LPR: Causes, Symptoms and Treatment

the complete guide to lpr

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 and larynx area. There are a host of symptoms, but the main issues revolve around problems with the throat, but issues can arise with the sinuses, ears and other digestive issues too.

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 acid reflux symptoms.

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. Though it tends to be some are much more common than others.

Doctors and physicians alike will often assume reflux and prescribe anti-acid tablets like PPI’s (proton pump inhibitors). This can help certain people and for others may not help at all and in fact hinder. Below I am going to cover each of the different options that can cause LPR with advice on how to tackle each of the problems along with silent reflux treatment advice and help to diagnose LPR with all the LPR symptoms explained.

LPR Causes

lpr causes

#1 Weak Sphincters

The number one cause of LPR is because of a weak or malfunctioning sphincter. There are a few sphincters that can have an effect, I cover each of them below.

Lower Esophageal Sphincter (LES)

stomach diagram

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. As you know with most muscles if you overuse them they can get sore and stop working properly – this is basically what can happen to an overworked LES. A LES that is overworked often means a LES than needs to relax more because of this overworking and therefore means more reflux and LPR symptoms. This is because the LES is not creating a barrier against reflux as it should.

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.

Keep in mind that the LES that is malfunctioning may not always be directly caused by the LES but another reason. It could be caused by other things that put more pressure on the stomach. Whether that is a condition or a habit we will cover them below.

How to Fix a Malfunctioning LES


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 worse, 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 minimize. 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. For more information on the LES – stomach sphincters important role in acid reflux.

Also avoiding foods and drinks that are highly acidic would be advised. Most common trigger food/drinks include – 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. It can also have the effect of tiring the muscles after years of eating big meals for example as I mentioned before.

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.


Another 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. I will cover each of them briefly below.

How the Linx surgery works is basically they place a magnetic band around the LES area of the stomach. This magnet goes around the LES and tightens the LES to prevent the acid and gas from refluxing back up into the esophagus. When you swallow food the magnet opens and it allows the food to pass through and once the food passes into the stomach it will retract which will help keep the LES tighter and prevent any reflux. The upside of this procedure is that it is easy to remove if any problems arise or if you don’t get the benefits you intended.

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. The clear downside is this is the most permanent of the 3 options.

Finally, the last option is called Stretta. How it works is the Stretta system delivers radiofrequency energy at the LES. It is meant to remodel and improve the muscle tissue. The muscle around the LES area or just above should be thicker which will mean increased barrier against reflux. This therapy is minimally invasive, and you should be able to continue back to normal the following day. For more information on Stretta – Stretta and it’s effectiveness for treating LPR.

For complete information on all surgery options check here – LPR Surgery.



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. Though it is worth mentioning that there are a host of side effects such as drowsiness, mental moods, hallucinations just to name a few. Check out this study about it’s benefits here.


Most people know about melatonin for its use to help with sleep. 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. It was shown in the people that did the study had lesser heart burn, lesser epigastric pain and importantly more pressure in the LES.

So, it shows the it can directly help with LES pressure as that appears to be a common reason the reflux incidents with patients where much reduced after taking melatonin and it definitely makes it something worth considering. I talk about this further in my Melatonin for Acid Reflux article.

Upper Esophageal Sphincter (UES)

throat diagram

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.

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. Therefore, there is little to no research on the UES in regard to reflux even though it may play a very important role with LPR. The same applies to LPR as there isn’t much research on it when compared with GERD where there are countless studies.

Pyloric Sphincter

stomach close up diagram

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.

There hasn’t been that much research on the Pyloric sphincter and thus we will still need more knowledge and information to be able to draw a more accurate conclusion. Though as I have mentioned following a low acid diet will often help symptoms for both.

#2 Too Much Acid

If you have went to your doctor or physician about your LPR. You will have likely been prescribed PPIs (proton pump inhibiters) or H2 Blockers. A few which I have listed below. Both of which are used to lower the amount of acid production in the stomach with PPI’s being the most potent acid blocker.






H2 Blockers






These tablets are used to lower the acidity in the stomach. 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. Check out the study here.

*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. I am sure plenty of you have a similar experience when it comes to being prescribed PPI’s and you can relate to my story.

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. I myself learned the hard way going from taking 40mg per day to 0mg which gave me tremendous reflux, so much so I ended in the emergency room a couple of times.

This happened because of a rebound like effect. 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%. They will then end up thinking “I need these tablets to control my reflux” – but in fact this is simply the rebound effect.

There have been studies done to show this rebound effect from people who are healthy and don’t even have any reflux problems – once these healthy people stop these PPI tablets they end up with the reflux symptoms that they never had before! Here is the study.

If you are currently taking PPI’s with no benefit I would advise to taper off 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.

The PPI’s usually have some small balls inside each tablet, so you can roughly split it yourself if needed. For me it took me about 1 month to taper my dose from 40mg to 0mg. Please remember when you lower the dose you may get a slight increase in reflux, but this will only be short term. Lower the dose once you feel settled at the current dose – the longer you have been taking PPIs and the higher the dose, the longer you may need to taper off them, but I would suggest 4-8 weeks’ time.

If you do plan on doing this I would highly recommend doing this alongside my treatment advice below in this guide. For more detailed information check my article – Acid Rebound and Getting Off PPIs.

#3 Treating Pepsin

Pepsin is the main problem that is causing most if not all of your LPR symptoms. Not the acidity like a lot of doctors believe. Therefore treating or stopping pepsin plays is essential if you want to stop your LPR symptoms

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 tissues it basically tries to digest it. This is where you will usually get the problematic symptoms from.

The thing with pepsin is that it 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.

When it is in contact with something of a pH of 6 of above it will start to become inactivated and will stop its function and therefore in an LPR sufferers case will stop/help the symptoms. On a pH scale 7 is neutral with everything below being acidic and everything above being alkaline, the lower the more acidic and the higher the more alkaline.

At a pH of 6 is when the pepsin starts to become active though its activity is still really low at about 10% and shouldn’t bother you much if at all. At about a pH of 5 is when it really starts to become more active to the point you don’t want – it’s about 40% activated at pH 5 and progressively gets more active as things get more acidic. Check out the graph below for reference.

pepsin activity diagram

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 


The best way to treat pepsin is to simply lower the acidity 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 benefit if you follow this diet.

There have been a couple of books that directly follow this principle of simply following a diet with foods and drinks with a 5 pH or higher. Though in my experience and research those diets have had some mistakes and important things that they didn’t cover. This is why I personally created the Wipeout Diet to give people all the important information so they can stop their symptoms as fast and effectively as possible.

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 acidic 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 in glass

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 studies to deactivate pepsin, so when you drink it, it should help deactivate pepsin in the throat that it comes in contact with.

This means when you drink alkaline water it will help deactivate pepsin in the throat and digestive tract which should also help lower or stop any symptoms you may be experiencing.

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 these would 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 2nd option is adding drops to your own water to make it more alkaline. Drops like these ones can be added to your water to make it more alkaline.

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 (under 1 week). Check out my article on how baking soda works for helping acid reflux and how to make the mixture yourself.

A final thing I know you are thinking is how to measure the pH of your water to know you get it to the right level. 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.

I would instead recommend getting a digital pH meter like this one. 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. For more information on alkaline water check out my article – Alkaline Water for LPR.

#4 Too Little Acid

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. As someone gets older the body produces less and less acid. This is part of the reason it is said people some develop acid reflux when they get older. This is the idea of author Jonathan Wright who wrote a book directly about that topic called – “Why Stomach Acid is Good for You”. In his book he talks about why you need high acid in the stomach and why you should avoid PPI’s at all costs.

The question that is relevant to us is can this affect people with LPR? 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.

There is a test called the Heidelberg stomach acid test that can be done to measure the acid level in your stomach to see if you are stomach acid level isn’t acidic enough and if you should consider taking this supplement. For this test you swallow a small tablet, and it will measure the acidity level in your stomach and it will pass through. This way you would know more accurately if your stomach acid level is too low and should consider takin the betaine HCL supplement.

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)

When food enters your intestines, this food starts to ferment. Usually when someone has SIBO that means they have too much gas that is being produced. This gas can lead to pressure build and the gas sometimes can end up passing back up through the stomach giving you reflux and gas. The problem is this gas can contain the pepsin that we mentioned earlier, and this can give you the LPR symptoms.

There hasn’t been much if any research done on SIBO and if it could effect LPR but there is some interesting findings and correlations. For example after speaking with one of the leading experts in LPR he told me that around 1/3rd (33%) of people with LPR are positive for SIBO. He also told me that SIBO can cause or at least contribute to causing of the LPR symptoms.

Because I had a lot of gas and burping I decided to test myself for SIBO by doing a hydrogen (lactulose) breath test which can be quite easily done at home and then sent back to the lab for results. My own result came back positive for hydrogen SIBO.

I wanted to stop and help the SIBO and see if it would help my LPR symtpoms. I followed the recommended course of antibiotics called rifaximin. Along with that anti-biotics course I started to follow a low FODMAP diet which can been shown to help stop and lessen SIBO symptoms.

After the course of antibiotics and while following the diet I definitely noticed a good improvement in my LPR symptoms. And noticeably 50% less burping which proved lessening the SIBO had helped.

Therefore I highly recommend if you find yourself burping a lot or have IBS symptoms or gut issues alongside your LPR symptoms, then checking if you have SIBO is highly recommended. Of course for some people SIBO might only be part of the problem but if it helps symptoms then it’s definitely worth it. If you want advice on the low FODMAP diet I’d recommend this one from Monash University.

