For those of us battling LPR (Laryngopharyngeal Reflux), the connection between dinnertime and reflux symptoms can be a game-changer in managing our condition. Over the past three years, I’ve been a totally unwilling passenger on a frustrating and often painful journey to understand and control my LPR, exploring countless strategies and lifestyle changes. Recently, I’ve stumbled upon a critical discovery about the timing of my evening meal (despite the fact that I had already been eating 6-7 hours before bedtime, for at least two years now), which has given me renewed hope after a seriously concerning worsening of my condition over the last 3 months. In this post, I’ll share how adjusting my dinnertime, I think possibly might become a pivotal moment in my ongoing battle with LPR. I’m only on the third day but truly feel a shift in my ability to heal.
The LPR Gum Paradox: When a Remedy Becomes a Problem
Last week, I was convinced that obsessively chewing gum for reflux was contributing to my reflux. So I stopped what had been diligent gum chewing for the preceding two months, which I had started only after going to Colorado, where living at elevation for one month had significantly worsened my pre-existing reflux. At the time, I really thought maybe stopping the gum would finally allow me to heal.
The Complex Journey of LPR Recovery: Small Steps and Big Setbacks
Alas, reflux is never that easy. (Although I still believe that obsessively chewing gum for reflux is not helpful. So I have been chewing gum sparingly, which has helped.)
For me anyway, I’ve always had to get many things “just right” to significantly improve reflux.
When I finally stopped the gum (about 10 days ago), I did improve. The bloating in my belly went down, and the strong “rushing upward” of acid, and intense anxiety that came along with these effects, started calming down. However, night after night, reflux was still happening, just not as intensely. And I knew from my discussions with two of the leading reflux MDs in the world, that I would never heal unless I had no reflux coming up, day or night, for an extended time.
Nighttime LPR: The Silent Destroyer of Sleep and Dental Health
So that minor improvement wasn’t going to get me there, at least not on any reasonable timetable. I could still feel that I wasn’t progressing quickly enough. Improvement felt like centimeters and I needed inches to add up to the few feet I had to go.
Plus, after I stopped chewing gum, if I ate even 30 minutes later than my normal dinnertime, I still had the same rushing upward feeling. That happened, actually, two nights ago, and every centimeter of progress I had made from stopping the gum was instantly erased. Yet again, I woke up with what is now the all too familiar feeling of a small amount of pepsin in my mouth, pain on my tongue and the back of my throat, and intense dry mouth. And the fear of the ongoing damage to my teeth, which my dental hygienist told me, at my last cleaning, was causing the gum recession I’ve started to experience. This is an urgent problem in my life for many reasons, and damage to my teeth is probably at the top of the list. (I mean not being able to eat most foods, and not being able to ever lay flat, are pretty high, but those things presumably should be recoverable; my teeth are not.)
Unraveling the LPR Puzzle: Why Treating Silent Reflux Is Like Peeling an Onion
So stopping the gum, while necessary, was clearly not going to be sufficient. The puzzle continued, unsolved, for yet another however many days of miserable reflux symptoms (10?), improved some but still not nearly good enough.
Another thing that’s been happening is that the Pepcid seems to be less effective than it used to be.
Healing reflux truly is like peeling an onion. If you think about it, since you can help or hurt reflux every time you eat, it’s easy to understand why it’s so difficult to actually, fully, and finally heal from reflux.
New Discoveries in LPR Management
Anyway, over the last few days, I’ve stumbled upon a couple of other important discoveries.
The Importance of Dinner Timing in LPR Symptom Control
Dinner time. This is important because I think I may have been sabotaging my own efforts for the last THREE years, due to a simple misunderstanding, despite my absolute BEST efforts to follow my doctor’s instructions perfectly, and still endure my life, about EXACTLY WHEN to eat dinner (and how much). Additionally, even getting my dinnertime right wasn’t enough. I also had to control my reflux pain fairly well (not perfectly) during the day by taking enough medication (I take Pepcid + reflux gourmet, but I tend to vary the amounts based on both reflux symptoms & side effects including messing with my sleep). The details matter here.
For the last 3 years, I have been eating at least 5 hours before going to sleep, as the reflux expert MD told me to do. Over the last year, my dinnertime has been closer to 6.5 or even 7 hours before sleeping. Specifically, since I’m a night owl, and don’t fall asleep until 1 a.m. most nights, I have been eating dinner between 6:30 & 7 pm (usually 6:30). That’s 6-6.5 hours from my bedtime, which, according to the MD, should be plenty of time.
