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This article looks at what Laryngopharyngeal Reflux (LPR) is, and how to control it with diet.
Do you have trouble sleeping at night with acid reflux? A simple answer can be found in this article on this website, here.
Just What Is Laryngopharyngeal Reflux (LPR)?
Most people know what reflux is – at least they think they do.
When most people think of reflux, heartburn pops in their head. The name of the disease is GERD (Gastroesophageal reflux disease). It is reflux into the esophagus.
However, there is another type of reflux: laryngopharyngeal reflux (LPR). It is gaseous reflux which infiltrates the airways.
This article looks at the principal symptoms and the main ways to control it – including the LPR Diet.
5 Common Symptoms of LPR
LPR causes inflammation of the airways.
What symptom someone feels the most varies. Any inflammatory condition in your airways can be connected to LPR.
These are the most common symptoms:
Hoarseness
By far the most typical sign of LPR is hoarseness.
Why?
The voice box sits directly next to the entrance of your esophagus. There is not much distance to the stomach. That is why the voice box is hit the most by reflux.
Our voice is a very delicate thing. Even the slightest inflammation leads to problems – like hoarseness.
Chronic Cough & Throat Clearing
Our cough reflex is meant to clear our airways from anything that blocks them. Coughing ensures that we can breathe freely.
You see that when you have a cold. While sick your body produces more mucus. Without a cough reflux, the mucus would choke you to death.
The problem is, LPR causes chronically increased mucus production. The result: you need to cough all the time to clean your airways.
Asthma
For some people, the inflammation hits the lungs. They have trouble breathing.
While it is technically not asthma, it feels the same.
In the beginning, you only feel the symptoms when you need a lot of oxygen – like during a workout. Less oxygen reaches the blood, and your stamina is reduced.
Post-Nasal Drip
Post-nasal drip is another symptom related to mucus.
You simply feel mucus from your sinuses dripping down the back of your throat.
Dry & Sore Throat
Dryness is a sign of weak inflammation.
Surprise, Surprise! Many people with LPR have a feeling of dryness in the throat or mouth.
If this sensation becomes worse, it starts to feel more like soreness or burning.
What Are The Causes of LPR?
The exact reason why someone develops reflux varies. That topic goes beyond the scope of this article.
What you eat is part of the picture, and you can help yourself by adopting an LPR diet (see below).
However, there are two causes which are the same for everybody with LPR:
Defective Lower Esophageal Sphincter (LES)
LPR as well as GERD are both caused by a malfunctioning LES. That is the valve between the stomach and the esophagus.
The difference is: LPR is gaseous reflux. It is way more difficult for the LES to hold back gas than fluid, which you reflux in GERD.
Even the slightest malfunction can cause you to reflux gas constantly.
That is why to a gastroenterologist (stomach doctor) the LES often looks fine – even if that person has LPR.
The Key Cause: LPR and Pepsin
The most overlooked element in laryngopharyngeal reflux is pepsin.
You may ask: what is pepsin?
Pepsin is a stomach enzyme – the most important one. It digests protein. Without pepsin, you would have no chance digesting protein-rich food like meat.
Most people think of reflux as acid. This is not the case. It is impossible to reflux acid alone. Reflux always contains pepsin as well.
If pepsin is refluxed into the esophagus, it is not that bad. The esophagus is well protected against pepsin.
If pepsin reaches the airways, you have a problem. The airways are very easy to damage.
Once in the airways, pepsin goes on doing its job. It digests. It digests our cells. You can guess that nothing good comes out of that. The result of pepsin digesting our cells is inflammation.
Above, we discussed that all symptoms of LPR are based on inflammation. Now you understand how this inflammation is caused. It is pepsin damaging our airways.
A Vicious Mix: Pepsin & Acid
The damage pepsin creates is not always the same. It varies based on how much acid is around.
The more acidic the environment, the faster pepsin can digest.
That makes sense.
Pepsin is supposed to be active only in the stomach – where it is very acidic. That is why pepsin has a protective mechanism to deactivate itself when there is no acidity.
The problem is that most people consume -loads- of acid in their diet. For example, sodas and coke. Fruits are acidic as well. Most canned food too.
