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Acid Reflux, Silent Reflux, and Histamine Intolerance: The Connection

You go out for lunch with friends. It’s a delicious meal. A spinach-strawberry salad followed by a BLT sandwich with avocado. You split a chocolate-walnut brownie for dessert. Then suddenly you are not feeling too well. Heartburn, indigestion, acid reflux…not again. Why is it happening to you all the time? 

It was a high-histamine meal. Is it possible that histamine intolerance is causing your acid reflux? The answer is yes. Histamine intolerance originates in your gut and is a common cause of symptoms of acid reflux and silent reflux.

In this article, you will learn what acid reflux and GERD are. I will go over their symptoms. You will understand what is silent reflux, its symptoms, and how it’s different from acid reflux and GERD. You will understand what histamine intolerance is. I will explain the connection between histamine intolerance, acid reflux, and silent reflux. Finally, I will offer some solutions to improve your health naturally if you have histamine intolerance, acid reflux, or silent reflux.

What Is Acid Reflux

Acid reflux and gastroesophageal reflux disease (GERD) are often used interchangeably. Though the two are closely related, they are not the exact same thing. 

Acid reflux may also be referred to as gastroesophageal reflux (GER), heartburn, or acid indigestion. It refers to a backward flow of stomach acid back. When stomach acid flows back into the pipe connecting your mouth, esophagus, and stomach. Acid reflux may cause irritation and a burning sensation called heartburn.

Anyone can experience time to time. You may feel some irritation, discomfort, or heartburn after drinking coffee or alcohol, finishing a large meal, or eating a sour or spicy meal. If you are experiencing acid reflux on a regular basis, it can progress into GERD. Just like acid reflux, GERD happens when stomach acid backflows from your stomach. However, it is usually a chronic and more frustrating condition. If you have GERD, you may experience acid reflux and heartburn several times a week. Some people experience acid reflux from GERD on a daily basis. It may cause difficulty swallowing, pain, coughing, wheezing, indigestion, and difficulty sleeping (1).

Symptoms of Acid Reflux and GERD

Symptoms of acid reflux and GERD may include:

  • Irritation in your throat and chest
  • Heartburn after meals
  • Heartburn that may get worse at night
  • Feeling like you have a lump in your throat
  • Difficulty swallowing
  • Chest pain
  • Regurgitation of sour liquid or food
  • Belching
  • Nausea
  • Chronic cough
  • Disrupted or poor sleep
  • Laryngitis
  • New or worsening symptoms of asthma

What Is Silent Reflux

Laryngopharyngeal reflux (LPR) is also known as silent reflux. It is a similar condition to GERD caused by the backflow of stomach acid. However, the symptoms of silent reflux and GERD are different. If you have silent reflux, you will likely not experience heartburn and irritation in your chest. Instead, it can cause irritation of your throat and vocal cords, discomfort, coughing, throat clearing, and hoarseness. Silent reflux and GERD may be linked and some people may have symptoms of both conditions (2, 3).

Symptoms of Silent Reflux

Symptoms of silent reflux may include:

  • Sore throat
  • Chronic cough
  • Having a burning sensation in your throat
  • Bitter taste in your throat or mouth
  • Hoarseness
  • Difficulty swallowing
  • Need to clear your throat frequently
  • Feeling like you have a lump in your throat
  • Feeling like you have mucus buildup or post-nasal drip
  • Red, swollen, or irritated vocal cords or voice box (larynx)
  • Asthma

Silent reflux may lead to:

  • Chronic cough or sore throat
  • Swelling of your vocal cords
  • Ulcers on your vocal folds
  • Chronic or repeated laryngitis
  • Recurrent pneumonia
  • Development of masses (granulomas) in your throat
  • Development of oral cavity disorders
  • Increased risk of lung and breathing disorders, laryngeal cancer, and esophageal cancer
  • Having frequent and worsening symptoms of asthma, bronchitis, and emphysema

What Is Histamine Intolerance

Histamine is an essential chemical in your body. It is necessary for a multitude of functions. Histamine supports your immune system by getting rid of allergens. This can lead to an allergic response, such as itching, redness, swelling, or sneezing. This explains why we are commonly recommended to take antihistamines for allergy-symptom relief by conventional medicine practitioners. 

In addition to dealing with allergies, histamine also communicates with your brain and triggers stomach acid release to support digestion affecting your entire body. You will see how this becomes important when it comes to the connection between acid reflux and histamine intolerance.

