REFLUX DISEASE AND LARYNGOPHARYNGEAL REFLUX DISEASE (LPR) NUTRITIONAL GUIDELINES

Reflux disease results when acid gets past the one-way valve at the bottom of the esophagus and escapes the stomach. Small amounts of acid in the esophagus or throat can cause injury to the lining of these structures and cause symptoms of heartburn, hoarseness, difficulty swallowing, excessive mucous in the throat, chronic cough, chronic throat clearing, sensation of a lump in the throat, etc. Laryngopharyngeal Reflux refers to acid coming all the way up into the throat and causing symptoms due to injury of the voice box or throat.

The following nutrition guidelines for Reflux disease and LPR are recommended to lessen the likelihood of reflux and to avoid irritation of sensitive or inflamed esophageal tissue and throat injury. Listed below are recommendations that may help to manage Reflux disease and LPR:

Decrease total fat intake.
High fat meals and fried foods tend to decrease LES pressure and delay stomach emptying thereby increasing the risk of reflux.
Avoid large meals.
Large meals increase the likelihood of increased gastric (stomach) pressure and reflux.
Avoid chocolate.
Chocolate contains methylxanthine, which has been shown to reduce LES pressure by causing relaxation of smooth muscle.
Avoid coffee if needed.
Coffee, with or without caffeine, may promote reflux.
Avoid other known irritants.
Alcohol, peppermint, spearmint, carbonated beverages, citrus juices and tomato products all may aggravate reflux disease. Chili powder or black pepper may also cause discomfort.

Other lifestyle modifications that can help manage reflux disease/LPR include:

Eat several small meals throughout the day.
Exercise at least three to four times each week.
Wear loose-fitting clothes, especially in the abdominal area.
Wait 3 hours after eating before lying down.
Maintain upright posture during and after eating.
Lose weight if you are overweight.
Raise the head of your bed 6-9 inches by placing wood or cinder blocks under the headboard and sleep on your left side.
Stop smoking.

It is important to note that there is not one specific diet that will prevent all symptoms of reflux disease or LPR. The best way to design a meal plan that is appropriate for you is to discover which foods you tolerate well and which foods aggravate your reflux. One way to identify these “trigger” foods is through journaling. The dietitian will provide you with a food journal.

Food Group	Recommended Foods	Foods to Avoid
Milk and Milk Products	Skim/1% milk Soy milk Nonfat/lowfat yogurt Lowfat cheeses Lowfat ice cream Sherbet	2% and whole milk Cream High-fat cheeses Chocolate Milk Regular ice cream Milkshake
Meat and other protein foods	Tender, well-cooked lean meats prepared without fat (poultry, fish, eggs) Dried beans and peas Nuts and nut butter	Fried/breaded meats Bacon or Sausage Pepperoni Salami or Bologna Hot dogs Buffalo wings
Grains	Whole Grains prepared without added fat	Any prepared with whole milk or high fat
Vegetables	All other vegetables	Deep fried or cream style vegetables Onions (raw) Tomatoes
Fruits	Apples, berries, melons, bananas, peaches, pears	Oranges Grapefruits Lemons
Fats	Heart-healthy vegetable oils such as olive or canola oil	More than 4 tsp of oil or butter per day Creamy salad dressings
Beverages	Caffeine free herbal teas (no mint) Juice (no citrus or tomato) Water	Coffee if causes symptoms Cola/caffeinated or carbonated beverages Alcohol Hot Cocoa
Dessert	Low fat desserts	Doughnuts, pastries and other high-fat desserts Chocolate / Brownie
Other	All condiments except pepper Low fat soups	French Fries Cream based soups Corn or potato chips Mint chewing gum

Sample Day-1 Menu for Reflux Disease

Meal	Menu
Breakfast	1 cup oatmeal w/ raisins 1 cup skim or 1% milk Caffeine-free herbal tea (no mint)
Lunch	Chicken salad (made with low-fat mayo) and lettuce on whole grain bread Banana 1 cup skim or 1% milk
Snack	6 oz apple juice 1 ounce lowfat cheese 4 whole wheat crackers
Evening Meal (Eat at least 3 hours before bedtime)	½ cup Green Salad 1 Tbsp Vinegar and oil dressing Baked, skinless chicken breast (4oz) ½ cup herbed brown rice ½ cup steamed broccoli ½ cup lowfat frozen yogurt ½ cup Fresh fruit salad (no citrus)

Food/Symptoms Journal

Food	Time of Day	Symptoms

References:

American Dietetic Association. ADA Nutrition Care Manual. “Gastroesophageal Reflux Disease Nutrition Therapy”. Available at: nutrition care manual.org. Accessed December 2009.

McKinley Health Center. “The GERD diet”. Available at: http://www.mckinley.illinois.edu/Handouts/pdfs/gerd_diet.pdf. Accessed December 2009.

Laryngopharyngeal Reflux (LPR): Information Sheet. Available at: http://www.lahey.org/PDF/VoiceCenter/VoiceCenter_LPRFactSheet.pdf. Accessed April 2010.