Keep in mind people who have been taking PPIs are much more likely to have SIBO because PPI’s cause or increase the chance of SIBO as been backed up by medical studies. Therefore sometimes stopping PPIs can also have a beneficial effect from that point of view too.

LPR Symptoms

lpr symptoms

Sore throat – this is probably the most general and common symptom of the bunch, and generally speaking what most people with LPR will have.

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. 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 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. Keeping the throat moist with water/tea(read advice).

Lump in throat feeling – Try not to be concerned with this feeling. It is almost never an actual lump but some irritation caused by the pepsin entering the throat.

Hard to swallow

Sore to talk

Post nasal drip

Breathing problems / Sinus Congestion – Believe it or not the pepsin can enter the sinuses and cause irritation, inflammation or dryness. Which may make your sinuses become more congested or blocked. For more information on blocked sinuses and advice check our article – Acid Reflux and Sinus Congestion.


Dry throat (read advice below)

Ear pain – pepsin and acid can cause irritation in your ears. The ears are connected to the throat via a tube called the eustachian tube. This can inflame the tube and cause ear problems and pain. Such as ear infections or ear dryness etc. If your ears are dry applying some olive oil 2-3 times per week is recommended. For more information on ear problems correlating to acid reflux check our article – Acid Reflux and Ear Pain.

Dry lips – Basically when the pepsin gets into the mouth it can also get onto and dry our the lips and cause irritation. Try not to lick your lips as this will make it worse. Instead apply some regular vaseline 2 times per day to help protect them.


Check out my article on LPR Symptoms, for detailed information on each of the symptoms

Advice for Throat Relief

As I have mentioned drinking water and in particular alkaline water is best. 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.

Chamomile tea will soothe the throat thanks to having anti-inflammatory properties. 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. For more remedies check out my article on natural remedies for LPR.

Also sometimes eating something cooling is a good idea. For example foods like celery, cucumber and watermelon offer a cooling effect to the throat and they won’t irritate or worsen acid reflux symptoms.

If you think you are refluxing it’s also a good idea to take something like Gaviscon advance which provides a barrier like effect to protect the throat which we will cover more below.

LPR Treatment

lpr treatment

As I mentioned in the “too much acid” section above LPR is most commonly treated with PPI’s which have been shown to NOT help with LPR thanks to studies that have been done, read more about PPI’s etc. in the section above as mentioned. For more information on PPI’s ineffectiveness and effective check out our silent reflux treatment article.

Luckily for us there are other options out there which can be used to treat LPR and actually give you relief which are below. 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

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 low acid 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.

There was a study done to test the effectiveness of Gaviscon Advance when treating LPR. 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.

The best way to take Gaviscon Advance is 15-30 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 especially if you think you have nighttime reflux.

To purchase the UK version if you are in the US is quite simple, it is available on Amazon here.

An alternative to Gaviscon advance that has a similar ingredients and effects is Reflux Gourmet and is usually more accessible in the USA. You can buy it here.

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 acidic fruits (bananas and melon are allowed fruits)
  • Avoid chocolate
  • Avoid caffeine

The type of diet I recommend is avoiding foods with a pH of 5 or below. As I mentioned in the section above about pepsin, it becomes reactivated more at pH 5 and below. So, if you avoid eating foods and drinks with a pH of 5 or below you aren’t reactivating the pepsin in your throat and thus should directly help with your symptoms and healing process.

For more advice and tips check out my LPR Diet article as well as my article on the best food choices to calm LPR symptoms. I also have an article on What Can You Drink When You Have Acid Reflux.

For a complete diet plan that is tailored to LPR check out my Wipeout Diet Plan here.

Also if you want tailored advice and guidance on how to treat your LPR consider a private consultation here.

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.

Use a Wedge Pillow When Sleeping

When you are sleeping you are more prone to reflux and LPR because you don’t have the advantage of gravity helping keep the acid in the stomach. Using a wedge pillow is the best way to elevate your head when sleeping and it can help with nighttime reflux. I would recommend this wedge pillow. Also worth reading this article – advice on what to do to help prevent acid reflux at nighttime.

Lowering Stress

Someone who has lots of stress/anxiety in their life is more prone to have reflux symptoms. If you find yourself stressed or anxious often this could be making your LPR worse or even bringing it on in the first place. Doing meditation daily has been proven to help with this. Also drinking chamomile tea which helps with relaxation.

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. If you are someone who is often worried or stressed etc. I would recommend giving this book a read it could not only help your LPR but also your whole body and mindset.

For more information on dealing with stress and anxiety and its link to LPR check out my article on LPR and Anxiety.

Laryngopharyngeal Reflux – Conclusion

I hope this guide has offered you the insight and guidance you need to get started with properly treating and addressing your LPR. If you have any questions or concerns, please feel free to leave a comment below or contact me using the contact page. Best of luck on your healing journey and remember to stay positive!

Some more additional resources –

Acid Reflux Sore Throat Healing Time

GERD vs LPR – The differences between the 2

154 thoughts on “LPR: Causes, Symptoms and Treatment”

      1. Hi David,

        Great advice and knowledge around this subject. Much appreciated for sharing.

        Will you ever be able to go back to normal after LPR with food and alcohol?

      1. Thanks for the great article David. I went to the doctors because I was experiencing burning mouth symptoms. Somehow she figured I was dealing with intestinal issues and it turned out to be gall bladder issues. Specifically, roaming sludge (cholesterol crystals). I’m experienced at natural healing and healed myself within weeks of that. (Numbers went back to normal and all discomforts went away.) And have been well for months. (But then a chronic cough that I thought was allergies has led me to realize that I most likely have LPR.) But of the 3 doctors that I saw for my gall bladder issue, none could make a connection between the gall bladder and burning mouth syndrome. In fact, most pretty much ignored it even though I mentioned it in detail each time I met them. But then, once I healed myself, such symptoms haven’t returned. So I’m also sure there was a connection. But it’s disappointing that no one thought it relevant.

        1. Hi Irene,
          Thank you I am glad you found it helpful. Yes unfortunately it seems like LPR isn’t something a lot of doctors are well informed on so perhaps that’s why they didn’t see the connection. Fortunately you did your own research and didn’t leave it solely up to them.

        2. How did you heal your self? I’ve been suffering for a year with no prevail.. I’ve tried everything under the sun and nothing is working. I have the constant cough, burning throat I’ve been diagnosed with lot. I can not tolerate ppis. I do smoke, I know that is a factor and I have bad anxiety because im so frustrated that I can’t stop these symptoms. Any information would be greatly appreciated. Thank you

          1. Diet is the most important one I would say myself. I would also suggest trying to stop smoking, that will likely be making it all worse.

        3. Hello Irene, I couldn’t help but notice your remark especially on natural healing. What and how does it work as I am interested in applying it to my daily lifestyle. Thanks

  1. Thank you so much for sharing your journey. Today is my fist day of tapering off Prilosec & I happened to find your article, I immediately purchased the Gaviscon Advance (UK) from Amazon. I had the scope done from my ENT & he told me my LPR has burned my vocal cords. 🙁

  2. Wow, this is such a thorough description of LPR and measures to resolve it. You never think about LPR until it rears it’s ugly head again and then it’s all you can think about.
    Thank you so much for your help, as I clear my throat:( Looking into your suggestions now and yes, stress triggers it without doubt

  3. David, first let me wish you on behalf of most readers here a Happy New Year and an LPR free one.

    Second, thank you for taking the time to research and share with us GERD/LPR sufferers.

    Most people don’t realize that a medication free cure to any disease is what medicine should be about. I studied medicine for 2 years and then dropped out: kids are never patient 🙂

    This is my first 2 weeks with what looks like LPR (had intermittent bursts of AR since 2008). I have been taking omeprazole 20 mg once in the morning for 14 days now. I will reduce and let you know.

    It all started after a virus induced bronchitis and coughing a month ago. I also suffered a couple of horrible episodes of laryngospasms.

    Maybe this could help some of the readers. An upper respiratory infection is correlated with a flare of GERD/LPR. 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. It could also trigger a hiatal hernia.
    Maybe you (and the readers) can share what triggered the initial symptoms.

    If you accept donations or contributions please let me know.

    Will keep on reading.

    Thanks again for being a kind and generous human,


    1. Hi Bassam thank you and happy new year to you also!

      In terms of LPR I always recommend healing it naturally through diet if possible. It is generally the most effective way to heal it.

      Typically PPI’s are prescribed and for me also I too took them for 1-2 years with little to no benefit. Generally speaking stopping PPI’s will do more good than harm especially in the long run.

      Also as you mentioned yes there are some possible correlations and ways people have mentioned to me of how LPR can come about in the first place and it seems there is no common cause but a host of potential causes for different people.

      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. My point being that there are a host of potential causes just like the one you mentioned with a respiratory infection.

      Yes I do accept contributions just send me an email to david@wipeoutreflux.com

      I’m glad you appreciate the information, I’m happy to know I can help people like yourself learn more about LPR and how to help it.


  4. Thank you so much. I have researched LPR for a year now. This is the most comprehensive and informative information that I have seen thus far. I love a cup of coffee and a glass of wine daily but I am giving up the coffee and will do wine weekend only. Not sure what I will do for my wake up drink in the mornings since caffeine is a no go lol. In regard to foods are you saying anything with pH of 5 or above best?
    I can’t afford to buy the wipeout diet. I will have to try the basic alkaline diet etc. Are bananas and melons the only fruit? I understand all I have read just not sure I will have the knowledge to put meals together best for me. My main symptoms are burning throat and lots of little burps. That being said which one of the three sphincters do you think is my problem. Thank you for your research and this very informative guide. Blessings to you!

