Acid Reflux and Sinus Congestion – Is There Any Relation?

Acid Reflux and Sinus Congestion

So, is there any relation between acid reflux and sinus congestion? The answer is a definite yes.

Sinus congestion is often caused by acid and pepsin getting into the sinuses which leads to inflammation and irritation which makes the sinuses feel congested and generally irritated.

Now I will delve deeper into how it all happens and what you can do it help prevent it from happening.

Can Acid Reflux Cause Sinus Problems?

Of course, it is possible acid can reflux up until the point where it can affect your sinuses and even cause nasal congestion. Not only can it block your sinuses, but it can also affect your breathing in some cases. As you would imagine the acid causes direct inflammation which can make the sinuses more swollen.

Also, along with the acid there is a thing called pepsin which refluxes up. Pepsin is a digestive enzyme that is produced in the stomach and is used to break down proteins in the stomach. When pepsin enters the throat and the airways it will only further irritate and inflame them.

While anyone with acid reflux can be affected it is more prominent in people who suffer from LPR (silent reflux). This is because for someone with LPR it is more typical for the acid to reflux up into the throat where it can start to reach your sinuses. Whereas for someone with GERD or just minor acid reflux it is more uncommon for acid to reflux further up the esophagus and start to affect your sinuses/breathing though it is still possible.

Understanding Pepsin and its Important Role in Sinus Congestion

Before I mentioned about pepsin and how it really causes the problems with our sinuses. I want to delve into a bit more detail about it here.

If you didn’t know already pepsin is an enzyme that is produced in the stomach. As I mentioned before pepsin is used to break down proteins in the stomach. When someone has gaseous reflux, which is more typical for someone with LPR the acid from the stomach and the pepsin come up into the throat and then from there into the sinuses. This often leads to sinus inflammation or other symptoms like a dry or irritated nose, sometimes the nose may even bleed.

If you didn’t know how pepsin works it basically becomes more active when the pH or acidity is more acidic, as can be seen in the chart below. When the pepsin gets into the sinuses even if you don’t have acid reflux the pepsin can lay dormant which can be reactivated by coming in contact with something acidic.

pepsin - pH levels

Also, when something alkaline with a pH above 8 comes into contact with it, it will neutralize it.

This is important to understand, I will cover exactly why in the section below oh how to stop acid reflux inflaming the sinuses.

How to Stop Acid Reflux from Inflaming the Sinuses

So, there are multiple ways to help ease and prevent acid reflux from irritating or inflaming the sinuses. I will cover each of the important elements below.

Diet

Probably the most important thing you should be doing is looking at your diet. You really want to follow a natural low acid diet. This should help stop or lessen the acid reflux from happening in the first place.

Firstly, check out my LPR Diet article where I cover the first steps that are important for stopping acid reflux such as eliminating triggers foods. If you want a clear and detailed diet plan tailored for people with acid reflux and silent reflux, I suggest you take a look at my Wipeout Diet Plan.

Lifestyle Changes

On top of the diet, I also highly recommend a few lifestyle changes. The most prominent ones being not eating big portions of food, not eating soon before bedtime and losing weight if you are overweight particularly around the stomach area.

To explain why – when you eat big portions of food this puts more pressure on the LES valve above the stomach and the stomach too which increases chance of valve opening and therefore acid reflux.

Not eating soon before bedtime is recommended too. This is because you don’t have the advantage of gravity keeping the food down in your stomach so there is more pressure on the LES if you eat and then lay down soon after. I would suggest at least waiting 3 hours before laying down after eating, or ideally 4 hours.

Finally, the final point of being overweight around the stomach. This works on the same principle as other points that when you have more weight around the stomach this puts more pressure on the LES valve which makes it more likely to open which will increase the chance of acid reflux.

Nasal Spray

The first recommendations where around stopping or targeting the root cause of the problem. Here with the nasal spray, we are not treating the root cause though we are helping ease the sinuses quickly which can give relief within 1-3 days’ time.

Keep in mind this is not any regular nasal spray and I do not recommend you use a store nasal spray for this. You must make your own nasal spray and I will explain how.

Before I explain how I want to come back to the pepsin which I talked about before. When pepsin comes into contact with an alkaline substance it becomes neutralized. Also, any acidity gets lowered when mixing with an alkaline substance which is an added benefit.

Based on this principle of how pepsin and acid work spraying an alkaline mixture into the nose can help stop or at least help sinus congestions and problems caused by acid reflux.

How we make this mixture is we get water, preferably mineral water with a higher pH ideally 8 pH or more (you can usually check it on the bottle). Then mix it with sodium bicarbonate or baking soda – this baking soda here for example. This will make a highly alkaline mixture that will neutralize and ease symptoms as I explained before.

