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clear search termsChronic Post Nasal Drip: Missing a Simple Solution?
Chronic post nasal drip (PND) can be a particularly annoying symptom in our clients. Or sometimes they aren’t even aware of it until I point out how often they seem to need to clear their throat. Either way, it can be a recipe for digestive issues or being more prone to viral or bacterial infections over time. It’s just another opportunity to help clients to be wildly satisfied with simple solutions!
Certainly, there are many possible causes to PND. Anything to which a client’s immune system is having an ongoing negative reaction can make their symptoms chronic: a laundry detergent, a perfume, new curtains in the home, or some other food like eggs. Immune system inflammation can cause a wide variety of reactions including such disparate symptoms as headache, eczema, achy joints, depression, PND, weight gain, or acid reflux. Frankly, I have been surprised at how often in my practice we find clients have food sensitivities. And indeed in 80%+ cases of PND, we find the true root cause is (at least in part) a reaction to dairy foods which thickens (and also perhaps increases) mucus secretions.
For these types of symptoms, I always recommend a full two-week elimination of the food in question and help my clients to understand that the elimination must be 100% “cold turkey” in order to be a valid trial. I also like to give them a Dairy Elimination Client Handout to help with avoiding hidden dairy sources. For example, I find many clients don’t understand that whey protein powder is a dairy food (and almost always contaminated with the protein casein as well). Or many soy-based protein bars include caseinate ingredients (a derivative of the dairy protein). Or perhaps even more confusing, a product labeled “lactose free” does not necessarily mean it is truly “dairy free”. If your clients are wary of trying an elimination, giving them simple food substitutions can help to increase their confidence and willingness to experiment (e.g. coconut creamer vs. cream for coffee, almond milk vs. dairy milk for making oatmeal, or a mix of hemp, flax, and chia seeds instead of a whey protein powder for a smoothie).
Most of the time, clients will experience palpable or complete relief and be readily convinced of the need to avoid these foods long-term. If they are resistant and need more validation, however, then I recommend suggesting a formal reintroduction trial of the foods. That is, consuming two moderately-sized servings of dairy foods twice a day for three days in a row. This is actually the gold standard of testing for food sensitivities (vs. any type of labwork). Make sure they know that slowly and gradually adding back the foods is not a valid assessment! In the presence of a sensitivity, the repeated, short-term consumption will trigger significant immune system reactions, including PND and likely other inflammatory symptoms as well. The three full days is required because IgG-mediated immune reactions specifically can take more than 12 or even as much as 48 hours to manifest as symptoms. If your clients is assessing their sensitivity to more than one food, make sure they only reintroduce one food at a time and take a ~3 day break in between each trial in order to ensure reliable results.
This article focuses on annoying, chronic post nasal drip, but food sensitivities in general can cause a very wide array of symptoms and frustrations or even debilitating disease. If you need information collateral to help your clients to buy in to the notion of food sensitivities, this is a simple write-up from Dr. Mark Hyman (on Dr. Oz) which might help. This video is also a quick explanation about food sensitivities. Even conventional medical research is beginning to acknowledge the role of IgG-mediated food sensitivities in various illnesses such as IBS, ADHD, and rheumatoid arthritis.
The old adage “Disease begins in the gut” is often completely true! If you wish to learn more about food sensitivities in depth, as well as immuen intolerance overall and how it affects the rest of the body, you will get great value from the SAFM Asthma, Allergy, and Immune Intolerance clinical course.
P.S. If you are passionate about transforming healthcare through the power of functional medicine, we encourage you to learn more about SAFM’s practitioner training programs. Enrollment for our next cohort is now open!
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16 Questions for “Chronic Post Nasal Drip: Missing a Simple Solution?”
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8.1
There is a true abundance of choices on the market and many of them work well. We generally recommend supplements with the least amounts of fillers and no additional colors/flavors. A few examples here would include:
– Solaray Betaine HCl with pepsin
– Pure Encapsulation Betaine HCl pepsin
– Thorne Betaine HCl & Pepsin
– Designs for Health Betaine HCl
– Betaine Plus from Douglas Labs
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Liz says:
Your feedback is so amazing and thorough. I’ve been reading through your materials and I’m interested in food sensitivity testing. Thank you so much for you time spent on helping people. I greatly respect your work.
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7.1
SAFM Team says:
Thank you for your kind words! We recommend you read through this more targeted post: https://schoolafm.com/ws_clinical_know/food-sensitivities-what-why-and-how/ . We do recommend working with a qualified practitioner who can help select the type of test that will be most helpful in your situation and also interpret the test results; different types of tests are more vulnerable to false negative vs. false positive results.
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John Harris says:
I have had really BAD pnd for over a decade, it just seems to be getting worse as i get older!! One doctor says it’s acid reflux, another says it’s sinus and allergy related, another says its both, and one says its in my mind! Can u please help me???? Thanks
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6.1
We appreciate your sharing, John. As the article discusses, there could be various reasons for PND and we encourage you to work with a functional medicine practitioner to get to the bottom of what are your unique drivers in order to get better. We wish you good health!
