Your Guide to the Most Effective Dietary Strategies for LPR
- About LPR Diets|
- LPR Causes|
- Which Foods Can Cause LPR?|
- LPR Diet Plan|
- Different LPR Diets|
- Other Diet Tips|
- Supplements for LPR|
- Recommended Products|
Finding the right diet is one of the most important components of managing laryngopharyngeal reflux (LPR), or “silent reflux.” But what’s the best LPR diet?
Certain foods and drinks, including acidic foods, spicy foods, and alcohol, have been shown to both contribute to the development of LPR and trigger symptoms.
Underlying food sensitivities or imbalances may also contribute to LPR symptoms indirectly by feeding bacterial overgrowth, promoting the production of stomach acid, or causing inflammation in the digestive tract.
Implementing the right diet can lead to significant symptom improvement or even complete resolution. At the very least, a healthy and individualized diet serves as a healthy foundation from which to approach other treatments.
In this article, we’ll guide you through the different kinds of diets that may help with LPR and show you how to determine which LPR diet is best for you.
LPR Diet Snapshot
What does determining and optimizing your ideal LPR diet look like? Before we get into the details, here’s a quick overview of the steps you can take.
- Eliminate common LPR triggers
- Acidic foods
- Spicy foods
- Oily foods
- Find your ideal LPR diet
- Start with a low-acid Paleo diet
- If symptoms do not improve, consider:
- Low histamine diet
- Low FODMAP diet
- Modify dietary habits
- Avoid lying down after eating
- Stop eating 2-3 hours before bedtime
- Eat slowly and in moderation
- Add supplements as needed
- Probiotics to support a healthy gut and digestive system
- Melatonin, l-tryptophan, prokinetic herbs to reduce stomach acid
What is LPR or Silent Reflux?
Laryngopharyngeal reflux (LPR), like other reflux disorders, involves contents of the stomach traveling back up into the esophagus (which connects the stomach and the throat).
In the case of LPR, reflux reaches the pharynx (throat) and the larynx (voice box), typically leading to symptoms like cough or hoarseness.
Because the symptoms are often non-specific and may or may not include classic signs of indigestion like heartburn, LPR is commonly referred to as “silent reflux”.
Symptoms of LPR may include 1:
- Sore throat
- Chronic cough
- Frequent throat clearing
- The feeling of a lump in the throat
- Difficulty swallowing
LPR differs from the better known gastroesophageal reflux disease (GERD), which occurs when stomach contents travel back up into the esophagus but do not reach the throat. GERD typically causes classic reflux symptoms like heartburn and regurgitation.
What Causes LPR?
There are several possible causes of LPR, and multiple factors may contribute to the development of the condition.
LPR often overlaps with GERD, and some research suggests that GERD causes LPR 2. The same is true of irritable bowel syndrome (IBS) 3.
Some research has also found that the same gastrointestinal issues often underlie both IBS and GERD, suggesting that they may share a common cause 4.
Other possible causes of LPR include:
- Low esophageal motility (esophageal contractions that should move food towards the stomach are weak) 5
- Sleep apnea 6
- Hiatal hernia (when part of the stomach pushes up into the chest) 7
- H. pylori infection 8
- High levels of pepsin (a digestive enzyme) 9
- Consumption of certain foods including acidic foods, spicy foods, alcohol, caffeine, sugary beverages, and fermented foods 10 11 12
Can Certain Foods Cause LPR?
Certain foods may both contribute to the development of LPR and cause reflux symptoms 10 11 12. And if you have LPR, you may have noticed that your symptoms tend to worsen when you eat something spicy or drink alcohol.
Some dietary triggers may be less obvious, which is why an elimination diet is often helpful. And in some cases, certain kinds of foods may indirectly contribute to reflux without necessarily causing immediate symptoms.
For example, if small intestinal bacterial overgrowth (SIBO) is an underlying cause of digestive dysfunction including reflux, then high FODMAP foods that feed bacterial overgrowth may worsen the condition.
