LPR: Causes, Symptoms and Treatment
LPR which stands for Laryngopharyngeal Reflux or as it’s sometimes known as silent reflux is a condition where acid comes up from the stomach and burns/damages the throat. There are a host of symptoms, but the main issues revolve around problems with the throat.
There are a selection of different things that can cause LPR. Also because of this there are a selection of ways to solve the problem depending on the root cause.
LPR Causes
#1 Weak Sphincters
Lower Esophageal Sphincter (LES)
The sphincter that most likely will be the one causing you the problem is called the Lower Esophageal Sphincter or LES for short. This sphincter is directly above the stomach and opens and closes as food passes through from the esophagus. The problem occurs when the LES is weak or relaxed when it should be closed and tight.
This causes the stomach acid to reflux up into the esophagus which then ends up reaching the throat where the main problems of LPR arise.
Unlike most muscles in the body the LES doesn’t get stronger with more usage but in fact gets weaker.
Things like overeating and eating shortly before bedtime put more pressure on the LES and this can cause the problem over years of constant overworking the LES.
How to Fix a Malfunctioning LES
Diet
The best way to treat a malfunctioning LES is by changing your diet. There are a host of foods which are known to make the LES weaker which in turn will make you reflux more not because of more acid but because of the LES being open when it shouldn’t be.
The common foods that you should be trying to avoid are drinks with caffeine particularly coffee and soft drinks, chocolate, fatty foods (fried foods, cream, ice cream, bacon etc). Coffee and chocolate both contain methylxanthine which makes muscles relax more and this in turn can affect the LES and lower the pressure in the stomach. Also foods that are high in fat have shown to take longer to digest and take longer for the stomach to empty. This means more acid in the stomach for longer which will make the LES work for longer and harder which we want to avoid. The LES is not like a traditional muscle that strengthens when it’s used more – it needs the time to be worked less in order to properly heal and return to its normal function.
Also avoiding foods and drinks that are highly acidic would be advised. Things you should avoid – alcohol, citrus fruits, tomatoes, mint and all carbonated drinks.
If you are prone to eating big meals this puts more pressure on the LES because the stomach becomes more full or overloaded and at some point, will struggle to keep the food and acid inside the stomach because of the stomach being too full.
So therefore, eating smaller sized meals with about the amount of food the size of your fist would be more appropriate. You can still eat as much as you normally would, but it is better to split amongst more smaller meals instead of few larger meals.
Surgery
The second option is surgery and should only be considered among people who have tried all other options. There are a selection of different options available but 3 of the more notable and successful options are called Nissen, Linx and Stretta.
Medication
Baclofen
Melatonin
Upper Esophageal Sphincter (UES)
The UES is the sphincter between the throat and the esophagus. When it comes to reflux it is the last barrier before the acid gets to the throat. 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.
Technically speaking if the UES doesn’t stop the acid then you will develop LPR symptoms. The LES and the esophagus are made to tolerate high levels of acid whereas the UES typically doesn’t fair as well when acid stomach comes its way.
How to Fix a Malfunctioning UES
The best way to help the UES is by following a lower acid diet, avoiding acidic foods like I mentioned in the diet section in the LES part above. When you avoid these foods, this will allow the UES to heal and recover and should in turn help it come back to its normal function.
Pyloric Sphincter
The final Sphincter is the Pyloric sphincter. It is the Sphincter between the stomach and the intestines. Once food has been digested it will pass through it into the intestines. When a Pyloric sphincter doesn’t function correctly bile which is usually found in the small intestine can end up passing up through the stomach and then giving reflux symptoms and LPR symptoms. This is called bile reflux.
It can also have the affect that if the Pyloric sphincter is stronger than the LES and the pressure is building in the stomach one sphincter has to give and that usually happens to be the LES – when that happens you get the reflux effect.
How to Fix a Malfunctioning Pyloric Sphincter
Typically, the same things that will benefit a LES will also benefit a Pyloric sphincter. Physicians and doctors will often prescribe a PPI and it can help though I would personally recommend following my diet advice the same as for the LES instead.
