Hi David, I started having trouble swallowing solid foods four weeks ago. I would instead recommend getting a digital pH meter like this one. 2.) Hi David, thank you for this wonderful information. I’ve had an issue for over 2 years, that every morning, normally within around 2 hours of waking, and normally shortly after I’ve had breakfast (although sometimes it would begin before I’d eaten breakfast), I begin to have a need to clear my throat. Well the common thing for testing is pH is pH strips though through my own experience pH strips aren’t that accurate and can leave you somewhat guessing at your pH level. Everything above is alkaline. Also worth checking out – advice on what to do to help prevent acid reflux at nighttime. Perhaps you could be making some mistakes even still because LPR really needs a strict diet to get the best effect(thats what I created the Wipeout Diet for). It is generally the most effective way to heal it. Each acidic reflux will not only transport new pepsin into the throat, but on top of that, the acidity will reactivate the pepsin that is already there. I have decided against taking these. Today is my fist day of tapering off Prilosec & I happened to find your article, I immediately purchased the Gaviscon Advance (UK) from Amazon. He turns down widely and scientifically proven causes of reflux as lies without backing that up in any way. For me personally I believe it was because of taking anti-inflammatories and anti-biotics which started my stomach problems but later down the line when I developed LPR symptoms I believe it was due to stress. Hi David. These can include Proton Pump Inhibitors, Histamine Receptor Antagonists, and over-the-count… GERD vs LPR – The differences between the 2. There is a theory based the stomach having too little acid and this may seem confusing to readers as they are usually treated for having too much acid instead of too little acid. Do you drink them as is or mix anything in with them? Thank you so much for the information you have provided. Sphincters are valves that keep food in the right organ of your digestive system until it’s ready to be passed on. Slowly over the last year it also started happening more and more later in the day, again after eating. It takes longer for standard medical treatment guidelines to change. The Fundoplication is proven to work for most LPR patients. A diet can help the LES I believe because if you have less reflux it will allow it to heal more easily and return to its normal function over time. Imagine it like a tube of toothpaste. I think the swallowing problem could take some months to heal. H2-Inhibitors have limited use in LPR for the same reason as PPIs. My questions. The lack of diagnosis precision and variability of inclusion criteria particularly create bias in all reported and included articles. Drops like these ones can be added to your water to make it more alkaline. But as I started eating again they came back. Water that you usually drink would typically be around the pH of 7 or about neutral on the pH scale. I have been having a burning pain in my throat and behind my nose for more than a year now. There is a test that is semi reliable to test if you have SIBO. I learned that not all, but many companies will use a lack of education about a disease to their advantage where they can – in this case, to push more PPIs against LPR onto the market. Baking soda is pure sodium bicarbonate. How Nissen works is basically part of the stomach is wrapped around the LES area which in turn will tighten the LES and theoretically lower the chance of reflux because the LES will be tighter. Hey Michele, Thank you for your kind remarks. But how else can I explain it if I never had it in my life before? 1. One way to do that is to avoid reflux in the first place. I am remaining positive but this has certainly been a roller coaster ride. But showing that most people with reflux have low stomach acid? Drink plenty of water. I’m looking for a little hope I guess. During a study where patients took melatonin for reflux (GERD) alongside a commonly prescribed PPI and also without the PPI to see its benefits if any. You most likely have LPR but it is also possible you could have a mixture of both LPR and LSN. I bought some normal Gaviscon instead for now. I’ve lost 45 pounds in 3 months and my last bloodwork I’ve have become anemic. My doctor put me on PPIs and I took 40mg for three weeks, I felt my throat was better but still experienced the acid coming up. I do suffer with UTI’s and over the years have taken many antibiotics to treat these, I was wondering if Hiprex a drug i was recommended to use with Vitamin C 1000mg, and started last week, would cause this? Usually with LPR you won’t have any heartburn that typically comes with reflux and GERD (Gastroesophageal reflux disease) and