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The Surprising Cause of a Chronic Runny Nose and Cough

CoughIf you have chronic postnasal drip, a frequent cough and/or a sore throat that won’t quit, you might quickly blame it on a persistent cold or allergies.

What you may not know: These same symptoms can be caused by a little-known digestive condition known as airway reflux.

ACID IN THE AIRWAYS

Unless you’re among the lucky few, you’ve probably experienced the burning pain of heartburn, also known as gastroesophageal reflux. This discomfort occurs when harsh digestive fluids surge out of the stomach and into the more vulnerable esophagus.

But another kind of reflux, airway reflux, occurs when irritating acid droplets and vapors escape from the stomach and reach further—as far as the throat, the larynx (voice box) or the back of the nasal airway.

Sometimes called “silent reflux” because many people don’t experience telltale heartburn symptoms, common signs of airway reflux include postnasal drip, cough, sore throat and hoarseness. Many people with airway reflux suffer for years because their symptoms are mistakenly attributed to hay fever, a cold, sinusitis or other airway-related problems.

GETTING DIAGNOSED

Doctors who are familiar with airway reflux can usually diagnose it from a description of the symptoms (see above)—particularly if the patient gets worse after meals and/or when he/she lies down.

Another tip-off: A slight feeling of heat in the chest, usually after meals. The sensation isn’t as painful as heartburn, and it’s likely to occur around the upper part of the breastbone. Heartburn, on the other hand, is felt lower in the chest, somewhere between the nipples and the indentation at the bottom of the sternum.

Important: Many doctors aren’t familiar with airway reflux. Even gastroenterologists sometimes miss it. If you suspect you might have airway reflux, your best bet is to see an ear, nose and throat specialist (otolaryngologist).

DRUGS DON’T HELP

Widely used for heartburn, acid–suppressing drugs, such as cimetidine (Tagamet) and omeprazole (Prilosec), rarely work for airway reflux.*

Why: You actually need some stomach acid to prevent airway reflux.

The stomach’s pH (a measure of acidity) is normally between about 1.5 and 3.5. That’s strong enough to dissolve most metals! Yet you need this highly acidic environment to kill microorganisms and for efficient digestion.

People who do not produce enough stomach acid—this is common in those age 45 and older and in those who internalize stress or have poor diets—digest their food more slowly.

The stomach compensates with increased muscular contractions (peristaltic action), which help accelerate digestion, but these contractions also increase pressure that can force acid vapors and droplets into the airways.

A clue: If you find yourself burping excessively after eating meals, it’s probably because of the carbon dioxide that is released by stomach yeasts—organisms that survive only when stomach acid is low.

BEST APPROACH: MORE ACID

For airway reflux, I recommend taking a digestive-enzyme supplement that contains betaine hydrochloric acid (HCI) and pepsin. The two work together to digest food more efficiently. Pepsin, an enzyme that breaks down proteins, is activated by hydrochloric acid.

What I prescribe for my patients: A product called DuoZyme, which contains HCI and pepsin. It should be taken as directed on the label and with meals. This supplement generally improves airway reflux symptoms within a week or even sooner. It’s available at health-food stores and online.

Most people do not notice any side effects, although some may experience a little stomach upset when they first start taking the supplement. The stomach discomfort usually goes away within a few days.

Important: Check first with your doctor if you have a peptic ulcer, since this product could worsen symptoms.

Also helpful: A fish oil supplement. It will reduce levels of arachidonic acid, an inflammatory substance in the body that can irritate airway mucous membranes and make you more susceptible to acid vapors.

Nordic Naturals makes high-quality fish oil products. I recommend that patients take fish oil with their evening meal. Check with your doctor before taking it because it may increase bleeding risk.

OTHER EFFECTIVE TREATMENTS

In addition to the steps described earlier, the following strategies can help airway reflux…

  • Fletcherize your food. “Fletcher chewing,” which is named after the Victorian–era health-food enthusiast Horace Fletcher, means chewing each bite of food until it’s about the consistency of applesauce. That’s a lot more than most people chew.