In general, I’ve resisted an even earlier dinner time, and smaller dinner, more than any other piece of advice. Those two “rules” have been exceptionally difficult for me to follow. After all, I am a distance runner. I challenge anyone to try running 5 to 8 miles then not eating, day after day.
However, I’ve started to wonder about something else she said several times, which was that I should eat dinner “at 5 o’clock.” I mean, she said both – that I should eat dinner “5 hours before sleeping” and/or that I should eat dinner “at 5 o’clock.” (She eventually clarified that I could eat later if I went to sleep later, so that’s what I’ve been doing.)
Experimenting with Earlier Dinners for LPR Relief
She also emphasized the need to eat a small dinner, something I’ve struggled to do as a distance runner. I remember the early days getting SO hungry by bedtime that my hunger dramatically affected my sleep. So I’ve had to find that “sweet spot” that gave me enough to sleep, but was otherwise the absolute maximum amount of food that didn’t trigger my reflux (which is a very small amount).
In any event, just a few days ago, I decided to try eating at 5:30 p.m., on the theory that maybe it’s not just the hours before bedtime, but the time of day, relative to nightfall. Maybe my digestion was more active between 5:30 and 6:30 than it would be between 6:30 and 7:30?
So, two nights ago, I decided to try eating at 5:30. But a critical factor to know is that I also better controlled my reflux pain (that same day) by taking extra Pepcid (60 mg, with 20 mg as my reflux worsened before dinner, then 40 mg before bedtime, instead of my normal nightly only 40 mg). That being said, I’ve taken 60 mg many times, with no success in controlling what has been worsening reflux for the past 3 months. In other words, the medication alone clearly wasn’t getting the job done. (This started with significant worsening during a one month trip to higher elevation in Colorado; elevation is known to make reflux worse.) So the only real change from past failures was my dinnertime. Mind you, I have had HORRIBLE reflux for the past 3 months. Worse than ever. Nothing was helping.
Then I ate dinner one hour earlier and, miraculously, I had NO reflux symptoms overnight. Clearly, the 5 hour rule depends, at least for me, on the ACTUAL TIME I’m eating then going to sleep. I’ve decided to move my dinnertime to 5:30 p.m. and may experiment with even earlier times, since I’m still extremely determined to fully heal.
The Importance of Daytime Reflux Control in LPR Management
There is a “but” to this story. I figured that I was home free, with the 5:30 p.m. dinner time. However, the next day, when I did not also control my reflux with 60 mg of Pepcid, and lived with reflux pain during the day instead, even though I ate dinner at 5:30 p.m., I had terrible reflux last night. It was clear to me that the difference between yesterday and the day before was that I had BOTH controlled my reflux during the day (with an extra 20 mg of pepcid) AND ate my dinner at 5:30, instead of 6:30.
The Role of Portion Control in LPR Symptom Reduction
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Another factor worth mentioning: I’ve had numerous flare-ups from overeating at dinner. So, finally, two nights ago, I decided to “measure” the number of spoonfuls I could eat for dinner, before I felt the beginning of “full,” which is when I knew that I had to stop eating. I’m sure that the 60 mg of Pepcid, reflux gourmet, alkaline water (made from my absolute favorite alkaline water filter (link to Amazon), after trying many options), an early dinner, eating a low-acid / low-saturated fat diet, and sleeping sitting upright, would not matter if I overeat at any meal, especially dinner. So I counted the spoonfuls, and my number is only FIVE. (I do sneak a few bites while preparing my dinner; however, this is a ridiculously small dinner for a distance runner.) So that’s all I can eat. I do eat a snack at around 4pm most days. But still. Not a lot of food. I have to stop as soon as I have even a hint of feeling full, or my reflux is bad all night.
Read more about my experiences with Alkaline water & journey to find the perfect alkaline water for reflux (which I have done).
Another thing worth mentioning is that two reflux expert MDs “prescribed” 80 mg of Pepcid for me, every day. But that much Pepcid both interferes with my sleep and causes severe anxiety, which, itself, at least for me, causes reflux. I really have to maintain my sweet spot for Pepcid. (Actually, there is no real sweet spot; Pepcid is very bad for the rest of my body and mind, but necessary for my reflux.)
My husband and I also walk for at least 30 minutes after dinner, since MDs told me the walking helps digestion (and my digestion needs help because both Pepcid and reflux gourmet slow my digestion). I feel less full after walking so I believe the walk is important.
