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Ask the RD: Leg Cramping on Paleo and Laryngopharyngeal Reflux (LPR)


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Join Kelsey Kinney, MS, RD and Laura Schoenfeld, MPH, RD, as they answer your questions about ancestral and Paleo nutrition. A must-listen for anyone new to the Paleo diet or looking to improve their current Paleo diet based on their personal needs and health goals.

The content on this show reflects the opinion of Kelsey and Laura and does not represent the opinions of Chris Kresser, who has not reviewed the content of this podcast.

We have another Q&A episode this week! Sorry about the double intro, but we didn’t realize our new and improved introduction would be ready for this episode! (And Laura apologizes for being a bit spacey this week, since she stayed up watching the BCS bowl game the night before recording and was running on a sleep deficit. Just goes to show you the power of a good night’s sleep!)

Here are the questions that Laura and Kelsey address in this episode:

  1. I’ve been doing paleo for 12 years and take magnesium supplements, as well as some others, but I still get some cramps in my legs and feet every so often, even when just walking around the house. I’m wondering if I’m not absorbing the magnesium well? Thanks.
  2. I have been suffering from Laryngophosageal [sic] Reflux (LPR) for two years and have tried everything. A friend suggested Paleo and I have been following it for several weeks without any change in my LPR symptoms. Do you think I should continue on with Paleo or do you have any other ideas?

Links Discussed:


About Laura: Laura is a Registered Dietitian with a Master’s degree in Public Health from UNC Chapel Hill. She is passionate about making traditional diets healthful and accessible for all her clients. You can learn more about Laura by checking out her blog or visiting her on Facebook.

About Kelsey: Kelsey is a Registered Dietitian with a Master’s degree in Human Nutrition and Functional Medicine. She works in private practice and recommends individualized dietary therapy focusing on biologically appropriate diet principles to aid her clients in losing weight, gaining energy, and pursuing continued health. You can learn more about Kelsey by visiting her website.


Thanks to Amy Berger for working so hard on these transcripts! She has a great article on the role stomach acid plays in GERD, so check it out if you’re interested.

LAURA: Hi everyone! Welcome to this week’s episode of Ask the RD. I’m Laura. I have a Master’s in public health nutrition from UNC Chapel Hill, and I’ll have my RD at the end of 2013 (hopefully soon!).

KELSEY: And I’m Kelsey, a Registered Dietitian with a Master’s in nutrition and functional medicine.

LAURA: Thanks for joining us for this week’s Ask the RD podcast. We’re excited to be here and we hope that you’ll enjoy learning about nutrition-related topics. Remember to submit your nutrition-related questions through the online submission form, which we’ve linked to on Chris’s site. We’ll be answering your questions on the show, so feel free to submit as many as you’d like. And as a reminder to everyone, this is just general advice and should not be used in place of medical advice from a licensed professional. So are you ready to get started with our podcast, Kelsey?

KELSEY: Yeah, and this first question’s for you, Laura. “I’ve been doing Paleo for twelve years and take magnesium supplements as well as some others, but I still get some cramps in my legs and feet every so often, even when just walking around the house. I’m wondering if I’m not absorbing the magnesium well. Thanks.”

LAURA: Okay, so first I want to just give a little disclaimer if my voice cracks, as you might have seen in the intro, I was up kind of late watching the BCS Bowl last night, so I have a little sore throat this morning but I’ll do my best to plow through this question. Okay, so I do think this is a really good question because it’s a common problem for people that are new to Paleo, and muscle cramps are generally caused by an imbalance of electrolytes, such as potassium, calcium, magnesium, or sodium, and this can be from dietary deficiency, illness, or excessive exercise, which are the most common reasons. However, muscle cramps can also be caused by a number of other problems as well, and when I was doing some research, I came up with a list of all the issues I could find that can cause muscle cramping, and this includes sitting or standing in one position for too long; certain medications; anemia; inactivity; fibromyalgia; hormone imbalances; allergies; arthritis, atherosclerosis; dehydration; hypothyroidism; varicose veins; and ALS, or Lou Gehrig’s Disease. So you can see that there are many different factors that could be playing into this particular person’s cramps. However, I’m going to focus on the most common treatments that should be tried first if people are suffering from frequent cramps, since any of those conditions could be affecting anyone and there’s too many different things to kind of go into all of the details, but I’ll give recommendations for the general population for what they can do if they’re getting cramps.

So the first thing you need to do is ensure that you’re getting enough calcium and magnesium. And calcium can actually be quite hard to get enough of if dairy’s not on the menu, and most people aren’t eating bone-in fish on a regular basis, which is another really good source of calcium. And personally, I don’t believe that bone broth is a good enough source of calcium to rely on it to meet your daily needs. So if you do a diet analysis and you see you’re not getting enough calcium—and by “enough,” I mean 600mg per day as a minimum—you can use supplements. And the same thing goes for magnesium, which is difficult to get solely from food, and not to mention our modern lifestyle causes us to need more of it. So that could be anything from drinking caffeinated beverages, to staying up too late, like I did last night, or being stressed. So magnesium can actually be a maintenance supplement for anyone, but particularly those that have muscle cramps. So if you have cramps, I do suggest using chelated forms of either both of these minerals, or use bone meal powder for your calcium, and specifically magnesium malate if you’re going to supplement with magnesium, since the malate form has been shown to be especially helpful for muscle cramps. And the reason I like bone meal powder is because it’s one of the most natural sources of calcium and it does contain other minerals as well. So if you’re supplementing with calcium, I suggest trying to get about 600-800mg per day, separated into at least two doses, and you can take at least 400mg of magnesium, and should probably aim for more like 800mg per day of magnesium.