Foods and drinks that have been associated with the development of or symptoms of LPR include 10 11 12:
- Acidic foods (including citrus fruits and tomatoes)
- Spicy foods
- Oily foods
- Fatty foods
- Fermented foods
- High carb foods
Your LPR Diet Plan
A natural LPR treatment plan involves a few different steps, starting with diet as a foundation and moving on to improving the gut microbiome, supporting stomach acid, and adding additional therapies as needed.
Diet alone can have a tremendous impact on your LPR symptoms and your digestive health.
For example, one study found that a plant-based Mediterranean diet combined with alkaline water (water that has been treated to render it less acidic) was slightly more effective than proton pump inhibitors (PPIs) for the treatment of LPR 13.
This speaks to the power of diet in general when it comes to silent reflux treatment.
There are a few different options to consider when it comes to developing your own LPR diet plan. We’ll cover a few different options, including Paleo, low histamine, and low FODMAP diets, below.
Read more Mayo Clinic Q and A: Lifestyle changes may ease laryngopharyngeal reflux
First, here are the fundamental steps to take in order to find your ideal LPR diet:
- Eliminate known reflux triggers. Acidic foods, spicy foods, alcohol, and coffee, which are common triggers of reflux symptoms, should be eliminated as a starting point.
- Identify and eliminate personal trigger foods. For this piece of the puzzle, some experimentation is required. An elimination diet based on the framework of a healthy anti-inflammatory diet (like the Paleo diet) can help you to determine which foods agree with you and which ones don’t. Follow your chosen diet for 2-3 weeks and monitor improvements. If your symptoms don’t improve with the first diet you try, you can move on to a more specialized diet.
- Experiment with re-introduction. Once you’ve found a general diet framework that improves your symptoms, experiment with re-introducing certain foods one at a time and monitor how you feel. This will allow you to settle on a diet with as little restriction as possible. Keep in mind that objectively unhealthy foods like sugar and processed foods should continue to be avoided as much as possible.
- Maintain your diet. Once you’ve found a diet that works for you, stick with it. Keep in mind that you can always try to re-introduce additional healthy foods further down the road as your condition improves.
If your symptoms have improved with diet but are still problematic, you can move on to the next stage of treatment (identifying and treating gut health imbalances). Your healthy diet will likely have built a solid foundation.
Should You Follow a Low Acid Diet?
A 2020 systematic review concluded that a low acid diet in combination with alkaline water could help to reduce symptoms of LPR 14. However, this diet hasn’t been well defined, and it may be best to simply avoid highly acidic foods as one component of your LPR diet plan.
The general principle of a low acid diet is to eliminate acidic foods (like citrus fruits) and other foods that have been shown to trigger acid reflux, like oily or fried foods. Some food lists will go a step further, rating foods based on measurements of their acidity or alkalinity.
Avoiding acidic foods and other known reflux triggers is important, but focusing too much energy on the level of acidity of every food item you eat may be counterproductive, as it may lead to anxiety around food and distract from underlying issues.
A more balanced approach may be to follow a better defined healthy diet (like the Paleo diet), modifying it as needed to remove highly acidic foods and other triggers.
I often recommend the Paleo diet as a starting point, as it eliminates many common triggers, has been shown to reduce inflammation and improve gut health, and allows for the intake of a variety of whole foods 15.
The Paleo diet removes processed foods, additives, grains, and dairy products. It emphasizes a balanced intake of fruits and vegetables, healthy fats, grass-fed or pasture-raised meat and poultry, fish, and eggs.
Within a Paleo (or any) diet framework, personal modifications can always be made. For example, while tomatoes and citrus fruits may be fine for most people following a Paleo diet, they’ve also been shown to trigger reflux, so they may need to be eliminated.
During the reintroduction phase of your Paleo diet, you may find that you can tolerate certain kinds of whole grains or dairy products in moderation, and your ultimate diet may end up looking more like a Mediterranean diet, which is less restrictive.
I would recommend trying a Paleo diet if:
- Your current diet contains common triggers like processed foods or grains, and;
- You don’t have any known intolerances or conditions that may require a more specialized diet.
Low Histamine Diet
One of the functions of histamine in the body is promoting the production of stomach acid, so for those whose acid production may be too high, reducing histamine is likely to be helpful. This is why antihistamine medications (H2 blockers such as Zantac) are often recommended for reflux.