    1. Yeah ideally you want to only eat/drink things above a pH of 5. In terms of fruits there are a selection that meet that criteria just like melons and bananas as you mentioned, a couple others that comes to mind are papaya and dragon fruit though there are more yes.

      As for the root cause of why is it happening – it is quite impossible to say without more information and tests though the most likely cause is the LES I would guess.

      You are most welcome for the guide and the information I hope it can help you on your journey to healing 🙂

  5. P.S.
    I forgot to ask what does Chamomile and Marshmallow Root Tea taste like?
    Do you drink them as is or mix anything in with them?

    1. Both of them are quite subtle and smooth tasting. I personally mostly drink them on their own though I occasionally add a half spoonful of honey into chamomile for a little sweetness.

  6. Hi David! Thanks for this comprehensive guide. Very informative. I was recently diagnosed with LPR. I first tried to tackle the problem with Zantac and that did nothing for me. Then the ENT started me on a PPI 2x a day. I’ve been on the PPI for one month AND doing the AWD diet noted above. I’ve seen some improvements and believe the diet is a big reason while the PPI is giving my throat time to heal. My goal is to get off the PPI and follow the diet. Many docs have told me that the healing is at least a 6-12 month journey and diet is a must for long term management. I am remaining positive but this has certainly been a roller coaster ride.

    My question to you – have you experienced sinus issues with your reflux? I’ve noticed that if I have a flare up, it immediately triggers my nose to gets stuffy and I experience clicking in the ears. I have also experienced headaches. Any tips to manage this?

    1. You are most welcome Dawn. I think you are already on the right track with the diet. As you said, I would advise getting of the PPI’s and instead you could replace it with Gaviscon Advance as I mentioned which will be more effective at helping your symptoms. As for your sinus issues yes I have experienced it myself and with my ears also. The best thing you can do is the diet and take the Gaviscon advance that is what I would advise and this in turn should lessen if not completely stop your symptoms. Best of luck!

  7. Hi David,

    I’ve just stumbled upon your page, it’s really great – thank you for all this information.

    I have been suffering with sore throat, horse voice, and sometimes the taste of acid coming up. 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 think I may have LPR as food seems to come up even though I am following the acid watcher diet. It seems to come up when I eat my main meal and also when I have porridge.

    I’m finding it really hard to make the lifestyle changes though, I don’t have the time to make lots of small meals and just want to get my dinner with my family and have a normal sized portion!

    The biggest one for me is wine, I miss socialising with friends. Do you think it can be managed to have wine every so often if you follow a fairly strict diet the majority of the time? Everything I have read says avoid alcohol and chocolate, but I feel for most, this is unrealistic to never have these things.

    Many thanks

    1. Yeah if your symptoms are still affecting you quite a lot I would personally advice from drinking any alcohol because it’s one of the worst things for reflux. I think once you have healed somewhat then maybe you can try to introduce some alcohol in. As far as chocolate goes I would advise basically the same though it’s much less reflux inducing when compared with alcohol for example so taking a litle of that maybe is something you could try sooner than alcohol. I know plenty of people who follow the diet and vastly improve their symptoms and they can take these things with little to no negative effect – that is typically after healing though. Hope this helps Steph 🙂

  8. Hi David,
    Thank you for the thoughtful information. I just began suffering from some of the symptoms of LPR. However, I do have stomach pain, upper abdominal pain and chest/back pains at different times. My doctor has said that I have GERDS with possible LPR symptoms. ENT told me that I may have LPR but inconclusive. I suppose my question, will following your diet plan assist with both? Would using a PPI and following the diet be an issue?
    Your feedback would be appreciated.

    1. Hi Gino,

      To answer your questions yes my diet plan with absolutely help with both GERD and LPR. If you have both GERD and LPR symptoms I think taking a PPI and following the diet plan should be absolutely fine. 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. Hope this helps Gino.

  9. Hi David, thank you so much for your article! It’s amazing and gives me hope. I started having acid reflux with red/burning throat and acid taste in my mouth 6 days after I had endoscopy. Have you heard that being a cause of LPR? I didn’t have anesthesia and was very nervous and had some retching to do during 4 min of EGD. My GI doctor said that it’s impossible for me to develop it. But how else can I explain it if I never had it in my life before? My other question: how long does it take appr with strict diet and supplements to heal LPR? Thank you so much!

    1. Hi Tatiana,

      I haven’t heard of an endoscopy causing LPR before no, but it could even of been because of the bad nerves you had before having it done potentially. As for following a diet plan like the wipeout diet plan most people usually start to see improvements in under 2 weeks but for others it can take a little longer. It is all dependant on each person and there is not a simple answer that works for everyone.

      1. I actually didn’t have any lpr symptoms till after I had an endoscopy. 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

        1. Sorry to hear that. Seems there are a lot of different potential triggers for different people and circumstances.

  10. Hi David

    Thank you for your excellent web site. It really is extremely helpful.

    I have just one question. How long does it take for the symptoms to start to improve with the diet? I am planning to start removing things from my diet soon, and I am wondering how soon I can expect an improvement.

    Many thanks for your help.

    1. Hi Andrew,

      You are most welcome. To see an improvement you should follow a diet plan like the wipeout diet plan. Assuming you follow a diet plan like it most people see improvements in under 2 weeks time.

  11. Reading this has really helped me. I have been taking omneprazle which hasn’t helped much but now I know why. Will follow the diet you suggested and here’s hoping. Many thanks.

  12. Hi David, thanks for your info.It is very extensive and informative.

    Like you my LPR has been misdiagnosed by ENT, GP and Gastroenteroligist. I have questioned for many years why I keep having to clear my throat, keep getting post nasal drip and hoarse voice.

    Hundreds of dollars and time wasted going back and forth to doctors, taking PPI’s.

    I believe LPR has occurred in contracting Heliobactor Pylori. They tell me that many, many people have it and don’t even know. Lots of children have it and most people can just live with it or some can not. It is very difficult to erradicate. I have been on three courses of antibiotics and now await a forth very strong batch of specialised antibiotic to arrive from overseas which needs to be approved by the government to enter the country (sounds ominous)!

    I would recommend that LPR suffers get tested for Heliobactor too as the two go hand in hand. Heliobactor is a bacteria that lives in your stomach lining. It causes reflux or silent reflux and heartburn which eventually cause LPR.

    I hope this info can help

    1. Yeah thank you Mary. This is definitely a possibility and it worth considering if you haven’t been tested for it before

  13. Hi David, great info. Recently diagnosed by GP for condition too. Thought I was going mad with chronic cough. I been put on lansoprazole 30mg x 2 daily. I have noticed cough slightly reduced. I HAVE STOOPED SPICY AND ACIDIC STUFF FROM DIET 2 WEEKS NOW, but not really noticed any change, how long does it take for lpr to heal and symptoms stop. thanks

    1. Hi Shaun,

      It’s hard to give an exact timeframe for healing LPR as everyone is different and how they treat it may not be quite right. The best advice I can give is following a strict diet plan like the Wipeout Diet along with taking gaviscon advance the uk version after meals – both these have been proven to lower and even stop symptoms for certain people. If you are confident you have LPR taking a PPI like lansoprazole likely won’t help your symptoms much if at all, you can read more about why here – Silent Reflux Treatment

  14. Hi I have most of the symptoms of lpr and have been battling the symptoms off and on for years. I went to An ent twice and he said to use ppi. I have been using them 2x a day for two week no real benefit I just received the galvison advance a couple days ago. It hasn’t started to have an effect yet.
    It is not a wonder I have lpr my favorite diet is any spicy foods, tomatoes, coffee, and a glass or two of wine. This is going to be hard for me. The biggest problem I am having is coffee in the morning. I have tried to give it up but I am getting bad headaches and feel in a fog all day. Any suggestions? Thank you

    1. Yeah diet is the most important change that you will need to do to help your symptoms. The wipeout diet is a diet tailored to help people with LPR, you can find it here. If you have the UK gaviscon advance as suggested that should help to a degree but you really need to follow a strict diet plan like the one suggested. As for something like giving up coffee in the morning I understand your situation too, I had that struggle myself but I felt better for it once I did stop. But using coffee as an example the headaches usually pass after 2-3 days of not taking it. Also giving up certain foods and drinks like the ones you mentioned will be worth it because you will feel much better for it when you do.

  15. Hi David. Very informative article. Thank you. 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. 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. I noticed you mentioned Gaviscon.I had tried peppermint tea and found it gave me a burning sensation in my stomach. Is there peppermint in the
    Thanks again for the info and this forum.

    1. Hi Donna. Thanks for the kind words. With probiotics it seems to just be person and even brand dependant – some people have success taking them whereas others get a bad effect like yourself, everyone is different so you just have to figure out your triggers and avoid them as best you can.

      To touch on the point you mentioned about peppermint tea I would recommend you avoid that. Peppermint is a trigger for reflux and would likely irritate your throat as well if you have LPR.

  16. HI David, I just got diagnosed by ENT with a Endoscope by looking at my throat with acid damage everywhere.
    He has put me on PPI’s and basically told me to drink Gaviscon Advanced all the time! my biggest symptom is feeling difficult to breath in, like my airways are a bit constricted. Is this normal with LPR? Just started the Diet too, if this breathing issue is related will it go away u think?

    1. Hi Steve,

      Yes gaviscon advance the Uk version is great and will definitely help but its important to do alongside the diet as well. And yes it’s somewhat common to feel short of breath with LPR as I had that myself before when my symptoms where worse. The best advice I can give is following a low acid diet like the wipeout diet and taking gaviscon advance alongside it. If you are doing both of them your shortness of breathe will most likely stop.



