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Two popular books ("Dropping Acid" by Dr. Jamie Koufman and "The Acid Watcher Diet" by Dr. Jonathan Aviv) claim that tissue damage in GERD and LPR is caused by the digestive enzyme pepcin.

In their model, reflux leads to the presence of pepcin outside the stomach. Exposure of the pepcin to acid then activates it and causes tissue damage. Based on this model, they recommend consuming low-acid foods and drinking slightly alkaline water to reduce the activity of the pepcin.

Is this model accurate, and is the resulting recommendation reasonable?

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