The low histamine diet aims to naturally reduce histamine levels by eliminating foods that are high in histamine as well as those that trigger the production or release of histamine.
A low histamine diet eliminates fermented foods, aged foods, alcohol, and certain fruits and vegetables, including citrus fruits and tomatoes.
Although the low histamine diet hasn’t been studied for the treatment of LPR, several high histamine or histamine-releasing foods have been shown to trigger reflux and LPR symptoms.
I would recommend trying a low histamine diet if:
- Symptoms do not improve on a low acid or Paleo diet, and;
- You have suspected or diagnosed histamine intolerance or a mast cell disorder.
Low FODMAP Diet
The low FODMAP diet eliminates various kinds of fermentable carbohydrates that feed excess gut bacteria. High carbohydrate foods and diets have been associated with LPR symptoms 10.
Low FODMAP and similar low-carb diets have been shown to reduce heartburn and other reflux symptoms for those with GERD 16 17 18. The low FODMAP diet is also a common treatment for SIBO and IBS. It’s been shown to significantly improve digestive and non-digestive symptoms of both 19 20 21.
As there’s a great deal of overlap between LPR, GERD, and IBS, the low FODMAP diet may help with LPR as well. If symptoms improve on a low FODMAP diet, it may also point to an underlying bacterial overgrowth (like SIBO), which can then be treated.
The low FODMAP diet has also been shown to significantly reduce levels of histamine in the gut microbiome, which may help to reduce excess stomach acid production 22.
I would recommend trying a low FODMAP diet if:
- Symptoms do not improve on a low acid or Paleo diet, and;
- You have suspected or diagnosed SIBO, IBS, or GERD.
Other Diet Tips
A healthy diet is about more than what you eat. Eating habits, including how and when you eat, can also affect your digestion and your LPR symptoms.
Read more Is Juicing Good for Weight Loss? Here’s What Doctors Say
Habits and lifestyle changes that may help to prevent LPR symptoms include 23 24:
- Finish eating for the day at least two hours before bedtime
- Try to eat smaller meals and avoid overeating
- Avoid lying down for as long as possible after eating
- Be cautious about fasting
Should You Drink Alkaline Water?
Alkaline water has been ionized in order to reduce its acidity. While it’s unlikely to hurt, alkaline water is probably not a key component of an effective LPR diet.
Limited research has suggested that alkaline water may be helpful in the treatment of LPR and other reflux conditions. One systematic review concluded that a plant-based Mediterranean diet combined with alkaline water improved symptoms of LPR 13.
However, the alkaline water was not separated from the diet, so it’s unclear whether or to what extent it contributed to the improvements.
If you’re interested in trying alkaline water, you can purchase an at-home ionizer or look for packaged alkaline water at your local health food store.
Supplements for LPR
Certain kinds of supplements may be helpful alongside your LPR diet.
Probiotics, which help to restore balance in the gut microbiome, have been shown to improve symptoms of GERD 25.
There are also a few supplements that may help to normalize sphincter function, reduce esophageal damage, and improve reflux symptoms:
- Melatonin 26
- L-tryptophan (in combination with melatonin) 27
- Sodium alginate 14
- Prokinetic herbs (herbs that strengthen GI motility) 14, 28
The Best LPR Diet Is Personalized
What and how you eat can make a huge difference when it comes to managing laryngopharyngeal reflux.
Certain kinds of foods have been shown to contribute to LPR development, trigger symptoms, or both. Dietary changes have been found to improve the condition.
Finding an ideal LPR diet plan for you involves removing common reflux triggers as well as identifying and eliminating your personal trigger foods. Paying attention to when you eat and supporting your gut with probiotics may also be helpful alongside your diet changes.
My book, Healthy Gut, Healthy You, goes into much more detail about how to improve your gut health and digestive wellness. For more personalized guidance, you can request an appointment at my functional healthcare center.Get Help
— Update: 13-03-2023 — cohaitungchi.com found an additional article Mayo Clinic Q and A: Lifestyle changes may ease laryngopharyngeal reflux from the website newsnetwork.mayoclinic.org for the keyword silent acid reflux diet.
