Is it safe to use a PPI (Proton Pump Inhibitor) over the short term to determine if I actually have LPR as opposed to chronic sinus infection? Also, if it is (reflux-related) LPR, is it necessary to go on medication? My doctor keeps telling me that it would be worse to have acid in my esophagus/pharynx as it can have cancerous implication in my future.
Although PPI drugs are relatively safe short term (a couple of weeks), they are absolutely NOT safe longer term, and I have written about the many risks in this article, GERD – Why standard treatments are ineffective.
Beyond the safety issue, there is no evidence that taking a PPI is effective for LPR, so it won’t be an effective way to diagnose or treat this condition.
According to this systematic review of several clinical studies, Management of laryngopharyngeal reflux with proton pump inhibitors “Data from these trials show that PPI therapy is no more effective than placebo in producing symptom relief in patients suspected of LPR”.
The same conclusions were reached by this 2016 meta-analysis of more recent studies, Meta-analysis of the efficacy of proton pump inhibitors for the symptoms of laryngopharyngeal reflux: “The difference between PPIs and placebo groups in overall improvement of symptoms in adult patients with LPR was not statistically significant. The difference in cough improvement was also not significant between PPIs and placebo groups.”
As a result, “the American Gastroenterological Association guidelines for GERD recommended against the use of acid-suppression therapy for acute treatment of patients with potential extraesophageal GERD syndromes (laryngitis, asthma) in the absence of typical GERD symptoms” cited in this study, Optimal treatment of laryngopharyngeal reflux disease.
Why PPIs Do Not Work For LPR
The most likely reason that PPIs don’t work for LPR is because they only reduce stomach acid and have no effect on the reflux of pepsin, bile salts, bacteria and pancreatic enzymes which may be even more damaging in the absence of stomach acid. To effectively address LPR, one must therefore control reflux itself. PPIs can work against you here because PPIs promote SIBO and dysbiosis which I have proposed as underlying causes of reflux.
A proof of principle supporting this idea is the use of fundoplication surgery for LPR. A 2011 study titled Impact of Nissen fundoplication on laryngopharyngeal reflux symptoms showed that LPR patients who underwent the surgery reported a 73 to 83 % improvement of voice fatigue, chronic cough, choking episodes, sore throat, lump in throat, and throat clearing. Even asthmatic symptoms showed improvement, though to a lesser extend (60%).
The dramatic improvement in LPR symptoms following fundoplication supports the idea that stopping reflux is the key in controlling LPR symptoms as opposed to blocking acid. Although fundoplication surgery is effective for LPR, this invasive procedure involves risk of infection and a variety of side effects that are mostly associated with trapped gas covered here.
A Natural And Science-Based Alternative for LPR
To keep all these (pepsin, bile salts, bacteria and pancreatic enzymes) non-acid components where they belong, we need to address the root cause of reflux, which I firmly believe is SIBO (small intestinal bacterial overgrowth) and / or dysbiosis (an imbalance of gas-producing intestinal bacteria). Several potential underlying conditions can promote SIBO and dysbiosis, but the single biggest problem is over-consumption of hard-to-digest carbohydrates for most people.
Here is the mechanics of how hard-to-digest carbohydrates drive SIBO / dysbiosis. When you over-consume hard-to-digest carbohydrates, they often escape digestion and absorption potentially overfeeding gut bacteria. The overfed bacteria produce excess gas in your intestines which drives reflux. I.e. Mentos in a coke bottle. Carbohydrates, not proteins and fats are the preferred energy source of these bacteria, hence dietary intervention that restricts hard-to-digest carbohydrates is the best way to control reflux.
This is different from the pervasive online dietary advice for LPR which is the same as that for acid reflux / GERD such as avoidance of acidic, spicy, and fatty foods as well as alcohol and caffeine, etc. And this trigger food approach has been proven to be ineffective according to this systemic review of lifestyle modifications for GERD in 2006.
It has been over 10 years since I proposed SIBO / dysbiosis as the underlying cause of reflux in my first book, Heartburn Cured. Since then, my approach based on the original theory has been transformed into the Fast Tract Diet and our individual consultation program based on the holistic 3 Pillar Approach:
- Dietary modification to control hard-to-digest carbohydrates
- Pro-absorption (gut friendly) behaviors and practices
- Identifying and addressing other potential underlying causes of SIBO/Dysbiosis
BE COMPLIANT and FOLLOW THE DIET EXACTLY AS THE BOOK AND APP OUTLINE. Many of my readers and clients are pleasantly surprised by the effectiveness of the Fast Tract Diet approach.
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If you suffer from LPR and are prescribed a PPI, please share this article with your doctor. If your family and / or friends suffer from LPR, please share this article with them.
We are committed to changing the way the world perceives digestive health. Our goal is to elevate science-based holistic dietary solutions to first line therapies for a broad range of digestive and systemic disorders at the grassroots level. 10 million people off drugs and antibiotics.
Thank you for your assistance.