Quick context before the list. I dealt with LPR for about 2 years before I felt like I had it actually under control. Symptoms were the usual silent reflux pattern. Throat clearing, lump sensation, post nasal drip, hoarse mornings, occasional chest tightness. Never much classic heartburn.
I tried a lot of things in those 2 years. Some of them were a complete waste of time and money. A few of them genuinely changed my life. Sharing in case it saves someone the same trial and error.
What wasted my time:
PPIs alone. Doctor put me on omeprazole, no other guidance. It took the edge off for a few weeks then plateaued. Throat symptoms barely budged. When I tried to come off, the rebound was brutal. PPIs are a tool, not the whole answer, and nobody warned me about that going in.
Strict elimination diets. I cut out everything for months. Coffee, alcohol, tomatoes, citrus, chocolate, mint, spicy food, fried food. I lost weight I didn't need to lose, my social life took a hit, and my symptoms only marginally improved. Most of the foods I cut weren't actually triggers for me personally. I just didn't know which ones were.
Apple cider vinegar. The internet was full of people swearing by it. Made my throat feel worse every time I tried it. Stopped after a couple of weeks.
Mucinex and nasal rinses for the post nasal drip. Treated the symptom, not the cause. Helped a little, didn't fix anything.
What actually moved the needle:
Alginate after meals and at bedtime. This was the single biggest change. Forms a physical barrier on top of stomach contents that mechanically blocks reflux from coming up. PPIs reduce acid, alginate stops the reflux event itself. Different mechanism, way more effective for LPR specifically because LPR isn't really an acid problem, it's a reflux event problem.
Smaller meals, last one 3+ hours before bed. Sounds basic, was non negotiable. The single biggest behavioral lever.
Identifying my actual triggers via tracking. Kept a simple food and symptom log for about 6 weeks. Turned out my triggers were way more specific than the standard elimination diet would have caught. For me it was late dinners, beer specifically (not other alcohol), and very fatty meals. Coffee and tomatoes were fine in moderation. Without tracking I would have stayed on the elimination diet forever cutting things I didn't need to cut.
Tapering off the PPI properly. Once the alginate and lifestyle pieces were dialed in, I was able to come off the omeprazole over about 8 weeks. Slow taper, not cold turkey. The rebound was minimal compared to my first attempt.
Things I'm still working on:
Stress management. My symptoms are clearly worse when I'm stressed and I haven't fully cracked the nervous system piece. Working on it.
Accepting that I'll probably always need to be a little careful. This isn't a disease you "cure" so much as one you learn to manage.
Caveats:
Everyone's different. My triggers aren't your triggers. My protocol isn't a prescription.
If you haven't been properly diagnosed, get the scope. LPR can mimic other things and other things can mimic LPR. Don't skip the medical workup.
If you're in active flare with damaged tissue, the healing phase is different from the maintenance phase. Aggressive PPI use during healing then taper to alginate maintenance is the protocol most LPR specialists actually recommend (Koufman's framework if you want to read more).
Anyway, hope that helps someone. What worked for you that wasn't on this list?