Calcium supplements can be dangerous for people who are deficient in the fat-soluble vitamins A, D, and K2, and vitamin D is needed to absorb calcium that you take orally, so make sure you’re either getting sunlight or getting the fat-soluble vitamins from a supplement if you’re in a cold climate. K2 can come from grass fed dairy, natto, fermented foods, and as I mentioned, supplements. And vitamin A is high in liver and egg yolks, but you can also take a maintenance dose of these three vitamins if you’re concerned about your dietary intake or sun exposure. And also taking warm magnesium salt baths can be helpful for people with cramping. If you only get them in your feet, you can soak your feet in hot water with Epsom salts or you can add Epsom salts to a whole bath and soak your body. And I think this is a good habit to get into no matter what your health situation, but for people with muscle cramps it could be especially helpful. So for this person asking this question, I’d be curious to know what type of magnesium he or she is taking, and if it is the malate form versus magnesium citrate or whatever other type of magnesium supplements that are out there. So definitely try to get the malate or another chelated form if you are taking a different type of magnesium.

So next, you need to consider your salt intake. And many people who switch to a whole foods Paleo diet tend to drop their sodium intake significantly. This is okay for some people, but other people may not hold onto salt very well, or they maybe sweat a lot while exercising, and that means they might be losing salt more rapidly than the average person. So be sure you’re salting your food to taste if you get muscle cramps, especially if you’re a highly active person. And along with additional salt, make sure you’re drinking enough water throughout the day, because dehydration can cause cramping as well. So make it a point to drink a glass of water every three hours or so during the day. And if you’re really active and sweat a lot during the day, I would even recommend rehydrating with something like pickle or sauerkraut juice. I know that sounds really gross, but as some football fans may know, that’s actually the original Gatorade— pickle juice.

KELSEY: Right.

LAURA: And so it’s really good for replenishing sodium and other electrolytes, and plus you get the benefit of probiotics and sulfur, if you use the sauerkraut juice. So sometimes if I’ve had a hard workout—and I’m like a crazy sweater, so getting electrolyte replenishment is really important for me—and sometimes I’ll just drink sauerkraut juice because it has that salt and it has lots of other good compounds.

KELSEY: Right, it’s got a lot of great stuff for you.

LAURA: Yeah, and it’s not the most delicious flavor, necessarily, but if you like sauerkraut, it’s actually possibly good. So maybe you can dilute it with water if you don’t want to drink it straight out of the jar, but I think it’s a really good drink to drink if you’re an athlete or someone that sweats a lot while you’re exercising.

KELSEY: Yeah. I make a homemade Gatorade. Not pickle juice Gatorade, but “new” Gatorade, where I just put salt, lemon juice, and a little bit of honey, and mix that with some water, and it’s pretty good.

LAURA: Nice!

KELSEY: And if you’re someone who sweats a lot, like you, Laura, that might be a good option as well.

LAURA: Yeah. If I don’t pay attention to my salt intake and I’m exercising a lot, I do get charley horses sometimes. Not lately, but in the past I used to get them, so I found that the magnesium helped a lot, but I’m sure the salt makes a big difference too if you’re a Sweaty Betty like me. But anyway, potassium is actually another important mineral that you need to consider, and it is possible that people eating a low-carb Paleo diet aren’t getting enough potassium because they’re avoiding starchy plants that are high in potassium, like white potatoes or bananas. And there are lower-carb foods like spinach, avocado, acorn squash, salmon, and mushrooms, that have high amounts of potassium in them, so if you absolutely can’t add stuff like white potatoes or bananas for whatever reason, just make sure you’re getting enough of those other potassium-rich foods. Potassium supplementation is kind of a touchy subject, so that’s one of those things I’d rather people just get potassium from foods since it’s a little bit easier to go overboard with potassium supplements, and they can be contraindicated with certain medications.

And there are some herbs that have used for muscle cramps, and I’m not going to go into all the different options here because people can look them up on the internet if they’re interested in going that route. One recommendation I came across that sort of falls into the food category is something called cramp bark tea, so that could be helpful if you’re already doing all the other things I recommended. This tea is not appropriate if you’re pregnant. And check with your doctor before drinking it, especially if you’re on any medications. Other potentially useful herbs are meadowsweet, valerian, and skullcap. And these can come in tea form as well, but again, check with your doctor before taking them. And on that note, any of the supplements I listed above should actually be discussed with your doctor, especially if you’re on medications.

So one last thing I’d like to mention is that there are a lot of anecdotal reports of muscle cramping on low-carbohydrate diets, and there are a few different theories on why this might happen. I’ve seen some people say that low-carb diets cause excessive magnesium loss. Other people say that low-carb diets tend to be low in calcium, so that could be the major cause. Another issue is that a common side effect of ketosis is actually dehydration, because it has a diuretic effect when your body’s trying to get rid of those ketones. So people that are on a very low-carb diet may need to work on drinking more water, even if they’re not necessarily thirsty. And even low blood sugar can cause muscle cramping, so if you’re on a very low-carb diet, perhaps adding some extra carbohydrates in, particularly before bedtime or after a strenuous workout, this could help with cramping as well.