  17. Thanks David for this well informed website of your journey. My LPR started this past Jan when I got Strep throat and in Fed Tonsillitis. This all to seemed have started for me September 2018 when I decided to stop drinking soda. Mid October comes and I started getting heart burn and went to the doctor and they prescribed a PPI. In which I did not start taking till mid November cause I really do not like to take medicine if I really do not have to. December 26th, 2018 I had a EGD cause I wanted to make sure nothing else serious was going on. Diagnosed with Gerd. Took PPI’s for 3 an half months. Once I stopped taking a PPI I started feeling better so I know for a fact PPI’s are no good for LPR. I decided to start taking HCL and started getting even better. So it all started when I stopped drinking soda and started getting better after stopping PPI and taking HCL’s. What are your thoughts on this? Low stomach acid and the soda’s were helping me digest foods. So for the last 5 plus months I have been on a similar journey like yours. Every time I drink soda as I started again about 3 weeks ago I feel great. Go figure.

    1. Hi David,

      Yes that is quite ironic. Seems like your problem was related to low stomach acid so lowering the acidity did exactly the opposite of what you needed. Of course everyone is different and that worked for you as it has some others. I myself tried betaine HCL before and it made my symptoms much worse so low acid wasn’t the root cause for me. But glad you got your problem fixed and can enjoy some soda now! Thanks for letting me know.


  18. Hi David,

    After 1 year, I had a very bad LPR flare but this time is different, I got a metallic taste in mouth and developed Mouth burning syndrome. My tongue is inflames, do you think its still has to do with LPR and pepsin coming up ? What do you suggest, thanks

    1. Hi Luke,
      It’s hard to say for sure but for myself I do think there is some correlation between the 2. I had some burning mouth/tongue when my symptoms where worse as well. I would say treat it as if its LPR and it should help both the LPR and the burning mouth as well.

  19. Hi David! Your blog is so helpful, I was recently diagnosed with LPR because of a weak sphincter after years of restricting and then bingeing, and was advised PPIs despite having tried them already and having no relief. I have just come out of recovery and really want to be able to eat normally again, and what and whenever I want, so I was wondering if once the throat/sphincter heals, is it possible to go back to eating how I normally did with no bingeing/overeating or would I have to follow the diet for the rest of my life? Thanks!!

    1. Hi Ellie,
      Thanks for your kind words I am glad it has helped. As for your question – yes I do believe it is possible for some people to return to normal eating once they are healed. 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.

  20. Hi David, thank you for this wonderful information.
    I have been having a burning pain in my throat and behind my nose for more than a year now. I have tried ppis and nothing seems to help. I have been on the low acid/high ph diet for a week now and have maybe seen a few small improvements, but I also feel like when I may “reflux” again the pain is actually worse than before. Could that be because I am starting to heal and the acid/pepsin just opens old wounds as it were? Also, how long should I follow the diet strictly before seeing true pain relief? You mentioned that you noticed improvements after just a few days, but how long before you knew that you were going heal eventually. I’m looking for a little hope I guess. Thank you!

    1. Hi Claudia,
      For everyone it is different but for people who follow my diet plan they usually see improvements within 2 weeks. The key is to make sure you are not eating or drinking anything that can further stimulate the pepsin and bring back or worsen symptoms.

  21. Amanda Cox-Cahill

    Hi David
    I have had a good read through your website, thank you for your detail. About a week ago, I was eating an oreo mcflurry when a bit of the biscuit went down the wrong way making me choke/cough a bit, (not a
    lot) but since then i have been left with a feeling of a lump in my throat or something stuck. I went to A&E as I thought something was stuck in there, and they could not see anything from a tube down my nose. I then had a burning throat for a few days and a headache, I have also been to the doctor (its driving me crazy) and they have given me a PPI to take 20mg 2 x a day. I have not taken this as i noted that once of the side effects was vertigo, which I have only just recovered from a couple of months ago, and the thought of bringing this on again filled me with dread. I have purchased Gaviscon Advance, and have avoided any of the foods mentioned, I am worried to eat at the moment, and have lost my appetite. My question is do you think I could have LPR or just an inflammation to the throat, I have never had a problem with acid reflux in my life. Does LPR suddenly come on later in life, I am 42. I am overweight by two stone, but I have been this weight for a long while. I am at my wits end! 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? It works in trying to make your urine more acidic!

    1. Hi Amanda,

      Perhaps you did damage your throat from something getting caught on your throat but it also could be from acid reflux. 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. It’s because most vitamin c tablets are made up of ascorbic acid which is highly acidic and would likely irritate the throat and cause acid reflux perhaps. So probably remove that first and after some time if it doesn’t help consider the anti-biotics. Anti-biotics have also been shown to cause/irritate acid reflux so that could also be related but its better first to remove the vitamin c because thats the clear recent change you have made.

      Hope this helps,

  22. Hi David,
    Excellent website. I also have LPR and about 4 weeks ago went from taking PPIs to not taking them. The rebound was really bad right away, then calmed down, but I think I may still be rebounding weeks later because I have reflux now all the time, especially at night. You said you went to the emergency room twice during your rebound. A few questions: 1.) How long did your rebound last? 2.) Did you ever have a period where you refluxed almost all the time during your rebound, like I have?
    Thank you so much!

    1. Hi Ken,
      Thank you I am glad it’s been able to help you. As for the PPI’s and the rebound effect yes when I stopped them or lowered them a lot its when I had the worst reflux ever. The best way to stop them is gradually over a period of time. Basically I recommend slowly lowering the dosage over the period of 1 month. So if you where taking 40mg lower to 30, then 20 then 10, then stopped or something like that. That should be over a period of about 1 months time. I also recommend taking gaviscon advance the uk version with it which should make lowering the dosage easier and should also help symptoms.
      Hope this helps,

      1. Thanks, David. Much appreciated. Unfortunately I went pretty much cold turkey due to my doctor not telling me about rebound – and I’m still paying the price a month later with horrible reflux. I have Gaviscon UK but it doesn’t help a ton. I just hope this passes.

        1. Yeah unfortunately most doctors aren’t aware of that. 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. That is what reflux expert Jaime Koufman recommends.

  23. I’ve been battling issues with stomach/esophagus pain, heartburn, and the warm liquidy feeling in my throat for almost 2 months now. Some days it got/gets so bad that any activity would make it feel worse. I’ve been to 5 diff doctors and they just throw Ppis at me, which aren’t working fully, so then they tell me to take an H2 at bedtime also, still no full relief. It only seems to get worse, as now I have developed chest tightness and difficulty breathing intermittently throughout the day. In fact I should be sleeping right now, but I foolishly drank ONE beer tonite and the acid in my throat is going haywire STILL after my Omeprazole, pepcid, and 3 tums… Interestingly enough not one doctor recommended a diet change which seems obvious to me. I had to begin the quest on my own. Guess I’ll finally lose that extra weight I’ve been wanting to drop. Anyway, I just wanted to share my story bc I’m so grateful that I stumbled on this website. It’s great to read others stories, very similar to my own. It’s like a support group!! Thank you. You da’ man.

    1. Hey Michele,
      Thank you for your kind remarks. Unfortunately a lot of doctors don’t know how to treat LPR properly but if you are following my advice you should be on the right track 🙂

  24. Thanks for the info. Started with bronchitis and sinus infection end of May 2019. No one really treated the “lump in the throat” and mild hoarseness until mid July 2019. I was given amitriptyline and omeprazole, which was changed to Nexium 40mg twice a day and Gaviscon at night. To make things worse, now I have developed anxiety/panic attack as a result. Have lost 25 pounds since May. Haven’t been eating much. Breakfast with oatmeal and no lactose milk. Lunch is rice with broth or an apple. Dinner rice and broth or apple. I also have pears or apple sauce. I only drink water. Hoarseness is gone. But I still have that “lump in the throat feeling.” The amitriptyline only worked for 3 days (completely no symptoms). Don’t know if I have LPR or LSN, although my ENT “thinks” I have reflux. Wondering if you ever heard of this one-symptom ordeal.

    1. Hey Mari,
      Yes I have heard of similar symptoms. Most likely following a strict low acid diet like the wipeout diet will be your best bet. You most likely have LPR but it is also possible you could have a mixture of both LPR and LSN. The best way to know is based on your symptoms, certain symptoms can mean LPR whereas others mean LSN, depending on them symptoms is a great way to know how to best treat your problem. I you would like to email me about your symptoms I can offer you some advice 🙂

  25. Hey David,
    Lots of info. which makes logical sense.
    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. Been on PPI’s(Pantoprazole 20mg,3 times a day for 1st month,2 times for the next month, and now 1 time a day) till now and diet (no tea/coffee, tomato, chocolate, citrus fruits, soda, mint, alcohol and spicy/deep fried foods) as advised by my ENT. Not having Tea/Coffee and Alcohol is the most difficult part.
    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. Also i have started to take Melatonin (3mg) and DGL for the last 10 days, not sure if they are helping. Also i have an inflamed vocal cord for the last 2.5 months (as seen in laryngoscopy).
    My concern is do people recover 100% from this condition? Also will i never be able to have fried/spicy food, chocolate, tea/coffee & alcohol again? Is this for lifetime?
    I don’t have access to Gaviscon Advance (not available in India, even via Amazon), is there any alternate to it (natural or medical)?


    1. Hey Aman,
      Sounds like following the diet is helping which is good. 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). As for your question, yes you can absolutely recover and return to eating normal foods – for some people they may need to follow a strict diet to keep symptoms at bay whereas for others then can return to their normal diet once they are healed – important thing to remember is that everyone is different. 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.