Each time you consume something acidic, pepsin is reactivated.
And of course, reflux itself is acidic.
How LPR Is Treated
Now that you understand how LPR is caused, let’s talk about how to get rid of it!
Here is an overview of the most successful ways to cure LPR:
The LPR Diet
The LPR Diet is the first and most important measure against LPR.
It is also the most successful.
You must change what and when you eat.
The most dangerous meal is dinner. If you eat late, food will lie in your stomach the whole night. During sleep, our natural reflux defenses are in power saving mode. While most people with LPR reflux during the day, the most severe cases are night-time refluxers. Not eating 3-4 hours before going to bed makes a huge difference. For simple remedies to curb night time reflux, check out this post.
Overeating is an obvious reason for reflux. If the stomach is full, its contents simply burst through the sphincter. Eating smaller meals will improve LPR.
Above, we talked about pepsin. It causes more inflammation the more acidity there is. That is why it is crucial to stop eating acidic foods as part of an LPR diet.
Avoid Acidic Food And Drink
Each time you take acidic food or drink you will reactivate pepsin and start LPR.
Dr. Jamie Koufman pioneered the treatment of laryngopharyngeal reflux disease through low acid diets. She wrote a book on how you can treat LPR by eliminating acidic food and drink.
Anything under pH 5 should be banished from the diet, at least until the symptoms have disappeared. After that, a reintroduction of slightly acidic foods up to pH 4 may be possible without LPR symptoms returning.
Most fruits are more acid than pH 5 and therefore should be eliminated by LPR sufferers, though melons are an exception. They have an about neutral pH and can, therefore, be eaten.
Sodas are even more acidic. Their pH is between pH 2.5 and pH 3. We’ve written more about soda and acid reflux here.
If in doubt about a food’s acidity, you can simply test the acid level with pH strips.
Chewing Gum
A 2001 study (ref 1 at end of article) involved 40 individuals with LPR. The data show that gum chewing consistently reduced LPR, and that bicarbonate gum caused greater increases than regular gum. For patients with LPR, chewing gum appears to be a useful addition to anti-reflux therapy. More on this here.
Medication
For reflux into the esophagus, acid-blocking medication works great, but be aware of the long term side effects.
For LPR, this is not the case.
Acidity is only part of the equation in LPR. Studies show that acid blockers do not work better than placebo against LPR. Still, most doctors do not know about that and prescribe acid blockers against LPR. Be careful which doctor you trust.
Surgery
It does not make a difference whether you have LPR or GERD – the surgery is the same.
However, the gaseous reflux in LPR is much more difficult to fix. The success rate is lower for LPR than for GERD.
The most common procedure against LPR is the Nissen Fundoplication. The surgeon wraps the upper part of the stomach around the esophagus. It tightens the valve. The Nissen is the oldest and at the same time most successful surgery against LPR.
The downside is that the procedure has the most side effects as well. The Nissen tightens the valve so much that gas is trapped in the stomach. While no leaking gas means no LPR, it can also cause painful bloating.
Then there is the LINX implant. The LINX is a magnetic band which is implanted around the lower esophageal sphincter. It is a bit weaker than the fundoplication but also has fewer side effects.
The least invasive procedure is the Stretta. It is a stretch to file it under surgery. The Stretta procedure uses electrical stimulation to cause the muscle of the lower esophageal sphincter to grow.
The Stretta is often less successful than other procedures. However, permanent side effects are rare. You can combine the Stretta with any other surgery, which makes it very appealing.
To Sum It All Up
LPR is gaseous reflux which delivers pepsin into the airways. The stomach enzyme causes inflammation. The damage is worse in an acidic environment. That is why it is crucial to cut out acidic drinks and foods from the diet.
On top of that, all standard reflux and LPR diet advice makes sense. Do not overeat, do not eat late at night, etc.
Medication is not very helpful. If dieting does not work for you, there are some possible operations. The Stretta is a great treatment choice. For tough cases, the LINX or the Nissen fundoplication are possible surgeries.
While LPR is tough to treat, everybody can get better. Some people just need longer to find the treatment that works for them.
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