Silent Reflux (LERD) – A Commonly Misdiagnosed Health Problem and How to Hopefully Find Relief

Silent Reflux (LERD) - A Commonly Misdiagnosed Health Problem and How to Hopefully Find Relief

Laryngopharyngeal reflux disease is a newer, less understood cousin of GERD (gastro esophageal reflux disease). LERD (larygopharyngeal reflux disease) differs from GERD in that people with LERD suffer from more of the upper airway symptoms of reflux disease. Most people who suffer from LERD do not have traditional heartburn, pain in the throat, chest, or any symptoms of GERD. LERD sufferers usually have their symptoms during the day, whether they eat or not, and symptoms usually arise when they are sitting. GERD sufferers typically have their symptoms in the evening, after they eat, and when they are lying down. Most LERD symptoms are instead felt upon waking from sleep in the morning. It is also harder for LERD to be diagnosed correctly because the symptoms are so universal for most people. LERD can disguise itself as asthma, oral cavity, ear, or sinus issues.1 2 3 4

Symptoms of LERD include:5 6 7 8

  • Coughing
  • Hoarseness
  • Roemheld syndrome
  • Tachycardia after eating
  • Esophageal spasms
  • Post-nasal drip
  • Sore throat
  • Lump in the throat feeling (globus pharyngitis)
  • Hoarseness
  • Dry mouth
  • Bad taste in mouth
  • Halitosis (bad breath)
  • Periodontal disease
  • Loss of sense of smell
  • Ear infections
  • Problems with hearing
  • Tinnitus
  • Fullness feeling in ears
  • Ears pop while swallowing (eustachian tube inflammation)
  • Asthma
  • Perceived breathlessness
  • Unlike GERD, the esophagus usually appears undamaged in people with LERD. The esophagus appears undamaged because the acid and pepsin that are refluxed are quickly swallowed downward. The stomach contents not being trapped in between the two sphincters, creates a lot less damage to the esophagus itself and more damage to the upper airway, UES (upper esophageal sphincter), oral cavity, sinus cavity, eustachian tube, and larynx because pepsin remains there and breaks down the tissue.9 10 11 12

    Pepsin is the main enzyme used by the stomach to digest protein. Pepsinogen activates and converts into the enzyme pepsin in the presence of stomach acid. Pepsin helps break down protein into amino acids the body can absorb and then becomes inactivated, by turning back into pepsinogen when it is mixed with bicarbonate released from the pancreas in the small intestine. This neutralization protects the rest of the intestinal system from pepsin and stomach acid.13

    The inactivation of pepsin by sodium bicarbonate does not strongly occur in the esophagus. Anytime you swallow anything with a low pH like vinegar, for example, pepsin is reactivated and begins to cause tissue inflammation. I recommend drinking alkaline water after meals, throughout the day, and before bed to inactivate pepsin. In addition, limiting acidic foods like citrus fruits or vinegar can also help relieve the symptoms of silent reflux.14

    An endoscopy may also be performed to get an idea of esophageal damage and the general function of your LES, UES, and stomach. During an endoscopy, a flexible wire with a camera positioned at the end of the wire is swallowed. The camera takes pictures down the esophagus and into the stomach. Traditional endoscopies are known to have issues associated with the procedure including potential injury or death from sedation, increased risk of aspiration, and increased risk of infections from improperly sterilized (autoclaved) scopes. I recommend you talk to your doctor about performing the safer; transnasal esophagoscopy procedure, that does not require sedation.15 16 17

    One of the best assessments utilized in the diagnosing of LERD is an esophageal PH monitoring test. A flexible catheter with a PH monitor at the end is placed through the nose down into the esophagus for at least 24 hours. A 48-hour dual sensor pH catheter monitoring test (one pharyngeal probe and one esophageal probe) that can measure both acid and nonacid reflux events is very useful in establishing a LERD diagnosis.18

    Finally, there is a noninvasive test for LERD known as the Peptest. The peptest tests saliva, sputum, aspirate, and gastric juice for pepsin. If your saliva tests positive for pepsin, you are probably refluxing the enzyme, causing your issues. You can order the peptest yourself; you do not need a doctor to order the test.

    In most people with LERD, the upper and lower esophageal sphincters are not functioning properly. The UES, known as the upper esophageal sphincter, closes off the oral cavity and the upper airways from the esophagus. In most people with GERD, the LES, known as the lower esophageal sphincter, is the only sphincter in the esophagus not functioning properly. The nonfunctioning LES causes acid to become stuck in-between the stomach and the UES. The UES is the sphincter at the top of the esophagus that opens and closes when you swallow to protect the upper airways from aspiration; the trapped acid between the two sphincters is what causes the sensation of heartburn for most people.19 20 21 22

    The main problem with LERD is conventional medicine does not have an effective treatment for it. There is no proven diagnostic cause of LERD. My best hypothesis is that it is caused by any combination of any of these issues: SIBO (small intestine bacterial overgrowth), magnesium deficiency, adrenal fatigue, hypothyroidism, vagus nerve issues, zinc deficiency, upper gut overgrowth, chronic viral infection (V. zoster), improper collagen production in the body, inefficient production of endogenous vitamin D, possible unknown infection, nerve damage to both the LES and UES.

    General Advice for LERD:

    • Ask a physical therapist about “shaker” neck exercises that can be used to strengthen neck muscles (and the UES) after someone has had a stroke.23 24
    • Drink only room temperature water during meals, and do not overeat. Eat three meals daily only and try not to snack at night to help maintain proper MMC (migrating motor complex) function.
    • Chew your food well while you eat especially if you are eating anything with carbohydrates (to mix well with what little amylase we have in our saliva). The more you masticate your food, the less your digestive system has to work.
    • Drink two oz. of naturally, alkaline water (Evamor, Icelandic Spring, and Mountain Valley Spring Water are good brands) two hours after a meal to deactivate pepsin in the larynx (from stomach contents reflux) that might cause irritation. Swish well with the alkaline water before swallowing. In addition, drink two oz. of naturally alkaline water before bed.25
    • Wash the nasal passages out with saline at least once a day. In addition, use saline drops in the nose daily and blow your nose afterward. The saline is to deactivate excess pepsin that might be in your nose from the reflux caused by the LERD. Do not use a neti pot unless needed because it can wash away the beneficial mucus barrier in the nose.
    • Sleep on your left side at night to prevent reflux. Sleeping on our left side or back prevents LES weakness and helps with maintaining proper anatomical position. If you cannot tolerate sleeping on your left side, sleep on your right side, do not sleep on your stomach, it puts too much pressure on the gastrointestinal system. Possibly look into using the Reza Band at night to prevent reflux. I cannot fully recommend it because it is relatively new and more post-market studies need to be performed. Finally, practice good sleep hygiene. Melatonin production is important for proper digestive health and LES function.
    • Reduce intake of acidic foods that can trigger silent reflux. I would try to limit what I ingest with a pH lower than 5.5.
    • If you have are suffering from bile reflux, combined with silent reflux, reduce your ingestion of foods high in omega 9, known as oleic acid. Avocados and extra virgin olive oil is an example of foods high in oleic acid.
    • Increased endogenous production of vitamin D seems to help most people with silent reflux. I cannot stress the importance of this advice enough; it has made the biggest difference in my life and those I have coached that made the lifestyle changes. If you live in an area where it is hard to get sun or UV-B, the use of a UV-B producing tanning bed or supplementation might be needed. Get your 25-hydroxy and 1-25 hydroxy levels checked to see if your vitamin D levels are in range.
    • Maintain proper amounts of omega-3 fatty acids in your diet. Ingest leaner fish like cod, flounder, and salmon.
    • Practice Buteyko breathing techniques when possible.