that’s why sometimes LPR is also referred to as silent reflux as you don’t have the typical reflux patient symptoms. Hey Frank, Love to hear that you are feeling a lot better now, that’s brilliant. If diet alone is not enough, there are also surgeries available: A very established surgery is the Nissen Fundoplication in which a part of the stomach is wrapped around the LES to tighten it up. My tongue is inflames, do you think its still has to do with LPR and pepsin coming up ? My question to you is that the tip of my tongue seems to suffer the most from my LPR. Thank you so much! I’ve been on the low acid for nearly the entire four weeks. It sounds like you follow a good diet though the thing with LPR is one small mistake especially for someone with more sensitivity can prevent healing, so really looking into the details could be important for you. I have followed it religiously for 3 weeks, have had nothing to drink but water and my diet has been very limited. Thank you! Patients who need them long term are usually better off with surgery. Though keep in mind for most people with LPR this won’t be the right option, but I wanted to make you mindful of it. If low stomach acid were the cause for reflux, then the rebound effect from PPI usage would not exist. From feedback of patients and physicians, I assume that some people indeed get better on PPIs while others get worse. How to Treat Silent Reflux (LPR) – The Right Way. If you are doing this step alone without following the diet you still likely will be reactivating the pepsin so I would only advise to do it if you follow the diet alongside it. The predominant research on sphincters has been done primarily on the LES as that’s where doctors and physicians alike assume the main problem arises. Gerrit is a German data scientist & medical publisher. Effects of DZNep on animal survival, anti–double‐stranded DNA (anti‐dsDNA) antibody production, proteinuria, renal histopathology, cytokine production, and T and B cell numbers and percentages were assessed. The absence of specific LPR symptoms and treatment methods make LPR a difficult condition to assess. For some they may be able to eat whatever they like and for others they may have to avoid some of their triggers – it’s just different for each person. Thanks David for this well informed website of your journey. Also avoiding foods and drinks that are highly acidic would be advised. I know myself from personal experience I was afraid to travel for a while because of fear of not following my diet as I should do etc. The lower the pH is, the higher the damage potential of pepsin: Once refluxed, pepsin can stay in your airways for days or weeks. How it works is the Stretta system delivers radiofrequency energy at the LES. I think another surgery will be the first line of defense against LPR in the future: the Stretta Procedure. That is why I got into the education of people instead of doing market research. For digestion to work, your stomach needs to contract and press food out into the intestines. Accessed 10/5/2018. It is all dependant on each person and there is not a simple answer that works for everyone. There are a selection of different options available but 3 of the more notable and successful options are called Nissen, Linx and Stretta. -Ken. I’ve been battling issues with stomach/esophagus pain, heartburn, and the warm liquidy feeling in my throat for almost 2 months now. Thank you so much! These are the three sphincters that play a role in LPR: The LES is the first anti-reflux barrier and the best-understood sphincter. The problem with this is people who try to stop the tablets on there own get this massive amount of reflux if they stop taking them going from 100% dosage to 0%. As I have suggested a very strict low acid diet and taking the uk gaviscon advance is the best way to remedy this. Note that many SIBO diets tend do be overly complicated and confusing. Hey Jane, Thank you for the kind comments. Regards and congratulations for your Website. I have researched LPR for a year now. PPI’s don’t usually help with LPR though they are effective for GERD symptoms so I think for you that is a good choice. I only drink water. The best way to treat a malfunctioning LES is by changing your diet. Thank you so much for this website! The endosxoywas done for swallowing issues which they found a stricture and dilated and helped with the swallowing issues but then the sore throat and tightness started and hasn’t left after 4 months. Like you my LPR has been misdiagnosed by ENT, GP and Gastroenteroligist. This causes them to grow and reduces the amount of relaxations. Thank you for your research and this very informative guide. 