      1. Hi David,
        I did a Upper GI endoscopy as the symptoms are still there (not as severe as before) and the doctor said i have LAX (doc. said its medical term for kind of weak) LES everything else is fine. Also said that PPI’s and some basic diet control should help and if its not then surgery and believes LPR and GERD are the same thing.
        I am 33 and don’t want to do a surgery, Can LES become normal on it own? Is there an option for me to stay without PPI’s and live a normal life with a normal diet?
        Does diet alone can 100% cure LES?
        Very very confused and tensed!!

        1. If you just have LPR symptoms PPIs likely won’t help though they can help if you have GERD symptoms like heartburn. Yes diet is the most important factor for most people. For me personally diet improved my symptoms about 60% in under 1-2 weeks when I did a strict diet. 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. I personally would never trust a doctor who says LPR and GERD are the same thing he is obviously lacking knowledge on the subject though that is quite common to be honest.

  26. Hi David,
    Thank you so much for taking the time to help others like myself.

    My symptoms of tooth pain, chest pain and sore throat started 3 months ago. I’ve lost 45 pounds in 3 months and my last bloodwork I’ve have become anemic. On top of that I have kidney stone that will require a procedure to be removed in 5 days. I believe from a combination of taking 800 mg ibuprofen(knee surgery), antibiotics from a ear infection and stress/anxiety. I still haven’t officially been diagnosed with anything. I believe it’s lpr but my doctor thinks it’s cancer and is trying to find it. I’ve had bloodwork done many times, a MRI of my abdomen and head, a barium swallow and enema test, x-Ray of chest, ultrasound of my abdomen(3mm polyp on gallbladder), a endoscopy and now prepping for a colonoscopy in 2 days. Endoscopy came back completely clear. How can my throat be sore for 3 months and not even be red or swollen?

    I’ve eliminated all possible reflux triggers and only drink alkaline water. I only eat whole foods with lots of fruits and vegetables. Eliminated all gluten and dairy. I take L-glutamine, digestive enzymes, 80b probiotic, bone broth, collagen and melatonin. But still haven’t seen any improvement at all. I plan to order the Gavison advance.

    My questions.
    Could a kidney stone be the cause of lpr?
    Could lpr be a result of a vitamin/mineral deficiency?
    Could lpr be caused by an intolerance?

    I’m really struggling with this and not sure how much longer I can do it for without completely losing my mind. I really appreciate any advice that you have.

    Thank you,

    1. Hey Steve,

      I think based on what you have said there is a good chance your symptoms have started from taking the ibuprofen and the anti-biotics. In fact I had a similar experience. If you are still taking either of them you should aim to stop them, both are known to be bad for the stomach particularly the ibuprofen. Consider curcumin (turmeric extract) as a natural alternative to ibuprofen that won’t negatively effect the stomach and digestive system.

      Throat could be not swollen or red and still sore most likely because of LSN – you can read more about it here.

      Kidney stone – I personally don’t think it can be the cause of LPR no.

      Mineral deficiency – There is a probability that it could be though I think the chance of it is quite low. As an example some people being low in vitamin D can cause the LES to not function correctly.

      LPR intolerance – it could be worsened by a food intolerance yes.

      My best advice is to lower and stop the anti-inflammatories and anti-biotics if you are still taking them along with following a low acid diet like the Wipeout Diet. Also getting the gaviscon as you said also will help.

  27. Hi David,
    I believe that I have developed silent reflux due to this “sore throat” affecting my singing voice. I have been dealing with these symptoms for about a month or two before I did some research of my own. It has been really depressing dealing with these problems. Thank you so much for the information you have provided. I have a couple questions if you don’t mind answering.
    1. Can silent reflux also cause a stuffy nose?
    2. I read elsewhere about juice fasting, how effective is this treatment and with what fruits? Also how long should I put this method into practice? What other things should I be aware of before doing a juice fast?
    3. Will I ever be able to eat normal things again? Is there no cure or will I have to constantly keep track of my acid levels and continue to diet? Are there any stories or references of people you can link who have survived through silent reflux and overcame it?

    1. Hey Ian,
      Let me answer your questions –
      1. Yes it can cause a stuffy nose. Basically the acid and more importantly can get into your airways and can cause inflammation leaving your nose stuffy.
      2. I don’t know anything personally about a juice fast.
      3. It depends for each and every person it can be different. Some people may need to maintain a strict diet to remain feeling good whereas others after being healed can return to a normal diet. There are plenty of people who have overcame it, look on the likes of forums and facebook for them.

  28. Hi David, lovely running into your article. One day I just could not swallow solids, no other symptoms I can recall. Doctor dilated my esophagus, placed me on PPI, told me I had gastritis and esophagitis, acid reflux from the endocospy. Then my ENT and STATED I had lingual tonsil pharyngitis and treated it this with steroids. 5 weeks later (today), I can eat better, but I’m stressed this would happen again, so I have start meditation. For over a year, I cleared my throat, coughed and released lots of mucus. Still my voice gets tired when talking and deal with a bit of hoarness.
    Today with the low acid diet , I’m not experiencing any symptoms other than my throat feels a bit raw. I am confused about what symptoms I’m looking for , regarding triggers from foods. That is in order to keep them out my diet. Any suggestions. I will continue the diet but would like to start introducing some things back. What triggers should I look for? I’m also going to start lowering my PPI intake slowly. My dosage is super high. 80 mg a day. Other then the swallowing issue (which is better), I’m only clearing my throat once or twice in the morning.

    1. Hey Jessica,
      It is hard to exactly tell what could be causing any slight trigger for you without knowing your diet and daily routine. In the wipeout diet i include a list of foods that are allowed and won’t cause any issues that is the best thing I can really suggest. Also I think it’s a good idea for you to slowly lower your PPI dose that could actually help in the long run as well.

  29. Hello David, My Name is Olivier from Belgium…
    I have 48 years old, at the age of 30 i was diagnosed with GERD since that time I take PPI. All was well until 2 years ago,
    i started to have typical LPR symptoms. Since 2 years I have seen several doctors and passed several exams
    with visible inflammation at nasofibroscopy in the larynx and pharynx… since a few weeks I found your website with very good advice. Here in Belgium, we have the same Gaviscon Advance highly dosed alginate (same as in UK). Since 15 days I am totally changing my diet I take 20mg Pantoprazole 2 times a day and Gaviscon Advance 4 times a day (the evening before sleep also). For now I still have sore throat especially on one side, but I read that healing can take 6 or 8 months…

    has the improvement been long for you too ?

    Regards and congratulations for your Website.

    1. Hey Oliver,
      Thank you for the compliment and I am glad you enjoyed the site. As for your question yes healing can take many months for some people as many as you suggested is a good rough idea. It’s good you have that Gaviscon available to you in Belgium, stick with it and a good low acid diet and I am confident you will be seeing improvement in no time!

  30. My problem began over a year ago with a lot of clear mucus whenever I ate just about anything, even water, and especially vinegary things. I spat out the slimy stuff. As the months went on, I had to spit into kleenex soon after lying down to sleep. One morning, I checked the kleenex, and it had blood in it. I dried, and saved it to show my NP. She said to use flonase, so I did, and it was no good. Meanwhile, my digestion was okay, but my throat was always clogging up, and it was hard to clear it. Hoarseness followed. Then bronchitis. I went to a lung doctor, and all clear. I suffered along. 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. I am taking Zantac, but no help. Stomach hurts intermittently, feels full even after a tiny low acid meal. Still spitting out junk as usual. No sour burps, but I have to twist my waist from side to side to burp properly most of the time. I am trying to get an appointment with a GI doc and have an endoscope exam. I guess the blood makes me fear cancer, or something. I never had any breaks from the spitting out junk. My sinuses were clear. This junk collected at the back of my throat every night, and swallowing it was not possible, or a good idea. I am Vegan, and consider my diet to be good. I have a constant feeling that something is lightly pinching my stomach inside.

    1. Hey Binnie,
      Sorry to hear your struggles but know that it can be helped and fixed with the right technique. As I have suggested a very strict low acid diet and taking the uk gaviscon advance is the best way to remedy this. Send me an email if you have any questions.

  31. Thanks for a wonderfully thorough explanation of LPR. I had a cough for about three months and my doctor said this could be due to reflux. I got some omeprazole and did 20mg twice a day. It didn’t help with the lump in the throat, difficulty swallowing, laryngospasms and post nasal drip.
    You mentioned Gaviscon Advance with sodium alginate. I noticed that you can buy a bag of aglinate as a food thickener. Do you think there would be any benefits to adding alginate to water and just drinking that?
    Thanks again!

    1. Hey Darrell,
      Thank you for the kind comment. I have read some people basically making their own gaviscon advance with the alginate but personally I would advise against it. The reason being that it really needs to be carefully measured out because of the way the alginate binds and thickens could mean for problems if you don’t have the exact right amount. I believe also you need the have some form of calcium carbonate combined with the alginate because this has an effect with the alginate, here is a good post that talks about it and the potential hazards with it – https://www.reddit.com/r/GERD/comments/a1lpfh/how_to_make_your_own_gaviscon_advance_at_a/

  32. Glad i found this…suffered for months with a sore throat got the usual..have ppi’s..then ranatidine..i told the docs i got tested for pepsin.which was present in my salive…higher mid day..one said whats that..sent for an endoscope..i told them there would be no acid damage to my osophegus or stomach and there wasnt..been refered to the e n t again..might as well bang my head on a wall.. i have now started on the high ph water..my home tap water is about 8 so 3 drops of alkalizing drios it goes to about 9 5…i add 1 tablespion sodium bicarb to 500mls…gargle thru the day and have a small spray bottle also. Advance now i read 30 mins after food and shall be scalling down meal size and eliminating triggers as best as i can..2 years roughly suffering with this…throats a mess…wish me luck and again great info here

    1. Hey Johnty,

      Thank you for sharing. That sounds like quite a good plan, the one thing I would suggest looking more closely at your diet and triggers as you said. You can send me an email if you would like.