    LERD Protocol

    • Zinc carnosine – One to two capsules with each meal.
    • Magnesium glycinate – 200 mg per 50 pounds of body weight, taken at bedtime. Glycine has been shown to help increase LES strength.

    Coat and Rebuild Your Esophagus and Larynx

    • Supplement with collagen daily.
    • Recipe to help coat and relieve your throat – In one cup of hot filtered water, mix in 1/2 teaspoon of slippery elm powder and 1/8 teaspoon of DGL powder, consume after each meal. Swish well, mixing with saliva before swallowing. Consider adding one tsp. of manuka honey to the drink to help coat your throat and reduce possible bacterial overgrowth in the upper gut.
    • Eat organic grass-fed beef liver once weekly for a good source of retinol and ceruloplasmin-bound copper.
    • Consider using D-limonene to help coat and protect the esophagus and larynx. For some people, it helps immensely, for others it may not be easily tolerated.
    • Consider using liposomal colostrum to help invigorate your immune system and reduce inflammation.

    Tackle Outstanding Medical Problems That may Cause LERD:

    4. Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006.
    8. Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006.
    12. Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006.
    13. Patton, Kevin, Thibodeau, Gary, Douglas, Matthew. Essentials of Anatomy and Physiology, Mosby, March 16, 2011.
    22. Beers, Mark. The Merck Manual, Merck Research Laboratories, 2006.
    1. Hi John,
      Thanks so much for that amazing article. I have been coughing for 5 years now, I started out with a pulmonologist who prescribed flonaise, advair, an asthma pump and PPI’s. The pulmonary doctor after 4 years referred me to a Gastroenterologist becasue of a hiatal hernia,who promised he would get rid of my cough. I have had a bronchoscopy, endoscopy, colonoscopy, Bravo PH24, all the PPI’s and finally I had the Nissen Fundoplication,(November 2016) and the Hiatal Hernia repair. AFter the Nissen, I stopped coughing for nearly 2 months. I was ecstatic to say the least, I had high energy and was able to do activities that I couldn’t while dealing with GERD. I have never had the typical symptoms just a dry non-productive cough so I was surprised to hear that I had GERD all I do is cough all day, especially when I am mobile, which makes me have shortness of breath and I literally cough until I see stars. Recently, when I get up in the morning I have mucous in my throat but only in the morning. Throughout the day when I am mobile its like air in my throat which makes me cough. However, as long as I have a Halls cough drop the cough is somewhat managed but I can’t be too mobile or I will have a horrible coughing spell. I have purchased The Chronic Cough Enigma by Dr. Jamie Koufman and The Acid Watcher Diet by Dr. Jonathan Aviv and I do tons of reseaech. I know that the Nissen typically takes a year to heal, but I am in need of some relief from this cough. All suggestions are welcomed

    2. If it is nerve damage to the LES, how would you treat it?

    3. Hi John,

      I appreciate this article very much. Can you weigh in on my situation?

      The first symptoms began about two years ago with a sudden pressure and tightness in the center of my chest just beneath the solar plexus. This caused shortness of breath and waking up in the middle of the night choking, which at first scared me quite a bit and I went to the hospital and was diagnosed with GERD and put on PPIs. The PPIs consistently made me nauseated and I heard about the potential risks of taking PPIs longterm, so I stopped. I was also tested for sleep apnea and the results were negative. I was diagnosed with Asthma years and years ago as a small child but went nearly a decade without symptoms, threw away my inhaler, and during my first episode of the chest tightness I went to the hospital and they checked my lungs, and they were fine, so it does not seem that asthma is the culprit.

      The tightness in my chest and the resulting shortness of breath and breathing disturbances during sleep came and went for the next few months. I cut out gluten and most dairy products at the behest of a health professional I was working with, and this seemed to help quite a bit for a while.

      Recently the symptoms have returned with a fury. Not only do I have the tightness in my chest again and the gasping for air when I lay down, I now feel the gasping for air sensation when I am fully awake. I feel a lump in my throat, spasms in my neck, I feel my airway narrowing, and this happens after almost every meal at this point. I also experience dizziness and a flush sensation throughout my body but I imagine these latter symptoms are a result of the anxiety reaction from having such labored breathing.

      I am going for an endoscopy in a few days. I have started Jamie Koufman’s reflux diet. I am 23. I smoked cigarettes and marijuana very frequently for about 6 years. I have been smoke free for the past three years, and just recently smoked marijuana again while I was in Colorado. I do not know if this was the cause of the worsening of the condition, but the timeline seems to be related. Anyway, I read one of your earliest comments to a question someone asked, where you said that it takes a long time for recovery from silent reflux….a couple months.

      So, my questions to you: I just started Jamie Koufman’s diet which recommends oatmeal. I had some granola with almond milk and immediately felt the restricted airway feeling as soon as I put the food into my mouth. This also happened to me the other day with salad dressing. Could this be an allergy? Should I expect those kinds of symptoms to persist for weeks while I am on this strict reflux diet before seeing relief? Does the presence of symptoms mean that the larynx is not healing? What should I expect in terms of symptoms as I do this diet for a few weeks? Can you weigh in on anything else that sounds significant in what I’ve shared with you? I feel somewhat helpless having to resort to these online forums and blog posts and alternative medicine literature in order to actually get people to listen to me. My doctors are absolutely worthless. They don’t even know that there is a distinct condition called silent reflux. Please point me in the right direction in any way you can!

      • It is possible that marijuana is irritating your throat. It is a possibility that you have developed histamine intolerance and eosinophilic esophagitis, I would look into these. It might be a good idea to try a low histamine diet and get sunlight to increase vitamin D.

        • Hello John,

          Thanks for providing such depth on LERD in your article.

          Can you explain what you mean by “Perceived breathlessness”? I have breathlessness as my main (and worst) symptom, that none of my doctors can get a handle on.

          This is more pronounced when I wake up in morning, as if someone threw a switch to turn on the symptom.

          Also, I have a very strong co-relation to a high BP reading when having the breathlessness episode.
          Has there been any studies done that co relate breathlessness to a high BP, and the reasons?

    4. Hi I think your comments and advice are brilliant!
      I have been suffering from LPR since October 2016 following a very tough hard year stress wise. I have a constant sore burning throat I have had an endoscopy/ microlaryngoscopy/ and oesophoscopy and all were normal!
      I have lost quite a lot of weight since Christmas as I have been watching my diet and food intake!
      I am taking glutamine /zinc carnosine /collagen vit d lots of water vit b omega 3 so trying to keep my body well
      I do yoga Tai Chi and pilates as I am trying to keep this beast at bay! I do have negative thoughts but try and wish myself better!!!
      I have had food intolerences over the years and the odd kidney stone and urosepsis!
      I think the body sometimes makes a sign hey slow down cannot cope !!
      I have always gone a 100 miles an hour!
      I have been on PPI’s Gaviscon advance but with no difference at all!
      I am following a naturopath healthy diet exercise and positive thinking
      However if you can suggest any other advice It would be greatly appreciate!!

      • Hello,

        I’m responding to this very upbeat post. I’ve known I’ve had LPR for quite a while but the physicians and healers I’ve seen were not helpful. Of all I’ve read John Brisson’s advice is best. Looking into the connection to the Vagus Nerve is brilliant. I have herpes simplex2 and it has been the bane of my existence for years. Now that I’ve been suffering from LPR, I understand that it has damaged my Vagus Nerve. I’m going to consult with John and follow much of his advice. But I do have some answers and questions I wanted to share.