80 mg a day. Hi Luke, It’s hard to say for sure but for myself I do think there is some correlation between the 2. So I’m also sure there was a connection. It hasn’t started to have an effect yet. Most legumes like beans and peas are also highly fermentable and worsen SIBO. PPIs are better at treating GERD symptoms than H2 blockers, and they can heal the esophageal lining in most people with GERD. If you have went to your doctor or physician about your LPR. I think that’s somewhat common. It is important that your LES can resist the pressure in your stomach. My concern is do people recover 100% from this condition? If the patient is lucky, that treatment tackles the root cause. Which is why there are many potential solutions as well. I’m also going to start lowering my PPI intake slowly. This is something I want to personally highlight because I myself took doctors advice for taking PPI’s for LPR. GERD and LPR. For example, I would take 2 20mg tablets a day for a total of 40mg per day. It is the Sphincter between the stomach and the intestines. Yes I do accept contributions just send me an email to david@wipeoutreflux.com. Hi David! Otherwise, the damage potential of pepsin will be increased massively. As the months went on, I had to spit into kleenex soon after lying down to sleep. In his book he talks about why you need high acid in the stomach and why you should avoid PPI’s at all costs. Also i have started to take Melatonin (3mg) and DGL for the last 10 days, not sure if they are helping. Technically speaking if the UES doesn’t stop the acid then you will develop LPR symptoms. For more information on dealing with stress and anxiety and its link to LPR check out my article on LPR and Anxiety. The good thing with Stretta is, if you do not get better, you can still do any other kind of surgery. He said he didn’t believe it was LPR because ‘there are no symptoms with LPR’. It avoids reactivation of pepsin. Other treatments target pepsin more directly: Each time you consume acidic drinks or foods your throat is bathed in acidity. It would last for around 45min – 1hr. Try to do things which can calm the mind like some of the things I have mentioned in this article. I wish you the best of luck and happy healing . I think once you have healed somewhat then maybe you can try to introduce some alcohol in. I also belch a lot and feel bloated all the time and sometimes experience regurgitation. You mentioned you are taking a new high dose vitamin c tablet – ideally if you can I would avoid that because that could be causing you acid reflux. This all to seemed have started for me September 2018 when I decided to stop drinking soda. Though as I have mentioned following a low acid diet will often help symptoms for both. It’s great to read others stories, very similar to my own. Other options include marshmallow root, B complex vitamins, vitamin C, digestive enzymes and essential amino acid complex. When food enters your intestines, this food starts to ferment. Is there peppermint in the Thanks again for the info and this forum. If you have both GERD and LPR symptoms I think taking a PPI and following the diet plan should be absolutely fine. If the stretta procedure is safe why not recommend everyone to try it and lastly 4. That means less pepsin will make it into the airways. Some quick tips about food choice for this diet –. The book describes exhaustively how acid and digestive enzymes are the basis for healthy digestion – which is correct. actually coined the term “LPR” and has treated thousands of patients in nearly thirty years. You are most welcome. Many people in online forums, less well-researched health blogs, and the social media are raving about how you supposedly can heal reflux by supplementing with artificial stomach acid to boost your digestion. Try to move unto the second phase of the diet which was quite recently added and if you have more questions send me an email. To answer your questions, 1 – Yes I believe these 2 things can help you a lot, of course there are other smaller things which can contribute but these are easily my top 2 recommendations. Throat could be not swollen or red and still sore most likely because of LSN – you can read more about it here. The wipeout diet is a diet tailored to help people with LPR, you can find it here. Much appreciated. This helps you to quickly find foods that work for your LPR – and which you enjoy eating as well. Things you should avoid – alcohol, citrus fruits, tomatoes, mint and all carbonated drinks. He alluded to a change in diet but minimal changes at best. I have also suffered with anxiety for years and recently have had a really bad episode of anxiety causing me to be off work. It could also trigger a hiatal hernia. If someone claims that supplementing stomach acid can cure reflux in everybody: do not believe that statement easily. Medicationsto reduce stomach acid or to promote normal motility. The more reflux gets through, the more the