A: For people taking Refluxter as a general preventative measure against acid reflux or LPR, it is best to take Refluxter 15-20 minutes after meals to allow the food to settle and mix with stomach acid. Do not take Refluxter before or with meals, as the food entering the stomach will disrupt the raft. * It is very important to remember this. Refluxter will not work well if you take it before or during meals. It must be taken after meals. * For overt heartburn symptoms, as a rescue measure Refluxter can be taken at the time of symptoms. For more severe/extreme symptoms you can take an extra capsule if you feel that 2 capsules isn't relieving the heartburn. In our opinion, everyone who often suffers from reflux and heartburn should take a daily serving of Refluxter 30 minutes before sleeping to help prevent acid reflux from damaging the esophagus and throat while laying flat during sleep. This is regardless whether one actually feels active reflux or heartburn symptoms. Also, sleeping on one's left side will allow the stomach and its gastric juices to remain lower than the esophagus, thereby preventing easy flow of acid up.

A: There is a California law called Proposition 65 (“Prop 65”) that mandates warnings be given to consumers in various circumstances. For example, under Prop 65 an exposure to an amount of lead over 0.5 micrograms (mcg) per day would require a reproductive toxicity warning. The level requiring a reproductive toxicity warning is set at a level around 1000 times less than the level of exposure where there is no observable effect of harm, a level which is far lower than that set by the FDA. One serving (2 capsules) of Refluxter contains approximately 0.28 mcg of lead. If we had stated to take Refluxter only once a day we would not have been required to give a Prop 65 warning for California residents. However, we wanted people to be aware that they can take Refluxter after every meal and before bedtime if desired. Therefore, 8 capsules of Refluxter would contain approximately 1.12 mcg of lead, which is still far below the amount of lead in common food items such as 90 grams of shrimp (~18.9 mcg) and 1 cup of cooked rice (~2.17 mcg). Even fruits can contain lead. A single serving (one cup or 230 grams) of grapefruit contains approximately 5.98 mcg of lead, which exceeds the Proposition 65 limit by nearly 12 times. The European Food Safety Authority (EFSA) estimates the average adult consumes around 50 micrograms of lead per day, which is 100 times the Prop 65 limit. The FDA's interim reference level for lead is 8.8 mcg/day for females of childbearing age, with a 10x safety factor built in (the FDA had determined 88 mcg is the upper limit of safety, but wanted a 10x safety factor to err on the side of caution). This ensures lead intake stays well below levels associated with health risks. Some Prop 65 chemicals, such as lead, are prevalent in the soil of the natural environment, and they unavoidably end up in supplements that contain natural ingredients. Products with synthetic ingredients or which are heavily processed can more easily avoid introducing or remove natural contaminants. This unfairly impacts natural products.

A: Yes, Refluxter works great for LPR. Make sure to take 2 capsules after every meal. Do not skip a dose since LPR is more difficult to treat since pepsin can be a gas. You may need to take an extra capsule at night before sleep for severe LPR. Alginate is safe at even high doses, but monitor calcium and sodium intake if you have kidney or blood pressure issues. Source: Lechien, J.-R., Mouawad, F., Bobin, F., Bartaire, E., Crevier-Buchman, L., & Saussez, S. (2021). Review of management of laryngopharyngeal reflux disease. *European Annals of Otorhinolaryngology, Head and Neck Diseases*, *138*(4), 257-267. https://doi.org/10.1016/j.anorl.2020.11.002

A: Yes, you can take Refluxter after every meal and before bedtime. However, be mindful of the calcium and sodium intake if you have any kidney or blood pressure issues. Many people like to take Refluxter just before going to sleep to help them deal with the acid hitting their throat when laying flat during sleep.

A: Yes the non-systemic nature of the ingredients used in Refluxter make it safe for use while pregnant. From the literature on alginate use during pregnancy, no particular risks have been shown to date for both the mother and unborn baby when alginate had been administered during all the pregnancy trimesters. Source: Quartarone G. Gastroesophageal reflux in pregnancy: a systematic review on the benefit of raft forming agents. Minerva Ginecol. 2013 Oct;65(5):541-9. PMID: 24096290.

A: Refluxter starts to work very quickly. You should feel its effects within 10-15 minutes after taking it. The “raft” that is formed can last up to 4 hours.

A: There are no dietary restrictions. You can take Refluxter without it affecting your lifestyle. Carry Refluxter with you when you know you are going to eat something that will cause heartburn.

A: After thoroughly reviewing the scientific literature on potential interactions, we found no evidence that the nutrients in this formula would adversely interact with prescription medications or interfere with the formation of the raft. However, it is best not to take Refluxter and other medications or supplements at the same time. You can take other medications or supplements 1 hour before Refluxter (at the minimum 15 minutes before) or 4 hours after Refluxter. This allows other medications or supplements to not be caught in the alginate raft. If you take medications at the same time as Refluxter there is a chance the medications can be caught in the raft and absorption will be delayed until the raft itself dissolves, which could take up to 4 hours. If you are taking prescription medications and considering taking Refluxter, we recommend consulting with your physician first. With regards to PPI’s, as long as some acid is present in the stomach Refluxter will be able to form its raft. Research studies have shown that 1 PPI per day blocks around 50-60% of stomach acid production. 2 PPI per day blocks between 80-85% of acid production. So even when taking PPI, people are still producing enough acid for the alginate raft to form. Studies have also been done where it was shown that adding an alginate to a PPI regimen improves symptomatic control. Refluxter, unlike PPIs like Prilosec and H2 blockers like Pepcid AC, does not interfere with your body's natural production of stomach acid.

A: Though it is best not to eat or drink after taking Refluxter, you still can without any harm. The alginate raft that forms has a foamy gel-like consistency and food or liquid will pass through it with the assistance of peristalsis and gravity.

A: The ingredients for Refluxter come from all over the world. Our suppliers for the raw ingredients change often so we can not legally say exactly where each ingredient comes from because that could change from batch to batch. For example, the seaweed for the sodium alginate is usually harvested in Norway, USA, or Chile. Each raw ingredient for every production run is tested for purity to meet strict industry regulations. Refluxter is manufactured and packaged in the USA at a facility that is certified to follow GMP (Good Manufacturing Practices) and whose factory is routinely inspected and audited by NSF International, the leading authority in supplement regulation in the USA. Please visit https://en.wikipedia.org/wiki/NSF_International to learn more about NSF.

A: The alginate raft will simply be digested.