Silent reflux or laryngopharyngeal reflux (LPR) is a hidden condition most people and even some doctors are unaware of. It is “silent” because you don’t feel the characteristic burn of acid reflux. LPR can damage your windpipe (larynx), your lungs and even your sinuses. It’s often mistaken for post-nasal drip, asthma and chronic bronchitis. This can lead to inappropriate prescriptions and further suffering.
Today we’ll be discussing silent reflux, the symptoms, and why they happen. I will share a real patient case study and talk about what we did to achieve remarkable and sustained results. Finally, I’ll be sharing some of my key natural treatment strategies for managing LPR.
Let’s dive in!
– Frequent throat clearing
– Chronic cough
– Hoarse voice or voice changes
– Choking episodes
– Trouble swallowing
– Feeling of food being stuck in the throat (Globus sensation)
LPR Symptoms Explained
Silent reflux symptoms most often creep up on you over years.
It may start with you clearing your throat often or noticing some mild voice changes. Perhaps nothing too bothersome at first. But as fluids rich in pepsin, an enzyme which digests local tissues and causes inflammation, is refluxed into your windpipe, you begin to notice symptoms. Your bodies natural response to this is to produce mucus. Naturally you clear your throat. You often notice this gets worse for you after eating or when lying down at night. Over time, the repetitive cycle of reflux, pepsin exposure, mucus production and you clearing your throat, damages your larynx and vocal cords. Again, it may be fairly innocent at first.
As reflux reaches further and further you begin to aspirate it. This irritates and damages the lungs which causes you to develop a cough.
You may experience choking episodes or an uncomfortable sensation of something stuck in the throat.
Any of this sound familiar?
Don’t worry, that’s not the end of your story…
As we’ll see momentarily this condition responds quickly and often dramatically to naturopathic treatments.
Silent Reflux Case Study
The following case study involves a real patient with a severe case of silent reflux.
Let’s call her Janet.
This patient came to me with a new diagnosis of a severe lung disease after suffering a terrible cough for over a year,with no relief. Treated with antibiotics for double pneumonia and steroids for lung inflammation, she found little relief.
“I Feel Like I’m Going to Die”
As a very sociable person she noticed that even a bit of conversation would set off a coughing fit that would last hours. At one point she was coughing so hard she dislocated a rib!
She was a very active spin instructor and personal trainer for several years. Janet was “healthy” by all standards. She never smoked a day in her life.
Things were so bad she told me she thought she would die soon. Janet was desperate. She crossed the border to go to a renowned respiratory clinic in the US.
Then we talked.
Our first appointment
When we sat down for our initial consultation, I reviewed her entire health history. When I questioned her about the cough, she said that it would get worse with talking for longer periods of time. This is common. In addition to this, we discovered that the cough would also appear shortly after eating or drinking. This is a classic feature of silent reflux. She denied having any “heartburn”.
When I asked her about her family history though, she told me that her father passed away from esophageal cancer. She also told me that her brother has barrett’s esophagus, precancerous cells in the esophagus.
Her family history was significant for reflux disease.
She was a bit reluctant to admit a problem like silent reflux could be causing such a debilitating cough and subsequent decline in her health. That changed when we put her on an elimination diet.
We removed common foods known to contribute to silent reflux as well as other common food sensitivities from her diet for 4 weeks. After this, we carefully re-introduced foods while Janet kept a journal of her symptoms.
The Follow Up
What happened next was nothing short of a miracle.
During the 4 week period she experienced a dramatic reduction in her coughing. She could breathe again. Her energy came back. She went back to teaching spin classes. She got off her medications (all of them).
Janet couldn’t believe it!
During the re-introduction period of the elimination diet – where foods previously restricted are reintroduced – gluten and dairy containing-foods, coffee, alcohol and carbonated beverages would trigger the return of her symptoms. This confirmed our suspicions.
What else did we do?
Aside from the dietary changes we made, we also used herbs like black seed oil. Black seed oil helps to lower inflammation in the esophagus and lungs. She was also given Sulforaphane from broccoli sprouts to help the body generate its own antioxidants. This also helps to protect both the lung and esophageal lining from repeated damage.
Finally, I gave her some digestive bitters to take before meals. Bitters can help to prevent reflux in the first place by improving the tone of the lower esophageal sphincter. This is the flap that protects our stomach acid from flowing back up into the esophagus. Keeping this sphincter working properly is imperative for those suffering with reflux of any kind.
Present Day
That was over a year and a half ago now and to this day she hasn’t relapsed. She’ll notice a mild cough reappear when she consumes certain foods or beverages. The difference is now she’s aware of how much she can get away with as she strikes a healthy balance. One between the foods that nourish her and the foods she enjoys.