And Chris did talk about nighttime cramps in a podcast. I guess it’s a few months old, but we’ll link to it in the show notes. And he said in this podcast that in his experience, the most common perpetrators of cramping are either iron excess or magnesium deficiency, potassium deficiency or imbalance, B12 deficiency, sodium imbalance or dehydration, low blood sugar or elevated blood sugar, and he talks about the suggestions in that podcast. So I suggest you listen to it, and as you can see, a lot of them are the ones I’ve already discussed.

KELSEY: Yeah, and I would say if you’re not sure what your blood sugar levels are like, that’s probably a good thing to check, and you can check that at home, even. You just buy a glucometer. And like you said, low blood sugar can definitely lead to those cramps. So if you experience symptoms of low blood sugar, like feeling very cranky before you eat, feeling like a completely different person after you eat, then that to me suggests low blood sugar and you may want to check out what your blood sugar levels are like when you’re getting those cramps, specifically, too.

LAURA: Right. Okay, well those are the major recommendations I have for cramping. Like I said, there are a lot of different options out there, a lot of different herbal remedies, a lot of different supplements that people recommend, but I really think it’s important to make sure you’re covering the bases of what I mentioned in this answer. So, calcium and magnesium really are the main two minerals that people need to make sure they’re getting enough of. Salting your food to taste, eating potassium-rich vegetables, and replacing electrolytes if you’re sweating a lot if you’re highly active. Because sometimes people that are active don’t realize that they’re losing a lot of liquid if they’re not dripping with sweat at the end of their workout like I do. (Laughing.) Now everyone’s disgusted, so…

KELSEY: Everyone knows your secrets now, Laura.

LAURA: Oh, trust me, it’s no secret if you ever see me leave the gym, you’ll know immediately that I have a sweating problem…

KELSEY: (Laughing.)

LAURA: But I guess that’s all I had to say about cramping. So I don’t know if you think I missed anything, or…

KELSEY: Yeah, that was perfect. Definitely the electrolyte balance is a huge, huge part of that, and definitely start there if these cramps are something that you haven’t really addressed with any sort of electrolyte balancing. That’s the place to go first. But of course, everything else you mentioned is absolutely crucial, too, and you might want to look at those things if you’ve tried eating more sodium, getting that magnesium, and still having some problems.

LAURA: Yeah. And I think the calcium issue is always going to be a hot topic in Paleo, mainly because some people think certain foods are adequate to get enough calcium from. There’s debates about how much is enough calcium. I’ve seen 600mg listed as the minimum.


LAURA: I mean, as you and I know, we were taught that definitely around 1000mg is what people should be shooting for, depending on your age and gender. But you know, that’s a huge difference, so if you’re getting 600 or 700mg a day and that’s not enough, but you think it’s enough, that could be leading to some problems.


LAURA: And then the whole bone broth thing. I know this might be controversial, but I personally don’t think that you can get adequate calcium just from bone broth.

KELSEY: Right, just from bone broth. I would tend to agree with that too.

LAURA: Right. So unless you’re eating things like bone-in canned salmon or bone-in sardines, or I mean, even leafy greens, you’ve got to be eating a lot of them to get enough calcium. So if you’re not doing dairy and you’re eating a lot of bone-in fish, you might want to consider the bon e meal, which is basically like eating bone-in fish. It’s just ground up bones, so as far as calcium supplements go, I think it’s one of the more natural ones, and a little bit more food-based, as opposed to just taking a calcium pill.

KELSEY: Right. And there’s definitely some interesting evidence about calcium supplementation. It’s personally not something that I recommend to my patients, at least right now. I’ve just seen too many bad things about it. But the bone meal is interesting. And that, to me, makes perfect sense. Exactly what you said, it’s just like eating bone-in fish, except without the fish part. (Laughing.)

LAURA: Right. I mean, not that I’m saying it’s a good substitute, because bone-in fish has other great things, but if you’re really not going to be eating enough bone-in fish, or you don’t like it, or you can’t afford it, not that bone meal is—actually, I don’t think bone meal is that expensive, but it’s just easy. You can throw it in a smoothie, or…sorry, my voice is starting to crack. But you can put it in…like, if you make bone broth and you want to pump up the calcium amount, you can just put in a tablespoon. I just feel more comfortable with people taking something like bone meal as opposed to a calcium supplement.

KELSEY: Oh, absolutely.

LAURA: To be fair, the calcium studies that have been done don’t necessarily address things like vitamin A and vitamin K2 levels, so like I said, you definitely need to make sure you’re getting an adequate amount of those nutrients if you’re supplementing with calcium. And obviously, don’t go above 1000mg per day if you’re supplementing. You should try to figure out how many milligrams of calcium you’re getting from your food, and then try to stay under 1000mg with the food and the supplement combined. Again, this is something you should probably be working with someone with if you’re trying to figure this out, but I do think that a lot of people doing Paleo may be calcium deficient, but that’s just my opinion.

KELSEY: It’s certainly possible, yeah. Especially if you don’t have the dairy and you’re not doing bone-in fish or anything like that, it’s definitely possible.

LAURA: All right! So now that my voice is officially going out the window, maybe we should move on to your question?

KELSEY: Sure, sounds good.

LAURA: All right. So, this question is, I have been suffering from…oh, my gosh, this is going to be a difficult word…I have been suffering from laryngopharyngeal, I think is…oh, did they spell it wrong?

KELSEY: They may have.

LAURA: Yeah.

KELSEY: Laryngo-pharyngeal reflux, or LPR.

LAURA: Right. Because this person wrote “laryngosophageal” and I’m like, I don’t think that’s a word! So, LPR? Can you repeat what that is?