  33. Thank you for all the great information. I will be purchasing your book soon. I judt have a couple questions. 1. Along with GERD/LPR I also have a HH. Can I still find relief if I follow the diet and Gavison Advance, and other suggestions? 2. When talking about consuming soda in any form, is it going to be an issue as I have high blood pressure. I also have IBSD and Diverticulitis. Maybe theres no way to get this all under control. Being a Senior it seems like a dead end street. What do you think? ?

    1. Hey Georgia,
      Thank you for the kind words, I am also glad you are considering the diet plan. 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. 2. As far as the soda is concerned I would highly recommend to stop drinking it. It is very acidic and one of the worst things you can take if you have GERD/LPR (ideally if possible drink water only). I understand you feel like it’s a dead end but trust me that if you make the right adjustments you will start to feel better in no time. I personally had similar feelings myself but once I figured out the best plan of action I felt better very soon after.

        1. It could be possible. When it’s colder the shear cold when you breathe it in could be more irritable to the throat etc. Also the humidity might change and this could also affect your symptoms.

  34. Hi David thankyou for all the information on LPR. I used to have a lot of heartburn and cough after eating at break time and lunch at work because we would have to get up straight after and start bending picking up boxes etc. I took antacids for it. I have also suffered with anxiety for years and recently have had a really bad episode of anxiety causing me to be off work. I had a sinus infection not long after being off work and it needed three lots of different antibiotics to clear it up. I stopped eating properly and would only eat a very small amount so I could take my antibiotic as I needed to take it with food. Whilst I was taking them I started with this lump in my throat on and off at first so I went to my doctor and he said it was the anxiety, but then it started to be there all the time so I went back to docs and he gave me ppi. I took these for 4 weeks and I didn’t feel at better. Now I have the constant feeling of lump in my throat and every time I eat I get a huge amount of pressure around my throat straight away and small amounts of wind coming up. I have a permanent feeling of bloating at the top of my stomach. It is making me feel so much more anxious and I know I should eat but I’m afraid too sometimes. I am overweight still but have lost at least 2 stone since this started at the end of September. I have read your advice and have bought some gavisvon advance and started to eat low acid. Btw is milk kefir acidic? Do you think this is lpr or just my anxiety many thanks for reading sorry I have rambled on.

    1. Hey Jane, Thank you for the kind comments. Let me answer your questions. Kefir milk technically is a little acidic. Ideally when someone has bad LPR like yourself I would recommend not drinking it until thinks have started to settle, once things have settled you can take it but make sure you get one with no additives. LPR or anxiety – I think it’s LPR though being anxious a lot will definitely worsen your symptoms and could even bring it on in the first place. Try to do things which can calm the mind like some of the things I have mentioned in this article. Also know that with following the right diet and following my tips you will start to feel better so focus on the positive – it will definitely help.

  35. Elizabeth Sheridan

    I’ve started Hiprex and cranberry 60000 to help combat Recurrant Ecoli UTI. I suffer from reflux. If I take Gaviscon at bedtime will it undo the Hiprex?

    1. I am not certain but I did some research and it seems they should be safe to take together without any negative effect.

  36. Hi David, I have suspected I have LPR (after GP diagnosed me with acid reflux) given the
    signs and symptoms. My doctor advised that I stay on PPI for now, but I have also purchased the Wipeout Reflux Diet. Unfortunately I still have problems eating really solid food even after chewing so I am now limited to blended food (poached and grilled chicken, fish, fresh spring roll), oatmeal, and banana so I cant really follow the plan mostly. I do think I am getting a bit better, but I am just concerned that I easily get tired and symptoms (coughing, throat mucus, dry mouth, breathing hard) appear easily with just some exercise (walking a few blocks) not even close to what I usually do. I also get sleepy tired and cold with just a few hours at work. 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. Do you have insights on how I could incorporate exercise and travel in LPR management, and also maybe a bit on preventing or managing the tired sleepy feeling and sometimes cold feeling? Thanks a lot and keep it up. You help a lot giving us some positive outlook in terms of healing.

    1. Hey Byron, first of thank you for purchasing the diet. Now let me answer your questions. I think if you are lacking energy try to eat more fruits to give yourself more sugar which could help with the lack of energy perhaps. Also try to do a little more exercise, simply walking should be enough, try each day to do a little more ideally at least 30 minutes a day could really help. In terms of travelling I think don’t be afraid just do it. 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. Just bring some gaviscon with you and have an idea of some foods you can eat when you are travelling which are more loosely compliment with the diet. Also going to an airbnb with a kitchen might be a good idea so you can make your own food instead of a hotel.

  37. Hey david great read this article is awesome for people who are looking for answers this can honestly help people get their health back on track much respect to you a few questions I have for you 1. Is LPR permanent 2. How long have you personally had it and do you still get any type of symptoms to this day even minor? 3. If the stretta procedure is safe why not recommend everyone to try it and lastly 4. 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?

    1. Hey Josh,
      1.Different for everyone, for most people no
      2.I had it for a few years, I feel good the majority of the time now
      3.I would prefer to advise people to make some other changes than suggesting a surgery when the problem can often be fixed naturally. Also stretta is not available in most countries and it can be quite expensive for some people
      4.I feel normal the vast majority of the time and countless others have cured their LPR

  38. Hi,
    Thanks for everything, really appreciate you posting and helping us. I’ve had LPR symptoms for 2 months: first month did nothing, 2nd month PPIs, 3rd month tapered off and have been on diet you suggest with constant alkaline water. Started taking magnesium as well. Use UK Gaviscon as well. My larynx is the main source of pain. A fellow sufferer who had respiratory effects said taking HCL with pepsin wiped out everything. I said, “WITH pepsin?!”
    Despite my skepticism I started taking a pill before protein meals because I’m desperate. Please let me know what you think? It’s so frustrating because it’s so difficult to isolate for what’s working and what’s not… I was reluctant to try the HCL because I have been on a steady but subtle trend of improvement, so I don’t want to introduce new variables, but my pain/desperation led me to try it.
    Thanks so much,

    1. Hey Matthew, thank you I am glad to help 🙂 I personally have tried the HCL and it made my own symptoms worse, though yes for certain people it can and does help. 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. So if you take it and don’t have low acid you will experience heightened acid reflux symptoms most likely. I would suggest keeping with what you are doing and seeing how things progress in next 3-4 weeks. Then if you haven’t seen improvement then you can try the HCL but if you do I recommend starting with a low dose.

      1. Hi I want to tell you that my experience is I feel a burning throat all the time and an acidic taste in my throat even when my stomach is empty. I also belch a lot and feel bloated all the time and sometimes experience regurgitation. I do not experience heartburn the burning seems to be in my throat much of the time. Does this represent LPR and what would you advice for me be?

        1. Hey Adam, yes it does sound like LPR from what you have mentioned. My advice would be just as I have covered in this article.

  39. Hi David,
    I followed Dr. Jonathan Aviv’s Acid Watcher Diet for six weeks and it made no difference for my lump in the throat sensation which happens to be my only symptom. If I don’t have any other symptoms, could this still be LPR? Can you tell me how your diet is different from the AWD?
    Thank you!

        1. Of course as with any diet there are overlapping parts as to be expected. I would say the main difference is I have put in first hand advice from myself and others who have followed the diet and little tips and tricks to really help you get all the right elements to heal as effectively as possible.

  40. Claire Ratcliff

    Hi David,
    I started having trouble swallowing solid foods four weeks ago. I bought your diet and follow it as much as I can. I eat low acid purées and smoothies. I’ve had some coughing clearing of the throat and asthma also during the last four weeks. Gaviscon advance is on its way but has been delayed during the shipping process. I have started using reflux gourmet in the last two days. I feel like my asthma and coughing has improved tremendously. I’m still having difficulty swallowing foods. I’ve been on the low acid for nearly the entire four weeks. Once or twice I had a glass of wine to relax me and a couple times I had coffee. But other than that everything has been alkaline. I’ve lost 15 pounds over the last month. My scope showed GERD grade a and esophagitis. Doc did not mention LPR but I think that’s what I have. I do take one Prevacid in the morning. He put me on much higher doses of Protonix and it gave me terrible anxiety. In your experience talking to other people with swallowing problems how long has it taken them to heal or at least see major improvement? Thank you so much for this website!

    1. Hey Claire,
      Thank you. Yes the reflux gourmet has the sodium alginate which is the important ingredient so it should be helpful. I am actually wanting to test it myself so then I can recommend it if its as good as Gaviscon. I think the swallowing problem could take some months to heal. It’s hard to say an exact number but if you are still having problems after 6 months there maybe something you need to change with your diet/lifestyle etc. I think you are on the right course now though so that’s a great thing 🙂

  41. Hi David,
    I had been coughing and clearing my throat for about 4 months and had a sore throat for longer than that. After numerous doctor visits, an ENT finally gave me the LPR diagnosis and started me on 40mg PPI. He alluded to a change in diet but minimal changes at best. I found your analysis and diet plan about a month into the PPIs and purchased the diet plan. I wasn’t getting better at that point. I’ve been on your diet for 3 weeks now and am feeling much better, maybe around 80% better. Got of the PPIs that I was on for a couple of months last week. The diet was helping, the meds were not.