Janet’s case demonstrates just how important it is to get a proper diagnosis. Laryngopharyngeal reflux should always be considered when someone has a chronic cough. People with asthma in particular should be screened for reflux diseases like LPR. This is because up to 65% of those suffering with asthma also have acid reflux.
Up to 65% of those suffering with asthma also have acid reflux.
NOTE: As mentioned earlier, this was a more serious presentation of silent reflux. Your symptoms should never have to get as serious as Janet’s in order for you to do something about it.
Ok, next I’ll share some treatment options I consider when someone walks through my doors with silent reflux.
Natural Treatments For Silent Reflux
As I highlighted in Janet’s case, diet is a crucial component in reversing silent reflux.
Some of the more common dietary triggers may include:
- Coffee
- Citrus
- Tomatoes
- Peppermint
- Chocolate
- Onions
- Garlic
- Dairy products
- Gluten-containing foods
- Alcohol
- Vinegar
- Fried or fatty foods
- Carbonated beverages (Soda, sparkling water, beer)
- Red meat
There can also be a high degree of difference in triggers from one person to another. This is why it’s important to work with a naturopathic doctor who can tailor a treatment approach to your individual needs.
What about plant-based diets?
Follow me for a second…
We produce pepsin in the stomach when we consume protein. Less so with plant-based protein. Therefore, it makes sense that a more plant-based diet with reduced animal protein may help with silent reflux. In fact, researchers found when they compared the effects of diet to strong heartburn medications for the treatment of LPR, diet was more effective!
More people responded to a plant-based mediterranean diet, and to a greater degree, than those taking medication. Those following the diet were also told to drink alkaline water. Alkaline water has the ability to inactivate pepsin, so this makes a lot of sense.
While proton-pump inhibitors (PPIs) are the drug of choice for LPR, many patients don’t get relief. What’s worse is these drugs have real long-term consequences. It’s nice to know treatment with diet is actually more effective!
- Concerned about the risks of heartburn medications? Check this out
- Trying to wean off heartburn meds but can’t? Read this
Bitters
Bitters stimulate digestive secretions such as saliva, stomach acid, digestive enzymes and bile. They prepare the stomach and intestines for digestion. Increasing bitter foods in your diet such as arugula, kale and dandelion greens are a good place to start.
As I mentioned previously, herbal bitter formulas can also be helpful for increasing tone in the esophageal sphincters. This prevents reflux in the first place! You should only use bitters under supervision. They may not be suitable if you have acid reflux as they can increase stomach acid and worsen symptoms. More often they are helpful in non-acid reflux which we see commonly in silent reflux.
Acupuncture
I’ve discussed the benefits of acupuncture in acid reflux elsewhere. But I’ve seen good treatment outcomes by using acupuncture to help with the symptoms of silent reflux.
Herbs
Herbal medicines like Slippery elm, Marshmallow root, Black seed oil and others are helpful in soothing inflammation in the lungs and esophagus. These have particular use in soothing an irritated cough.
Rikkunshito, A japanese herbal formula may help reduce globus sensation in sufferers of silent reflux when drugs fail. This is great because if you’ve ever experienced this sensation – it’s absolutely awful!
NOTE: It’s important not to self-prescribe herbs. Contrary to popular belief, just because herbs are “natural” doesn’t make them inherently safe. They may interact with your medications or have unwanted side effects. This is especially true with formulas that contain multiple herbs. Where you source your herbs also matters. For example, herb adulteration or the manufacturing malpractice of replacing ingredients listed on the bottle, with cheaper, lower quality ingredients may be harmful to your health. And they probably won’t help either. So always talk to a regulated healthcare provider, ideally a naturopathic doctor, before adding herbal medicine into the mix!
Silent Reflux: Not a Life Sentence
If you are currently suffering with any of the issues mentioned in this article please seek out help. As these things generally go, once symptoms appear they usually progress over time. Don’t wait until the stage of puffers and prednisone before getting help. Take action now!
Don’t suffer in “silence”
References:
Zalvan, Craig H., et al. “A comparison of alkaline water and Mediterranean diet vs proton pump inhibition for treatment of laryngopharyngeal reflux.” JAMA Otolaryngology–Head & Neck Surgery 143.10 (2017): 1023-1029.
Ates, Fehmi, and Michael F. Vaezi. “Insight into the relationship between gastroesophageal reflux disease and asthma.” Gastroenterology & Hepatology 10.11 (2014): 729.
Tokashiki, Ryoji, et al. “Rikkunshito improves globus sensation in patients with proton-pump inhibitor-refractory laryngopharyngeal reflux.” World Journal of Gastroenterology: WJG 19.31 (2013): 5118.