KELSEY: Yeah, laryngopharyngeal reflux.

LAURA: Okay. So this person has been suffering from LPR for two years, and they’ve tried everything. “A friend suggested Paleo and I have been following it for several weeks without any change in my LPR symptoms. Do you think I should continue on with Paleo, or do you have any other ideas?”

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KELSEY: Great, great question. So first I want to explain a little bit about exactly what LPR is. And it’s basically a type of acid reflux, and it’s often called “silent reflux,” because patients don’t typically experience the classic heartburn. Rather, they’ll get a sore throat, or a constant sore throat and a cough, or feel like there’s something stuck in their throat that they can’t dislodge, or something like that. And it can be very, very irritating, especially since patients can feel like it’s difficult to talk sometimes because their throat is so sore all the time. Either they’ll wake up with a very sore throat, or by the end of the day, their throat will be really, really sore, and they feel like they have a difficult time speaking because of that. So with any type of reflux, whether it’s just the regular GERD or if it’s something like LPR, I try a couple things. One of the first things I always try, if they’re not doing it already, is to eliminate wheat and to eat low-carb. And that usually tends to be lower than 100 grams, but it depends on how many calories total that they tend to eat. For people who haven’t tried doing that already, it usually makes a pretty big difference, and it’s pretty powerful for some people, to the point that some patients experience complete relief, though I will definitely say that’s a bit more rare, but it does happen. Even if you’ve stopped eating all wheat and even all grains, it’s still worth trying to go lower carb, as this sometimes helps beyond doing just a regular Paleo diet. So I’m not sure whether this person was doing a low-carbohydrate Paleo diet or more of a moderate or high-carbohydrate Paleo diet, but if they weren’t doing low-carb, that’s definitely something I would try.

Some other dietary factors that may help in the short term are avoiding really large meals, and going more for the smaller, more frequent meals. That tends to keep reflux at a more manageable level, though of course that certainly depends on the patient as well. If you’re someone who has always eaten those three large meals a day, it might be worth it to try a few smaller meals throughout the day and see if that difference helps. And you might also want to do a reflux-specific elimination diet that gets rid of things like alcohol, chocolate, acidic foods like citrus or tomatoes, and very spicy foods, to see if those foods trigger any of your symptoms. So that may be something that this person has already tried, but if they haven’t, that would definitely be one of my suggestions as well.

Now, some lifestyle modifications to try include reducing your stress, because our digestive system is so tied to our stress level, and it’s really important to incorporate some type of mind-body medicine, so like meditation, tai chi, yoga, deep breathing, anything you’d like. But make sure you do it on a regular basis. And that’s something that I think a lot of people with reflux, they tend to overlook. It’s not something that we tend to connect to our digestive system because it doesn’t feel like it’s connected. They feel very far apart, our brain and our digestive system, but they’re intimately connected, and I think that this helps a lot of people, of course along with doing a lot of other things as well, but it’s a very big, important thing to focus on, especially if you tend to be someone who’s very stressed out a lot of the time. This is probably something that needs to be at the top of your focus. And it’s something that we very, very often overlook. So make sure you check in with yourself, and you may want to keep a diary of when you’re getting your reflux, specifically. Some people, they’re getting it in a daily basis, but some people, it’s a little more rare. They may not get it for one day but they’ll get it the next. So see when you’re getting it, and try to connect that to the things that are going on in your life, and see if there are any connections there.

If you notice that you’re getting some reflux either at the time you become stressed, or maybe a little bit after you become stressed, then it’s a really good indication that focusing on stress relief activities would be very beneficial for your condition.

Another lifestyle modification is if you’re overweight, to lose some weight. That definitely can help to reduce the reflux symptoms as well, but of course, that’s much more of a longer term modification that we’d need to make.

Now, in terms of supplements, there’s plenty of things that you can try. The thing that I always recommend to start off with for anyone with any kind of reflux is to add in demulcent herbs, like marshmallow root, slippery elm, or DGL, which is a type of licorice. Now, these demulcent herbs, what they do is they coat, soothe, and heal the mucosal tissues, which really helps people who are suffering from reflux. And the reason I recommend these herbs is for a couple of reasons. One, I want to protect that esophageal lining while we’re trying to fix the issue, and also I want to protect the throat. If someone has LPR, more specifically it’s the throat that’s having more of the issue. So you don’t want someone with really bad reflux burning away their esophagus as we’re trying to fix the issue. We want to actually protect that lining by creating a coating, which is exactly what these herbs do. They make a coating that allows the acid that isn’t supposed to be there to do less damage. So it kind of creates a barrier between the acid and the sensitive tissue that’s not used to having acid there.

Second, it helps to give them some symptom relief, which can of course help make the patient happier as we’re trying to figure out what’s going on, and trying to sort of heal those underlying factors. Nobody wants to have their esophagus or throat burning or feeling irritated all the time. It’s really not pleasant. And it also helps to heal…these demulcent herbs, it helps to heal that tissue that’s been damaged by the acid. So when tissue is already irritated, any acidic foods you’re going to eat, like tomatoes or citrus, they might burn that already irritated tissue, and that’s definitely going to cause the patient to experience their symptoms. So by healing that tissue, actively healing it, making that irritated tissue go back to normal, as well as creating a coating or barrier between the acid and the tissue itself, that’s going to give the person a lot of relief. It doesn’t happen immediately. Sure, that coating can help somewhat, but usually it’s somewhat more of a longer term strategy, where we’re protecting and healing at the same time. So that’s exactly what these demulcent herbs do, and that’s precisely why I think they’re one of…usually they’re my first line treatment along with the dietary adjustments that I talked about before.

