LPR Symptoms and Treatment

Medical Q&A [Moderated]
1

Hi Guys,

Love the new forum idea, excited to see where it goes. I saw a post that Dr. Baraki made on the SS forums awhile back about having bad LPR.

I have a chronic cough and I think I too suffer from this, I had been diagnosed with GERD and prescribed omeprazole about 10 years ago. I’ve since lost weight and gotten stronger. While I was eating SUPER healthy I didn’t tend to notice many acid issues but while heading back to a normal eating lifestyle I think LPR either came back or it’s always been there and is compounded by diet. I haven’t been formally diagnosed with LPR mind you but I’m guessing that’s all there is left. I’ve been to an allergist and an ENT and both have told me that I have minor allergies and my sinuses are prone to congestion. Nasal flushing and habitual allergy meds haven’t done much to alleviate the cough. Daily PPI use doesn’t appeal to me. I’m not sure of the validity of the studies revolving them and dementia but my grandpa has been on them since they first came out and he was recently diagnosed with Lewy Body Dementia. It’s been a rough year for him to say the least.

My question for you Dr. Baraki, is have you had any luck treating this? I’m guessing my symptoms would be alleviated if I cut out everything good(alcohol, coffee, sweets, etc.). Perhaps you might have a suggestion on where to start? I don’t REALLY want to go full blow paleo or something like that…but I guess I may have to consider it. My cough is getting out of control and it seems to be that dry unproductive, cough. I’m pretty sure it’s acid related because I can be fine until I start to talk, then I get horse and will have to hack a good bit.

My diet right now consists of the following:

M-F
Breakfast
Protein Shake(whey + milk)
Cold brew coffee(milk and truvia)

Lunch
Some type of batch cooked lunch, meat, veggie, starchy carb. Could have peppers/garlic in it. Might eat out with my team once a week, usually like a Jimmy Johns or sandwhich place

Dinner
Meat and veggie. Fish, ground beef/venison, sometimes eggs. Veggies could be frozen, sometimes veggie tots etc.

Work has free drinks so I’ll usually snag a Diet Dew and a La Croix throughout the day.

May have sweets or a Halo Top one night a week.

Weekends
Breakfast - Same as M-F
Lunch - likely same as M-F
Dinner - Probably eat out at least one night
Usually have a few beers throughout the weekend.
May have the occasional sweet.

Male 6’1" 205.

2

Hi there,

Your post immediately reminded me of some new published research on the matter:
http://www.jwatch.org/fw113300/2017/…092831&jspc=IM

Researchers identified two cohorts of patients diagnosed with laryngopharyngeal reflux at a New York hospital from 2010 to 2015 — 85 patients treated with PPIs plus standard reflux precautions, and 99 patients treated with alkaline water (pH >8.0) and a plant-based, Mediterranean-style diet plus standard reflux precautions.

After 6 weeks, 63% of the diet group and 54% of the PPI group had achieved a clinically meaningful improvement in a reflux symptom score. Additionally, the diet group had a significantly greater mean reduction in the score than did the PPI group (40% vs. 27% reduction).

Regarding your other questions: I’m not aware of convincing evidence of a causal link between PPI use and dementia, but there are several other long-term side effects and I don’t like having patients on them forever if I can avoid it. Sometimes, however, we don’t really have a choice (like someone with severe esophagitis, Barrett’s esophagus, etc.)

The first things that jumped out to me on your list is the cold brew coffee, sodas, and alcohol. (The good stuff, I know).

I generally point patients to this resource on the issue of reflux symptoms: Choosing Wisely: An Initiative of the ABIM Foundation

Hope that helps.

3

Thanks for following up Austin.

I stumbled onto this yesterday and I initially thought it may be more Dr Oz quackery, but it generally lines up with what you’re saying as well. Dr. Koufman appears to be on the forefront of this anyway.

http://www.doctoroz.com/article/silent-reflux-epidemic

The reflux epidemic appears to be related to too much acid in the food supply! How did this happen? Following an outbreak of food poisoning in 1973, the Food and Drug Administration (FDA) set Good Manufacturing Guidelines for all food and beverages in bottles and cans. And what did they mandate? Acid, acid, acid. By law, everything in a bottle or a can must be acidic. This kills bacteria and prolongs the shelf life of products, but it also causes reflux disease.

If you have reflux, the only thing you should drink out of a bottle is water, and alkaline water is best.

Is there any merit to the idea that ingesting acidic foods can lead to higher stomach acidity and reflux symptoms?

I can certainly cut down on those three things you listed. I actually switched to cold brew because it is less acidic and seemed to lead to less coughing after I drank it vs hot coffee. Apparently I need to cut down on soda and beer too.

4

It appears the second link in my last post was taking you to the wrong page. I’ve corrected it here: Choosing Wisely: An Initiative of the ABIM Foundation