        There’s another form of breathing that seems very promising, I wanted to share that I discovered when I followed links beyond the ones John offers:

        I’ve found a great Liposomal Colustrum by Sovereign that I would recommend. I just started it.

        My question concerns alkaline | acid charts. Most charts, including the FDA chart, measure a foods pH before you eat it. Others measure it’s effect on the body:

        I followed Dr. Jamie Koufman’s low acid low fat diet and it helped very little.

        I’m confused about this. Maybe John could weigh in on pH.


    5. Hey John thanks a lot for this article. How long did it take you to heal from LPR once you started exposing more to the sun and kept high levels of vitamin D?

      I just found your article this week and started taking vitamin D3 drop (2000 units a day). This sounds like a very reasonable explanation for situation since I don’t go out of the house much. I could sometimes spend entire weeks without getting any exposure to sun.
      My doctor was a bit skeptic but said that a dose of 2000 units wouldn’t hurt. It turns out that my HMO stopped preforming vitamin D checks since the entire population of my country suffers from vitamin D deficiency. Since I live in a Mediterranean region there are high rates of skin cancer here and apparently everyone is hiding from the sun.
      I’ve suffered from LPR (without knowing it’s LPR) for the past 6 months now. Gastroscopy exam didn’t find anything and most doctors I saw didn’t take too serious my complaint about a feeling of lump in my throat. I’ve suffered in the past from dry coughing and post nasal drip which I associate to mainly to spring allergies but I wouldn’t be surprised if it was misdiagnosed.
      Cheers, Izik.

    6. Thank you for this wonderful blog on Lerd. I definitely have it and have learned a lot. Can you tell me how long these supplements like zinc carnosine take to work? I’ve been on vit d3 5000 a day for over 3 mos and really don’t know if it’s working. The same with magnesium. I’m also on mega dose of nexium and Zantac . Any info would be great.


        • Hi John,

          Great article. I’m still trying to figure out if this applies to me. For over a year now I have been feeling a pressure in The back of my head between my ears and my ears feel like they need to pop. Throughout the day I am massaging the back of my head and opening my mouth to pop my ears. I have been to the dr and Ct scan and they can find NOTHING. I have never had this issue before. My hearing is fine and nothing is glogged. I do have heartburn throughout the day but nothing crazy. I pop a tums and it’s gone. Please let me know what you think.

    7. Thank you John,
      Just realized both my UES and LES is the problem. I bought a bed to elevate my head and found I still had acid saliva coming through. I didn’ eat for a day to determine if food was really my problem. I will be trying everything you recommended and get back to you. PS I had surgery on my les and I believe I didn’t need it. I had a pouch on my esophagus and they took it off and said my les was the problem. I was without problems for 3 years.

    8. Hi. I have been suffering for 6 months now firstly with a strange flickery feeling in my throat and hoarseness discovered from reading at bedtime to my children. Ppi’s thrown at me. Have been on all, all at varying degrees if mg’s, and if anything, they have given me acid/bile rising inti my throat everynight. I am lucky if I have 5 hours sleep. Endoscopy clear, so the awful gastro basically said that this is it for me. Was EXTREMELY rude and no help whatsoever – he clearly needs to retire as the problem solving part of his job is non existent. ENT said on both visits that I have swollen and inflamed pharynx and vocal cords bone dry. He gave me usual advuce…drink 2lts water per day, steam inhalations, gargling with alkaline drops. I go back in Jan. Have decided to wean off ppi’s after Christmas because they clearly do more damage than good. Am not looking forward to the rebound acid though. I suffer everyday with a dry irritated throat that feels that I am being strangled. The gi doc said I should live with this…..feeling asthmatic everyday, having the sensation of being underwater in my nose and throat everyday, only getting relief when chewing gum and swallowing what little saliva I do have everyday, thinking about how long before the damage becomes throat cancer, not being able to read my kids bedtime stories anymore because it makes my throat ache. It sucks. No one cares or listens. No it’s not normal reflux…it does what it wants, when it wants. I am finding it hard to accept that at 40, my life has completely changed and I live with constant fear of what is happening to my throat, how I can’t control it and how I want to rip my throat out. I gave up smoking 3 months before this happened, started running and ate healthily….too much all at once perhaps? I just wish the feeling of liquid rusing into my throat everytime i turn from my right side would GO AWAY! It’s like I tense my stomach and liquid shoots up. I have read that low acid can cause issues by not breaking up food?

      • Lindsay I find it interesting that your problem started once you quit smoking and began a health program.

        I have found this is common and suggests a strong EMOTIONAL component to your issues. It’s as if your mind is bored and so it has found this new ailment to take the attention that was being taken by your cigarettes. Also somehow once we decide we are going to start a health kick we become so in tune with our bodies that we can easily begin a cycle of health anxiety, worry and fear.

        I would suggest looking into some techniques such as Claire Weekes or John Sarno, in addition to continuing the positive lifestyle changes that we know are healthy, tried and true. If we fear that the condition will not resolve than it will persist.

        Good luck!

        • Thank you for posting this Jeffrey. I too believe much of my heartburn/GI issues are emotionally related and have found great relief via the work of John Sarno and his colleagues. My mind is very powerful and will try to distract me from emotions by giving me some sort of physical ailment to obsess about…migraines, burning mouth syndrome — and currently the reflux/chest pain/lpr. I’m learning to focus more on emotions and less on the physical symptoms that serve as a distraction from what my brain thinks is too harsh to face. I’m also a very anxious person with OCD and an eating disorder (also distractions from emotions) so Sarno’s theory fits perfectly with my personality.

      • Lindsey I can totolynrelate. I feel so hopeless. 41 just gave birth in Dec. and I can’t enjoy my baby or other children because there’s this constant feeling of drowning and when that subsides slightly I have this ball and scatchy y feeling in my throat. I go in for an EGD with gastro. But even if I’m diagnosed withLPR it doesn’t seem much could be done. It’s like the worse thing to have happen. Feeling so bummed.

        • I can relate as well always feel fluid coming up in my throat to my mouth and just staying there. 😕 Doctors only put me on ppis which don’t take the sensation away and won’t do the surgery my Gi wanted done. So depressing.

    9. John
      In your opinion can LPR be cured? or is it simply managable at this point? I don’t want to loose hope but I also don’t want to be naive to falling for gimmicks either…..

      • I did not think it could be for every person, including myself. I have recently cured mine with endogenous vitamin D production from proper sunlight exposure.

        • Hi john …. my name is Myron and I went to an ENT doctor about 3 weeks ago and he diagnosed me with GERD because I only get the sensation of something small stuck in the back of my throat and sometimes chronic coughing depending what I eat also when I stress out it makes me cough more but I try not to stress too much …. I don’t get the sensation of heartburn at all or hardly so that leads me to believe that maybe I have LPR instead and I was thinking of going to a gastrologist instead of the ENT doctor since my next appointment with him is in 2 weeks by the way if it is LPR would you recommend vitamin D3 capsules or how did you fix it and what is it that the Vitamin D helped you in what organs I’m thinking it might have helped your esophagus spinster upper and lower but I’m not sure would you elaborate more on this issue with me and I sincerely thank you for your attention

