Jaime Daniero shares why alginates are underused in the U.S. and his mission to make high-quality, effective alginate options more accessible for reflux sufferers.
The Origins of RefluxRaft and Clinical Need
Josef Kreitmayer
You’re in scrubs—looks like you just came from the clinic.
Dr. James Daniero
Yes, I was doing surgery this morning—an esophageal dilation for a patient with dysphagia.
Josef Kreitmayer
That’s a big topic. It’s interesting because you and your colleague Spencer are both ENTs and also the medical minds behind RefluxRaft. Reflux isn’t traditionally an ENT domain, but with so many LPR-related cases, it seems you were drawn in. How did RefluxRaft come about?
Dr. James Daniero
I’m a laryngologist, so I treat disorders of the throat, including the upper esophagus and larynx. Many of my patients came in with LPR symptoms, which can be challenging to manage.
They don’t respond well to proton pump inhibitors because LPR doesn’t present like typical GERD. We were prescribing PPIs more as a default than with confidence, and it felt like we were potentially doing more harm than good.
In Europe, alginates are widely known, but in the U.S. they’re rarely recommended. We wanted to make alginates more accessible and more effective for our patients.
Personal Experience and Product Innovation
Josef Kreitmayer
In Europe, where I’m currently living, I rely on a generic alginate product at night. But most gastroenterologists don’t even mention alginates—only PPIs. What’s been your experience?
Dr. James Daniero
The same. I personally ordered European formulations because the U.S. versions didn’t contain enough alginate.
But they weren’t user-friendly. So we designed something better tasting, easier to use, without artificial preservatives or excess sugar.
We sourced high-quality alginate from Norwegian seaweed, eliminated preservatives, used organic glycerin, and optimized the formula so people could get results with a smaller dose.
Dosing, Ingredients, and Enhanced Formulations
Josef Kreitmayer
What’s the typical dose?
Dr. James Daniero
We recommend 5 to 10 milliliters. At night, 10 milliliters works best because it creates a larger raft that lasts longer.
We also developed enhanced formulations:
A lemon-ginger version, where ginger supports motility and reduces inflammation.
A midnight berry version with melatonin, which may strengthen the lower esophageal sphincter and support sleep.
Josef Kreitmayer
Melatonin is new to me in this context. Is it safe for long-term use?
Dr. James Daniero
Yes, it can be used as needed. Alginate is mechanical—it’s not something the body becomes dependent on.
Many patients use it more during symptom flares or while tapering off PPIs, then less as their tissue heals.
How Alginates Work and Why They’re Different
Josef Kreitmayer
Can you explain what alginates do and how they differ from PPIs?
Dr. James Daniero
Most people with reflux don’t make too much acid—the acid simply escapes. Acid belongs in the stomach; it helps digestion.
Alginates work by forming a physical barrier that keeps stomach contents where they belong. They don’t suppress acid like PPIs.
That’s why I like them—they work with physiology, not against it.
The Raft Mechanism and Sleep Position Tips
Josef Kreitmayer
So it forms a floating barrier?
Dr. James Daniero
Exactly. In the stomach, alginate reacts to form a gel-foam raft that traps carbon dioxide bubbles. That allows it to float at the top of the stomach and seal the lower esophageal sphincter.
Even if you drink water afterward, the raft resurfaces and stays in place.
At night, alginates work best when combined with left-side sleeping and elevation, such as a wedge pillow.
Dosing Frequency and Possible Side Effects
Josef Kreitmayer
How often can people use it? Any risks?
Dr. James Daniero
It can be used up to four times daily—after meals and before bed.
Mild constipation can occur with higher doses, especially if hydration is poor. Alginate isn’t absorbed, so drinking enough water helps it pass through smoothly.
RefluxRaft Availability and Medical Community Response
Josef Kreitmayer
Where can people get RefluxRaft?
Dr. James Daniero
It’s currently available in the U.S. We started formulation in 2020 and officially launched in 2024. International expansion is planned for 2025.
Josef Kreitmayer
How have doctors responded?
Dr. James Daniero
Laryngologists have been very receptive. Patients want alternatives to PPIs, and clinicians see alginates as a low-risk, effective option.
PPI Side Effects and Digestive Consequences
Josef Kreitmayer
PPIs worsened my bloating. It felt like food wasn’t breaking down.
Dr. James Daniero
That’s common. Reducing acid impairs digestion. Food becomes under-digested, ferments, and causes bloating.
It can worsen overall gut function.
Gastroenterology and Shifting Paradigms
Josef Kreitmayer
Are gastroenterologists changing their views?
Dr. James Daniero
Slowly. They’re trained to treat acid hypersecretion. They don’t always see throat-based reflux like we do.
But there’s growing recognition that alginates may be better for mild to moderate reflux and LPR.
Dysphagia and Reflux-Related Narrowing
Josef Kreitmayer
You mentioned esophageal dilation earlier.
Dr. James Daniero
Long-term reflux can cause the upper esophageal sphincter to over-tighten, leading to narrowing.
We use a minimally invasive balloon dilation. If reflux is controlled afterward with diet and alginates, many patients don’t need repeat procedures.
Time Between Dilations and Non-Cancerous Causes
Josef Kreitmayer
How long do dilations last?
Dr. James Daniero
Often three to five years if reflux is well managed.
The narrowing is muscle-related, not cancer, but we always rule out malignancy with endoscopy.
PPI Overuse and Tapering Strategies
Josef Kreitmayer
Are patients surprised when swallowing issues turn out to be reflux?
Dr. James Daniero
Very. PPIs are often overused. Once healing occurs, we taper patients off using diet changes, alginates, and sometimes H2 blockers to avoid rebound acid.
Natural Dysphagia Support and Swallow Therapy
Josef Kreitmayer
Can dysphagia be treated naturally?
Dr. James Daniero
Mild cases can respond to swallow therapy, diet changes, and alginates.
If reflux is the cause, addressing it can restore normal muscle coordination.
Esophageal Dysmotility from Irritation
Dr. James Daniero
When the esophagus is inflamed, it loses rhythmic coordination—this is dysmotility. Treating reflux often restores normal movement.
Diagnosing Dysphagia vs Dysmotility
Dr. James Daniero
We use barium swallow studies or manometry to distinguish structural narrowing from motility problems.
Non-Acid Reflux and pH Monitoring
Josef Kreitmayer
How important is non-acid reflux?
Dr. James Daniero
Very important. It’s less about acid amount and more about how far reflux travels.
Non-acid reflux can still irritate the throat, lungs, and sinuses. pH impedance testing helps identify it.
Pepsin, Enzyme Reactivation, and Damage
Dr. James Daniero
Pepsin is a digestive enzyme that becomes damaging when refluxed into the throat.
Acidic foods or drinks can reactivate it hours later, prolonging injury.
Natural Strategies: Chewing Gum and Alginate Benefits
Dr. James Daniero
Sugar-free gum increases alkaline saliva and swallowing, which helps clear reflux.
Alginate also binds pepsin and carries it back to the stomach, which is especially helpful for LPR.
The Role of Alginates for Heartburn and Throatburn
Josef Kreitmayer
We almost need a new word—like throatburn.
Dr. James Daniero
Exactly. I cross out heartburn in my talks and replace it with throatburn.
I believe alginates should be first-line therapy for both GERD and LPR. They’re safe, effective, and work with the body rather than against it.
Josef Kreitmayer
Thank you for this insightful conversation and for creating RefluxRaft.
Dr. James Daniero
Thank you, Josef.
Josef Kreitmayer
Wishing you a wonderful day.