How it helps: Lengthy chewing will saturate the food with saliva, which jump-starts digestion. That’s because food that reaches the stomach in a partially digested form requires less peristaltic action, the vigorous stomach churning that can trigger airway reflux and heartburn.

  • Know your trigger foods. Most people discover that their symptoms increase when they eat certain foods.

Common offenders include: Tomatoes, onions, chocolate, coffee, peppermint candy and alcohol. Some of these foods weaken the lower esophageal sphincter, the muscle that keeps stomach acids where they belong. Other foods are simply irritating for some people for unknown reasons.

  • Sip—don’t gulp—during meals. If you drink a lot of water during meals, you are adding volume to the chyme, the slurry of foods and digestive juices in the stomach. The extra volume can cause a high-velocity spray of acid vapors and droplets.
  • Eat dinner earlier in the evening. It takes a few hours for the stomach to empty after meals. When you lie down soon after eating, stomach acid is more likely to leak out. Let gravity work in your favor by staying upright for a while after eating.

My advice: Don’t eat for at least three hours before bedtime. This is particularly important if you favor desserts or other rich nighttime snacks. High-fat foods take longer to digest.

  • Relax for a few hours after eating. A leisurely stroll after eating is good for digestion, but a vigorous jog is not. Anything that increases intra-abdominal pressure—vigorous exercise or lots of bending—can increase reflux.

FAST REFLUX RELIEF

An over-the-counter product such as Tums will quickly neutralize that acid-in-the-throat sensation, along with any other reflux symptoms.

But here’s an all-natural way to get on-the-spot relief for heartburn and airway reflux…

What to do: Mix one-quarter teaspoon of baking soda and a pinch of Epsom salts in four ounces of spring water, which is free of the contaminants that can sometimes be found in tap water.

When your symptoms flare, sip slowly. You’ll typically get relief within a few minutes.

Note: This remedy can be taken up to one-half hour before eating and no sooner than one hour after eating—otherwise, it can dilute the stomach acid needed for digestion.

*Acid-suppressing drugs can help if you also have an ulcer but should be taken for only a few weeks. Used long-term, they can weaken immunity, decrease your ability to digest food and absorb nutrients and may increase risk for osteoporosis-related fractures and depression.

Source: Andrew Rubman, ND, medical director, Southbury Clinic for Traditional Medicines, Southbury, Connecticut. SouthburyClinic.com.

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CoughIf you have chronic postnasal drip, a frequent cough and/or a sore throat that won’t quit, you might quickly blame it on a persistent cold or allergies.

What you may not know: These same symptoms can be caused by a little-known digestive condition known as airway reflux.

ACID IN THE AIRWAYS

Unless you’re among the lucky few, you’ve probably experienced the burning pain of heartburn, also known as gastroesophageal reflux. This discomfort occurs when harsh digestive fluids surge out of the stomach and into the more vulnerable esophagus.

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But another kind of reflux, airway reflux, occurs when irritating acid droplets and vapors escape from the stomach and reach further—as far as the throat, the larynx (voice box) or the back of the nasal airway.

Sometimes called “silent reflux” because many people don’t experience telltale heartburn symptoms, common signs of airway reflux include postnasal drip, cough, sore throat and hoarseness. Many people with airway reflux suffer for years because their symptoms are mistakenly attributed to hay fever, a cold, sinusitis or other airway-related problems.

GETTING DIAGNOSED

Doctors who are familiar with airway reflux can usually diagnose it from a description of the symptoms (see above)—particularly if the patient gets worse after meals and/or when he/she lies down.

Another tip-off: A slight feeling of heat in the chest, usually after meals. The sensation isn’t as painful as heartburn, and it’s likely to occur around the upper part of the breastbone. Heartburn, on the other hand, is felt lower in the chest, somewhere between the nipples and the indentation at the bottom of the sternum.