    My question is, when is it safe to add some food or drink that is not included in your diet plan? I have followed it religiously for 3 weeks, have had nothing to drink but water and my diet has been very limited. Wild Halibut, wild salmon, chicken, vegetables, white rice, eggs, oats, bananas, Bosc pears and Food for Life breads.

    Thank you for your work and help with this problem I had never even heard of prior to my diagnosis.

    1. Hey Frank,
      Love to hear that you are feeling a lot better now, that’s brilliant. 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.

  42. Hi David,

    Found your site after experiencing another bout of LPR. Amazing info!

    Re: alkaline water, I’ve been using the Santevia water system, which alkalizes water and adds minerals. Wondering if you’re aware of it? I haven’t tested the water’s alkalinity after filtering, but the website claims the pH becomes around 9. I’ve used this system for years and am really happy with it.

    1. Hey Karen

      Thank you very much 🙂 I was not aware of that one in particular though I have seem similar ones before. I think it’s great especially if it makes the water more alkaline. If it dose what it promises it seems like a no brainier to try out and use.

  43. Hi David,
    Thank you for publishing such concise and helpful information on LPR. I have had LPR symptoms
    for several years and have yet to find a doctor who has been able to sucessfuly treat my LPR. My question to you is that the tip of my tongue seems to suffer the most from my LPR. Have you heard of this problem? 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. I follow a low acid diet. No sugar or desserts. When I sleep, I am awoken every two or three hours with a burning tongue or sour taste in my mouth.
    Kind regards. Paul

    1. Hey Paul,
      Thank you. I think that’s somewhat common. I used to have a similar feeling before myself with my tongue burning, it could also be related to burning mouth syndrome perhaps. The best thing you can do is to stop the acid coming up as I have suggested in this article and others here on my blog.

  44. Hi David,

    Really great website, very glad I’ve found this.

    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. There would be mucus to clear, some of it quite thick. It would take a lot of coughing and throat clearing to get rid of it. It has been really quite irritating, but as it was something that slowly crept up, I simply learned to live with it. It would last for around 45min – 1hr. Slowly over the last year it also started happening more and more later in the day, again after eating.

    In the last few weeks things have got much worse. The need to clear my throat of mucus will last hours after eating! It has also developed into a cough, a muscular dull pain in the centre of my chest and a raw feeling in my windpipe (similar to a feeling of having been running fast in very cold weather). I have not had classic symptoms of heartburn. But in the last week I have felt a mild acidic feeling at the very back of my throat. The only thing that has helped up to now, was when I did a 30 hour fast a few days ago. By simply not eating at all, all my symptoms slowly decreased. But as I started eating again they came back. Even eating something as simple as 1 poached egg caused more than 2 hours of throat clearing/coughing/chest pain.

    I had a telephone consultation with a gastroenterologist a couple of days ago (seems impossible to see a doctor face to face currently because of the Coronavirus!). He prescribed me with PPIs. He said he didn’t believe it was LPR because ‘there are no symptoms with LPR’. I have decided against taking these.

    I’ve been trying to source Gaviscon Advance in the UK or anywhere in Europe, but it seems impossible. I’m wondering if it had been discontinued? I bought some normal Gaviscon instead for now. I also found a product called silicol®gel which I have ordered. Have you tried this before?

    For the last 24hrs I’ve taken some Gaviscon after eating and my symptoms have been greatly reduced.

    I’ve started following a very bland, low acid diet also. Nearly all the other lifestyle advice doesn’t really apply. I don’t drink alcohol, don’t smoke, don’t drink fruit juice, carbonated drinks, coffee or anything with caffeine, don’t eat processed food, peppers, raw onions, tomatoes, sugar or any citrus fruits. I’m definitely not overweight either. My diet was high fat/low carb however. Pretty much a keto diet.

    1. Hey Jack,

      Thank you! Yes I don’t agree with what your doctor said it sounds exactly like LPR symptoms to me that have built up over time from what you have said and I also agree with not taking the PPIs. As for the Gaviscon it doesn’t really need to be that one in particular, really any one with sodium alginate can help, ideally at least 250mg per 2 teapoons. Though more would be preferable, as a reference Gaviscon Advance is 1000mg per 2 teaspoons. I have heard of the silicol gel though I haven’t tried it myself. 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.

      1. Hi David, thanks for the reply.

        I couldn’t source any Gaviscon Advance at all, so decided to order some sodium alginate, which arrived today. So I’ll start trying that and sticking to a super bland diet. The diet definitely seems to be helping. I had a slip up yesterday and ate some ice cream with chocolate sauce and the symptoms came back with a vengeance!

        1. Hi Jack,
          Glad to hear you have seen improvement already. Yeah you just to be particularly careful especially at the start of your healing journey.

  45. Hi David,
    I took your LPR test and It came up with a 26.
    I just have 2 questions.
    1) I would like to order Gaviscon Advance -UK version from Amazon but it’s unavailable at this time. I would like to order it elsewhere, but how can I be sure it’s the UK version? Does it says somewhere on the picture of the bottle?
    2) Can I put alkaline drops into soup, cereal milk, and the water I boil for the teas you suggested?
    Thank you so much for your very helpful article.

    1. Hi Mick,
      Yeah that score is highly indicative of LPR.
      1. Usually by the appearance of the bottle. It has red labelling, you can always send me a link here or to my email for me to check for you.
      2. Well yes you can in theory, though I wouldn’t bother. You just need to make sure what you are taking is not too acidic (above 5 pH).
      Happy to help.

  46. Just wondering how long tissues take to heal completely from pepsin once you start following the diet? For instance, if pepsin has floated to the throat and will constantly be reactivated by acidic foods, will the tissues regenerate and heal without pepsin at some point months down the road on the diet?

    1. A few, though most people tolerate it well. Perhaps due to the fiber count for some people can cause gas which can lead to reflux for some people.

  47. Thank you for this site. I keep coming back to it as it’s the most reliable on the web I’ve found. My LPR symptoms are so unbearable. The mucus and coughing has made my throat sore and me so miserable. Anything I eat or drink sets me off. Initially dry foods (nuts, seeds) and starches (rice cakes, crackers) were the main issue. Now even an egg, or some (canned) fish, or even a cup of herb tea or a glass of water can cause either raging heartburn, phlegm or both! Gaviscon Advanced does help at night with the burn (I get mine on Amazon or a local chemist as I’m in the UK). I’ve dabbled with the various diets and I can see the logic in them, but because proteins cause me so much grief, FTD is not an option for me. I read about the study using a plant based diet with alkaline water for LPR, but would need to avoid too many grains and pulses! What would you say are the most neutral, safest foods that I could focus on for a day or two to get relief. I’m a bit underweight, so don’t think I should fast. Thanks again for all your info.

    1. Hi Claris,
      Thank you, I’m glad to be of help. Yeah the alkaline style diet works well. The foods I would suggest are things like rice, potatoes, pasta, oatmeal. If you want relief things like cucumber, celery or watermelon are soothing and calming which should help calm symptoms too.

  48. Hello, excellent advice, very nice job.
    One year ago I suddenly felt a burning sensation in my throat, thought it was
    heartburn and I got some Zantac occasionally but no improvement. Then things went worse I did an endoscopy and doctor said I had Esophagitis A grade, the doctor prescribed Nexium twice a day. By the third day thing were far worse with a lot of coughing. I stopped Nexium and doc gave omeprazole one per day for a month, there was no improvement, on contrary by the end of the month my bones started feeling pain. The doctor said he cant understand what is going on then I got a second endoscopy after two months and he said I had B grade esophagitis, again he said to double the PPIs dosage. Of course I didn’t follow his treatment. I have some breathing problem due to LPR occasionally. I don’t follow a diet. when I first had these symptom a year ago I had been through stress and I was on a diet. I cut cola and everything bad but when i restart cola my symptoms get better but not the LPR symptoms. The last two months I have melatonin every night. I’ve seen some improvement but not great. I think I have some functional dyspepsia stress induced. Do you have any advices for all this. Thank you for all your words, you are really saving people lives here. Well done.

    1. Hi Konstantinos,
      Thank you for the kind comments. As per your story I had heard many similar situation including my own of the treatment and it not working. I would suggest of course a low acid diet like my wipeout diet plan. Also only drinking alkaline water and nothing else. In terms of medications an alginate medication is best after meals and before bed. Options are UK gaviscon advance or US reflux gourmet.

  49. Hello David , I am really thankful for your site as I am positive it will really help me which is why I subscribed with the diet plan immediately I came across it but I experienced some challenges signing back and having access to the content of the diet plan . I am a bit confused and would really appreciate if you assist me with ASAP. I also have a screenshot of my proof of payment if that could help resolve the situation. Thanks

  50. Hi David,

    I understood that LPR is benign if treated and would not lead to complications, but what “treated” exactly mean? I think for most people with LPR, ” 80% normal” is probably a very good outcome, but would it be counted as “treated”, (as with even 80% success you still have some pepsin in your throat damaging your tissues)? And if not, then would LPR inevitably lead to complications? Personally I have my good days and my bad days, but even in a good day, I have some minor symptoms nevertheless.

    So my question basically is, what is the prognosis of LPR? Are you aware of any study which followed “treated” or even untreated people with LPR over a span of a few years to see how their symptoms improved/worsened or lead to complications? I tried to search the internet, but couldn’t find any such study, which is kind of strange for a disease that has been around for decades and affects the life of millions of people.