Now another supplement to consider is melatonin. There’s a really interesting study that compared melatonin to common acid blockers, and they found that the melatonin actually tightened the lower esophageal sphincter. Now, the lower esophageal sphincter is the sphincter that connects the stomach and the esophagus, and it’s supposed to be closed at certain times and open up at others. And what happens with any type of reflux is that it tends to be loose, meaning that it’s sort of open and allows acid to creep up into the esophagus and, in some cases, like in LPR, goes all the way up to the throat, where it’s not meant to be. And that causes the symptoms of either heartburn or LPR, where you’re getting a sore throat or cough, or something like that, because the acid’s not meant to be there. The esophageal sphincter is supposed to keep it in the stomach where it’s meant to be.

So, what these researchers found is that the melatonin actually tightened up that loose esophageal sphincter, which is really impressive, because we don’t have anything else like that that has been shown to do that. So the acid blockers, they just reduce the acid, y’know, the PPI’s. So we don’t necessarily want that, actually, because some people tend to have low stomach acid to begin with. It’s just that even that minimal amount of stomach acid they’re producing is getting up into the places that it’s not meant to be. Melatonin, on the other hand, it didn’t really affect the acid production, but instead, it just tightened that esophageal sphincter, which allows the stomach acid to stay in the stomach where it’s supposed to be, rather than creeping up into the esophagus and the throat.

So, honestly, I think there needs to be more research on this. This is just one study that I’ve seen. We don’t know if people have to supplement with this forever to maintain those results, or if it actually fixes the issue, and it would be really interesting to find out. I don’t remember how long the study was, but it wasn’t particularly long. But it’s certainly promising, and it’s something that I’ll use with patients if we’re having trouble with the reflux and they’ve tried a lot of other things and nothing seems to really quite be working with them. I don’t love the idea of supplementing with exogenous hormones if you don’t have to, but if someone is having trouble with their reflux and they’re also having sleep issues, then it tends to be one of the things that I’ll try eventually with them.

One other supplement also is hydrochloric acid (HCl). And Chris has talked about this in an article, so I’m actually just going to link to that, but what the theory is, is that some people with reflux actually have low stomach acid, and this causes sort of a chain reaction of issues that lead to reflux, and then by supplementing with the missing HCl, we can actually help someone’s reflux. So it seems a little bit backwards to give someone acid who supposedly has too much acid, or acid in the wrong place, but sometimes this is actually really useful for patients. So I’ll link to that so you can read a bit more about that process if you’re wanting to try that. But I would start with the demulcent herbs definitely, and see if that helps, because I find often that that’s a really big help for people that are suffering from reflux. And actually, one more thing I want to mention about the demulcent herbs: you want to get those in powdered form. And the reason for this is because we want it to come in contact with the tissues that are irritated. So if you take it in pill form—the licorice or the slippery elm—they’re not going to come in contact with the esophagus, the throat. It’s going to be broken down in the stomach, which is not necessarily going to help us. That can be useful if you have ulcers or something like that, but we want it to have contact with the throat, with the esophagus, and with the stomach, all the way down. So make sure you get it as a powder or a chewable tablet. In the case of DGL, you can get those chewable tablets. And if you get a powder, you want basically just mix it with a little bit of water or something flavored if you need it, because slippery elm at least is not my favorite flavor in the world. You can mix it with a little bit of water and just take it down as sort of a slurry type deal.

Lastly, it’s also worth checking in on your gut flora. It’s not hard to imagine that if there’s dysbiosis, which is basically just unbalanced gut flora, or small intestinal bacterial overgrowth, or parasites, that this might be affecting your digestion. So you want to find out if there’s anything going on in the gut and get treated for that as well, because, for example, SIBO, or small intestinal bacterial overgrowth, is actually quite common in patients with reflux. And by getting rid of that overgrowth of bacteria, usually the reflux is much more controlled. And then we can just work on healing those damaged tissues that have been damaged by the acid coming up for a long period of time.

So, that’s a long way of giving you a few ways you can work on your LPR or if other listeners out there are suffering with any other type of reflux, hopefully you have some more ideas on what you can do to deal with that reflux, because it’s certainly not a fun condition to deal with, and it usually takes a lot of experimenting to figure it all out. So I wish you the best of luck and I hope that some of these tips have helped you.

LAURA: Sounds good! I think that melatonin recommendation is really interesting, because it makes me wonder if adjusting your circadian rhythms and addressing your sleep if you do have sleep trouble, I almost wonder if that would have a positive effect on reflux.

KELSEY: Oh, I’m sure it would, yeah. Because if you’re exposed to artificial light all the time, yeah, you’re not making a lot of melatonin. So it wouldn’t surprise me if just by…that’s a really good point, Laura, just to work on your sleep habits and your artificial light exposure, that that might significantly help with your reflux, too.

LAURA: Right. And also getting in bed at a reasonable hour, unlike me.

KELSEY: Right. (Laughing.)

LAURA: All right, well was that everything you wanted to say?

KELSEY: Yeah, that’s it!

LAURA: It was a very, very well-answered question, so hopefully this will be helpful for the user that asked that question. And I guess that’s all we have for the podcast today. Sorry about the voice issues, but hopefully that won’t be a problem next time around. And we hope you enjoyed the show, and we would of course love any feedback you have on how we can make our podcast even better. And as a reminder, you can submit your nutrition-related questions through the link on Chris’s website and maybe we’ll answer your question on the next show. Have a great week, everyone, and we’ll see you around next time!