#2 Too Much Acid
For some people they may get some benefit from taking these tablets but often this effect will not last for long. For most people especially, people will LPR they often won’t get any benefit. The reason for this is because these tablets don’t tackle the problem directly. This doesn’t stop the LES from opening and you from refluxing. While the acidity in the stomach may be lower from taking these tablets it just isn’t targeting the main problem which is pepsin which I will cover in the following section about treating pepsin.
There have been studies done to test the effectiveness of PPI’s for treating LPR which ended up showing that PPI’s offer no benefit to someone with LPR.
Be wary of a doctor or physician that prescribes PPI’s for LPR
This is something I want to personally highlight because I myself took doctors advice for taking PPI’s for LPR. I took them for 2-3 years with little to no benefit. Almost all doctors and even so-called specialists in the gastro area all would prescribe PPIs, if that didn’t work which happened for me again and again they would try another variant or up the dosage.
The reason for me pointing this out is that most medical experts simply don’t know or have the knowledge about LPR and they will often treat it as if it where GERD. This treatment is completely wrong, and I would proceed with caution when taking advice from someone who prescribes them so readily to you.
Part of the problem with this is that LPR is a somewhat new problem that has only come around in recent years. The second problem being it is often overlooked and treated as if it where traditional heartburn or GERD as I mentioned.
Rebound effect of PPI’s
There is a good chance some of you are currently taking PPI’s with little to no success for LPR. While I would advise you to stop taking PPI’s you must taper of them slowly.
If you are currently taking them with no benefit I would advise to taper of them slowly. For example, I would take 2 20mg tablets a day for a total of 40mg per day. I would want to lower to 30mg per day 20mg in the morning and then 10mg in the evening both before meals. I would do that for maybe 1-2 weeks then continue to lower it to 10mg & 10mg per day and then finally 10mg per day. If you aren’t able to get tablets in a lower dose, I would recommend splitting the tablets yourself.
If you do plan on doing this I would highly recommend doing this alongside my treatment advice below in this guide.
#3 Treating Pepsin
Pepsin is one of the digestive enzymes that the stomach produces and is used primarily to help break down proteins. After research from some experts in the field it has shown that people with LPR have this pepsin present in the throat area whereas with a typical person this pepsin is not present. The clear problem with this is that pepsin is used to digest proteins so when it comes in contact with the throat it basically tries to digest it. This is where you will usually get the problematic symptoms from.
The thing with pepsin is that is only becomes activated when in contact with something acidic. This is because its meant to be in the stomach and when acid is produced to help with digestion it will become activated which is exactly the point of it being there.
Though with somewhat limited research it has been shown pepsin can lay dormant in cells for 1-2 days’ time so if you refluxed the day before then ate something that was acidic the acidity of the food merely passing over the pepsin that was in the throat before would reactivate it and give you your LPR symptoms even if you never refluxed.
How to Treat Pepsin Through Diet and Things to Avoid
Diet
The best way to treat pepsin is to simply lower the acid of the foods & drinks you consume. Foods that are lower in acidic level activate the pepsin less if not at all which then will lower and vastly help your symptoms. It’s clear that pepsin reactivates mostly from foods and drinks with a pH of 5 or less. 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. 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.
Some quick tips about food choice for this diet –
Drink only water ( most other drinks such as soft drinks and alcohol are highly acidic )
Eat a diet with as little processed food as possible
Avoid most fruits ( bananas and melon are an exception and can be eaten )
Avoid spicy food
Avoid most condiments (high in preservatives and things like vinegar which will irritate the throat further)
Avoid tomatoes, raw onions
Avoid fatty foods or foods deep fried
Avoid chocolate
Alkaline Water
Water that you usually drink would typically be around the pH of 7 or about neutral on the pH scale. Alkaline water is water with a pH of higher than 7. Water with a pH of 8 or above has been shown in studiesto deactivate pepsin, so when you drink it, it should help deactivate pepsin in the throat that it comes in contact with.
There are a few ways you can get alkaline water with a pH of 8 or higher. The best way is to get water that comes from the source and has the higher pH of 8 or more. Options like thesewould be the best and most natural choice.
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. In that way you will get the biggest benefit possible.
The 3rd option is to add baking soda to your water. You simply mix it up with your water to make it more alkaline. This is clearly the worst option because of the amount of baking soda you would be consuming but it should be okay for short term usage.