    10. Hello, my doctor recently diagnosed me with reflux. It only came up during a follow up visit for my low iron levels. She noticed that I was having to clear my throat a lot and my voice was a bit hoarse. She asked if I’d been having to clear my throat a lot. I made me realize that yes I had been. She said it was classic reflux and prescribed Zantac. I took it for a while, and I think it did help some, but I did not want to stay on it. I have tried Apple Cider Vinegar (raw, organic), but I don’t think it helped, however I was not taking it 30 minutes prior to eating. I am trying DGL supplements, not sure that is helping either. I do not have any heartburn that I can tell. My throat burns slightly from time to time. My vitamin D levels are on the low side, so I have been taking between 2000-3000 mg/day. My TSH was in the upper range of normal, but has come down since I started taking a multivitamin with iodine. I don’t know if I have LPR? It sure does not seem like typical reflux. I wonder about Leaky Gut, as I am reading that could cause reflux, but I don’t really have other symptoms of Leaky gut. I have been a vegan for 5+ years and I wonder if my diet could have caused this, or possibly stress. I mostly avoid processed foods, but eat oatmeal every morning. I am fairly active, run around 12 miles a week usually and sometimes do strength training videos. I have added eggs and fish and greek yoghurt into my diet because I can’t seem to keep weight on and worried about protein. I have had strange episodes of not feeling well (hard to describe, a general feeling in head of just not feeling good a a shaky feeling, like I just want to lay down). Those seem to have subsided since I have been eating more, but I wonder if the eating more has contributed to my problem. I really have to count calories and make myself eat more even though I am not hungry. I am thinking about going to a natural doctor to get tested for gluten allergy. I have read that that can be a cause? There is so many different opinions out there, I just don’t know what to think.

      • Low iron can be an issue with ceruloplasmin or overgrowth in the gut (our microbes need iron as well). You being vegan can also cause both a lack of vitamin D, B12, and iron. Your symptoms sound like LPR.

    11. Good day John!
      I find all of this extremely interesting – since I also just recently found out I suffer from LPR -after struggling with the symptoms for about 2 years now!!
      My biggest concern is – Is it possible to tell how often Silent Reflux causes cancer of the upper airways? Or how long do you suffer from this before there’s a real chance of getting this cancer?

      • It depends on a lot of different factors. Genetics, epigenetics, status of immune system, vitamin D blood levels, omega 3 intake, etc. It seems that if you are having bile reflux with silent reflux it increases inflammation and strongly increases your chances for developing cancer. In addition, having Gram-negative overgrowth in the stomach (H. pylori) also increases the chances.

        • Thanks for the answers!It is really helpful – since you don’t get any straight answers from the doctors! How will I know if I have H.pylori overgrowth? And how do I go about treating it?

    12. Doesn’t alkaline water just cause more stomach acid to be produced?

    13. Thank you for this post. It is probably the most helpful post I’ve read. I’m only 25 years old, so it’s been pretty scary for me to be experiencing LPR. It all started in January this year when I was having horrible sinus issues/infection. They put me on amoxicillin twice a day for two months, which turns out I’m allergic to. Ever since completing the antibiotics, I have had horrible belching, having the lump in my throat almost all day except for when I wake up in the morning, feeling short of breath, and I’m exhausted all the time. My doctor did a swallow study on me, but they did not find a hiatal hernia. They said it looked like maybe a small amount of gastritis in my duodenum and they put me on a PPI, which does absolutely nothing for me. I’ve tried doing honey and apple cider vinegar, digestive enzymes, probiotics, stopped caffeine, and cut out wheat and dairy. I’ll get better for a week then have two weeks of terrible symptoms. I’m at a loss for why this is all now happening to me. I’m very fit, healthy, and active. Out of the recommendations you made which do you think would be most beneficial for me to do?

      • I would ask your doctor about a low PH, low oleic acid diet like Jamie Koufman’s diet. I would leave out gluten. I would supplement with zinc carnosine and try to increase endogenous vitamin D trough proper sunlight exposure.

    14. Hello, John

      I have been dealing with LPR for 20 years. Was first diagnosed as post nasal drip then Gerd.
      Wasn’t until last year that an ENT diagnosed it as LPR. He also said I had an 80% chance of getting cancer.
      I too have done tons of research on both Gerd & Lerd.
      Now I am on a very strict diet & have lost 50 pounds. Try elevating my head during sleep & getting more exercise. I even work in the sun now but yet it’s not any better.
      Have lost so much sleep, feel horrible in the morning. Spitting up phlegm for @ least an hour after I wake.
      I did feel like the alkaline water has helped some but I don’t always have it.
      Either way I am going too get my vitamin D levels checked & my thyroid.
      I am on alot of medication too & it will be very hard too get off of it all. Nexium worked @ first but it’s just a mask, not a cure .
      I appreciate your input & I am willing too try almost anything too not feel like this anymore.
      Also I will try the neck exercises.
      I do have allergies too though was tested. I don’t understand why the Allergist didn’t do a food allergy test.
      Doctors know nothing about natural remedies, only more meds too keep you sick.
      Thanks again

      • Get your vitamin D and thyroid checked for sure. Maybe try a more alkaline diet and try to reduce foods that are high in oleic acid and that can trigger bile reflux like almonds. Maybe talk to your doctor about trying zinc carnosine. Magnesium supplementation can help as well.

    15. Thank you so much for such an awesome and informative website. I am suffering from LPR and am doing as much research as I can on this condition. I have two questions I am hoping you can help me with.

      1) I did the baking soda low acid test twice and never burped so I’d been using HCL with Pepsin for a couple days and my symptoms have improved, especially the acid reflux I was feeling, still have some throat clearing and bitter tasting mucus after eating. I’ve been using alkaline water after meals to denature the pepsin but have worried that taking extra pepsin could be bad for LPR. I then found your website where you say that for silent reflux one should take HCL without pepsin. Makes sense but can you explain more? Since taking HCL acid actually helps limit acid reflux for many (with low stomach acid) could the same thing apply for LPR with supplementing with pepsin for pepsin reflux? Really curious how that works and the reasoning behind it either way.

      2) Yesterday I read on this page about Shaker neck excercises could strengthen the UES. I feel that with my hypothyroidism, stress levels, MTHFR, low bone density, etc something could easily be weakening my UES causing more issues. If only I could strengthen the UES… I looked into Shaker neck wxcercises and it appears those help with swallowing by making the UES OPEN more… Isn’t that the opposite of what LPR sufferers need? If so, could doing an opposite type of neck excersie (head lift in the reverse direction and hold or pulling head backwards against a resistance band) help strengthen it’s ability to CLOSE??? Just a theory of mine but I have awful neck posture from always being on my phone, staring at a computer or iPad, etc…

      Could my poor neck posture be opening my UES when it should be shut and that is adding to my problem? If so could reverse excercises and better neck posture help for LPR?


      • 1. The main reasoning behind it is that unlike taking betaine and pepsin to decrease stomach ph and increase acid signaling in people with silent reflux we do not have a deficiency in pepsin. If you refluxed the pepsin that you took with the supplement it would irritate your throat more which is why I do not recommend it.

        2. Correct, shaker exercises workout the UES, in people with swallowing problems it seems to help relax it when needed. In people with silent reflux it seems to strengthen the UES tone. It improves tone and can be used in people with swallowing issues and silent reflux.
        Improving neck posture may help improve blood flow and the vagus nerve which may improve silent reflux symptoms but not cure it.

    16. Dear John. Thank you for all the information it is very helpful , and to all of you who are and have gone through this I wish you all the best. And may you be blessed with an abundance of health. I too have this and have been diagnosed with gerd from the beginning. Then hpylori was given lots of antibiotics. My body couldn’t take it was hospitalized they did lots of tests and nothing and same as others told it is stress related and they kept me on Xanax now and ppi. Who isn’t going to be stressed when you can’t eat or swallow or have trouble breathing. But I have also decided to take care of myself. No more ppi’s. I believe only we know our bodies and what we are feeling Thank all of you for your information. I am trying everything I can.