KELSEY: All right, take care, Laura.

LAURA: You too, Kelsey.

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  1. I may be stuck. I am dairy sensitive, but all calcium supplements I have tried, cheated and bone meal alike, make me terribly constipated (as does dairy). Also I am not digesting fats well, so I am worried that my supplements of vit d, k, and a might not be used by my body. Is there an answer here?

  2. I have been diagnosed with LPR, and have had that waking up/choking feeling described by a few people above, also shortness of breath intermittently, and the feeling of something stuck in my throat. My doc says I have chronic post nasal drip which is either causing the LPR or is making it worse, and prescribed Flonase and Zantac. Not taking the Zantac. I also seem to have some sensitivity to histamines because of migraine and eczema… Anyway, I’m SO confused. What to try? GAPS diet? No grain/low carb? Am reluctant to start eating a lot of fermented foods because they tend to trigger headaches and GI distress. Help. Can others with LPR give me any advice?Thanks!

    • What to try? Get a sleep study! That waking up choking/gasping. You have sleep apnea. Your airway is collapsing and stomach contents are getting pulled into your throat by the vacuum created. Nasal congestion at this point isn’t just caused by allergies anymore but also by stomach contents getting into the upper airway and nasal cavity. I’d venture you have an unrecognized skeletal deformity passing for normal, various hypoplasias basically: weak chin / retrognathic profile, long lower third, flat cheeks, humped nose / deviated septum, allergies, malocclusion, etc. Yes, this is very common and NOT normal but not always enough to be problematic, at least until old age and weight gain set in. This disease is set to surpass metabolic syndrome by 2050 if nothing is done to address it, it’s a freaking pandemic. How the f@ck haven’t textbooks been updated to cover this sh$t yet? Well, you’re here so it should be obvious by now, the medical system SUCKS at detecting problems sometimes. It takes a president or celebrity coming out to talk about it before anyone will take it seriously. Good luck!

    • I have been doing The Fast Tract Diet by Dr. Norman Robillard. This diet is high “good” fats and very little fiber. It works on the thought that SIBO is our cause and most wonderful health fruits and veggies cause fermentation in our small intestines. I take NOW digestive enzymes with HCL, Accura probiotic and multivitamin. Please google the book and the doctor for more info. It’s extensive. My LPR is about 50% better, but elimination has slowed down badly and is becoming a problem for me, as I’ve always struggled with chronic constipation. I would like to try the recommendation set forth in this article/pod cast: marshmallow root and a very low carb paleo diet. It is my hope that I can add at least some fiber back in without it causing too much trouble (again, back to fiber and fermentation potential). I have also raised the head of my bed approximately 4 inches. Lastly, wellness chiropractic care. I do not know if one of these things or a combination of all 3 is helping. One more thing, I’ve struggled with chronic anxiety for years. I have just recently recognized that and am coming to terms with it and trying hard to do something about that through mindfulness and gentle exercising (walking. I gave up running and high intensity exercise classes). I’m still on this journey. Good and bad days. I want the LPR cured, but I fear it is going to be a life long condition that we simply must learn to manage the best we can.

  3. Hi – I was wondering about DE Diatomaceous Earth – is made of one celled alge (silica) and food grade is used to treat parasites, yeast etc.. Was wondering what Chris thinks of DE. Is this safe effective way to treat gut issues and is this a possible source of calcium(or other nutrinents) as well?

  4. These doctors who specialize in LPR believe that it is caused by pepsin adhering to the epithelial lining of the throat (as one already commented above). When reading about the effects of cortisol on the body, I learned that it causes an “increase in intracellular pepsin.” I am wondering if almost everyone suffering from LPR (not GERD) had had a high level of stress just before their symptoms came about.

    • my symptoms i believe may be triggered by stress. i have a constant stream of mucus coming up from my stomach and constantly clearing my throat. this happens usually for 4-6 weeks and then stops for a couple of months. the bout of lpr starts up with an unusual amount of gas for 2-4 weeks then the excess mucus starts along with throat clearing. i believe my trigger is stress although i don’t really know 🙁

  5. I was diagnosed with GERD 8+ yrs ago. It started with a funny cough mostly after I would eat. I have had occasionally laryngitis my whole adult life (Im sure all connected). I was put on PPIs and told to have another scope in 5 years and just stay on the med! I had another scope 3 yrs ago, no Barrett’s, was told to just continue on Omoprezole. Last spring I had my 1st routine dexscan(bone scan) and it showed I already have Osteoporosis! I am generally very healthy, thin, and always eat well. I have done weight bearing exercise for years etc. When I saw my primary doctor and reviewed the scan, he said he didn’t think the PPIs were to blame. I know I want to now switch doctors! He started discussing the Osteo drugs, and I said I am not going to put another bandaid on another major problem! I took myself off the PPIs and have been trying everything to feel better. I’ve been taking HCL, I am eating a high alkaline diet, testing my PH daily, but still suffering from the LPR. I can’t even have a cup of herbal chamomile tea plain without feeling symptoms. Everybody seems to have their own remedy to try. I have done it all, but to no avail. I’ve been off the PPIs since last June, taking HCL the last couple months. Saw an ENT today to check my throat area, been very hoarse again. Looks inflamed and red, but no other permanent damage at this point. I am considering the surgery, need to see GI who does ph testing and mommetry to see if I am a candidate. Anyone have the surgery, and what is your opinion on it? Im sure their are numerous problems with that also, and it’s not a total cure all, but I’m ready to try if it helps!!

