How to Treat LPR

Controlling LPR through Diet

Choose bland rather than spicy foods. Spicy foods can make heartburn worse, and may also increase reflux symptoms generally. Heavily seasoned and spicy foods encourage your stomach to produce more acid. In general, start by eliminating all condiments and seasonings except black pepper. If there are particular condiments or seasonings you like, add them back 1 at a time and monitor your reflux symptoms.

Consume skim or low-fat dairy products. Full-fat dairy products, including milkshakes and regular ice cream, can exacerbate reflux symptoms. Stick to skim milk or try alternative non-dairy products (like soy milk), and look for nonfat or low-fat yogurts and cheeses. Experiment with eliminating different dairy products from your diet to find out which ones give you reflux. For example, you may find that ice cream causes problems for you. If so, you might try switching to low-fat frozen yogurt.

Avoid highly acidic foods and beverages. Reflux occurs when stomach acid acts in combination with the stomach enzyme pepsin. When you have LPR, it's actually pepsin that gets into your throat and airways. When you eat and drink acidic foods and beverages, it creates an acidic environment in your throat for pepsin to flourish and cause irritation. Try to avoid tomato-based foods and peppermint, which can all trigger reflux. Colas and other carbonated drinks are even more acidic than citrus fruits. If you must drink carbonated beverages, stick to sugar-free, low-carbonation drinks like Fresca. Try to avoid foods with a pH of 5 or lower. When in doubt, do an online search to find out about the pH of foods and drinks you are interested in. You might consult a chart like this one: https://www.clemson.edu/extension/food/food2market/documents/ph_of_common_foods.pdf.

Reduce your daily caloric intake. People who have weight issues are at much greater risk for developing reflux conditions, including LPR. If you are struggling with excess weight, talk to your doctor or a registered dietitian about healthy ways to lose weight. Generally, eating smaller portions puts less pressure on your esophageal sphincters, allowing them to keep your stomach acid down. High-fat and fried foods also may exacerbate your reflux symptoms. Frozen or restaurant foods often are prepared in oils that may promote reflux as well.

Eat smaller meals throughout the day. Smaller meals put less pressure on your esophageal sphincters as you digest, making it less likely that you will experience reflux symptoms. Treat your LPR by having 4 or 5 small meals a day, rather than 3 larger ones. In addition to eating smaller portions of food, try to eat more slowly. Make sure you thoroughly chew your food before swallowing, and drink water between mouthfuls. Allow your food to settle before you engage in any strenuous activities.

Drink plenty of water. Staying well-hydrated can help prevent reflux, and will also keep your throat clear. Aim to drink at least 8 glasses of water a day – more if you're engaging in exercise or other intense physical activity. Don't consider other drinks a substitute for water, even if they contain water. For example, although coffee is mostly water, coffee is a diuretic and can trigger reflux.

Eliminating Reflux Triggers

Keep a food journal to help identify triggers. Specific foods that aggravate reflux differ greatly from person to person. Writing down everything you eat can help you figure out how best to prevent your symptoms. There is no universal diet that will successfully treat LPR. Even foods that are common triggers may have no effect on your reflux.

Avoid chocolate, caffeine, and alcohol. LPR is caused, in part, by a weakened lower esophageal sphincter. Reflux occurs when that sphincter relaxes. Chocolate, caffeine, and alcohol all cause the lower esophageal sphincter to relax. Coffee may trigger reflux even if decaffeinated.

Quit using tobacco products. Tobacco use, including smoking, dipping, or chewing tobacco, encourages reflux. If you use tobacco, quitting may also resolve your LPR. Ask your doctor for tobacco cessation assistance and resources. If you monitor your LPR symptoms immediately after using tobacco, you can see the effect your tobacco use is having on your reflux condition.

Don't eat within 2 hours of going to bed. When you are upright, gravity can assist in keeping your stomach acid down. However, lying down causes the contents of your stomach to press against your lower esophageal sphincter, which can cause reflux. In general, avoid eating late at night, when your digestion process is slower. This includes midnight snacks, not just full-blown meals.

Elevate your head when sleeping. Most LPR symptoms happen during the day. However, if you have reflux at night, you may need to put the head of your bed up on blocks to prevent acid from traveling down your throat. Propping up on pillows or using a wedge won't work by itself. You have to raise the entire head of the bed 4 to 6 inches (10 to 15 cm). Eat at least 2 hours before bedtime to prevent your stomach contents from refluxing when you switch to lying down.

Review all medicines or supplements you're taking. Many over-the-counter and prescription medicines increase the level of acid in your stomach, which can worsen your LPR symptoms. Some nutritional supplements also increase stomach acid. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve) can increase stomach acid if you take them regularly and in large doses. If these medications trigger your reflux, try taking half your usual dose. It can also help to take them with a little baby applesauce or caffeine-free tea with milk, so you don’t have an empty stomach. Vitamin C supplements also may raise the level of acid in your stomach. Blood pressure and asthma medications, as well as birth control pills, may increase stomach acid. If you were prescribed a medication that you believe is worsening your LPR symptoms, talk to your doctor about switching medications. Do not stop taking your medication without first talking to your doctor.

Wear comfortable, loose-fitting clothing. Clothing that constricts your waist can put pressure on your abdomen, making LPR symptoms worse. Avoid tight-fitting jeans, tight belts, or clothes designed to compress your abdomen, such as corsets or body shapers. You may find it helpful to switch to pants that have some elastic in the waistband, or that fit lower around your hips instead of high up on your waist.

Seeking Medical Intervention

Try over-the-counter (OTC) medications. Particularly for minor LPR symptoms, OTC antacid medications such as Pepcid, Prilosec, or Tums may provide some short-term relief. These medications are only treating the symptoms, and won't have any effect on the LPR condition itself. If you've been diagnosed with LPR, you may want to talk to your doctor even before taking an antacid or other OTC medication. You should also consult your doctor if you find yourself taking an antacid regularly for more than 7 to 10 days in a row. Proton-pump inhibitors (PPIs), such as Nexium or Prilosec, are not equally effective for everybody. If these medications don’t seem to be helping your LPR symptoms, talk to your doctor about alternatives.

Discuss prescription medication options with your doctor. If your LPR doesn't improve with changes to your diet, you may want to try a prescription medication that increases the pressure of your weakened sphincters to keep stomach acid down. There are also prescription drugs that reduce the number of times the sphincters relax. This can reduce or even eliminate reflux. Prescription medications may cause side effects, and some can also interact with other medications you are taking. Talk to your doctor about the risks and benefits of any possible prescriptions, and tell them about other medications you are currently taking. These medications can be helpful in the short-term, but if you find yourself needing them for several months, it may be time to discuss surgical options with your doctor.

Consider surgery as a last resort. There are several surgical treatment options for LPR. In most cases, surgical treatment is successful, but it may cause uncomfortable side effects, such as severe bloating. Your doctor will be able to discuss surgical options with you, and may refer you to a specialist for further evaluation. Keep in mind that surgery typically is a permanent option that cannot be undone, regardless of the side effects you experience as a result.