Can You Have Acid Reflux Without Heartburn?
As a Registered Dietitian specializing in digestive health & reflux, I often encounter misconceptions about acid reflux and its symptoms. One common misconception is that acid reflux always manifests as heartburn. However, this is not necessarily the case. Many individuals experience acid reflux without the classic symptom of heartburn, leading to confusion and sometimes delayed diagnosis. In this article, we'll explore the relationship between acid reflux and heartburn, delve into the lesser-known symptoms of acid reflux, and discuss how diet can play a crucial role in managing this condition effectively.
Understanding Acid Reflux
To understand whether one can have acid reflux without heartburn, it's essential to grasp what acid reflux is. Acid reflux occurs when acidic stomach acid flows back into the esophagus, causing irritation and inflammation. To learn more, check out my Comprehensive Guide to Reflux blog which dives into the various diagnoses (GERD vs LPR vs acid reflux)!
Heartburn vs. Acid Reflux
Heartburn is the most common symptom associated with acid reflux and typically presents as a burning sensation in the chest. However, not everyone with acid reflux experiences heartburn, and symptoms are often overlooked or attributed to other causes.
Laryngopharyngeal reflux (LPR), also known as “Silent Reflux” or “Respiratory Reflux”, is the formal diagnosis for non-heartburn reflux - read more about this condition here. Now, let’s dive into the symptoms of LPR or reflux without heartburn
Symptoms of Acid Reflux Without Heartburn
The following signs and symptoms may indicate the presence of acid reflux or LPR. It’s essential to note that this is a comprehensive list. If you are experiencing these symptoms, seeking a consultation with an Ear Nose & Throat Doctor or Laryngologist is the best next step.
Hoarseness or Sore Throat: Irritation from reflux can trigger Pepsin activation in the throat, leading to voice hoarseness, throat burning, a feeling of something “stuck” in the throat, or a persistent sore throat.
Chronic Cough: A nagging cough that doesn't seem to go away, especially if it worsens when lying down or after eating, could be a sign of acid reflux affecting the airways.
Difficulty Swallowing (Dysphagia): Acid reflux can cause inflammation which may change esophageal tissue function or throat tissues. Continued reflux may also narrowing of the esophagus due to scarring, making it challenging to swallow food or liquids. Reach out to your medical doctor if you are experiencing difficulty swallowing.
Regurgitation: The sensation of food or stomach contents coming back up into the throat or mouth, sometimes accompanied by a bitter taste, is another common symptom of acid reflux. This may also present itself as frequent burping, that may or may not be accompanied by a bitter taste.
Excessive Mucus/Throat Clearing: Frequent throat clearing, especially in the absence of cold or allergies, may indicate irritation from acid reflux. Reflux is correlated with excessive mucus that coats the throat, which is often the body’s attempt to protect the esophagus from acid or Pepsin damage. This sensation may feel like post-nasal drip, sinus congestion, or the frequent need to clear the throat.
Thoracic Pain: Acid Reflux may cause pain under the ribcage or between the shoulder blades. This pain is caused by shared nerves of the thoracic cavity, which contains the upper back and esophagus, and can cause decentralized sensations of pain.
Managing Acid Reflux Through Diet:
Whether or not heartburn is present, managing acid reflux often involves understanding the right dietary and lifestyle modifications and practicing consistency to allow tissues to heal. Here are some dietary strategies to get started on your reflux relief journey:
Identify Trigger Foods: Certain foods and beverages can exacerbate acid reflux symptoms. While there are common food triggers for acid reflux, every body is different and your individual triggers may be different from the generalized list! Keeping a food log that tracks your symptoms can help to alleviate confusions and fear around eating.
Eat Smaller, More Frequent Meals: Large meals can put pressure on the LES, increasing the risk of acid reflux. Opt for smaller, more frequent meals to ease digestion and minimize reflux. For some meal ideas, feel free to use my free 3 day Acid Reflux Meal Plan to get started!
Avoid Eating Late at Night: Give your body ample time to digest before lying down to sleep. Avoid eating large meals or snacks close to bedtime to reduce the likelihood of nighttime reflux.
Stay Hydrated: Drinking plenty of water throughout the day can help dilute stomach acid and prevent reflux episodes. Consider alkaline water in between meals as this can help deactivate Pepsin and reduce LPR symptoms in the throat.
Incorporate Anti-Inflammatory Foods: Foods rich in antioxidants and anti-inflammatory compounds, such as fruits, vegetables, whole grains, and lean proteins, can help support digestive health and reduce inflammation in the esophagus. For more specific ideas, learn about Acid-Reflux healing foods!
Mindfulness & Mindful Eating: The mind-gut connection and the nervous system play a significant role in IBS/Reflux symptoms. Practice mindful eating habits, such as chewing food thoroughly, eating slowly, and avoiding distractions, to aid digestion and reduce the likelihood of reflux.
Alginate Therapy: using alginates, such as RefluxRaft, post-meal and before bed can help create a gel barrier to prevent reflux from moving into the esophagus. Try RefluxRaft here.
Take Away
While heartburn is a common symptom of acid reflux, it's important to recognize that acid reflux can manifest in various ways, including without heartburn. Being aware of lesser-known symptoms and adopting a proactive approach to managing acid reflux through diet and lifestyle modifications can significantly improve the quality of life for individuals affected by this condition. If you suspect you have acid reflux or are experiencing persistent digestive symptoms, consult with a healthcare professional, such as a Registered Dietitian or gastroenterologist, for proper evaluation and personalized recommendations tailored to your needs.
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Written by Molly Pelletier, MS, RD, LDN | Molly Pelletier is a Registered Dietitian specializing in acid reflux/GERD/LPR/IBS and a leading voice in nutrition for acid reflux. Molly's background in nutrition science and her personal health journey with GERD culminated in the curation of FLORA Nutrition, where she shares evidence-based tools and strategies to help others recover from reflux and optimize their overall well-being. Follow Molly on Social Media @mollypelletier.rd on all platforms | YouTube | Instagram | TikTok | Pinterest |
Blog co-created with FLORA Team Member & MS Nutrition, Jacqueline Gilpin
References
Kowalik K, Krzeski A. The role of pepsin in the laryngopharyngeal reflux. Otolaryngol Pol. 2017;71(6):7-13. doi:10.5604/01.3001.0010.7194
Vaezi MF. Atypical manifestations of gastroesophageal reflux disease. MedGenMed. 2005;7(4):25. Published 2005 Oct 27.
