MS, RD The Reflux Dietitian

Your "allergies" might not be allergies. If the throat clearing, the hoarseness, the lump feeling, and the post-nasal drip never fully go away, there is a strong chance the real driver is pepsin. Here is what I wish my doctor had told me years ago. Pepsin is a stomach enzyme that rides up with reflux and binds to the delicate tissue in your throat and voice box. This is LPR (laryngopharyngeal reflux, or silent reflux), and it often shows up with zero heartburn, which is exactly why it gets mislabeled as allergies or a cold that will not quit. The part almost nobody explains: pepsin stays stable on your throat tissue at a neutral pH around 7.4, and it reactivates every time acid reaches it from any source, including acidic foods and drinks (Koufman and Johnston, 2012, Ann Otol Rhinol Laryngol, PMID 22844861). So that afternoon coffee or soda can wake up pepsin already sitting in your throat. The symptom is in your throat. The driver sits below it. Here is the piece that frustrated me most. Acid suppression alone is not always the full answer, because pepsin can still be reactivated by what you eat and drink. Alginate is a real, evidence-based tool. In a head-to-head RCT (Pizzorni et al., 2022, Eur Arch Otorhinolaryngol, PMID 35032204, n=50), magnesium alginate was non-inferior to a PPI for reducing LPR symptoms and signs over 2 months. So here is what I teach my clients to lower pepsin's contact time and reactivation: - Keep acidic foods and drinks off an empty, irritated throat, and buffer them when you do have them. - Use an alginate after meals or before bed to physically block backflow. - The LES Lock. 1 to 5 minutes of diaphragmatic breathing immediately after meals, up to 5x daily, to cut reflux events. - The 3-hour buffer before bed so your stomach can empty. The symptom is loud. The mechanism is teachable. That is the whole point. Follow for more, and share this with someone whose "allergies" never quit. #SilentReflux #LPR #Pepsin #AcidReflux #ThroatClearing