DEAR MAYO CLINIC: My husband had a cough for months and eventually was diagnosed with laryngopharyngeal reflux. What is the best option for treatment? He is still constantly coughing and clearing his throat despite regularly taking omeprazole and antacids.
ANSWER: The medications you mention are standard treatment options often recommended for adults who have laryngopharyngeal reflux, or LPR. But, along with taking medications, if he hasn’t already done so, your husband also should consider making diet and lifestyle changes to ease his laryngopharyngeal reflux symptoms. Several complementary therapies may help, too.
Laryngopharyngeal reflux is a form of gastroesophageal reflux disease (GERD). Laryngopharyngeal reflux happens when stomach acid and other contents of the stomach flow all the way up the esophagus, into the back of the throat and, in some cases, into the back of the nasal passages. Frequent coughing and throat clearing are common symptoms. People with laryngopharyngeal reflux may feel as if they have something stuck in their throat. Laryngopharyngeal reflux can cause hoarseness and other voice problems, too.
Medications usually can reduce the symptoms of laryngopharyngeal reflux significantly. A class of drugs called proton pump inhibitors are typically the most effective. They work by decreasing the amount of acid the stomach produces. Omeprazole is a type of proton pump inhibitor.
Antacids and medications called histamine antagonists — which also decrease stomach acid — can be used to treat laryngopharyngeal reflux, as well. Medications that increase the movements or contractions of the stomach and bowels, sometimes called pro-motility drugs, may be recommended for people with laryngopharyngeal reflux.
Along with using medication, there are other steps your husband can take to help control laryngopharyngeal reflux. One of the most important is eating a diet that is low in acid. Research has shown that this type of diet often can reduce laryngopharyngeal reflux symptoms.
Examples of low-acid foods are melons, green leafy vegetables, celery and bananas. Foods that people with laryngopharyngeal reflux should avoid include spicy, fried and fatty foods; citrus fruits; tomatoes; chocolate; peppermint; cheese; and garlic. Foods that contain caffeine, carbonated beverages and alcohol also can worsen symptoms.
For people with laryngopharyngeal reflux, it helps to eat the largest meal of the day at midday or in the morning, rather than in the evening, and to avoid eating within three hours of bedtime. Don’t rush through meals. Take time to eat slowly, without distractions.
Other lifestyle changes that can make a difference for someone with laryngopharyngeal reflux include not smoking, maintaining a healthy weight, and reducing and managing stress in healthy ways.
Several complementary therapies also may be useful in managing laryngopharyngeal reflux. For example, some studies suggest that acupuncture — a therapy that involves inserting extremely thin needles through the skin at strategic points on the body — can reduce symptoms.
Taking a probiotic dietary supplement that contains good bacteria similar to bacteria already in your body may ease some symptoms, too. But they aren’t for everyone, and different supplements contain different types of probiotics. Before your husband takes a probiotic, he should ask his health care provider about the kind and amount that’s right for him.
Read more Eating More Fish Isn’t Hard, I Swear — Here’s How to Do It
Finally, voice therapy can be used to treat the effects of laryngopharyngeal reflux. Research has shown that people who take a proton pump inhibitor and participate in voice therapy show faster symptom improvement than people who only take medication.
Encourage your husband to talk to his health care provider about his persistent laryngopharyngeal reflux symptoms. They can discuss additional treatment options and lifestyle changes. In many cases, laryngopharyngeal reflux can be managed successfully. — Dr. Amy Rutt, Otorhinolaryngology, Mayo Clinic, Jacksonville, Florida
— Update: 14-03-2023 — cohaitungchi.com found an additional article The Best Diet If You Struggle with Silent Acid Reflux from the website www.nutribullet.com for the keyword silent acid reflux diet.
Acid reflux is one of the most common reasons why my patients visit me in my office in Michigan. Recent statistics from the American College of Gastroenterology say that 60 million Americans experience heartburn at least once a month, with 15 million having symptoms of acid reflux or GERD every single day. There’s a certain type of reflux that is referred to as “silent” reflux because those who have it don’t show the typical symptoms of acid reflux, such as heartburn.