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Marie Campins says:
Hello, I have a client of 19 years old, we’ve been working together for about 6 months cause she wanted to lose some fat. But on the first meeting she told me she had nose dripping allergy every morning until 11am. So we took out all dairy, wheat, gluten, nuts and sugar, added some Mag, Vit C and Probiotics (deff helping with fat loss!:))
But still not able to take that allergy from her. What more can we do here?-
5.1
Your client is lucky to be working with you, Marie! And waht a great progress – doing the dietary changes that you described is a no small thing, so congratulations to you and your client! It sounds that despite all these wonderful changes your client’s immune system is quite hypervigilant and may need support both via specific nutrients and or gut health support. Here are a couple of posts in this vein that may be of interest to you:
https://schoolafm.com/ws_clinical_know/seasonal-allergy-and-asthma-solutions/
https://schoolafm.com/ws_clinical_know/congestion-relief-for-allergies-and-colds/
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Paloma says:
Hi!
Are goat milk and goat cheese
included in this food sensitivity?
Thanks!-
4.1
It depends on a person. We’ve seen clients who had cow’s dairy sensitivity but not a goat or sheep dairy issues and also clients who had high reactions to all types of dairy, no exceptions. The best way to determine if an individual is mounting an immune response to a food is to do a food sensitivity test that measures IgG+complement levels or IgG and IgA levels in response to a particular food. These tests typically yield much less false-positive results making the elimination more targeted and more manageable, thus more successful.
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Bob says:
If coffee is a factor in post nasal drip, how long after quitting coffee would a person see some relief?
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3.1
The time before you notice a palpable difference can vary depending on the particular type of reaction. I would say a two-week trial is a reasonable place to pause to check for notable (but perhaps not complete) improvement. Keep in mind that because coffee is a hot, steamy beverage that part of the contribution might simply be the loosening of congestion in the nasal passages that causes it to drip afterward. One can certainly have a coffee sensitivity. However, coffee can also be contaminated with mold or pesticides that might drive an immune system reaction. It’s also possible that milk/cream used in the coffee is a primary driver, and relief would only result if other dairy foods were eliminated. Happy exploring!
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Hellen says:
What beverages should you take when having post-nasal drainage? Also, do foods with wheat cause more drainage?
thanks
Hellen
Kenya-
2.1
Hydration with plain water away from meals is always a safe choice that does not contribute to PND.
Food sensitivities are often a main contributing factor to PND therefore if possible I’d recommend a food sensitivity test or a proper elimination diet as described in the article. It is important that the elimination is 100% to get a clear sensitivity or no sensitivity reaction upon reintroduction of food.
Coffee and tea are potential food sensitivities. Wheat/gluten can be a major food sensitivity and also an exacerbating factor for the intestinal hyperpermeability in some people. For these reasons testing or an elimination diet are the two ways to determine the root causes of the PND in an individual.
Hope this helps.
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Greg says:
Yes.. question for you regarding post nasal drip. I have had an issue with clearing of my throat for 10 years now and I do not eat dairy whatsoever! And so my question for you is, if I have post nasal drip what would it be contributed to if I’m not eating dairy? I will say that I am HIV positive and have been for 25 years, however I am in fantastic shape because I am a natural bodybuilder and take care of myself on so many different levels. However, my biggest issue is this clearing of my throat and post nasal drip. I have been informed that I might even have what they refer to as silent reflux. I took the protocol a supplement called HCl with pepsin and this seems to help somewhat but does not resolve my issue. I was wondering if you have any other suggestions besides taking HCl with pepsin and enzymes? I am so wanting to cure my situation because I am a singer as well and it causes excess mucus and this chronic issue with clearing of my throat. I would be so grateful to you for a bit more information. Thank you in advance.
Greg-
1.1
Silent reflux can indeed be a driver. Using supplemental HCl with Pepsin (to increase stomach acid) is a great idea, since acid reflux can be caused by insufficient stomach acid. (we see this often in clients actually.) Consider experimenting to make sure you are taking enough HCl support. Some people only need 1 or 2 caps in the middle of each meal, while others need 5 or 6. Suboptimal magnesium can also contribute to reflux. Check your RBC magnesium (not serum) to make sure you are in the upper third of the typical reference range. Most importantly, many other food sensitivities can be a root cause of reflux or simply congestion due to mucus build-up from the immune system reacting to the food. We find dairy is the most common cause of those particular symptoms (with gluten being a close second), but there are many other potential culprits. You could either do a trial food elimination diet where you eliminate the major known sensitivities (e.g. gluten, dairy, soy, shellfish, peanuts, tree nuts, citrus, yeast) or consider a food sensitivity test, which will give you feedback on persistent IgG immune reactions to food. This post gives you more detail about food sensitivity testing. For relief in the short-term (while you are investigating), consider quercetin – taking 500-1000mg twice daily. Quercetin is a flavonol which is a natural anti-histamine – and potentially quite helpful for those with asthma, allergy, or atopy of all types. Hope that helps!
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Which supplemental HCl with Pepsin do you recommend?