Using a digital one will give you a very accurate reading, so you know you are getting the right level that you want. This meter can also be useful for measuring the pH of other foods and liquids if you plan on following the diet of 5 pH or higher as you can then test the pH of things if you are unsure.
#4 Too Little Acid
The answer being that there is no evidence and research to support that low stomach acid causes LPR and from people’s experiences for the most part this seems to be the case mostly. Though there are a few rare exceptions where it has helped people through taking a supplement called betaine hydrochloric acid (HCL), this is the acid the stomach uses to break down food and when you take it you are basically supplementing the acid in your stomach.
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.
#5 Small Intestinal Bacterial Overgrowth (SIBO)
There is little to no research done to show if there is a direct correlation with LPR and SIBO, though from my own knowledge and research it’s unlikely this will be your main cause though there is definitely a chance it could be. If you find yourself burping a lot or have IBS alongside your LPR symptoms, then considering SIBO could be worth your while.
LPR Symptoms
Sore throat
Need to clear throat – if you feel the need to constantly clear the throat try to stop doing that, when you do it constantly throughout the day it can irritate the throat further, instead of clearing try to take a sip of water or these lozenges. Once you start to do it less often you will slowly stop doing it over time. It will help the throat heal faster along with my other treatment advice.
Excess mucus in throat – The excess mucus is often because of the throat trying to protect and heal itself and is totally natural. Try to sip water when needed or lozenges like these to keep the throat clear.
Chronic cough – Just like with the need to clear the throat you might find yourself coughing frequently, try to not cough as much as it can further irritate the throat from doing it frequently.
Lump in throat feeling
Hard to swallow
Sore to talk
Post nasal drip
Breathing problems / Sinus Congestion
Hoarseness
Dry throat (read advice below)
Advice for Throat Relief
As I have mentioned drinking water and taking these lozenges are good options for some relief. A couple more options I would recommend are teas, the 2 options that follow all the guidelines are chamomile tea and the other being marshmallow root tea.
LPR Treatment
When it comes to curing LPR naturally it definitely is possible for a lot of people and usually the natural path is the best and fastest option for healing. The first 2 recommendations are what I would advise you get started with as soon as possible. After the first 2 options I have listed a host of other things that can also help you even further!
Gaviscon Advance (UK version)
Gaviscon advance is a great thing that will definitely help reduce your LPR symptoms and while it won’t fix the root cause of the problem it will help give you relief while you work on solving the actual root cause. The second important part of my advice is to follow a diet alongside taking the Gaviscon advance, the diet would be aimed at tackling the root cause while Gaviscon will help your symptoms and should aid healing as well.
The important thing to note when buying Gaviscon Advance is that you buy the UK version. Unlike the US version the UK version has different ingredients and most importantly the has the ingredient (sodium) alginate. Alginate is something that is extracted from seaweed. The thing with alginate is that it produces a foam on top on your stomach contents which helps create a barrier like effect which helps prevent against reflux. This foam is also great for filtering things like pepsin and bile which I have talked about earlier in this article and are some of the main causes for LPR.
The best way to take Gaviscon Advance is 30 minutes after meals as this is when the stomach enzymes and digestion are most active. You can take it before bedtime as well if needed.
LPR Diet
Another essential thing I recommend for treating LPR is changing your diet. Firstly, I recommend avoiding a selection of foods and drinks to get started –
Drink only water (soda, alcohol & coffee can all make LPR worse)
Avoid all spicy foods
Avoid peppers, tomatoes, raw onions
Avoid fatty and deep-fried foods
Avoid processed foods as much as possible
Avoid citrus fruits (bananas and melon are allowed fruits)
Avoid chocolate
Avoid caffeine
General Tips to help LPR
Losing Weight
Someone who is overweight is more prone to LPR. 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.
Using a Wedge Pillow When Sleeping
Lowering Stress
Doing meditation daily could help with this, also drinking chamomile tea which helps with relaxation could be a good idea.
The best way to help with worry and general stress is to have a overall mindset change. For me personally after reading this book called – “ How to Stop Worrying and Start Living ”, it really helped changed my mindset and definitely helped with my nervous tendencies and overall mentality.