    17. John,
      Thanks for this very informative article! I have dealt with LPR for about 2 years now. It began 6 months after having my gallbladder removed. Several of my doctors think it is bile reflux, I am not sold on that as I eat a low fat diet and am a vegetarian and foods that should trigger this don’t seem to cause the problems to manifest any more that others. I have been to ENT, gastroenterologists and internal medicine doctors. In the beginning I thought is was allergies as it started in the fall and improved in later spring. I then began to connect the improvement of my symptoms with more outdoor activity and sunshine. I do take dry vitamin D 5,000 every day.
      My main symptoms are throat clearing in the morning and during the day if I drink something hot, even something as gentle as chamomile tea. . I wonder if that is caused from the hot liquid relaxing the LES and UES. Very cold drinks seem to help. I have a ph filter that I use for all of my water.
      My situation is not as severe as others I have read about including on this site. My throat feels raw sometimes, but I do not have a burning raw feeling.
      My main concern is that of my respiratory system. Many mornings I cough up phlegm after I have been up for about 30 minutes. This seems to happen regardless of what I eat for breakfast. I have a stuffy nose from time to time but do feel that I often have sinus drainage connected to this.
      My mother, who has had severe GERD for several decades was recently diagnosed with idiopathic pulmonary fibrosis (IPF). I have read that studies are indicating a connection between GERD and IPF. This is another reason I continue to research.
      With the above information, thank you! I have studied many websites. blogs, etc and found this one to be not only helpful but encouraging.
      I am now adding MSM to my diet as well as Throat Coat tea as I have read that the ingredients in this are all very helpful for LPRD. Thanks again for your work in this area!

    18. Thank you so much for this article. I am at a loss as to what to do. I have been to two specialists, and I swear they don’t know what LPR even is. PPI’s do nothing, which is all they seem to come up with. Had the endoscopy, nothing. AT this point i’m just dealing with the globus, and the acid taste every day. Some days are worse than others. I just wish it would go away. I am thinking maybe surgery will work?

    19. john,
      this is so very interesting to me- particularly the hypothyroidism/low adrenal fatigue link. i’ve been struggling with various degrees of LPR for a year. lately, i’ve been trying hard to follow norm robillard’s fast tract diet, but it’s crazy-hard for me as an almost vegan. and i’m not seeing much difference doing it, either. do you see any connection between the high fermentative carbs and LPR? is it worth it for me, or can i go back to my beloved apples & bananas occasionally?
      thanks so much for putting out great info for us suffering with this,

      • In some people yes, in some no. I would recommend sticking to a low acid diet more, not an alkaline diet but restricting food with an initial pH less than 5.5. In doing so you might have to ingest more meat because a lot of fruits and vegetables contain a low pH. Finally, a lot of people who have silent reflux react negatively more to fat than foods that are high in carbs.

