Understanding an Unseen Culprit: Silent Reflux
When clients invest in seeing a nutritionist, it is often because they consider it a last resort. They have ‘tried everything’, sought medical advice, consulted Dr. Google, and spoken to their friends. It may be because my clients tend to be more senior, but I have recently had a flurry of cases of silent reflux in my clinic. Silent reflux has a number of annoying and seemingly unrelated symptoms, so I thought I should write more about it as I suspect it is more common than we think.
Silent reflux is a condition characterised by the backward flow of stomach acid into the throat and larynx. Unlike typical acid reflux, silent reflux lacks the usual symptoms of heartburn or regurgitation.
There are many factors that can contribute to silent reflux. These factors may also interact with one another, making it important to identify them. They may include obesity, dietary habits, pregnancy, sleeping position, chronic stress, medications, or an underlying medical condition. However, one often overlooked factor is low stomach acid – a topic to return to later.
In healthy individuals, there are four barriers between the gut and the throat and larynx, which together prevent reflux (gastric acid) from escaping upwards. However, silent reflux occurs when one of those barriers weakens. This means that stomach acid may escape the stomach and travel into the upper throat, leading to irritation and inflammation.
Persistent coughing, especially worse at night when lying down or after meals, is a common indication of silent reflux. Some may develop difficulty swallowing or experience recurrent episodes of a sore throat, hoarseness, and chronic throat clearing. Additionally, unexplained asthma-like symptoms, such as wheezing and shortness of breath or post-nasal drip, may also be linked to silent reflux.
You must consult a GP if you have a persistent cough, asthma, or shortness of breath to rule out potentially more serious health issues. Your GP will undertake a comprehensive evaluation of your symptoms, but occasionally silent reflux is missed due to the vagueness of symptoms. It is typically only when a client consults someone like me for something apparently unrelated that the dots get joined.
Where does low stomach acid come in? Low stomach acid and its related symptoms are just one possible connection to silent reflux when we consider the digestive process and any gut-related symptoms. When we have sufficient levels of stomach acid for proper digestion, providing the activation of digestive enzymes (these help to break down the food), things are in a good place. However, in cases of low stomach acid, the pH levels in the stomach become less acidic, fewer enzymes are produced, and this can impair the breakdown of food.
Several factors may contribute to low stomach acid. Aging is a common cause, as stomach acid levels tend to decrease with age. Chronic stress and a fast-paced lifestyle can also hinder acid production, as well as a poor diet. Another factor is the use of certain medications like proton pump inhibitors (PPIs) and antacids, which can suppress stomach acid production over time. Infections, such as Helicobacter pylori, can also disrupt acid levels.
Over time, low stomach acid may fail to activate the proper closure of the lower oesophageal sphincter (LES), one of our four protective barriers between the gut and the throat and larynx, making it easier for stomach acid to reflux upward and leading to symptoms of irritation. Other mechanisms may also contribute to the link between low stomach acid and silent reflux. One significant factor is that insufficient stomach acid may cause delayed stomach emptying, leading to prolonged contact between the stomach's acidic contents and the LES.
What can be done? A personalised nutritional approach together with carefully selected supplements may support silent reflux, alongside a long-term approach to keeping the gut in optimum condition. What has often been an irritant for months may be supported by a nutrition or other healthcare professional. Some self-help support includes:
Reducing or eliminating caffeine
Reducing or eliminating alcohol
Eliminating carbonated drinks
Losing weight
Not eating large meals before bedtime
Stopping smoking
Reducing the amount of very fatty meals
Always consult a professional before taking any supplements.
References: https://www.ncbi.nlm.nih.gov/books/NBK519548/