Always clearing your throat?

Still clearing your throat all day, even on a PPI? In LPR (silent reflux), pepsin is often what keeps the tissue irritated, and a PPI lowers acid without removing pepsin. Pepsin is a stomach enzyme that travels up with reflux and sticks to throat tissue. Johnston et al. 2007 (The Laryngoscope, in vitro lab study, PMID 17417109) found it goes inactive above pH 6.5 but stays intact up to pH 8. After 24 hours at neutral pH, it still had about 79% of its activity once acid came back. So the next reflux event, even a small one, can switch it back on. The throat sits around pH 6.8, so pepsin bound there is inactive but intact. Koufman & Johnston 2012 (Annals of Otology, Rhinology & Laryngology, in vitro lab study, PMID 22844861) tested pH 8.8 alkaline water on human pepsin. It permanently inactivated the enzyme, and it buffered acid far better than regular bottled water. Most tap and bottled water sits around pH 6.7 to 7.4, which leaves pepsin intact. The closest data in people is Zalvan et al. 2017 (JAMA Otolaryngology-Head & Neck Surgery, retrospective chart review, n=184 with LPR, PMID 28880991). One group used alkaline water (pH above 8), a 90% plant-based Mediterranean-style diet, and standard reflux precautions. The other used a PPI plus the same precautions. After 6 weeks, about 63% of the diet group and 54% of the PPI group had a meaningful drop in their Reflux Symptom Index. The water was one part of a bigger plan, so the study can't tell us how much it did on its own. How we use this with clients: Alkaline water between meals: pH 8.8 or higher, in small sips. Large volumes with meals add pressure in the stomach. Save this for your next flare and follow for more. #LPR #SilentReflux #AcidReflux #Pepsin #RefluxRelief