The exact measurements are 250ml of water mixed with 7.5g (1.5 teaspoons) of baking soda based on Dr. Mark Noars Recommendation.

Once you have mixed them well add to a nasal spray bottle like these ones here.

Then simply spray one spray into the nose as show in this video. Inhaling deeply as you spray.

You can do this after eat meals and at bedtime. I found the pattern that worked best for me is 3 times per day, once after breakfast, once after the middle meal of the day and once before bedtime.

How to Know if it’s Acid Reflux or Asthma?

Some people who may be suffering from breathing problems may have difficulty understanding if their problem is related to acid reflux or instead asthma – luckily, there is a reliable way to know the difference.

Someone who has asthma will have difficulty exhaling (breathing out) whereas someone who is being affected by acid reflux will have trouble inhaling (breathing in). This is the clear distinction between the 2 that is important to know.

It’s also worth mentioning that there is a relation between acid reflux and sinusitis. If you didn’t know sinusitis is a problem where the lining of the sinuses become inflamed.

One of the more common causes is due to viral infections but in our case the pepsin is causing the damage and inflammation. The same thing can also be said for postnasal drip and acid reflux. It’s a cause that sometimes isn’t even considered.

Frequently Asked Questions (FAQs)

Can Acid Reflux Cause Mucus?

Yes, when you reflux acid up into your throat the body’s measure to protect it is to create more mucus. This can sometimes lead to excess mucus or even phlegm that’s stuck in the throat.

Can a Virus Cause Acid Reflux?

Anything is possible though this wouldn’t typically be a common cause.

Can a Cold Make Acid Reflux Worse?

Yes, possibly a cold could make it worse. This could be because of the cough exerting more pressure on the stomach area and chest and it can even aggravate the chest muscles which is an area that can be affected with heartburn, indigestion etc.

What’s the Relationship Between GERD and Sinusitis?

Acid reflux can cause sinus issues so there is a definite possibility that GERD is causing your sinusitis. In fact the more appropriate term is Laryngopharyngeal Reflux which is a different form of acid reflux which primarily affects around the throat area and a typical symptom with it is sinus and breathing issues.

Can Omeprazole Cause Sinus Problems?

No omeprazole shouldn’t cause sinus problems. Though acid reflux can cause it. Importantly this kind of acid reflux called – Laryngopharyngeal Reflux (silent reflux).


34 thoughts on “Acid Reflux and Sinus Congestion – Is There Any Relation?”

  1. Avatar for D. Mattox

    Can LPR give you with a sinus headache, occasional ear ache, and resulting balance problems? Increasingly worse over the past 2-3 years. Not allergies. Thank you.

    1. Avatar for David Gray

      I think it is possible. At least the part with ear problems and earache. I am not certain it could affect your balance though. Hope this helps.

  2. Avatar for Wadebrown

    I’ve been having problems for years with coughing, post nasal issues. Nasal swelling,coughing clearing my throat with minimal phlegm expelled. I have a lot of issues when I go outside and it’s 35 degrees or below, my lungs start hurting right away and I start coughing. Could be 2 issues.
    Had breathing tests done, allergy tests done had a scope ran through my sinuses every thing is fine they say.
    They gave me fluaxetine nasal spray, azelatine nasal spray, albuteral rescue inhaler and omeprazole 60 mg for acid reflux.
    I still have issues everyday. When I sit in my chair, or going to bed laying down my head seems to plug up(sinus swelling). What do you think I should do? The doctors are giving me the runaround.
    I can sleep at night. I take sleeping pills and still wake myself in the middle of the night, like right now it’s 4 a.m., I’ve been up since 11:30.
    Thanks for any advice.
    Wade

    1. Avatar for David Gray

      Hey Wade,
      Best advice I can give you is diet changes like the diet I created on my blog. Also the best medication is Gaviscon Advance (UK version) for LPR, PPIs usually don’t help people with LPR. Ideally slowly tapering off them would be best.

  3. Avatar for cmanleylyons@gmail.com

    I have been suffering with reflux for a number of weeks now but also have bad sinus problems. It is most uncomfortable as I feel sometimes my airways are not clear and i have also felt I am breathless. Find it difficult to drive when I feel this way or go about my everyday chores normally. You article has really helped me to understand more thank you

  4. Avatar for Arnel Soledad

    Hi David,

    I tried looking for the Gaviscon Advance in amazom.com but it says they are unavailable. Do you know other website where I can order online. I’m from Canada, I tried first looking at amazon.ca but they don’t have it. I had acid reflux for many years now and about 2 months ago Im having problems with my sinus. I’m suspecting it has to do with acid reflux.