next barrier, the upper esophageal sphincter, has to fight. Hi David, I have suspected I have LPR (after GP diagnosed me with acid reflux) given the signs and symptoms. This is because the LES is not creating a barrier against reflux as it should. You can have it loosened to relieve side effects. How to Fix a Malfunctioning Pyloric Sphincter, *Be wary of a doctor or physician that prescribes PPI’s for LPR*, How to Treat Pepsin Through Diet and Things to Avoid, #5 Small Intestinal Bacterial Overgrowth (SIBO), stomach sphincters important role in acid reflux, Stretta and it’s effectiveness for treating LPR, baking soda works for helping acid reflux, What Can You Drink When You Have Acid Reflux, advice on what to do to help prevent acid reflux at nighttime, https://www.reddit.com/r/GERD/comments/a1lpfh/how_to_make_your_own_gaviscon_advance_at_a/. It contains an algae extract. I’ve started Hiprex and cranberry 60000 to help combat Recurrant Ecoli UTI. I follow a low acid diet. In some cases, gastric content may even reach the nasal cavities and/or ears via the Eustachian tubes, which can exacerbate rhinitis, sinusitis, or otitis media [7-9]. This is a drug which can be used to lower the number of times the LES relaxes therefore reducing the number of times you will reflux. has the improvement been long for you too ? Water with a pH of 8 or above has been shown in studies to deactivate pepsin, so when you drink it, it should help deactivate pepsin in the throat that it comes in contact with. What raised a huge red flag for me is that the author praises his method as being the ultimate cure against any kind of reflux (and many other diseases). While they definitely increase the pH I am not sure if they make a difference with LPR. However, many sources on the internet refer to whether acids or bases (alkaline substances) are formed during the metabolism – meaning inside your body. Thanks for a wonderfully thorough explanation of LPR. Do not go higher as it will lead to new problems like high sodium levels or neutralizing the acid in the stomach which you need for digestion. HI David, I just got diagnosed by ENT with a Endoscope by looking at my throat with acid damage everywhere. Returning now to the low-acid diet; Dr. Jamie Koufman, M.D., F.A.C.S. I went to the doctors because I was experiencing burning mouth symptoms. If you do plan on doing this I would highly recommend doing this alongside my treatment advice below in this guide. LPR Treatment. Being a Senior it seems like a dead end street. Not sure what I will do for my wake up drink in the mornings since caffeine is a no go lol. Most people I know who tried that only got a painful stomach (gastritis) and sometimes worsened reflux symptoms. It is not that uncommon. Attention: Gaviscon Advance is not available in the U.S. On top of that I have kidney stone that will require a procedure to be removed in 5 days. I think I may have LPR as food seems to come up even though I am following the acid watcher diet. Haven’t been eating much. I have heard of the silicol gel though I haven’t tried it myself. Do you notice that symptoms are worse in the winter than summer? The quality of those articles is secondary. The most commonly prescribed medication to reduce acid production is a group of drugs that are called proton-pump inhibitors (PPIs). In fact I had a similar experience. You can buy PPIs over the counter, or your doctor can prescribe one. Thank you very much I was not aware of that one in particular though I have seem similar ones before. This way you would know more accurately if your stomach acid level is too low and should consider takin the betaine HCL supplement. Hi David thankyou for all the information on LPR. The longer you take PPIs, the stronger the reflux symptoms become once you stop taking them. I just began suffering from some of the symptoms of LPR. The problem with the UES is that is really isn’t there to prevent against acid reflux and often won’t offer much of a barrier as you would like. The study showed that taking Gaviscon Advance(UK version) had a significant positive effect on LPR – proving that Gaviscon Advance(UK version) does help against LPR. -Claudia. But using coffee as an example the headaches usually pass after 2-3 days of not taking it. Your feedback would be appreciated. My LPR started this past Jan when I got Strep throat and in Fed Tonsillitis. Have you heard of this problem? PPIs might lead to more incompletely digested food and therefore more gas. Also foods that are high in fat have shown to take longer to digest and take longer for the stomach to empty. Really great website, very glad I’ve found this. Every time I drink soda as I started again about 3 weeks ago I feel great. If you lower the intake of foods/drinks like this, it will also stop the pepsin becoming reactivated and