Over seven years ago, I developed a strange cough. It was one of the first symptoms to appear at a time when I was under a huge amount of stress, working in a busy role as a lecturer while running my own business.
It was soon joined by other symptoms in different systems of my body. But this first one took me down the route of gastroenterology, to explore acid reflux and silent reflux.
After a severe bout of COVID, it got worse. It came with an awful taste in my mouth and real damage to my teeth: enamel erosion, teeth cracking and breaking, and fillings disappearing far too quickly.
I don't think there's a single nutrition, supplement or medication approach I didn't try. So in this blog I want to share what I've learned, both from my own recovery and from working with clients, in case some of it helps you.
1. Stress was the biggest factor
There's no doubt in my mind that stress was the biggest driver of all my gut symptoms. But it wasn't one thing. It built up over a couple of decades. I was first diagnosed with IBS in my 20s, and it was as I hit 40 that things became more chronic and debilitating.
What helped most was changing how I lived:
Working less
Spending far more time in nature
Walking every morning instead of running
Swapping power and rocket yoga for yin yoga and yoga nidra
Psychoeducation, to understand the links between emotions, the nervous system and my own lived experience
If you're in a similar place, I really recommend making some changes, even if you feel you can't, or don't want to. Start small and chip away at them one at a time.
2. The biological mechanisms that might be missed
Reflux is sometimes written off as simply "too much acid". And often very little distinction is made between silent reflux and acid reflux, yet the two warrant different treatment and interventions.
Here are a few drivers that aren't talked about enough:
Low stomach acid (hypochlorhydria): at times, the issue is too little acid rather than too much. Without enough acid, food is broken down less efficiently and can sit in the stomach for longer.
Delayed gastric emptying: food sits in the stomach for longer, so there's more there to push back up.
Slow transit time: when things move slowly further down, pressure and fermentation build.
Bacterial overgrowth in the small intestine (SIBO): gas from fermentation can push upwards.
Histamine and mast cells: histamine is involved in stomach acid production and inflammation of the gut lining.
Intra-abdominal pressure: extra weight around the middle presses on the stomach, so in some cases, losing weight can make a real difference.
With clients, I'll usually do a full symptom review to work out whether their reflux looks more histamine driven, mechanically driven, or linked to transit time and bacteria. That shapes where we start.
Many of these issues are a sign of a system under a lot of stress. So we also look at your total allostatic load (your whole life load) and make adjustments there too.
3. Diet: find the middle ground
There are lots of diet options. Some people go low acid, some go low fermentation, and some feel better on a low histamine diet. You might find a combination helps.
Ideally, any restriction is as temporary as possible. That's why I use supplements and medications alongside diet changes, so you're not risking undernourishment.
Sometimes it's easier to find a safe breakfast, lunch and dinner and not vary them too much while you work on the bigger changes in your lifestyle and nervous system.
I'd be careful about joining groups that insist on one strict diet. I joined carnivore, low acid and low histamine groups, and the pressure itself became another stressor. When you're stressed, you crave food, often the very foods you're being told to avoid. And with everything you're feeling emotionally, it's natural to reach for comfort food.
The sensible place is somewhere in the middle. Don't give yourself a hard time, but try simply reducing a couple of foods that clearly trigger you, as this can go a long way to giving you some breathing space for other changes.
4. Supplements that can help
I'm simply sharing these supplements to offer insights into how the system can be supported. Which ones I'd consider depends on what seems to be driving your reflux.
Enzyme support. Digestive enzymes are often a helpful starting point. These are a couple of options I tend to use commonly, and each works a little differently. NOW Super Enzymes is good as an all-rounder. NOW Digest Ultimate is a plant-based blend, so it suits people who prefer to avoid animal-derived enzymes. Enzymedica Acid Soothe combines enzymes with soothing ingredients: zinc carnosine, marshmallow root, papaya leaf and gotu kola.