    20. Although I am in remission with LPR…thought I’d share what my theory is and how I figured out how to help myself. I was diagnosed with “allergies in 2007..the nasal steroid didn’t work for me so I just lived with a stuffed up nose for two years. I believe that LPR in many instances rears it’s head with warning signs…but doctors don’t recognize it. I lived with a stuffed up nose for two years. And yes, you are correct there is a correlation with thyroid illness, snoring, low immune system response, etc. But I will explain later what my theory is based on my research. In 2009 I woke up one day in the middle of a very busy life. I was looking to retire in one year and move. I woke up with severe pain throughout the back of my head, cheaks, ears, nose. Horrible pain. I got into the doctor, yes the same one who told me I had allergies and gave me nasal steroids for an “allergy” evern though I told her I didn’t have allergies ever. Well when I went in and told her I had a severe pain in the back of my head running from the neck all the way up the top of my head, etc here first question was I still taking the nasal steroid? I was dumbfound…as I was there on another issue. I answered the question very respectfully and told her I had stopped it after a month because it didn’t work for the “allergy” she said I had. Anyway, she must have had a bad day…she must have felt my honest answer was against her advice two years previously. She looked at the back of my neck and declared once again I had an allergy and gave me another script for nasal steroid spray. Not being a doctor I left…but I was totally lost as to what did I do wrong to make her so upset…and why would I get yet another diagnoses for an allergy. I was in terrible pain in the back of my head, cheaks, ears, and nose… So I did what she said….it didn’t work. I was getting worse and worse…and I was trying to keep my life going. I was scared as I knew something was very wrong with me. But this time I was stumped. I know my body but I couldn’t pin down figure out what was wrong with me. I then dropped my primary doctor and got another one…she came into the examining room fuming at me…I was agast…couldn’t quite grasp why…she asked me why I was there…I explained I had horrible pain up the back of my head, ears, nose, cheeks…she said without missing a beat…”you were told you had an allergy! Take the nasal steroid for two months and if the allergy is better than there is nothing we can do for you.” And left appruptly. I naively thought it was ok to get another doctor and happen to pick a doctor down the hall from the last doctor. Obviously I think they talked and I was in trouble. Anyway…I was quite scared with with unfolding as I was in so much pain…but LPR is a real difficult anatomical illness to get a diagnosis on. No one recognizes it in its early stages. I’ve been able to piece it together. I finally kindly wrote a email to start documenting my pain level and ask kindly if I could have a referrel to an allergy specialist…since that is all they kept telling me. When I finally got into the allergy speciliast I was beyond my ability to cope with the pain. I was near quiet hysterics trying to convey to the new doctor that I was in so much pain throughout my head…something was really wrong with me and I needed help. He calming asked me to get up on the exmaining table…he checked me out throat, nose, ears neck…and said “…sit down…you do not have allergies…you have silent acid reflux…read this pamphelet…come with me to my office…” A series of quick questions, “have you had a throat culture done…No…you getting one today…have you had a nasal scan done…No…you getting one today…have you had a complete allergy test done…No…your getting one today…that was the beginning of the most horrific illness I could have imagained I could get next to cancer. They tried every medicine and prodical on me…I ended up sicker than a dog on the strongest PPIs they finally graduated me up to. I was told that stress is thought to cause LPR…I personal thought that was that dumbest thing I ever heard a doctor tell a patient. I think it is code for doctors not knowing how to treat the illness. I was so lost month after month with going to appt after appoint wiht different specialities…LPR is one of those that you stradal two specialisties….a GI and an ENT and one’s primary. It was beyond my abililty to explain how horrific how I was made to feel…no one talked…no one told me anything. I was just a quick slam bam thank you mame when I went into each of the doctors appts. In the end the PPIs at the strongest dose made me so weak…my legs felt like I had 500 lbs weights on them…I was getting sicker and sicker….and burned to death from all the medications. And I had to keep going at work as I needed to get my time in to retire. I was in such big trouble in every respect. It was touch and go. When I did not recover from pnuemonia 8 months into this dreaded illnesses…I began to read about the medications I was on…I was stunned. I began to realize that I could not get over pnuemonia till I got off proton pump inhibitors. They were slowly killing me….and I still burned to death from severe case of LPR. So I quietly took over my care…every so quietly. I stopped the PPIs cold turkey…it was not easy but in my way of thinking the PPIs weren’t helping me…they only added another serious layer of illness to an already serious case of LPR. My primary, my GI and my ENT were oblivious to it being the PPIs causing the severe pnumomina that I was not recovering from even after two dosings of antibiotics. I never bothered telling them I was done with PPIs….and besides that they knew PPIs werent’ working for me. So they sent me to surgery…what an ordeal. When I originally went to the surgeon I thought…well if I have to have surgery to fix this problem I will…it was worth the risk. But when I got in with the surgeon she said that surgery did not work for what I had…that at best I only had a 50/50 chance of getting better. I was distraught…I was having trouble bearing the pain of a searing throat…and I didn’t understand LPR…so I was so lost…and no one talked to me about anything. So I told the surgeon I was not leaving until I was assured that I could have a surgery…that I was willing to take the chance because I couldn’t live like this anymore…burning to death. So she had her collegue in surgery come in and evaluate me and he said he thought I had a 95% chance of recovery with surgery. So we moved forward. I was so hopeful. I didn’t understand LPR but I just wanted to be out of pain. I had the surgery…retired…my doctors gave me all the medications for pain after surgery that an LPR patient should not have…I burned to death on them…it took me awhile to figure out it was the medications causing me to burn…but by then my throat was in a severe state of burn…I was now in a new region trying to manage my own recovery without doctors set up yet…I started to wither away…burning burning burning without end. I endured it calling my surgeons…they said there was nothing more they could do for me…I had to go back a a GI…I went into the nearest ER 4 months after surgery as I was losing weight from not being able to swallow water or eat..I was struggling to get up…and not sleeping from non-stop pain. One of the scariest places to be in life…the ER doctor appraised me and sent me I kid you not to Behavorial Science for stress…but now I have given up…I was so lost in pain…I knew all my doctors were not thinking out side of the box…when they couldn’t figure out how to help me they reverted back to calling it stress. It is the scourge of LPR sufferers…no one believes them. I finally was able to make a new appt with a new GI in the new region…and she was livid with me when I told her that the original GI told me I had LPR. She went on livid with me…saying it said nothing like that in my medical file…I was at a loss as to how to make her believe me as I relayed my medical history. I felt like I had fallen into the twilight zone. My throat was in such severe condition and my doctors just didn’t get it. When she finally got hold of her anger and examined me…she came up to my shoulders and neck and palpated my throat…I winced in pain…that hurts? Yes I said. She went to the phone, call someone…asked them to see me when they could work me in..she indicated that our appt was done…I got up…mustered all the dignity I could as I was devastated that I was not believed…I asked if I she would be seeing me after the other appt and she said NO, you’ll be going to a primary…I said good bye…I was so embarrsed not to be believed as I could tell she thought everything I relayed was not true…I didn’t understand how my record didn not mirror what I said…she did not answer my good bye…I remember her holding her arms across her body…she didn’t say good bye. I felt like a problem patient…like they thought I was making it up. It was horrible. That appt she made did turn out to be with a new ENT…when he went down and scoped my throat…it was so so painful…he was aghast at it’s condition…he said I was so burned that he had to do an immediate procedure to see if I had cancer of the throat…I had been burning so severely for so long he said my throat in his opinion was a good chance I had throat cancer…he went on to say…that I had a large growth on my thyroid…that had to be removed after some xrays and a trip to the endocronologist. I wept as I drove home…wept and wept…I was so angry for how I had been treated…I realized that something was really wrong with the way I had be examined and dianosed…probebly back to 2007 with the ridiculous allergy diagnosses. I had the biopsy done…and the thyroid removal and was very lucky and had no cancer of either…but my problem remained severe….I had severe LPR with no let up in the pain. And I couldn’t take pain medicines as they made me burn horribly. No medicine of any kind worked for me…I was in big trouble and I knew it. My doctors were in my opinion incompetent. I felt it intuitively. So I did two things…I requested a outside opinion and requested that it be paid for by my health care provider. They insisted that I did not have LPR…when I asked the head ENT of the region what he thought I had then…he said we don’t know but we are not paying for a outside referral. You will just have to live with your condition. I thought for awhile about filing a charge on all of them…of requesting a hearing…but then I began to research everything I could get my hands on LPR. I knew I had LPR. It had a text book case of it…only it was severe. I figured out why I was burning so severely…the acid vapor after such a long time had burnt through the single layer of throat tissue and was burning directly onto the nerves that run up into the head and down into the body. It explained to me why I literally shook from pain…and couldn’t sleep. I was a burn patient on the inside but there was no urgency from my doctors to help me. I had become a chronic case they didnt’ know what to with. So it was easier to call it stress and that I some how could find a way to control it. But it knew that was wrong. Inspite of my horrible pain I studied day and night…piecing together the anatomy of my illness…figured out that they fixed the LES but there was nothing world wide for the UES….I kept at it…drawing to figure it out…what was the key to putting the puzzle together to help myself…and then one day in Aug 2011…I was quietly weeping from pain as I knew I was slowly withering away and had no support nor anyone advocating for me…not even my doctors…I for some reason when I put in a web research made the connection that the UES as I had been researching it as a sphincter…this time I put in “what strengthens muscles” into the web. The rest is history for me. It opened up a whole new world into a science I should have know about but I didn’t. The articles that came up said that athletes use Vitamin D, which is made by the sun on our skin, to strengthen their muscles in training…and it hit me like a bomb…I had stayed out of the sun for 40 years because I believed the hype about it being so bad for us…40 years!!! And I worked inside as an administrator. I realized that Vitamin D and sunshine probably could help me. At that moment I had also developed for 5 months two other illnesses, a prgressively leaking bladder and locked up shoulder blades. I didn’t bother to tell my doctors about those two problems as I was defeated by too much pain from LPR. That was front and center for me. The other health issues I just dealt with. I then studied how much D to take….took my first dose…and to my utter surprise the bladder condition and locked up shoulders blades disappeared…and LPR began to slowly lift…it took two full years for LPR to get to about a 95% improvement and another two years for ever so slow improvement to 100%. I now take D3 base don weight…and I get sunshine on the whole torso. I read and continue my research on evolutionary needs and 4 years later I am stunned still that I diagnosed and treated myself and have what I call a 100% remission in LPR. I am not cured…I keep my D levels hovering at 70-80 score…but every once and awhile LPR starts to return…I run to take a D test…and in every case so far…my D levels have fallen to 62…so I take 2,000 more D3 for a week and then drop back down to dosing based on body weight. Is D3 and sunshine a remedy for LPR…I don’t know. But I do know it worked for me and I believe I understand the science behind it. I have made it my cause to read all I can on sunshine and how critical it is for all of us to have it on our torso often. In modern society we have gone inside to do most of our living. Even when we go outside to excercise we have clothes on our back…our torso is where most of the D on our skin is made. I regret as a young women back in the early 1970’s I believed that erroneous scare on sunshine on our skin…it was a big mistake. The lack of it causes so many illnesses from utero to old age…so much suffering for something so simple to remedy. My heart aches for all the populations of the planet who suffer needlessly for something so simple to avoid illnesses of all types.

      • Correct, there is a huge correlation between lack of 1-25 hydroxy vitamin D and silent reflux.

        • Thanks a trillion to you JOHN BRISSON for running the amazing blog. All your opinions and comments are so helpful to overcome the LPR. Please keep up the good work. Appreciate your effort to give some valuable suggestions to get ride of LPR. You have made my day.

      • Thanks a trillion ELENA for your valuable research and self-case study, i have got this problem from a year or so and i have run to pillar to post from GI to ENT, with a little difference to improve my condition and unfortunately as rightly quoted by you many of them are not familiar with LPR or LERD. Now will try your way to see the difference, which i am quite hopeful that it would work. Also i sincerely feel that you should think to publish your research and make it more publicly available, which could make tons of difference for people around with LPR. I will get back to you after i observe the difference.
        My heartfelt sympathies are with you for all the suffering you have to incur due to improper diagnosis or treatment in this evolved scientific world. Hope that you would recover from the suffering and pain, my sincere praying and wishes are with you. Your article has really made my day and off late i have also been thinking on the same lines, because every time i test for vitamin deficiency, my Vitamin D values are always low, thanks once again, i have been researching on LPR from a year now, fortunately i have come across your article today. PPI’s and H2 blockers are the golden ducks for pharmaceutical companies and also do encourage physician prescriptions to thrive on them for revenue generation. So the effect of Vitamin D on LES / UES should be clinically evaluated.