will therefore heal and help your symptoms. I am guessing the excessive coughing would add strain to the whole mouth/stomach tract causing a lot of the sphincters you mentioned to weaken. Wouldn’t that mean that PPIs should help as they reduce the acidity in the reflux? Hope this helps Gino. I found your analysis and diet plan about a month into the PPIs and purchased the diet plan. I also have IBSD and Diverticulitis. According to Dr. Mark Noar, up to 40% of people with reflux have this problem. It is a band of magnetic beads which is implanted around the lower esophageal sphincter. This is the most comprehensive and informative information that I have seen thus far. It’s effective for people who have low acid level in their stomach though from my knowledge this tends to be more uncommon than the other potential causes. It starts to burn in the evening, though I eat my larger (about fist size) meal at noon time and do not eat after that. Firstly, I recommend avoiding a selection of foods and drinks to get started –. Let’s have a look at 5 groups of LPR contributors and their respective treatment: The key contributor to laryngopharyngeal reflux (LPR) are malfunctioning sphincters. You simply mix it up with your water to make it more alkaline. You can redo it if the wrap loosens up. Eliminated all gluten and dairy. I talk about this further in my Melatonin for Acid Reflux article. Also noticed that any form of probiotics or fermented kombucha caused a huge amount of gas that seemed to fill my rib cage and causevery painful long lasting burping. Some relax the sphincter-like chocolate, caffeine (coffee, tea, etc.) However, side effects like bloating are common and can be severe. I also do not recommend an anti-SIBO diet as a primary treatment, only as something to try out if you do not get relief from other strategies. If you have more body fat around the stomach area this causes there to be more pressure on the LES which often means more likelihood of reflux and LPR. It needs to open at exactly the right moment. Fiber rich foods are good for LPR reflux diet that includes spinach, corn, bran cereal, red cabbage, beans, peas, carrots, potatoes and fruit (apples, bananas and oranges ). Yeah there is most likely a connection. An assumption of the book is that low stomach acid is the root cause of many diseases, also of reflux. I am planning to start removing things from my diet soon, and I am wondering how soon I can expect an improvement. I’m definitely not overweight either. The reason is that H2-Inhibitors are weaker than PPIs and do not reduce acid production as much. As for your question yes healing can take many months for some people as many as you suggested is a good rough idea. I have been suffering from LPR from past 2.5 months, never had it before and the symptoms started after a week of some serious stress. What triggers should I look for? I actually didn’t have any lpr symptoms till after I had an endoscopy. The internet is an amazing tool to find information on improving your health. In the last few weeks things have got much worse. Marshmallow root tea is your best bet because it not only has the ability to coat and heal the throat, but it has the same effect of the whole digestive tract and has been shown to aid digestion and help reflux as well. Many physicians ignore the role of pepsin in LPR and only treat the acidic component. Additionally, the acid usually dilutes the pepsin in the gastric content. It should also help with the direct reflux because of the lower acid intake so its sort of a 2 in one if you follow this diet. Study design, patient characteristics, diagnostic method, exclusion criteria, treatment characteristics, follow-up, and quality of the outcome assessment were evaluated. Have you heard that being a cause of LPR? My NP finally sent me to an ENT, and I showed him the kleenex with brownish red sputum (I had tons of such samples) He checked my sinuses with a tube, a CT scan, and said he would refer me to a GI doc. You have to be careful when you are looking up the acidity of foods on the internet. 6. I have tried to give it up but I am getting bad headaches and feel in a fog all day. The UES is the sphincter between the throat and the esophagus. I dried, and saved it to show my NP. When it’s colder the shear cold when you breathe it in could be more irritable to the throat etc. Side effects are uncommon and may include headache, diarrhea, and upset stomach. Thank you for sharing. I spat out the slimy stuff. Anything that puts the digestive process out of balance might also lead to more reflux. It has been really depressing dealing with these problems. Symptoms have come down (say 50%) till now and the PPI’s was advised to me for 3 months.i think i won’t recover 100% in the remaining 15 days. After numerous doctor visits, an ENT finally