Silent acid reflux, or laryngopharyngeal reflux (LPR), is a condition that happens when acid from the stomach travels up the esophagus all the way to the laryngopharynx in the throat. It is commonly seen in GERD patients but may occur on its own without GERD.
Symptoms of LPR include:
- Sensation of a lump in the throat
- Need to clear the throat frequently
- Mild hoarseness
- Chronic cough
- Difficulty swallowing
- Sore throat
- Red or swollen voice box
Who is most likely to develop silent reflux?
Anyone can develop silent reflux, including men, women, infants, and children. Some lifestyle factors may make adults more susceptible, including:
- Poor diet (lots of acidic and spicy foods, too much caffeine)
- Alcohol and tobacco abuse
In infants and children, LPR can develop due to the developmental immaturity of the esophagus.
The Best Diet to Help Alleviate Symptoms of LPR or Silent Reflux
Research has shown that diet plays an important role in managing silent reflux. A study published in the Journal of the American Medical Association Otolaryngology found that a Mediterranean diet may be as effective as proton pump inhibitors (PPIs) in treating symptoms of acid reflux.
I am not suggesting you forgo all medication and attempt to treat your symptoms with diet alone unless advised by your doctor. Drug-free treatment may not be suitable for everyone. I am saying this: food is medicine. And what you put into your body every day plays a massive role in the condition of your health.
What is a Mediterranean diet?
The Mediterranean Diet comes historically from the eating habits and lifestyle of those living in southern Italy, Greece, Turkey and Spain. The diet consists of lots of high-fiber fruits and vegetables, quality fats and proteins, and an occasional glass of wine. Due to its many proven health benefits, including reducing inflammation, supporting healthy weight, improving heart health, and reducing disease risk, the Mediterranean Diet is considered one of the healthiest cultural diets in the world.
Foods Included in the Mediterranean Diet
The most common, day-to-day foods of the Mediterranean diet include:
- Fresh fruits and vegetables (leafy greens, eggplant, cauliflower, artichokes, tomatoes)
- Olive oil
- Nuts and seeds (almonds, sesame seeds)
- Legumes and beans (lentils, chickpeas)
- Herbs and spices (oregano, fennel, rosemary, parsley)
- Whole grains
- Wild-caught fish/seafood
- Pasture-raised chicken and eggs
- Goat milk
- Fresh water
- Red wine
Some foods moderately consumed include:
- Red meat (once a week)
- Kefir and yogurt
How To Choose High-Quality Olive Oil
Much of the research surrounding the benefits of the Mediterranean diet focuses on the consumption of olive oil. Olives have been a staple item in the Mediterranean region for over 5000 years, and those living there consume olive oil as a part of nearly every meal. Not all olive oil is created equally, however, and many of the “olive oil” brands you see on store shelves are fake imitations or devoid of their original nutrients. Always pick olive oil that is cold-pressed and extra-virgin.
Partha’s Prescription for Silent Reflux
- Eat more fiber. Fill your diet with plenty of fresh fruits and vegetables. A 2004 study found that dietary fiber is protective against reflux. Fiber also helps to promote regularity of bowel movements and improves digestive health. Daily, women should aim to consume at least 25 grams of fiber and men, 38 grams.
- Eat small meals every three to four hours. Overeating can aggravate symptoms of reflux because it puts a lot of pressure on the stomach and can push acid up into the esophagus. This is why I recommend eating smaller meals several times a day instead of traditional large meals.
- Limit sugar intake. Most Americans are eating way too much sugar. This leads to weight gain and obesity which, in turn, increase the likelihood of developing silent reflux. The American Heart Association recommends women eat no more than 20 grams of sugar and men consume no more than 36 grams.
- Limit caffeine and spicy foods. Caffeine relaxes the esophagus, making it easier for acid to travel up from the stomach and cause reflux symptoms. Spicy foods tend to irritate the esophagus and have been found in many studies to exasperate heartburn.
If you’ve made changes in your diet and lifestyle but have yet to feel better, it may be time to consult with your doctor. Silent reflux can often be a symptom of a more serious condition like GERD. Working together with a healthcare professional will help you make the best decisions for your unique health needs.
Find this and other health-promoting articles by Dr. Partha Nandi on his website, Ask Dr. Nandi.