  5. Avatar for Amandeep

    Hello I am suffering from blocked nose sometime in a day and reflux too from many days please suggest me what i need to do for that so that i can feel better please reply me as soon as possible you can

    1. Avatar for David Gray

      Try to eliminate the common trigger foods for acid reflux and follow a low acid diet like my wipeout reflux diet plan. On top of that consider to take gaviscon advance or reflux gourmet after meals and before bedtime. For the sinus issues try to make an alkaline spray with alkaline water and baking soda and spray into the nose after meals and before bedtime (before taking the gaviscon/reflux gourmet) as explained in this video – https://youtu.be/2H_VvFO3Fp8

  6. Avatar for Laura Davis

    Hi. My primary care dr said I had a bad sinus infection. However after 2 months nothing worked so I went to a ent dr he said I had inflammation in nose and throat and said it was reflux and gave me meds. However I have thick mucus in my throat that I cannot clear out and I feel like I’m choking. Any suggestions? I drink warm water,

    1. Avatar for David Gray

      Hi Laura,
      I would suggest to firstly eliminate the common acid reflux trigger foods, if that doesn’t work you may need a low acid diet like my wipeout diet plan. On top of that try meds like Gaviscon Advance (UK) or reflux gourmet (US) after meals and before bedtime. As you have sinus issues I also suggest to make an alkaline spray using baking soda and alkaline water and to spray into you nose before taking the gaviscon/reflux gourmet as explained in this video – https://youtu.be/2H_VvFO3Fp8

  7. Avatar for Ann

    Hi

    I have Gastritis and Gerd, but I also have post nasal drip that feels like it goes down to my stomach. Feels awful! I know I have lpr for sure! Any advice to stop post nasal drip in stomach? My nose is clear!

  8. Avatar for Judy

    I have suffered from reflux for two years now .For the last four month’s lm having sore throat and mucus on my throat trying to clear my throat all the time especially when l start to eat. What can l do to stop this? I’m always worried it’s the covid sympoms .l have no cough or fever.Help.

  9. Avatar for Selina

    Hello. I went to 3 ENT doctors. All of them said I have no problems with my sinuses (they even think I have very HEALTHY nasal mucosa…. -__-). And Yes, one of the doctors said I have GERD, but I have no feeling. I think it is LPR like what you mention.

    Well… My question is:
    I feel serious swelling feeling in my left deep sinuses (only left). Also I can not feel nasal (healthy) mucus production. Everytime when I drink vinegar, lemon juice, or any sour taste drinks, I felt my left sinuses swelling “immediately” (within 3 seconds!).
    When I take anything can stimulate Sympathetic nerve, I feel my left sinuses swelling and dry( no mucus).

    BUT, I also have dry eyes and ANA test is in borderline. My doctor thought I might have Sjogren’s syndrome. Sjogren’s syndrome patients usually have dry eyes, dry sinuses, dry throat,.. etc.

    Do you think my left sinuses is just resulted from LPR? Could LPR cause swelling feeling to only ONE SIDE sinuses? And would LPR cause dry sinuses but with HEALTHY nasal mucosa (It is so conflict…..)?

    Ps. Sorry, I have so much questions. Hope it would not bother you too much.
    Thank you for those posts. It lets me see the hope.

    1. Avatar for David Gray

      Hi Selina,
      Yes most likely the dry sinuses is from LPR, I and many others with LPR have that same problem as well, due to the pepsin getting into the sinuses and causing inflammation.

  10. Avatar for Selina

    By the way, I eat very clean diet for years (because I have a very weak body since childhood) . No caffeine, no chocolate, no fried, no dairy, no gluten, no add-sugar, no red meat. I eat low carbs medium fat, whole food, and only eat clean fish like wild alaskan salmon.

    Even I eat so healthy for years, I still have this strange issue and I can not find the root cause. I am so frustrated…

    1. Avatar for David Gray

      Sometimes 1 or 2 small tweaks or adjustments to a diet can make all the difference. It sounds like you are doing a good job on the whole, perhaps there are a couple small things that could make the difference for you.

  11. Avatar for Selina

    Sorry, one more question..

    Do you think LPR would cause a low grade fever? Since the left side of my sinus was swollen, I had a low fever every night (my low fever is not all day, only night. It lasts 6-8 hours).

    Thank you for everything you have done. 🙂

    1. Avatar for David Gray

      I don’t think the LPR would cause a fever no, I haven’t heard of that really. Though I have heard instances of people with stomach problems having fever or cold sweats etc, though in them cases the reflux was much worse. I had that myself but fortunately only for a short period.