Though histamine is absolutely necessary for your health, if there is too much histamine in your body causing a build-up, it can turn into a problem. Histamine intolerance is not a sensitivity to histamine. Histamine intolerance means that your body has too much histamine. In a healthy body, your body sends enzymes (eg. DAO) to break down histamine in order to prevent too much build-up. However, when there is too much histamine, it becomes difficult to break it down and metabolize it. Your body may also be dealing with trouble making DAO enzymes which can also lead to histamine intolerance.

Histamine intolerance can affect your entire body, including your gut, brain, lungs, and cardiovascular system. This may mean a long list of widespread symptoms, including skin problems, red eyes, low blood pressure, fast heart rate, anxiety, hormonal issues, headaches, seasonal allergies, digestive issues, sleep disturbances, bladder problems, and more. You can learn more about histamine intolerance, its symptoms, causes, and treatment options, in this article.

Acid Reflux, Silent Reflux, and Histamine Intolerance

According to a 2021 review published in Nutrients, histamine intolerance originates in your gut, thus it can cause various gastrointestinal problems (4). I have written about the connection between your gut health and histamine intolerance before. You can read it here. Understanding this connection, it may not be surprising to hear that histamine intolerance can play a role in acid reflux and silent reflux.

Histamine Triggers Stomach Acid Release

As you know, one of the main jobs of histamine is to trigger stomach acid release to support digestion. If the cells in your stomach’s mucous lining release histamine, it will increase stomach acid production by binding with histamine H2 receptors (5). It’s not surprising that Proton Pump Inhibitors (PPIs) and other medications that work as H2 antagonists can prevent stomach acid production (6). 

Increased stomach acid production from increased histamine release may result in inflammation, oxidative stress, tissue damage, and gastrointestinal issues, including acid reflux and silent reflux However, if H2 antagonists block stomach acid production, it may lead to too low stomach acid levels. Low stomach acid may also result in symptoms of acid reflux and silent reflux. According to a 2004 review published in the American Journal of Medicine, stomach acid production decreases with age and the risk and frequency of GERD and other acid-related health issues increase with age. This suggests a possible link between low stomach acid and reflux disorders (7).

High-Histamine Foods May Trigger Acid Reflux 

Furthermore, a histamine reaction to a high-histamine food may also cause gastrointestinal problems. It presents as acid reflux or silent reflux along with other digestive symptoms, such as bloating, diarrhea, or nausea.

A 2007 study published in the Journal of Pediatric Gastroenterology and Nutrition, esophageal cells in the esophagus may experience an allergic reaction from certain food triggers causing symptoms of acid reflux (8). A 2020 case report published in the Ear, Nose, and Throat Journal, the symptoms of silent reflux may be triggered by histamine intolerance (9).

Gut Dysbiosis, H Pylori, and SIBO May Cause Acid Reflux

Gut Dysbiosis

Moreover, histamine intolerance is often linked to gut dysbiosis and small intestinal overgrowth (SIBO). An overgrowth of certain bacteria and pathogens in your gut can result in a buildup of histamine and cause a variety of symptoms, including acid reflux, silent reflux, and other gastrointestinal issues. However, gut dysbiosis, bacteria overgrowth, and SIBO, are some of the common underlying causes of acid reflux and silent reflux as well.

H Pylori

H Pylori is a type of bacteria that’s able to survive in your stomach’s acidic environment. A 1997 study published in Gastroenterology has found that H Pylori may reduce stomach acid secretion which can cause acid reflux, silent reflux, and other issues (10). A 1998 study published in the American Journal of Physiology has found that addressing an H Pylori infection with antibiotics may improve both stomach acidity and symptoms (11).

According to a 2019 study published in the Journal of Thoracic Diseases, there may be a link between microbiome health and esophageal diseases, such as GERD, acid reflux, and silent reflux (12). Microbiome imbalance and bacterial overgrowth may cause symptoms of acid reflux and silent reflux. SIBO, specifically, can cause extra gas which may lead to heartburn, belching, and other symptoms of acid reflux. On the other hand, treating SIBO with PPIs can reduce stomach acid and worsen the condition (6). 


H pylori infection, SIBO, and other bacterial overgrowth can further trigger increased histamine release which can feed the cycle of histamine intolerance and related symptoms. If you want to stop the cycle of histamine intolerance, acid reflux, silent reflux, and other symptoms, you have to address all players and root causes of the problem instead of putting a bandaid on your symptoms. In the next section, I will offer my best natural solutions for histamine intolerance, acid reflux, and silent reflux.

