A diet for laryngopharyngeal reflux (LPR) should meet three criteria: The food should be low in acid and fat, and at the same time, improve digestion.
Low-acid diet for LPR
Acid activates pepsin, which promotes inflammation.[1] While acidic foods do not cause reflux, they massively exaggerate the symptoms. They add fuel to the fire.
For this reason, people with LPR (or silent reflux) should avoid acidic foods and drinks as far as possible.[2],[3],[4]
Important note: There are some misconceptions about which foods are acidic and which are not. The reason for this is the so-called “alkaline diet” trend. In these diets alkaline does not refer to the actual pH of the food. For instance, lemons count as alkaline, even though they have a very low or acidic pH. When I write about acidity, I am mean the pH of the food before it is metabolized. I address this confusing topic in more detail in a different article.
Unfortunately, almost all foods and drinks contain some acid. They may not taste sour, but still, they include a small amount of acid. Even bread is mildly acidic.
We cannot eliminate acid because there would be nothing left to eat! The goal of an LPR diet is, therefore, to reduce acid – not to eat a 100% acid-free diet.
Ideally, you should try to abstain from anything with a pH lower than 5 – at least for a while. Once symptoms improve, you can try to reintroduce foods with a pH of as low as 4.
The pH scale is logarithmic.[5] Each number in either direction on the scale corresponds to a 10-fold change in acid content. Foods with a pH of 4 contain 10 times as much acid as foods with a pH of 5 – the acceptable acid content for an anti-reflux diet. Foods with a pH of 3 already contain 100 times as much acid (10 times 10).
When avoiding acid, you should pay special attention to drinks:
Many beverages, such as Coke, soda and fruit juices, are very acidic. Acid is responsible for the fresh taste of these drinks. Without acid, they would merely taste like stale sugared water. The high sugar content masks the acid so that you cannot taste it. The pH of many soft drinks is about 3, which is very acidic.
As well as drinks, though, acid foods are also dangerous when you have reflux. You should especially avoid yogurt and fruits.
Anything pickled also has a high acid content. This is because acids, such as vinegar, are used for preservation.
I want to stress that it is vital to avoid any foods and drinks with a medium-to-high acid content. Even a few exceptions per week, such as a few sips of a Coke, can exaggerate the LPR problems.
Low-fat diet for LPR
Fat slows down the digestion by reducing gastric motility.[6]
This does not mean that you should eliminate fat from your diet, as this would be neither healthy nor constructive.
You should aim for a fat content of about 10%. A recipe with 10 g fat, 20 g protein, and 70 g carbohydrates would be excellent. The protein content is not critical – you can eat foods that are low or high in protein. With this strategy, you have a lot of variety and can use fat to improve the taste.
The balance is essential. One high-fat meal and four fat-free meals are worse than five meals with the same fat content. Occasional high-fat meals can cause acute, severe reflux that you certainly want to avoid, especially when you are just starting and would like to improve your symptoms rapidly.
Smaller snacks with high-fat content are fine on an empty stomach because it is the total amount of fat that matters. A handful of nuts does not cause problems, while a complete meal with the same fat percentage would cause severe reflux.
This fat restriction is mostly meant for the initial part of the diet. Just until you feel better. Later you can try reintroducing gradually fatter foods and see how you are doing.
By the way: Some people do well by reducing carbohydrates instead of fat. This seems to be mostly people who suffer from SIBO (small bacterial intestinal overgrowth). In those people, eating carbs can lead to a lot of gas in the intestines when bacteria ferment the carbohydrates. The belly swells up and puts pressure on the stomach, which leads to reflux. If you feel very gassy and bloated after meals rich in carbohydrates, you might be one of those people. However, SIBO only affects a fraction of patients with reflux. That is why I recommend trying a low-fat diet first because it works better for the far majority of people. No matter if you have SIBO or not, it doesn’t change the other components of the diet. Just the relevance of fat and carbohydrates.
Digestion-improving foods
The last important point is to eat foods that are good for digestion. Reflux occurs when digestive processes do not work smoothly. This can be avoided by choosing the right foods.
Many foods contain ingredients that impact reflux in either a positive or negative way. Of particular importance are ingredients that affect the lower valve of the esophagus, the lower esophageal sphincter (LES). Some foods relax the LES, which promotes reflux, while other ingredients may tighten the sphincter, thereby reducing reflux.
The correct LPR diet is individual.
You should learn to get a feeling for the right foods.
Listen to your body and pay attention to which kind of foods you feel better or worse after.
Not everyone reacts in the same way to various foods. The differences depend on our genes, our way of living, and our environment. While a low-fat diet works well for most people, some people do better on a low-carb diet.
The goal of an LPR diet is not to strictly follow the rules, but to find out what works best for you. You need to figure out what tastes good and at the same time is good for you.
Diet for LPR is a complex topic. For this reason, diet is the main topic in my online course for the treatment of LPR. It contains not only information about LPR therapy, but also an extensive list of reflux-friendly foods. This helps you to quickly find foods that work for your LPR – and which you enjoy eating as well. The course also contains recipes for tasty and healthy meals.
References
[1] Johnston N, Dettmar PW, Bishwokarma B, Lively MO, Koufman JA. Activity/stability of human pepsin: implications for reflux attributed laryngeal disease. Laryngoscope. 2007;117(6):1036-9.
[2] Koufman JA. Low-acid diet for recalcitrant laryngopharyngeal reflux: therapeutic benefits and their implications. Ann Otol Rhinol Laryngol. 2011;120(5):281-7.
[3] Koufman JA, Huang S., et al. Dr. Koufman’s Acid Reflux Diet: With 111 all new recipes including vegan & gluten-free: the never-need-to-diet-again Diet. Katalitix. 2015.
[4] Koufman JA, Jordan S, Bauer MM. Dropping acid: the reflux diet cookbook & cure. Reflux Cookbooks; 1st ed. 2010.
[5] pH Scale. Virtual Chembook, Elmhurst college. http://chemistry.elmhurst.edu/vchembook/184ph.html. Accessed on Oct 04, 2019.
[6] McSwiney BA, Spurrell WR. The effect of fat on gastric motility. J Physiol. 1935;84(1):41–49.
