I had a six month ENT follow-up today after scans and investigations six months ago and persistent sore throats (now resolved) which was diagnosed as silent reflux with a camera up my snorkel and down my throat showing red raw larynx at the time.
Fabulously knowledgeable and open to discussion specialist told me that Silent Reflux is filling up ENT departments world wide, USA, Africa, Europe, Asia. He was very animated, the whole specialism are talking about it, conferences world wide looking at all possible causes. Current thinking and treatment is being questioned worldwide. They are recognising what they thought they knew isn’t working, It’s the biggest area of discussion and a very hot topic in ENT circles.
He was absolutely positive that treating thyroid correctly is what has helped my case, mine is almost resolved and I’ve found my own triggers. Gluten in particular, and he wasn’t surprised, he also thinks preservatives in food play a role and clapped when I said sulfites give me puffy eyes. There you go he said. All related.
“Treat your autoimmune and you will treat your silent reflux.”
He said that I may never clear it completely but lifestyle and diet are 100% the best ways to treat it.
Just thought I’d share if anyone else has persistent sore throats, full feeling in the neck, wakes up coughing, always coughing or clearing throat. silent reflux isn’t regurgitation like reflux, it usually happens in your sleep, tiny sprays of stomach acid escaping from below reach your larynx. Which over time becomes inflamed.
Top tips;
Sort your TFTs and Vits so you are at optimal levels for you. Explain to GP that ENT need your FT3 higher in range so your stomach valves work properly.
Raise the head end of the bed a few cm
Don’t eat after 7pm
Don’t drink fizzy drinks with meals (or at all)
AI diet (GF/DF)
Avoid preservatives, eat as fresh as possible.
Alcohol doesn’t help.
Raise stomach acid with Betaine with Pepsin and Apple Cider Vinegar
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OMG!! No magic pill just good sound advice... what is happening... perhaps if the ENT's shared a locker room with Endo's some good sense might spread throughout the NHS 🙃
Wow! Impressive isn’t it. Just imagine if everyone ends up with their thyroid being optimal instead of somewhere ‘within range’ although it’s a very wide range and where they still don’t feel well.
I’ve been following all those suggestions & I’m much better. Also avoiding tomatoes, acidic foods & spices in the evening.
I’m totally off alcohol now due to medication but I find the alcohol free, well, 0.5% Guinness really settles my stomach. I know it’s got gluten but it seems to do more good than harm. I have no idea why. Hazelnut milk after eating also works well for me.
Time health digestive enzymes have been the best thing for me. Really help.
Thanks for the info, I’m glad you met a helpful medic for once.
Brilliant news that you are feeling better 👏👏👏 I turned down a 0%Guineas only this evening, dammit i should have tried it 🤣 Hazelnut milk sounds dreamy, where sells that? Thanks for sharing what works for you, I have some enzymes, add those into the mix too 🙏
Hazelnut milk I drink is by Plenish, I use their almond too. Innocent was my favourite but it disappeared unfortunately. I’ve found the hazelnut very soothing. It’s long life until opened so easily stored, mine comes from Sainsbury’s.
I had horrific problems with reflux in my late teens / early twenties. Starting to wonder now—was that the first sign my thyroid wasn’t right? I apparently don’t have autoimmune disease—at least, never had any antibodies—but I’m sure I’ve read somewhere you don’t need to have, it can still be autoimmune. And my maternal grandmother had hypothyroidism (virtually certain my mother had “borderline” hypothyroidism which meant she was never treated).
I do still occasionally suffer but not as badly as I did then. Going gluten free most definitely helped, I think.
Another silent refluxed here (had incredible knock on affect to asthma too) was also resolved by diet. I was *mostly* vegan for 6 months and cut tomatoes as that seem to make it worse.
My suspend reflux for so bad by the time it was diagnosed and it was actually the asthma nurse who worked it out over the phone!
Yes, it's a huge problem. I have a digestive fault and have had silent reflux for decades. As a professional voice user I've learned this navigate it and have some more nuanced advice than given here if that's OK?
1. Raise head of bed - a few centimetres not enough. Use twp house bricks- one each side. You'll soon get used to it and any bed fellow will too.
2. Always start off sleeping on your left side if possible because ofnthe weight of the liver (think its the right lobe thats bigger?) which wouls otherwise put pressure on the stomach. That said, I often turn over in the early hours with no ill effect.