  12. Avatar for See

    I am 10 days into the diet. I was recently given sucralfate (and PPI for 5 wks now) when I complained of hoarseness and very sore throat, until I can get endo/colonoscopy. I have been spraying my nose and throat as Dr Noar described – but now up to 10x a day. It is not helping much. Very short term. I’m not sure if I should use more. I am gargling with baking soda and alk water when needed. Back of my throat and tongue are sore. This is a battle. I see ENT next week. I need to lose weight but had some out-of-the-ordinary late night snacks when this occurred. I am down 10 lbs already. Thanks for all your guidance. I got much more from you than my GP and GI PA.

    1. Avatar for David Gray

      Happy to have helped. It seems you are on the right track in terms of diet and treating the problem which is great. Yeah ideally I wouldn’t take the sucralfate or the PPIs. Instead I would choose gaviscon advance because of the barrier effect it creates on top of the stomach.

      If you feel you are overweight particularly around the stomach area this could potentially be related to the acid reflux so it can only help loosing some weight around this area.

      1. Avatar for See

        So, I had two days of halving my PPI, seems to have flared up again, so had to go back to it 40. I’m at 14 days of the diet, no cheating at all. My throat is burning. I had some chamomile – but it’s so short lived. What is there that I can do to best relieve my throat? I have to see ENT tomorrow. And three more weeks til endo/colon-oscopy. This is a living nightmare.

        1. Avatar for David Gray

          The diet is good and you can and should taper off the PPIs though as I mentioned in this article – getting off PPIs, you should do it slowly over a periods of weeks/months. Doing the diet alongside and taking something like gavsicon advance(uk) after meals and at bedtime can aid the transition.

  13. Avatar for Celia Hulton

    Hi David.
    Just got your wipeout diet and am on the second day!
    I have so many of the same symptoms in the emails above. Sleeping is the hardest thing as my nose is SO plugged up. I am ordering a wedge pillow as you suggest. This is a living nightmare and I do hope this can help.
    Is corn ok to eat in the first few weeks? I see you haven’t listed it.
    Thank you so much.

    1. Avatar for David Gray

      Hi Celia,
      Thank you! Definitely I’m quite sure this should help you.
      I personally choose to omit corn because it seems to be a trigger for myself and multiple people with acid reflux. Though some people have no downside while taking it. I would say if you want to take it, keep it in moderation at least initially and monitor if it’s worsening your symptoms.

  14. Avatar for Lucas

    Hi David,

    Thanks for this post on sinus congestion due to LPR, I have this exact problem! I get congestion only on my right side after every meal.

    I tried the nasal spray you suggested to deactivate the pepsin but it seems to be causing the congestion almost right away… I used tap water thinking that the baking soda should make it more alkaline. Could this be why? Thanks for everything!

    1. Avatar for David Gray

      Hi Lucas,
      Yeah the tap water could be like a 6 pH in theory and then you add the baking soda and it gets it to a 7.5 pH but we need the solution to be at least over 8 to be effective. I think it’s better to use a bottled water that is alkaline ideally. Ideally over a pH of 8, if you can’t find one over 7 should be workable. Then you add the baking soda to it.

      1. Avatar for Lucas

        I’ll give that a try, thanks! I used to have pretty bad PND but that’s almost completely gone now that I’m eating dinner 3-4h before bed. The sinus inflammation is still around though and hard to solve. Would eliminating acidic foods make a big difference? I tried such a diet for a few weeks but it wasn’t sustainable for me. Also, would the diet be a long-term fix? Wouldn’t the symptoms come back as soon as I reintroduce the acidic foods? Thanks David!

        1. Avatar for David Gray

          Yes eliminating acidic foods would make a difference. Diet for some can allow the body to heal then can return to the normal diet afterwards whereas other people may need to sustain the diet to keep symptoms away. Point being that it’s different for each person.

          1. Avatar for Lucas

            Hey David! During most meals, I consistently get congestion (sinus inflammation, no mucus) about halfway through the meal (usually only on the right side). How does this happen? I understand that acid can reactivate pepsin, but how does it get all the way into my sinuses while I’m eating?

          2. Avatar for David Gray

            Hi Lucas, it was likely there from previous times that you eat. Where you had refluxed before and the pepsin has got into the sinuses and then may lay dormant or be active in your sinuses. Eating likely just reactivates it causing your symptoms.

            It likely got there in the first place from gaseous reflux. That causes to come all the way to the the throat and even the sinuses for certain people. Have you tried the alkaline spray into the nose, this would likely help alleviate this at least somewhat.

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