Important: Many doctors aren’t familiar with airway reflux. Even gastroenterologists sometimes miss it. If you suspect you might have airway reflux, your best bet is to see an ear, nose and throat specialist (otolaryngologist).

DRUGS DON’T HELP

Widely used for heartburn, acid–suppressing drugs, such as cimetidine (Tagamet) and omeprazole (Prilosec), rarely work for airway reflux.*

Why: You actually need some stomach acid to prevent airway reflux.

The stomach’s pH (a measure of acidity) is normally between about 1.5 and 3.5. That’s strong enough to dissolve most metals! Yet you need this highly acidic environment to kill microorganisms and for efficient digestion.

People who do not produce enough stomach acid—this is common in those age 45 and older and in those who internalize stress or have poor diets—digest their food more slowly.

The stomach compensates with increased muscular contractions (peristaltic action), which help accelerate digestion, but these contractions also increase pressure that can force acid vapors and droplets into the airways.

A clue: If you find yourself burping excessively after eating meals, it’s probably because of the carbon dioxide that is released by stomach yeasts—organisms that survive only when stomach acid is low.

BEST APPROACH: MORE ACID

For airway reflux, I recommend taking a digestive-enzyme supplement that contains betaine hydrochloric acid (HCI) and pepsin. The two work together to digest food more efficiently. Pepsin, an enzyme that breaks down proteins, is activated by hydrochloric acid.

What I prescribe for my patients: A product called DuoZyme, which contains HCI and pepsin. It should be taken as directed on the label and with meals. This supplement generally improves airway reflux symptoms within a week or even sooner. It’s available at health-food stores and online.

Most people do not notice any side effects, although some may experience a little stomach upset when they first start taking the supplement. The stomach discomfort usually goes away within a few days.

Important: Check first with your doctor if you have a peptic ulcer, since this product could worsen symptoms.

Also helpful: A fish oil supplement. It will reduce levels of arachidonic acid, an inflammatory substance in the body that can irritate airway mucous membranes and make you more susceptible to acid vapors.

Nordic Naturals makes high-quality fish oil products. I recommend that patients take fish oil with their evening meal. Check with your doctor before taking it because it may increase bleeding risk.

OTHER EFFECTIVE TREATMENTS

In addition to the steps described earlier, the following strategies can help airway reflux…

How it helps: Lengthy chewing will saturate the food with saliva, which jump-starts digestion. That’s because food that reaches the stomach in a partially digested form requires less peristaltic action, the vigorous stomach churning that can trigger airway reflux and heartburn.

Common offenders include: Tomatoes, onions, chocolate, coffee, peppermint candy and alcohol. Some of these foods weaken the lower esophageal sphincter, the muscle that keeps stomach acids where they belong. Other foods are simply irritating for some people for unknown reasons.

My advice: Don’t eat for at least three hours before bedtime. This is particularly important if you favor desserts or other rich nighttime snacks. High-fat foods take longer to digest.

FAST REFLUX RELIEF

An over-the-counter product such as Tums will quickly neutralize that acid-in-the-throat sensation, along with any other reflux symptoms.

But here’s an all-natural way to get on-the-spot relief for heartburn and airway reflux…

What to do: Mix one-quarter teaspoon of baking soda and a pinch of Epsom salts in four ounces of spring water, which is free of the contaminants that can sometimes be found in tap water.

When your symptoms flare, sip slowly. You’ll typically get relief within a few minutes.

Note: This remedy can be taken up to one-half hour before eating and no sooner than one hour after eating—otherwise, it can dilute the stomach acid needed for digestion.

*Acid-suppressing drugs can help if you also have an ulcer but should be taken for only a few weeks. Used long-term, they can weaken immunity, decrease your ability to digest food and absorb nutrients and may increase risk for osteoporosis-related fractures and depression.

Source: Andrew Rubman, ND, medical director, Southbury Clinic for Traditional Medicines, Southbury, Connecticut. SouthburyClinic.com.