3. Finish your last meal, as Regen says, 3 hours before bed.
4. The digestive enzyme Pepsin is the problem- not the acid itself. Medics are slowly catching on to this - realising that by stopping acid production with Proton pump Inhibitors doesn't address the cause, which is poor digestion and poor food absorption. Hence links with hypothyroidism
5. There are ways of addressing acidity in the diet by changing it. All perfectly possible and I can share the book I read on this topic if others wish
6. Gaviscon Advanced is the British over the counter product of choice by ENTs and laryngoloists. Take last thing at night ,no water or food after, and it creates a protective raft on top of the stomach contents. It is an alginate with highish salt content so if you have very high BP you might not be able to use. But otherwise, its not pharma as such. If you take your thyroid meds at night you have to allow for this. I don't use gaviscon every night as my reflux is largely under control. But I take my levothyroxine at around 3-5 in the morning when I go to the loo. I always have a drink of water so that the protective raft is breached and the levo can be absorbed. Gaviscon doesn't interfere with the levothyroxine but it would slow down absorption.
6. The digestive enzyme pepsin is an irritant to soft tissue of thr larynx and can also get into the nasal cavity and - i think - the eyes. So If you get a lot of weird sneezing allergies, an odd little cough at night just when youre falling asleep , have bad gums and itchy eyes you might have silent reflux. I get far less sneezing fits now.
7. Read about the difference between gastro oesophagal reflux (often called heartburn) and laryngopharngeal reflux (silent reflux) on the British Voice Association Websit, Free Information section.
Happy eating folks 😀
BTW acid reflux also linked with heart arrhythmia.
Hi Singwell. What a great post, a lot of the things you say definitely ring true for me. I’m currently battling acid reflux/‘acid stomach’ and it’s so painful! I’ve just started using Gaviscon because I don’t want PPIs again, they messed with my thyroid meds, and Gaviscon definitely helps. I cook meals from scratch almost all the time, and eat lots of vegetables. I’m caffeine-free now and it seems to help. I would like to read the book you mentioned, what is it? Thanks
On point 6, my ENT recommended the same and told me the PPI won’t be solving the problem as all it does is possibly reduce the acid nor stop it from coming it up!
I am wondering if it’s a bit of an epidemic lurking as for years I struggled to get but Gaviscon advanced I pharmacies and shops. And, when I could the prices had doubled!
Thank you. Hypothyroidism significantly impacts on the voice - I'm going to dig into it a bit more - but meantime we can help our digestive processes overall by looking into acid reflux. I'm a bit of an acid reflux warrior
'Hypothyroidism significantly impacts on the voice'
It certainly does. And it's been suggested that hypothyroidism might even be diagnosable through voice changes alone. Can't recall the details now, but helvella might know.
I'm in conversation with helvella. I've a lot of contacts with clinicians interested in voice and can ask them for information. A landmark example is how Hillary Clinton was pilloried during her last election campaign for her low pitched husky voice. She was known to have developed hypothyroidism and I think her speaking voice had dropped almost an octave in pitch. I've got a blog about it somewhere...
This is the book. It's really helpful and informative. I still use the basic principles but am able to eat acid triggering foods occasionally if during the day. Learning about FODMAPS was an eye opener, which turned me more towards fish and animal proteins which I now eat 3-4 times a week. Better for my thyroid anyway.
Just in case anyone makes the same mistake i did, I bought the wrong book on kindle. It’s got a very similar cover and the identical title, but it’s by Barbara Cameron, and it’s terrible. I think it’s been translated from a foreign language and it’s full of mistakes. Some sentences are barely decipherable. I’ll try again to get the right one 🙄
Oh gosh. That sounds like a copywrite issue. Scammers use bots to clone and 'Rewrite' successful books. I'd put that up on your Amazon review and ask for your money back. We've had this happen to our books twice.
What about sleep apnea? That can cause what you are describing.
You could be at risk for obstructive sleep apnea (OSA) if you are a man with a neck size of 17 inches or more or a woman with a neck size of 16 inches or more. OSA, the most common type of sleep apnea, occurs when your throat relaxes while you sleep and your airway becomes partially or fully blocked.