gave me the LPR diagnosis and started me on 40mg PPI. If you are currently taking them with no benefit I would advise to taper of them slowly. At night, all of your anti-reflux defenses slow down, which is why reflux causes more damage. Thank you for your work and help with this problem I had never even heard of prior to my diagnosis. Most acidic fruits contain fermentable sugars anyway. I want to still travel and go to places with my partner but I am scared that I may not make it if i go a bit farther. If there is anything you don’t understand or if you have any further questions please talk to your doctor or nurse. LPR is not the same thing as heartburn, and you should see your doctor to be diagnosed with LPR. PPIs are generally safe and effective. But other than that everything has been alkaline. which makes logical sense. Some of the water will also spill through the entrance of your larynx. Maybe it is a way to relieve pressure in the stomach. The best advice I can give is following a low acid diet like the wipeout diet and taking gaviscon advance alongside it. Klees 2019) fürsorglich, einvernehmlich beginnend, dann jedoch sexualisiert übergriffiges Verhalten, bei denen die Bedürfnisbefriedigung des übergriffigen Geschwisterteils im Vordergrund steht. Diagnosed with Gerd. His formal education is in qualitative research. I would say treat it as if its LPR and it should help both the LPR and the burning mouth as well. Ask your doctor for other suggestions and tips on treating and preventing LPR. The upside of the LINX is that it can be removed if it causes problems. I’ve used this system for years and am really happy with it. It is making me feel so much more anxious and I know I should eat but I’m afraid too sometimes. As with Gavison advance if you can find any gaviscon like alternative with the important ingredient called (sodium) alginate, that is the important ingredient – if you have a couple of options choose the one with the higher dosage of that ingredient. As I have mentioned drinking water and taking these lozenges are good options for some relief. Updated February 2019 Congrats on your decision! Hi David, thanks for your info.It is very extensive and informative. I have been taking omeprazole 20 mg once in the morning for 14 days now. If you have any questions or concerns, please feel free to leave a comment below or contact me using the contact page. However, what people remember is that he can supposedly cure pretty much everybody of reflux by supplementing with stomach acid and digestive enzymes. Yes the reflux gourmet has the sodium alginate which is the important ingredient so it should be helpful. Do you ever actually feel normal again or is LPR something that’s always lingering and recurring everytime you don’t stick to your routine? Btw is milk kefir acidic? In particular, many symptoms and signs commonly encountered in LPR are not assessed in the treatment effectiveness. I am 33 and don’t want to do a surgery, Can LES become normal on it own? I have a couple questions if you don’t mind answering. To make the business model work, publishers hammer out a huge mass of articles – often on multiple websites. Probably because the knowledge about pyloric sphincter malfunction and its treatment is still rather new and not widespread. If you are still having bad reflux that you feel is because of the rebound effect you could try taking some H2A’s like ranitidine until things are settled more with the gaviscon advance, anti-acids like ranitidine are less strong than PPIs and are much safer to take. I was recently diagnosed with LPR. Maybe you (and the readers) can share what triggered the initial symptoms. The lower esophageal sphincter reacts in the same way if it is being put under unnatural stress for long periods of time. Despite the UES’ importance in LPR, there has been little research done on it. They will then end up thinking “I need these tablets to control my reflux” – but in fact this is simply the rebound effect. I have had lots of sinus and strep throat infections in the last 18 months and reflux seems to be there when I have these infections. A pH of 1-2 is about the level of the empty stomach and is very acidic. I would recommend giving this book a read it could not only help your LPR but also your whole body and mindset. My dosage is super high. Baking Soda: You simply mix it with water. IL-6 signal blockade c … The effect of anti-IL-6 receptor antibody for the treatment of McH-lpr/lpr-RA1 mice that spontaneously developed destructive arthritis and enthesitis BMC Musculoskelet Disord. It a substance which is natural in your throat. I you would like to email me about your symptoms I can offer you some advice . What do you think? I haven’t tested the water’s alkalinity after filtering, but the website claims the pH becomes around 9.