        Cheers & Thanks,
        Vijay Nag.

        • Vijay and Eva, I am just reading your replies to my story. I very much hope that it is helping you. LPR is the most horrific illness to bare. Especially since doctors treat the patient with it with such disdain. I still can’t figure that part out. Thank you for encouraging me to write about what I accidentally researched and worked for me. I have written a very small book and in the process of polishing it before I go to publish it on Amazon. I was not meant to be a writer but in order to help others I will give it my best effort to put it out there. Please let us know if D/sunshine works. I’ve just got to know if it helps others. And yes, there are real scientific reasons why it worked for me. I’ve researched it and although I’m not a doctor nor a scientist, but I theorize based on the research why D and sunshine worked for me: The esophagus is made of cells that are much like cartilage and bone. And within the esophagus there are sphincters. In fact all our organs have sphincters. And the word sphincter is just another word for muscles. There in lies the science about why it worked for me. D and sunshine strengthened all my muscles of my body, which included my sphincters. And D doesn’t only strengthen muscles but it pushes (along with magnesium) the calcium to our bones/cartilage. And since the esophagus cells are much like bone and cartilage, I think it took awhile for D/sunshine to “repair” somewhat my esophagus and muscles. Though I think the damage is permanent. Sunshine on the whole torso is very very important evolutionary need of the all the body systems. Every biological system of the body needs sunshine! I regret spending 40 years avoiding the sun. From what I have researched it leaves permanent damage to all systems of the body. That is probably why I am only in “remission” with LPR. When my D level falls to US scoring of 62 ng/ml LPR starts to slowly return. And I don’t know how long remission will last as I age. At some point D and sunshine may not work for me anymore. But I’m so grateful for every day that I can eat, have no pain and have a normal life. So very grateful.

      • Elena I admire your strength to continue and find your own way to heal. I have been fortunate to find this site. I am taking more vitamin D and have started to enjoy the sun more. I too stood away from the sun for years and wore hats to cover up. I have been doing my own treatment for a few weeks now and I am starting to feel better. I have lost a lot of weight and am afraid to eat too much for fear of my throat inflaming. But slowly I am introducing different heathy foods. I am mostly on vegetables and some fruits. I was wondering once this healed for your will the dryness in the tongue and throat also go away?

        • I take D3 and I take it based on weight formula: 1,000 IU of D3 for every 25 pounds. I also get sunshine on my whole torso (I do have a private back yard) at the high sun hour as often as I can. And I test twice a year: once at the end of winter (end of March) and again at the end of summer (end of Sept).

          You will notice that the obituarys of every town in the US get longer in the winter months. It is because the sunshine in most of the US does not create D on the skin and deaths increase in those that have low D levels. I try to keep my D level hovering at 80, which is on the high end of the D scale but I consider my age, that I had melanoma and serious illnesses so I think I feel better about having a bit higher D level. I do not take calcium pills. I get calcium from raw nuts and food. And I try to eat foods high in magnesium and a take a 2 grams of purified fish oil and 2 gram of krill. So far this body that was ravaged with pain, aching bones, bad knees etc is holding together with no pain for the moment. I look back on my health and realized I had too much faith in doctors who are not trained to recognize basic deficiencies of the body. I cam to realize my personal illnesses was just part of a much bigger picture.

          • Hi
            Really interesting article. I have LPR and was wondering – you said you had melanoma – is it a bit risky sunbathing having had that before. I say this as I also have had basal cell carcinoma so am a bit scared about sunbathing and would like to know if D3 supplementation would suffice? and would really appreciate an answer (even if you think it would be OK to sunbath having had basal cell carcinoma from previous over exposure to the sun (the reason I have totally avoided the sun for the last 12 years – and the reason I think this could possibly be the answer).
            Thank you so much for your article – it was really excellent – you really need to get that book out.

      • Wow. This is what I am trying to avoid. As an RN, I have figured out from reading that I probably have LERD complicated by SIBO triggered by an acute gastroenteritis 8 mo ago. Based on symptoms. However, your description of a “stuffed up nose” got my attention right away, because I too have had mucus pouring out daily for several years and was told I have “allergies” and given steroids. Of course, I didn’t take them (downside too grave for long term use). I just blew my nose a LOT.

        With the onset of LERD symptoms and also those of SIBO, I went to a GP (mostly just to get a GI referral, as he just listened to my symptoms, shrugged his shoulders because he didn’t have a clue and curtly demanded to know “what did I want” to get rid of me). So, I got my referral.

        Went to a GI (who owns an endoscopy center I discovered), who proceeded to tell me maybe I had developed a food allergy, for which he had no cure, but he wanted to do an endoscopy AND a routine screening colonoscopy and was all ready to set me up. He told me I had given an excellent history. (Hello…I described the globus, etc and CLASSIC /LERD and SIBO symptoms I found later from doing my own research). Exit that Dr.

        I am talking to another GI that specializes in SIBO, doing all the palliative remedies I can find in the meantime to help me function. Your story is encouraging as I too, always “cover up” and avoid sun exposure even though I work mostly outside. (hats, long sleeves and sunblock). I don’t even drink milk anymore, so my intake of vitamin D precursors is likely low. I just ordered some on Amazon and I’ll bare my back to the sun tomorrow (if we get any since it may rain).

        Thank you so much for your history, and I empathize with how you were treated in physicians offices. I had my fill of it for the most part, and only see a physician reluctantly when I don’t have a choice (also retired from Nursing although I do maintain my license as current-I got tired of how patients were treated from BOTH sides). However, I am encouraged by the website of the Doctor I am planning to see soon, as I believe he is enlightened and patient oriented. In end analysis, we are responsible for our own healthcare and decisions. We can pay educated experts to teach us, but we must carefully evaluate what they tell us and decide for ourselves.

        Again, thanks to you, and to John for running this forum. I continue to hope for a cure as it’s only been 8 months and except for my chronic “sniffles” I was extremely healthy before the precipitating gastroenteritis episode (I think it put me “over the edge” for SIBO). I am 57 and female, with no other health issues, take no regular medicines, am 5’4″ and 125 lbs with good muscle mass. Sad that so many suffer at the hands of the doctors they trust to help them.

    21. John,

      Can you elaborate on adrenal fatigue and/or hypothyroidism and how it might cause LERD? Could adrenal fatigue be an underlying cause of LERD?


      • Hypothyroidism slows down motility and reduces LES pressure. Low motility can also lead to SIBO overgrowth causing excessive gas buildup pressure on the sphincters. Adrenal fatigue goes hand in hand generally with low thyroid function. Both could be the underlying cause in LERD for some people.

        • I am actually quite sure that my LERD is being precipitated by SIBO that has progressed into my stomach as well. Key clue for me is I went from regurgitating something like a “fine foam” to literally mouthfuls of very recognizable “foam” with large bubbles.

          The material is very mucoid and difficult to clear. When I do get it clear, my globus sensation is gone. If I can belch, it also relieves the globus sensation to some extent.

          Unfortunate that SIBO can be a difficult diagnosis and treatment, but the largest factor for me has been that living in a rural area local practitioners have no knowledge of it. I am going to Los Angeles to see an expert, and if I am cured believe me as an RN I plan to “educate” our local doctors on the condition.