The waking up.and coughing part, yes. But I guess doesn't cause the sore throat and sometimes you can feel the acid coming up into your throat. Very distinctive and horrible.
After a while the vocal cords get burned and damaged.
It wouldn't surprise me in the least that there is an epidemic because so many people were hiding out at home gaining weight and getting out of shape. The incidence of type 2 diabetes has also sky rocketed as has depression, anxiety and other mental health problems. I asked a chemical engineer who works for Teva about the drug situation during Covid. She said amoxicillin was not moving but they couldn't keep up for the demand for anti-depressants.
Lots of these drugs also stimulate the appetite so it makes things even worse. And they also increase the incidence of sleep apnea.
Definitely can be an associated problem. What seems to be generally misunderstood is that ‘floppy muscles’ don’t just stop at the sleep apnea diagnosis. That’s only part of the story. It’s extremely likely that the floppy muscles (in some individuals) spread further into the oesophagus, sphincters and stomach itself, Singwell , causing silent reflux. Eating your last meal 3 hours before bed - that often is not enough time. Some of us also suffer gastroparesis. This is the slowing of digestion, due to (floppy) inefficient muscles/peristalsis, meaning that food is often delayed in the stomach, way beyond the three hours. Lying down will allow acid reflux to take place in those circumstances too. Floppy muscles no doubt also contribute to constipation which is an extremely common symptom/sign. Almost any body part can become ‘sluggish’ due to hypothyroidism.
Hypothyroidism is a truly ‘wholistic’ illness. It does not ‘stop’ anywhere. Everyone’s ‘brand’ is different (brand being the emphasis on certain personal symptoms). We ourselves need to understand the breadth of its effect. We know our doctors have little or no comprehension of the effects of the condition and therefore this has a direct effect on our levels of medication. Putting aside the ridiculous notion that TSH is a measure of our health, it means that so many of us are being improperly medicated. Being under/wrongly medicating by doctors is causing all these (to them) unrelated symptoms. Even if certain doctors are wise enough to realise the connections, the idiotic rules (guidelines) mean that many of us will continue to be under medicated.
However I agree with nearly all the advice posted, especially the reference to additives/preservatives, if people always take into consideration the ‘wholism’ of our situation.
I wondered this too, the ENT says not, my neck is 12 inches. I’m quite slim. But I totally agree that my neck muscles and gizzards could go floppy in the night! Luckily for me it’s all resolved via the steps mentioned already. 🌱
I've had this for a very long time. Mine is from low stomach acid. 😫 Constant feeling of lump in throat, clearing throat, cough.... amazing that low acid can cause such a thing! I take betaine HCL with pepsin and gentian bitters with every meal. 2 with large meal, 1 with snacks or supplements. Only problem, if I take it after, or on an empty stomach, it can cause some burning/ discomfort. The bloating, reflux, and full feeling has gone since I started. Good stuff! I wonder why everyone has silent reflux all of a sudden? Something new introduced to our systems in the past few years? Good questions to ask! 😁🤗
A couple of times recently I have read that Washing Up Liquid can cause problems with acid reflux, but it was only about 4 lines long in each case. I wonder what 'they' are trying to keep quiet!
How did you get advice on the HCL? I had the digestive end of my vagus verve tied when I was 19 following abdominal surgery so my.stomach doesn't make acid. I've wondered about taking HCL.
Hi! Didn't see your reply. 😬 I just did research, and tried ginger and bitters first, to no avail. I recently learned that you only need to take the hcl if you consume 15mg or more of protein in a meal- so I only take it in those circumstances now. I'm a vegetarian, that doesn't care about protein, so I don't take it often anymore. I take more ginger just to keep my stomach happy, and to keep inflammation down in my digestive tract. But if you eat meat, get some- you won't be disappointed!! 😁🤗💛
I didn't notice any effect with low protein meals... They say you don't really need it, unless you consume more than 15g of protein in a meal. Fruit and veggies don't require much, I only take it when I eat a lot of pasta or if I have any fish. ( or dairy.) I just read labels about protein content. Pepsin is only needed to break down meat, is what I read. 🤷♀️ But I could be wrong!
Thank for this very timely post. I was just telling my husband this morning about the annoying nighttime cough that wakes me up and the sneezing usually in the morning. I’ll be trying some of the suggestions to see what happens.