Prokinetics, to support motility. Examples include MotilPro by Pure Encapsulations, artichoke and ginger blends, and Biome Kinetic by In Vivo Clinical.
Magnesium. A good dose of magnesium, either glycinate or citrate, can help keep the bowels moving.
SIBO support. Some people need treatment for bacterial overgrowth, either with natural antimicrobials or antibiotics, alongside lowering stress and supporting the nervous system. Antimicrobials are something I'd only use within one-to-one support. Please don't just start taking them, and never long term. This is especially true of oregano, which has an antibiotic-like effect in the gut.
Histamine support. If I think histamine is playing a part, I might use DAO enzymes, quercetin and luteolin.
5. Medications
Proton pump inhibitors (PPIs). These are the usual first treatment. Some people respond well and some don't. A higher dose is often suggested, ideally for a short period. If you don't respond, your reflux may be more histamine driven, so a combination of antihistamines and histamine-supporting supplements could be worth exploring.
H2 antihistamines, e.g. famotidine. These block histamine receptors in the stomach that drive acid production. In the US famotidine is widely used and easy to buy over the counter, especially for milder symptoms. In the UK it isn't routinely prescribed for reflux, though some GPs will if they think it might help.
Mast cell treatments. Even if you don't respond to these, your reflux, silent reflux or gastritis could still be linked to mast cells and histamine. The next options are things like montelukast, ketotifen or sodium cromoglicate. These are usually prescribed by a private specialist, or you can speak to The MCAS Clinic, an online service run from Glasgow.
Prokinetic medications. If delayed gastric emptying or slow transit seem to be part of the picture, prokinetics help move things through the gut. Examples include domperidone, metoclopramide, prucalopride and low dose erythromycin. They're prescription only, and domperidone and metoclopramide in particular are now only recommended at low doses for short periods because of their side effects, so these need to be discussed with your GP or specialist.
Low dose naltrexone (LDN). LDN is used off-label as a prokinetic, and is also valued for its anti-inflammatory effects. It's used for thyroid conditions and autoimmunity too, though the research is still emerging. It's available on private prescription, for example through The MCAS Clinic at Dickson Chemist.
SIBO treatments. If bacterial overgrowth is suspected, a breath test is the usual first step. The most common treatment is the antibiotic rifaximin, sometimes combined with another antibiotic when the test shows high methane. Herbal antimicrobials such as berberine, oregano and allicin are an alternative, and some people use an elemental diet under supervision. Because SIBO often comes back, the underlying cause matters too, which is why a prokinetic is often used afterwards to keep things moving.
6. Protecting the tissues
Gaviscon and Gaviscon Advance can be hugely helpful. Some people are reluctant to take them, but they work by forming a protective layer over the stomach contents, which shields the throat and oesophagus. Gaviscon Advance taken at night can be especially useful if your symptoms are worse when you lie down.
Other options:
Marshmallow root and slippery elm. These soothe the lining, though some clients find they cause lower gut symptoms, as they're more fermentable.
Esophageal Guardian by Life Extension. A chewable that uses the same raft-forming alginate approach as Gaviscon.
7. Everyday habits that help
A few simple changes can take pressure off while you work on the bigger picture:
Leave around three hours between your last meal and bed.
Raise the head of your bed slightly, or sleep on your left side.
Eat smaller meals, slowly, and avoid tight waistbands.
Notice whether alcohol, caffeine or late, large meals make things worse.
When to see your GP
Please speak to your GP promptly if you have difficulty or pain swallowing, unexplained weight loss, vomiting (especially with blood), black stools, or reflux that is new or worsening and you're over 55. These need checking before trying anything else.
Where to start
Reflux is rarely about one thing. For me, it was stress, histamine and gut function all feeding into each other, and histamine was one of the bigger drivers.
I made progress with medications, including an H1 antihistamine called ebastine, ketotifen, sodium cromoglicate and low dose naltrexone. I also include daily nervous system support, such as meditation and yoga nidra.
If you'd like support working out what's driving yours, you can book a consultation with me.