    1. Hi Pete,
      It depends who you are talking to really. Completely treated would mean no symptoms at all. Treated and maintained may be different with some minor symptoms as it sounds in your case. Who knows it could lead to complications over time and if you want to try to get to a perfect level you can of course. Though overthinking it too much in that sense in not good for my state of mind. So in my case it’s maintained well and I try not too overthink from there.

      There isn’t any study quite like that from my knowledge. I guess because the general medical industry isn’t quite caught up on LPR so studies are not as prominent as GERD in comparison.

    1. I actually prefer to suggest alternatives foods like watermelon, celery or cucumber and teas like chamomile or marshmallow root. Because these are natural they likely won’t irritate the throat or digestive tract.

  51. Hi David. Great blog with well explained content. I just have a query about strengthening the LES. If the LES needs rest to recover wouldn’t intermittent fasting or OMAD be of benefit? Instead most LPR literature and your diet recommends regular small meals spread throughout the day. Surly this pattern of eating would keep the LES in constant action, thus preventing it from healing?

    1. Hi Louise,
      In theory yes it would be but actually it’s shown to make things worse as was backed up by a small study. Because eating actually helps keep contents in the stomach and helps keep the stomach acidity in check better. Yes small meals are best because as I mentioned it keeps the stomach more balanced. The thing with the LES having problems often and usually isn’t directly derived from the LES but another cause, like mobility issues or other valves not working like the pylorus causing a back up in pressure and making the LES remain due to higher pressure in the stomach.

  52. David,
    I’ve been having a constant sore throat about 2 months now and don’t know if it’s from post nasal drip or LPR or both. I would sometimes get LPR from certain foods but if I controlled what I ate I was fine so I don’t know what’s causing the constant burning sore throat . Any ideas what’s going on? Also, is distilled water okay to drink?
    Pat Heisel

    1. Most likely I would guess that something you are eating or drinking is flaring things up more so, or something like you are eating too big portions for example. You can drink distilled water yes, though ideally I’d suggest alkaline water instead.

  53. Hi David,

    I’ve been experiencing symptoms ranging from a sour taste in the back of my mouth to periods of either dry mouth or hyper-salivation (sometimes these things happen simultaneously) for a little over a year now. I had an endoscopy done that showed nothing. Then I had motility and PH testing done that showed I have ineffective esophageal motility. I’m curious if you’ve learned anything about this condition and whether it’s related to silent reflux. The PH test appeared to show me at relatively normal levels, my esophagus was below a PH of 5 for 2% of a 24 hour period, which amounts to about a half an hour… but I was doing really specific things while I was doing the PH test to try to induce my symptoms. So for instance, I drank hibiscus tea, which is well below a PH of 5, so I think some of that may have influenced that 2% reading. Anyway, I tried following a very strict low acid diet for about three months without seeing any improvement. I also see no improvement from taking Reflux Gourmet. And of course PPIs and H2 blockers don’t help me either. The motility test seemed to also indicate that my LES was operating correctly, and that my main issue was esophageal motility. But I don’t know if poor motility correlates to my particular symptoms or not as from what I can gather, it’s not a well understood condition.

    I was just curious if anything I’ve experienced rings a bell with you and if you have any advice. Thanks for putting all this information together, it’s been very helpful to me, even if I’m not sure that it pertains to my problem or not!

    1. Hi Darian,
      Yes low motility can cause the silent reflux symptoms in the first place and the other symptoms you mentioned you have. There are drugs known as prokinetics that may be worth considering or asking an expert about, that is what I would suggest to you. Considering you have tried the diet and the reflux gourmet which often helps people with LPR symptoms. In regards to your PH testing impedance is the best kind if you had this, this is because it records motions up such as gaseous reflux which may not be acidic but can be an important cause of the problem while some other pH test only measure the acidity which isn’t the whole picture for LPR, not to mention even a few episodes can cause the problems even if this is deemed in the ‘normal’ range. Hope this gave you something to think about.

  54. Thank you for creating your website David. I have two problems. The first is that I had every symptom of LPR. Most of them subsided except for the breathlessness. The ENT put a scope down my nose and said it’s not LPR. I have an appt with a GI, but am not very trusting of the medical community at this point.
    The problem with dietary changes as a means to control this, is that I am just about down to double-digits with my weight. I can’t afford to lose anything else at this point.

    1. Just because he think’s its not LPR doesn’t mean he is correct on that. I would assume otherwise. I’d suggest doing the alkaline spray as explained in this video, in your throat and nose, I’d expect it to help your breathing.

      On the weight side of things try to eat more carbs and natural fats that will help with weight. Also don’t be afraid to eat a bit more to satisfy yourself properly.

  55. Thank you for this informative article and links.

    I’m very frustrated that my primary care PA instantly put me back on PPIs even though I told him I’d been previously diagnosed with LPR, not GERD. After 3 days of feeling worse, I stopped taking them. I have an Enviro filter that ups water alkalinity, taking Reflux Gourmet. All was under control until about 2 months ago. Personal stress from a life change coming up plus I was eating a lot of trigger foods. I see a GI doc later this month, and I am leery that he is also going to jump to the PPI “solution”, as that’s what his colleague in that practice had me on years ago that I weaned myself off. What can I say, and how can I say it, so that this specialist listens to me and my symptoms? And gives me the appropriate tests for pepsin and stomach acid levels (I’m in my mid 60s so I doubt I suddenly have too much stomach acid). Thanks in advance.

    1. I don’t think you should need to say it in a certain way to your doctor. If they are knowledgeable they should be able to advise you properly. That being said I would ask them why they are recommending a certain treatment or any tests, and what’s the benefit from doing them and what potential outcomes can come from it. It seems like you had things under control before so definitely work on that to make things better in the meantime.

  56. Very interesting information David. I recently started suffering from what I thought was just acid reflux but in the last two weeks has completely stolen the majority of sleep. I went to an Ear Nose and Throat doctor and after scoping down my nasal passage confirmed I have acid reflux. He ordered a sleep study done at home and I completed that night and actually got about 6 hours of uninterrupted sleep. Since then, I’m back to the 2 hours (maybe) intermittent sleep. He told me to take a OTC Prilosec before eating in the evening. Other than nothing until I see him in three weeks for a follow up. I can’t make it that long for sure. I messaged him back for an immediate appointment. The more I read your website, I’m sure it’s LPR. I do not have heartburn or indigestion. I just a constant need to swallow or clear my throat and the last few days starting to taste the acid throughout the day. I’ve begun to change my diet and understand it’ll take time, but I’m looking for more instant relief so I can sleep!

    Thanks for all your info and a chance to vent a little.

    1. Of course Tim. Sounds like it from what you mentioned here. Once you are on the right track you are sure to get relief very soon.

  57. Wow! Thank you so much!! The amount of information is just insane and I’m greatful. I’ve had the overwhelming sensation of needing to swallow for days along with throat discomfort. I also get ear aches often and have been told I have post nasal drip. Got to try out your methods before medication. ♡

  58. Katherine Anne Lipp

    I have sore and tight throat only, I am on a low acid diet except the coffee, it is hard for me to stop coffee, but I will stop. How long does it take after stopping coffee for sore throat to go away, for most people. Thanks

    1. If you are following the right treatment and diet advice you should see an improvement relatively quickly usually within 2 weeks. The secret is to make sure you aren’t eating or drinking something that is holding you back from healing like the coffee you are drinking could well be.

  59. Hi David, does the wipeout plan incorporate an element for SIBO as I have it also, and seeing as this was part of your healing, would be conscious that the plan helps in this regard also? Thanks.

    1. Hi Derek,
      Yes it does briefly talk about SIBO though not in great depth. If you do decide to get access to the diet you are always free to message me and I can advise on combining the diet into a SIBO friendly one too.

  60. Hello, thanks for all the info you’ve shared. I’m 5 months postpartum and have not been able to sleep on my back since giving birth because of a heavy feeling on my stomach and chest. I thought something might be wrong with my lungs or heart but I’ve had a cardiac work up and CT scan on my lungs and all is fine. The doctor suggested acid reflux because it’s only happening when I lay down. I read more about the symptoms and saw that yes, I often have a disconcerting lump in the throat and have had episodes where my esophagus felt so closed off that it was impossible to swallow. I have post nasal drip and am prone to sinus infections. I do not have any feelings of burning, no burping, and no sore throat or hoarseness.

    My first question is, does this sound like silent reflux? And have you heard it happening in the postpartum period, maybe from my stomach being squished during pregnancy?

    My second question is about the wipeout diet. I’ve been eating a high fiber, low inflammatory, plant based diet for more than 20 years, and I never smoke, drink, or consume caffeine. I almost never eat fried foods. I drink reverse osmosis water. No chocolate because it bothers baby whom I’m breastfeeding. Does it sound like the wipeout diet would have anything new for me, or should I chalk up my issue to a lingering pregnancy symptom that’ll eventually heal on its own?

    I also did intermittent fasting for many years, just ate two big meals per day. Loved it and felt great on it. I know you mentioned big meals can be problematic, but this whole issue only started during pregnancy when I started eating many smaller meals. Any thoughts on that?

    Thanks for any advice you can share.



    1. Hi you are welcome! Yeah it does sounds like silent reflux from what you mentioned. Yeah I have heard it happening during and after pregnancy. Clearly there is some relation there.

      Sounds like you are doing a good job in general with your lifestyle and diet though yes the wipeout diet would help you to understand the small things and differences that are important will allow you to stop and lessen your symptoms and heal more effectively. Things you may feel are healthy can be problematic for people with LPR and sounds like it would most definitely help you.

      It’s probably not correlated to the adjustment in your meal sizes. It’s more likely due to the pregnancy and how that can affect the stomach and it’s positioning for one.

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