simple as following a single protocol from a book. The details matter enormously: which specific foods you’re sensitive to, what time of day you eat, whether there are compounding gut health issues at play, and how your symptoms evolve over time. The Koufman books give you a strong foundation, but most people need to go further to get lasting control.

If you want a complete, structured plan built specifically around silent reflux — one that layers the Koufman principles together with a tighter LPR-specific food framework and implementation guidance — the Wipeout Diet Plan is what I put together after years of personal experience and research. It’s designed specifically for the LPR picture and closes the gaps that the Koufman books leave open. If the Dropping Acid books leave you wanting more precision and more detail around silent reflux in particular, that’s where to go next.

For a broader overview of treatment approaches, you can also book a one-to-one consultation to go through your specific situation in detail.

Frequently Asked Questions

What is the Koufman diet?

The Koufman diet (also called the Dropping Acid diet) is a two-phase, low-acid eating plan developed to reduce reflux symptoms by eliminating foods and drinks below pH 5 that reactivate pepsin in the throat and oesophagus. It was developed by Dr. Jamie Koufman, a laryngologist who coined the term laryngopharyngeal reflux (LPR).

How long do you follow the healing phase?

The original book recommended 2 weeks, but more recent guidance from Koufman recommends 4 weeks for the healing (induction) phase, particularly for people with more persistent LPR symptoms. After that, you transition to the more flexible maintenance phase.

Does alkaline water actually help with reflux?

Research published in the Annals of Otology, Rhinology & Laryngology by Koufman and Johnston (2012) confirmed that pH 8.8 alkaline water permanently deactivates (denatures) human pepsin in vitro, unlike regular water which has no effect on pepsin stability. While clinical trial data is still limited, the mechanism is well-established and it’s a core part of both the Koufman protocol and the broader evidence-based dietary approach to LPR.

Is the Koufman diet good for LPR (silent reflux)?

It’s a good starting point, but it has some minor gaps for LPR specifically. A handful of foods in the healing phase (notably honey) technically fall below pH 5, which can continue to reactivate pepsin in the throat. People with LPR may need to be slightly stricter than the book’s food lists during the healing phase. Overall it’s the best widely available reflux diet resource, but LPR sufferers should be aware of these nuances.

Which Koufman book is better — the 2010 or 2015 version?

The 2015 book — Dr. Koufman’s Acid Reflux Diet — is the more refined and updated version and is the one I’d recommend. If you can only buy one, start with the 2015 edition. The original 2010 Dropping Acid is still useful, especially for its recipe content, but the newer version is the better reference.

Can the Koufman diet replace medication?

A 2017 study in JAMA Otolaryngology found that a plant-based, alkaline water dietary approach produced LPR symptom reductions comparable to — and in some metrics greater than — standard PPI therapy. However, this doesn’t mean everyone can or should come off medication. Any medication changes should be discussed with your doctor, particularly if you have oesophagitis or confirmed GERD complications.

What drinks are allowed on the Koufman diet?

Alkaline water (pH 8.8 or higher) is the primary drink for both phases. Chamomile tea is one of the few other drinks permitted during the healing phase. Coffee, alcohol, all sodas, fruit juices, and most teas are restricted due to their acidity.

Related Articles

• The Complete Guide to LPR (Silent Reflux)
• LPR Diet: What to Eat and What to Avoid
• LPR Foods to Avoid for Faster Recovery
• The Ultimate Guide to Acid Reflux & GERD
• Is Chamomile Tea Good for Acid Reflux?
• The Stomach Sphincter and LPR: What You Need to Know

Research Sources

pH 8.8 alkaline water permanently denatures human pepsin in vitro and has significantly greater acid-buffering capacity than regular drinking water [Koufman & Johnston, Annals of Otology, Rhinology & Laryngology, 2012]. LPR patients treated with a plant-based Mediterranean diet and alkaline water saw greater mean RSI reduction than those on PPI therapy [Zalvan et al., JAMA Otolaryngology–Head & Neck Surgery, 2017].

High compliance with lifestyle modification independently predicts good LPR treatment outcomes; patients with high compliance achieved a 91.7% good-response rate [Yun et al., Scientific Reports, 2023]. Dietary modifications alone significantly improve LPR symptoms in a multicenter randomised setting, with combined diet and mucosal-protector approaches producing the strongest results [Gelardi et al., Frontiers in Medicine, 2025].

Pepsin, alongside acid, is a primary driver of laryngopharyngeal tissue damage; reducing pepsin exposure through dietary acid restriction is mechanistically supported [Lechien et al., Frontiers in Medicine, 2022]. Salivary pepsin concentration in LPR patients is directly influenced by diet consumed before samples, confirming the dietary–pepsin connection [Lechien et al., Laryngoscope, 2021].