  6. I read that a cause of LPR is that the digestive enzyme pepsin gets washed up onto and adheres to the esophagus, burning the tissues and numbing the nerves (hence “silent reflux”). I believe that I have LPR and I’m wondering if taking 2-3 HCI + Betaine + Pepsin with each meal, plus a digestive enzyme that also has Pepsin is actually making the situation worse? I’m taking these to help with low stomach acid (from suspected SIBO, histamine intolerance and adrenal insufficiency).
    Description of pepsin: http://www.doctoroz.com/videos/3-step-silent-reflux-prevention-plan
    Other research on LPR: http://www.voiceinstituteofnewyork.com/articles-and-publications/acid-reflux-15-groundbreaking-articles/

  7. I have regular acid reflux and it has improved since I elevated the head of my bed by six inches. I have three inch risers under the legs and use rigid plastic wedges to achieve the additional three inches. In addition, I’ve also used a large wedge pillow to sleep in a more upright, yet relaxed, position. Also, “somewhere on the internet” I learned about zinc lozenges to reduce reflux symptoms. I take one every night, with DGL, and they do help. I’ve also read that increasing saliva helps to calm reflux, so I keep very tart lemon candies (3.4g carbs each) with me, if I have symptoms and it’s inconvenient to do anything else. The zinc lozenges I can’t take on an empty stomach, but the candies are ok when I’m in line at the bank.

    Regarding leg cramps, my husband and I swear by Caleb Trees’ Stop Leg and Foot Cramps. It’s a mixture of apple cider vinegar, ginger, and garlic. (We don’t sell this, just use it.) With the ACV, it’s probably a similar solution to the sauerkraut/pickle juice mentioned.

    For me the dietary change from SAD to vegetarian to keto/paleo, well, hasn’t been the magic bacon bullet. Hasn’t hurt, but wasn’t an acid reflux miracle. Keto/paleo has been brilliant for reducing migraine. (My other favorite topic :D)

  8. Hi Kerry, I too wondered about that, when I was seeking a natural calcium supplement. As it turned out I’m building bone rapidly with the raw milk, as I mentioned in my post above, so I let that idea go. I’m sure it would be much more useful than taking calcium in isolation. My other concern was whether it came from cattle raised in confinement operations. Are you wanting to use it for building bone ?

  9. So I was diagnosed with LPR about 6 months ago. I adjusted my diet some and it seemed to go away during the summer months (live in the Northeast). Noticed it again in the Fall, but then seemed to dissipate again. Right after the holidays it came back again. My diet did get a bit sloppy over the holidays, but have tried to trim back the excesses recently. I’ve been Paleo for about 3.5 years and never had any kind of reflux before. When it did come on, was when I started to add a bit more safe starches such as sweet potatoes and rice. But, I’ve tried eliminating some of those recently to no avail. Tried HCL when I first got this, but made the area around my bellybutton sore. The herbs and melatonin idea sounds interesting. Question: how much of the herbs should one try and how much melatonin? Also, at any particular time of the day to take any of these?

  10. I was diagnosed with LPR 3 yrs ago by way of a scope done by an ENT which clearly showed acid has been coming up my esophagus and literally spilling over into my airway causing the wheezing-like symptoms which were my main complaint to my PCP. I have NEVER had any typical symptoms of GERD….hence the term SILENT reflux. So my question is if I have silent reflux, how can I possibly know immediately if a particular food is causing me symptoms? i have no immediate burning sensation to give immediate feedback. I have been strict paleo for nearly two years…no grains or dairy. I have tried to limit chocolate, caffeine and tomatoes, but it is hard to be totally.compliant. My sleep is good, too. I eat lots of fermented food I make…water kefir, coconut milk yogurt and kraut. My “wheezing” has diminished but is still there. I am hoping it is just going to take time to repair the gut damage from taking a strong PPI (sooo stupid of me) for six months.

      • No, they did not. I took them for 6 months or so. All they did was totally mess up my intestines. I finally decided after doing some research that too much stomach acid was not the problem and decided to manage with diet. Anything was better than the PPI.

        • I would agree. I would guess that the PPIs helped me just a little bit but diet has made a much larger difference. I have weaned off PPIs before and it was a nightmare. I am hoping this time goes better but I am not hopeful as I am on a high dose (i.e. Protonix 40mg x 2 per day). Did you have any problems getting off yours?

    • I suffered from LPR for 3 years as well. It was caused by gastroparesis in my case. PPIs didn’t help one iota. I ended up taking domperidone and it worked after a while but is difficult to acquire. Eventually I discovered that I have sleep apnea. Treating that eventually made all the symptoms go away.

      If you have idiopathic refractory reflux, then you should get tested for both of these. They’re both relatively common silent diseases usually easily missed by doctors and people in general. Your PCP can order a sleep study and a GI can order an emptying test.

  11. One intervention I have seen improve GERD and LPR with numerous folks is stopping caffeine use (coffee/tea/soda). My guess is that this is somehow effecting the esophageal sphincter.

    As an herbalist I tend to prefer using bitters with meals to promote a person’s natural HCL production (as well as a host of other digestive secretions). Bitters, whether it is food or herbal formulations, are crucial to healthy digestion and many common digestive complaints can be remedies by addressing “bitter deficiency syndrome”. 🙂

    Also astringent herbs can be used to help tighten up that sphincter. Again, my bias as an herbalist, but I tend to prefer botanicals to using exogenous isolated hormones like melatonin.

