The unseen culprit: silent reflux

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. I suspect it is more common than we think.

Silent reflux is the backward flow of stomach acid into the throat and larynx. Unlike typical acid reflux, silent reflux lacks the usual painful symptoms of heartburn or regurgitation. There are many factors that can contribute to it, and these factors may also interact with one another, – including obesity, diet, pregnancy, sleeping position, chronic stress, medications or an underlying medical condition. However, one often-overlooked factor is low stomach acid – I’ll return to this one.

In healthy individuals, there are four barriers between the gut and the throat and larynx, which together prevent reflux (gastric acid) from escaping upwards. Silent reflux occurs when one of those barriers weakens, meaning that stomach acid may escape the stomach and travel into the upper throat.

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 a recurrent sore throat, hoarseness or chronic throat clearing. Unexplained asthma-like symptoms such as wheezing, 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. Occasionally silent reflux is missed due to the vagueness of symptoms. It is typically only when a client consults someone like me, often for something apparently unrelated, that the dots get joined.

What causes low acid?

So where does low stomach acid come in? It – and its related symptoms – is just one possible connection to silent reflux when we consider the digestive process and gut-related symptoms. When we have sufficient levels of stomach acid, it activates digestive enzymes, allowing the breakdown of food. However, in cases of low stomach acid, fewer enzymes are produced, impairing food breakdown. Several factors may contribute to low stomach acid. Ageing is a common cause – stomach acid levels tend to decrease with age. Chronic stress and a fast-paced lifestyle can also hinder acid production, as does a poor diet. Another factor is the use of certain medications like proton pump inhibitors (PPIs) and antacids, which 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 those four protective barriers, making it easier for stomach acid to reflux upward and leading to symptoms of irritation.

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. Some self-help support includes:

• Reducing or eliminating caffeine and/or 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/