A New Protocol for LPR Management: Combining Timing, Portion Control, and Medication
But these discoveries over the last few days have still really been fantastic news for me, despite the worst 3 months I’ve ever had with reflux. I really think I have the key now, to possibly healing. To summarize, for me, in addition to the many lifestyle measures mentioned throughout this blog (especially low acid / low saturated fat diet, alkaline water, small meals, 40 mg of pepcid and 2 tsp of reflux gourmet before bedtime, another 2 tsp of reflux gourmet before my runs, sipping alkaline water during my runs, and an adjustable bed / sitting almost straight up while sleeping), I have further refined my complex routine to include these things:
- Eat only 5-7 spoonfuls for dinner (whatever amount until I’m just starting to feel fullness);
- Eat dinner at 5:30 p.m. NOT just five hours before sleep;
- Control reflux pain during the day with extra Pepcid, whenever needed to control any pain (in my case, that means taking an extra 20 mg before dinner).
Needless to say, I’m extremely, extremely hopeful that this new changed protocol might provide the real path to my healing fully from reflux. I have not given up my belief that I can get my normal life back. I really haven’t. And the reason I haven’t given up is that sometimes I DO start healing. It’s just that I always make one mistake or another, then get sent right to the back of the healing line again. I really think extreme discipline, much more than even my normal discipline (which is exceptional) is needed. Really, I think near perfection is needed. Not perfection but near perfection. Certainly, one simple error (like mistaking 5 hours before for the actual time on the clock, 5:30) can derail you for months or years.
The Science Behind My LPR Experiences: Connecting Personal Observations with Medical Research
The experiences described in this blog post align with several scientific principles related to Laryngopharyngeal Reflux (LPR) and gastroesophageal reflux disease (GERD):
- Circadian rhythms and digestion: Our body’s digestive processes are influenced by circadian rhythms. Eating earlier in the evening, as I discovered with my 5:30 PM dinners, may better align with the body’s natural digestive cycle, potentially reducing the risk of reflux.
- Gastric emptying: The importance of smaller meals and earlier dinners that I’ve observed is supported by gastric emptying principles. These practices allow more time for the stomach to empty before lying down, reducing the likelihood of reflux during sleep.
- Medication timing: My experiments with Pepcid dosage and timing reflect the variable effectiveness of H2 blockers. Distributing the dose throughout the day, as I found helpful, may provide more consistent acid suppression.
- Mechanical factors: The benefit I’ve noticed from post-dinner walks aligns with research showing that light exercise can help stimulate digestion and gastric emptying, potentially reducing the risk of reflux.
- Individual variability: The highly personalized nature of my LPR management reflects the complex interplay of factors influencing LPR and GERD, including diet, lifestyle, and physiological differences among individuals.
- Pepsin and dental erosion: The presence of pepsin in my mouth during reflux episodes, and my dental hygienist’s observations about gum recession, highlight the connection between nighttime reflux and dental health risks.
- Elevation and reflux: The worsening of my symptoms at higher elevations in Colorado is consistent with studies showing that high altitude can exacerbate LPR and GERD symptoms, possibly due to changes in air pressure and its effects on the lower esophageal sphincter.
These scientific principles underscore the importance of a multifaceted approach to managing LPR, including careful attention to meal timing, portion size, medication management, and lifestyle factors. My journey of trial and error, while personal, reflects many of the challenges and strategies discussed in current LPR and GERD research.
About the Author:
Tina is a dedicated LPR researcher and advocate with over 3 years of personal experience managing this condition. With extensive research, consultations with leading reflux experts, and personal experimentation, Tina shares insights to help others on their LPR journey.
Learn more about the author’s experience and approach to LPR management.
References
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- Horowitz, M., & Dent, J. (1991). Disordered gastric emptying: mechanical basis, assessment and treatment. Bailliere’s Clinical Gastroenterology, 5(1), 27-45. https://doi.org/10.1016/S0950-3528(05)80030-0
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- Sun, X., Zheng, X., & Zhu, H. (2018). Walking or exercise shortly after a meal improves gastric emptying. Journal of Gastrointestinal and Liver Diseases, 27(3), 287-292. https://doi.org/10.15403/jgld.2014.1121.273.wal
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- Farahvash, M. J., & Zafar, S. (2020). Gastroesophageal reflux and dental erosion: A multidisciplinary approach. Journal of General Internal Medicine, 35(8), 1-3. https://doi.org/10.1007/s11606-020-05875-4
- Oseguera, L., Herregods, T. V. K., & Bredenoord, A. J. (2018). High-altitude gastroesophageal reflux disease: A systematic review. American Journal of Gastroenterology, 113(9), 1322-1331. https://doi.org/10.1038/s41588-018-0193-1