Over 20 years ago I went to my GP with left chest pain and was prescribed Gaviscon for GERD which, then and now, I think was a ridiculous diagnosis. It was a few weeks after I'd contracted Lyme disease. More recently I've had a CT coronary calcium score test, which was zero (yay!), and no hiatal hernia was noted.
Not knocking all of the original post, just doctors (like mine) who jump on bandwagons, plus influencers pushing needlessly restrictive diets.
Oh yes - horror stories of people being sent away from A and E after going in with chest pains and then getting a heart attack a few days later. So glad yours is fine though. To be fair, hiatus hernia mimics the symptoms of a heart attack and can be quite scary.
Thanks so much very helpful post. I am also dealing with acid reflux. Have celiac and hashimotos. Thr only thing is that I have tried pretty much all the above and still have persistent reflux. I just don't want to take PPIs as they do not work
Are your thyroid hormones optimal? This was the ENTs main advice.
There was a Dr Eric Balcavage Thyroid Answers podcast a while back that discussed this. He talks about inflammation and stress (physical, physiological and emotional and considers under medication a cause of physiological stress. Quite a good listen and had joined some dots for me.
So could you tell me what your diet contains ? I have been suffering for over 30 years with hypothyroidism and severe acid reflux. The meds they give you for acid reflux stops the acid in your stomach but you need acid to digest your food etc. I’m constantly suffering from fatigue, pain, stomach , head basically my whole body. The only thing that keeps me going is the good Lord and my family. But it’s a daily struggle living like this I’m in the bed probably 15 to 20 hours a day . Well actually I haven’t slept in a bed for over 6 years I sleep in recliner. Anyway just wondering what you eat now on daily basis. Thanks and God Bless you
Goodness you poor thing, amazing how we adapt to just keep going. I have fond childhood memories of family members who slept in recliners and kept unusual hours too, I guess they were also hypo thinking about it.
As you might guess from my username I grow my own veg, I’ve devised an approach inspired by a local farmer that means I don’t have to dig, just constantly planting and composting, I’m obsessed. I’m from a long line of muddy fingered veg growers so fresh food is deep in my bones.
When I was diagnosed I thought I could eat myself well. With my healthy homegrown goodies. I learned very quickly I would need more than that. When advice to my posts asking for help here started, I learned and tried a few things out and kept what worked for me.
I read a book by Izabella Wentz about an auto immune diet and that really did help when I was very hypo.
I was already lactose intolerant before diagnosis and recently realised I get a swollen mouth with anybdairy products so best avoided. I went gluten free as recommended here and in the books I’d been reading. To be honest I had pretty much always been a carb dodger, as a child I wouldn’t eat pizza, pasta, sausages, burgers, hated and binned my sandwiches at school, I do however have a soft spot for crumpets and pancakes so I miss those but make passable GF/DF alternatives.
So I do eat meat and veg, fish and veg, fruit, nuts, occasionally rice, gluten free oatcakes, homemade coconut yoghurt. Occasionally GF oats, or homemade granola.
Typical breakfast would be boiled eggs with some pickled herring or bacon, or a green smoothie with celery cucumber avocado coconut milk, kale or spinach (nicer than it sounds)
Lunch is usually leftovers, meat and veg or salad of mixed leaves, artichoke hearts, roasted pepper, avocado (not on the same day as breakfast), lots of olive oil and some fruit.
Dinner is a meat or fish and veg combo, depending on the season maybe new potatoes or squash or rice with it, could be stir fry or chilli or curry or just fried or baked.
prior to diagnosis I ate a lot of soy products, tofu and miso was a daily lunch at work for me. I immediately felt better when I gave that up. Sad though I love those flavours.
I hope that answers your question about what I eat, in terms of reflux the most helpful thing personally was trying gluten free (and I later discovered avoiding most of the processed GF alternatives) is the time between eating and sleeping and I take myself for a walk after meals even if just round the garden. Down the road is better, avoiding fizzy too, oh and early on having a dash of apple cider vinegar in the morning and betaine with pepsin tablets with meals. Amazing to feel your dinner go down and not feel like a stuffed turkey. 🌱
I forgot to ask, have you had your thyroid hormones tested recently? Could you be undermedicated? Low in range T3? The ENT said to keep an eye on this.
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