          Also, I wanted to add to my comment above that Medical Doctors spend very very little time relatively on nutrition education and even more scary, very little relative time studying pharmacology, considering that they are charged with dispensing drugs as treatment. One would think they would have training more like a pharmacist but this is not the case. Thank you for your website John. The case histories are fascinating and very useful.

    22. Great article on LPR, or LERD as you call it. I take issue with one statement you made;”The main problem with LERD is conventional medicine does not have an effective treatment for it. ” First, since the problem starts with a weak or damaged LES, the solution for those unable to find symptom relief after attempting to maintain a safe weight, diet modifications, lifestyle changes, and medications is antireflux surgery. There are several, and some like the LINX system have very few side affects. Also, a new device, the Reza Band, augments the UES at night and many are reporting very good results. Other than that, I appreciate all the information you provided!

      Bruce @ RefluxMD

      • Dear Bruce,

        I stand by my statement, haha. Even Dr. Jamie Koufman would agree with the statement somewhat, and she is one of the few that thinks outside of the box and tries to treat it integratively.

        I will admit, however, after all; avenues have been exhausted, Lynx surgery would be the best result (with the current information and studies we have) for most people and is leagues better than a Nissen. I still consider Lynx to be a means to and end and not a truly effective treatment. Still a lot of issues associated with it I want to see post market studies and information ten years in the future.

        I like the Reza Band as well and have few concerns about it as a medical device. I would like to see more post-market studies of its safety.

        The statement is a little too broad, though. Few ENT and gastroenterologists truly understand the disease. All they want to do is throw PPI’s at it (studies have shown they do very little for the disease), and when they do not work, they recommend Nissen’s.


        • There is another surgical device called ENDO-STIM. with somewhat promising results.

      • If you are going to get to the root causes of the Lerd problem doesn’t the control of the UES come down to the vagus nerve? There is an interesting article on the website called 32 ways to stimulate the vagus nerve which may hold some solutions. One solution that I have tried is just gargling with plain h2o. It has the dual benefit of stimulating the vagus and neutralizing any pepsin as water (even tap h2o) has a higher PH. I read this on another website. There was an individual gargling a number of times a day at 5 and 10x a gargle with cool tap water who brought his/her weak voice back to an acceptable level after a bout of reflux laryngitis. Of course that is just anecdotal.

        While Koufman has advanced some pioneering theories and uses medications to address the vagus, I think there is a lot of unexplored territory in regard to therapies for this nerve which controls so much of the symptomology of Lerd i.e. cough, UES function, throat clearing, throat burn. This is a major nerve with a long reach. Perhaps we need to focus on reducing inflammation of it, stimulating it or repairing it.

    23. Now I have it. Got Jaime Koufman’s book “The Chronic Cough Enigma.” She writes “Common upper respiratory infections can damage nerves in the throat (namely the vagus nerves) that control all respiratory and digestive functions including speaking, singing, swallowing, reflux, asthma and cough.” She calls this PVVN (Post-Viral Vagal Neuropathy). That is how this LPR started for me. So nice to be able to name and describe it. Now, if I can only resolve it…

      • Yup, some people believe that they got their LERD after viral infections of the throat. I believe it is one of the proposed causes of the condition.

    24. Hi John,

      Just wanted to let you know I figured it out. I know my LPR began after I had bronchitis. I did a little googling and found comments by other people who said that is also when their LPR started. I kept waiting for the hoarseness and sore throat to abate and it never did. I went to an ENT/voice specialist in NYC and he said no evidence of relux. He did however say I had an abnormality–one of my vocal chords was bowed.

      But now I have to get rid of this acid that is coming up into my mouth. Am going to try the Koufman diet. Wondering whether this will work as the LES and UES may be malfunctioning due to injury during the bronchitis.

      It is certainly worth a try. Here’s hoping for some improvement!

    25. Hi John,

      Just want to thank you for this detailed description of LERD. This is what I have! You are right in saying there is very little about this on the web. I have not yet encountered anyone who really separated LERD and GERD like you did. For a long time, all I had was a persistent sore throat and hoarseness starting roughly early 2000. After reading your more of your info, I’d like to offer my thoughts on how this might have started for me. I did have campylobacter in the latter part of the 90s, but I first noticed the hoarseness and sore throat after I had a very bad case of bronchitis in roughly about 2000. Was wondering if, in the course of coughing so badly, I might’ve damaged the LES or UES. I have been so frustrated because my reflux never fit the standard profile. I am not overweight, don’t eat big meals and, as you describe, it goes on during the day–gets progressively worse as the day goes on. It is not as if it is tied to any specific foods or times. It is constant. It flipped into burning mode in about 2011 after I hit menopause. I thought for awhile that I had burning mouth syndrome. Besides the sore burning throat, that is the thing that is the worst for me–the constant burning acidic mouth and lips. I have just started to experiment with the fodmaps diet and the jury is out on whether I’ll get much relief from that. Considering SIBO, but it seems to happen no matter what I eat. I do wonder if it really is a functional prob. caused by the campy or maybe the antibiotics that I took for the campy. Any feedback from you on this would be welcome. Also, I have been a vegetarian since 2000 and wonder how that might play into it. I eat a pretty clean diet, organic whole foods, not wheat, not alot of grains. I think I will definitely try your d-limonene magic bullet. I had an endoscopy in 2011 which showed only mild esophageal irritation. I don’t have the strong burning pain in the chest and now I understand why. The acid is not trapped between the LES and the UES. The UES is malfunctioning, too.

      As a veg, I already eat a pretty low acid diet. Some nuts. I was drinking raw milk and butter which I can get in my state, but I stopped the milk as part of the fodmap diet, but so far it hasn’t seemed to make a difference. There is a Whole Foods near me that sells Akaline h2o (from a dispenser for .99/gal). Do you think the alkaline water really makes a difference?

      Sorry for the length of this, I’m just excited to find something that resonates so highly with my experience.

      Thanks again for the detailed profile. It has really increased my understanding of what this is about.

    26. I seem to have both GERD and LERD then, because my symptoms include both pain in the abdomen and chest area, along with waking up in the morning with a strange brown phlegm coating the inside of my mouth and a very soar throat.

      I’ve spoken with many a doctor and they simply throw PPI’s at the problem and hope it will go away (I’ve been on a mixture of Lanzoprazole, Omeprazole and Gaviscon Tabs for about a year now). The problem is, in switching from 60mg per day Lanzoprazole to just 30mg I noticed no difference and therefore concluded overproduction of acid was not the problem, instead it must be a weakening of the LES or UES. The strangest thing is, i’ve tested various diets and got no definitive answer.

      I’ve had days where I’ve deliberately drank lots of alchohol and ate loads of chocolate and junk food, and felt FINE! And then other days where I’ve ate nothing but spinach and drank strawberry smoothies and felt TERRIBLE! Likewise ive tried a diet of plain boiled rice for one week and some days I got terrible reflux (awake at night, heart racing, can’t breath kind of relux) while other days nothing at all.

      The strange thing is, my doctor said the only thing he knows currently is that the number of patients coming in to see him about GERD related problems has skyrocketed in the last year or so, so what is going on? And how the hell do we get round to fixing the heart of the problem which appears to be the LES/UES!!

      • I do not know why the cases have skyrocketed. More nonnative EMF effecting the calcium channel and relaxing sphincters?

        I would try low acid diet combined with zinc carnosine and alkaline water. It takes a long time for recovery from silent reflux. It takes a couple of months for the larynx to fully heal.

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