    Thanks for posting these with a transcript.

    Go SEC!

  12. I have suffered from restless leg syndrome for most of my life and the occasional cramps (the latter at night) and I found that magnesium made the restless legs far worse. Mine have been greatly improved by eating less wheat (I always used to eat bread at every meal) and eating more natural fats (butter, coconut oil, olive oil, lard etc.) I now eat wheat only three or four times a week.
    I am surprised that dairy should be mentioned as a source of calcium as it is very poorly absorbed from milk. Also it is noted that pasteurisation makes the major part of the calcium in milk insoluble.

    • So much misinformation surrounds this subject of dairy. Unfortunately I believed it. After many years dairy-free, my bones began spontaneously crumbling a few years ago. I returned to the raw dairy of my ancestors and within 2 years my bone density increased by a massive 20%. And no more fractures.
      Mill is designed to build flesh and bone.

  13. Anyone with LPR should be tested for sleep apnea. In the struggle to pull air in during apnea, a vacuum effect happens in the airway and that can suck gastric contents up into the airway. The individual may or may not snore or be aware of the apnea, but LPR raises the suspicion index for sleep apnea.

    The only way to rule out apnea is proper testing. It gets missed too often in women and people with normal BMIs. Dietary interventions will not fix it if apnea is not addressed.

    • I actually appearance a form of sleep apnea when my LPR gets bad (like it is now). It’s not your typical form though where you stop breathing once you are asleep. Instead, this is more like when I am about ready to enter sleep I will jerk back awake because it feels like I have stopped breathing/am being suffocated. I only notice this when the LPR gets bad so I know it has to be connected. Lately I have also been experiencing chronic shortness of breath which is terrifying….this is a terrible condition. I have been on a low carb elimination diet for about a week now and the breathing has gotten somewhat better.

      • When I had LPR I experienced the same sensation you describe, of jerking awake suddenly due to a feeling of suffocation. One night was so bad I couldn’t sleep at all. I was so drowsy I’d fall asleep and then jerk awake, repeat every few minutes ALL NIGHT LONG. Needless to say, I was waiting outside my ENT’s office as soon as it opened the next morning. His opinion was that it was due to inflammation in my throat – including tonsil inflammation – secondary to LPR because of the acid irritation. Sure enough, when I went on the GAPS diet and cured my LPR, the sleep episodes vanished. None of it has returned and it’s been 3 years. I only did GAPS for about 5 months. LPR is absolutely miserable and I wish everyone suffering from it the best luck in finding their cure. Digestive enzymes also helped me.

        • You are the first person who didn’t think I was crazy when I told them about this symptom. When my LPR got bad this time around I didn’t sleep for days because of this. It lasted all night EVERY night. That combined with a constant feeling in general like I was being suffocated made for some good times. I finally resorted to some sleeping meds which would knock me into a bed sleep.

          My cousin is one of the leading acid reflux surgeons in Indiana and he told me acid reflux can’t cause shortness of breath LOL. Both him and my family doctor told me it was just anxiety and that I should see a psychiatrist. I’m not sure how people can be so “educated” and yet so ignorant.

          I would love to communicate with you on how your healed your LPR. If you would please email me at [email protected]. I have started an elimination diet about a week ago and this is the only thing that has easied the shortness of breath/sleeping issue.

        • Hello M,

          If you could kindly forward any information to me as well regarding the curing of your LPR I would be so grateful. I’m very inspired by the fact that you’ve been able to move on with your life. I am desperately hoping to as well! Thank you and sending you my very best wishes. [email protected]

  14. With regard to the caution against relying solely on bone broth for calcium, I’m curious as to why that would be. Is it a quantity issue, i.e., it would require consuming absurd amounts? I’d heard that it’s such a good source that consuming much more than one bowl per day, if done for a long time, might risk hypercalcemia.

    • There is no way consuming more than one bowl could lead to hypercalcemia. All the research I’ve been able to find online indicates bone broth actually has far less calcium and other minerals than the equivalent in a glass of milk.

      That said you’d need to take in a massive amount of calcium before it would potentially lead to hypercalcemia. Your parathyroid glands normally regulate that and it’s not that easily thrown off without there being something wrong. (Speaking as someone who has had both hypercalcemia and hypocalcemia and has damaged parathyroid glands, those that remain, and gets blood calcium levels checked regularly.)

    • My mom has done calcium testing on her homemade broth before and found the levels to be pretty low. We’ve also seen professional tests that were low too. Maybe about 150 mg/Liter at most. So to get 600 mg/day (which is probably the lowest you’d want to go) you’d have to drink around 4L per day. I recommend eating bones as much as possible (e.g. bone-in fish, chewing on well-cooked chicken/lamb bones, etc.) or using bone meal powder as the supplement, since it contains other important minerals like phosphorus. Or dairy, of course.

  15. I think that leg cramps may be different for different people. Mine was 95 % cured with calcium (and made worse by magnesium). They say citrate is better absorbed altough I don’t know but I take 2 citracal at night.

    • For me, my potassium was too low. I experimented with both calcium and extra potassium, since I take high magnesium citrate and B12, and the legs cramps stopped immediately when I added more potassium. (I only had ankle/calf cramps at night when I stretched my legs in my sleep). It was fun figuring out why my body was doing it!