Lifestyle Advice for Patients with Laryngopharyngeal (“Silent”) Reflux
There are many things you can do at home to help manage symptoms of reflux without seeing a doctor. This article summarises lifestyle changes you can make. The changes below will often have a cumulative effect, so if a small benefit is derived from many changes, this can lead to a significant improvement in symptoms. For more information about laryngopharyngeal ("silent") reflux, please click here.
There is good evidence to suggest that losing weight and raising the head end of the bed by 15-20 cm helps reduce the symptoms of reflux. Good studies have not definitively confirmed the helpfulness of the other measures, but it is likely that many people will find making these changes helpful.
THINGS TO AVOID
Food and drinks that contain caffeine, such as coffee, tea, and some fizzy drinks, can weaken the protective sphincters at the top and bottom of the gullet (oesophagus). The purpose of the sphincters is to keep food in the stomach and gullet, so it is a good idea to avoid consuming products that compromise their efficiency. It is worth noting that decaffeinated drinks usually contain about 10-30% of the caffeine of their caffeinated equivalents and are rarely caffeine-free. The effects of caffeine last for about 10 hours. Other foods such as chocolate and peppermint contain chemicals that have a similar effect to caffeine, and can also promote acid production.
High-fat foods such as full-fat dairy products, fried food and fatty meats may also cause the sphincter at the bottom of the gullet to relax, making reflux worse. They also tend to sit in the stomach for longer. As large quantities of food and drink in the stomach are more likely to reflux into the gullet and throat, it is preferable to eat smaller amounts throughout the day, rather than eating two or three large meals.
Carbonated (fizzy) drinks and alcohol have both been found to have a significant impact on reflux. If your symptoms are particularly troublesome, it may also be worth reducing your intake of more acidic and spicy foods, which can directly irritate the lining of the throat. These include many fruits, particularly citrus fruits such as oranges and lemons, tomatoes and salad dressings.
THINGS THAT MAY HELP
Chewing gum has been found to help reduce symptoms of reflux. It does this by increasing the production of acid-neutralising saliva, and increasing the frequency of swallowing, which helps clear stomach acid from the throat.
A recent study has suggested that drinking alkaline water, and eating a plant-based mediterranean diet is as effective as taking proton-pump inhibitors (a powerful acid-reducing medication).
THINGS TO AVOID
Anything that causes a bloated stomach, or increases pressure within the abdomen, will markedly increase the likelihood of reflux.
Avoid wearing tight-fitting clothes. Wearing clothes that put pressure on your abdomen, increases the pressure in the stomach. This makes it more likely that the contents of your stomach will reflux back into your gullett, and up to your throat.
Consider losing weight if your body mass index (BMI) is greater than 25. Your BMI is calculated by taking your weight in kilograms and dividing it by your height in metres squared (BMI = kg/m2). A healthy BMI is in the range of 18-25). If you have too much fat this can increase the pressure inside the abdomen, making the contents of your stomach more likely to reflux back into the gullet. There are, of course, many other health benefits from losing weight.
Don't eat late at night - try and avoid eating three hours before going to bed. If you eat just before going to bed, the food you have eaten has less time to pass through the stomach, and is more likely to reflux when you lie down flat.
Avoid eating two hours before exercise. Take care with fluid intake before and during exercise, as drinking too much will distend the stomach.
Stopping smoking, as the nicotine in tobacco stimulates acid production by the stomach. It also causes the sphincter at the bottom of the gullet to relax, and reduces the production of saliva, which helps to neutralise stomach acid.
THINGS TO DO
Raise the head end of your bed by putting a brick or blocks of wood under the legs of your bed. This allows gravity to prevent reflux into the gullet and throat. It is not helpful to increase the number of pillows you use, as this usually causes the head and neck to be positioned at an unusual angle, but doesn’t significantly elevate them above the stomach and gullet.