Natural Solutions for Acid Reflux and Silent Reflux

If you are experiencing symptoms of acid reflux and silent reflux, as well as, histamine intolerance, I recommend the following strategies to improve your health naturally:

Follow an Anti-Inflammatory, Low-Histamine Diet

Changing your diet is the first step to health. According to a 2019 study published in the Journal of Thoracic Disorders, your diet may play a critical role in the development and treatment of acid reflux and silent reflux (13). Simply removing simple sugars, spicy foods, mint, caffeine, and chocolate and avoiding large, calorie-dense, or late-night meals may help to reduce your symptoms. If you are dealing with histamine intolerance, however, removing these few foods won’t be enough. You need to focus on a low-histamine diet.

First step

Your first step to getting better is removing all inflammatory foods, including refined sugar, refined oils, canned and processed meat, artificial ingredients, junk food, and highly processed foods. These foods may taste good at the moment, but they are highly inflammatory and going to wreck your digestion.

To reduce histamine intolerance, you also need to remove high-histamine foods, such as fermented food (eg. sauerkraut, kimchi, fermented vegetables, kombucha, etc), fermented alcohol (eg. beer, wine, champagne, etc), aged food (eg. aged cheese, processed and canned meat, canned fish, etc), over-ripe fruits and vegetables, soured food (eg. buttermilk, sour cream, sour milk, etc), vinegar-containing foods (eg. vinegar, olives, pickles, etc), smoked and certain other fish (eg. mackerel, anchovies, tuna, mahi mahi, etc), legumes (eg. beans, lentils, etc), processed foods, leftovers, and foods that are naturally high in histamine ( eg. avocadoes, eggplant, spinach, dried fruits, etc). In addition to high-histamine foods, avoid foods that may trigger histamine release, such as tomatoes, most citrus, bananas, most nuts, and dairy. Also avoid foods that may block the DAO-enzyme, including black tea, green tea, alcohol, and energy drinks. 

Now comes the yummy part. Follow a nutrient-dense, anti-inflammatory, and low-histamine diet rich in greens, vegetables, herbs, spices, fruits, healthy fats, and organic meat. Low-histamine foods include most fresh leafy greens and vegetables, non-citrus fruits, such apples, pear, papaya, and grapes, fresh grass-fed meat, pasture-raised poultry and eggs, and wild-caught fish, olives, extra-virgin olive oil, ghee, coconut oil, leafy herbs, and herbal tea. My book, The 4-Phase Histamine Reset Plan includes an extensive list of foods that you can eat and should avoid on a low-histamine diet.

Following an anti-inflammatory, low-histamine diet

Following an anti-inflammatory, low-histamine diet is delicious and fun. Yes, I said fun. I firmly believe that the key to any new diet or lifestyle change is experimentation and fun. Have fun in the kitchen and try new recipes. I recommend all the low-histamine recipes in The 4-Phase Histamine Reset Plan and my new recipe book, Fifty One Low Histamine Air Fryer Recipes. They are all simple, easy to make, low-histamine, gluten-free, Paleo-friendly, and super healthy. The best part: you don’t have to give up social and shared meals either. These low-histamine, healthy meals are so delicious that your family and friends will love them too. 

Address Your Gut Problems

Your gut health affects your entire body. Poor gut flora, H Pylori overgrowth, and SIBO can lead to histamine intolerance, acid reflux, and silent reflux. You may benefit from working with a functional medicine doctor (hint: set up your consultation here) and getting some gut testing done for signs of gut dysbiosis and gut infections.

Along with a gut-friendly anti-inflammatory diet, I recommend working with a functional medicine practitioner (like me) to test your gut and see if opportunistic bacteria, yeast overgrowth, parasites, H. pylori and/or leaky gut can be what is driving your histamine issue. 

Improve Stomach Acid Levels

If you want to reduce acid reflux, GERD, or silent reflux, you need to improve your stomach acid levels. Drinking plenty of water is important for detoxification, bowel motility, and healthy stomach acid levels. I recommend drinking at least 10 glasses of water throughout the day. However, avoid drinking water at least 30 minutes before, during, and 30 minutes after your meal. Drinking water before, during, or after meals can dilute your gastric juices, but holding off on water can support digestion and proper stomach acid activity.

In order to make enough stomach acids, your body need to be relaxed and activate your parasympathetic nervous system. Being stress and busy will reduce stomach acid production and may cause acid reflux or silent reflux. To ensure that your body makes plenty of stomach acid for healthy digestion, eat your largest meal when you feel the most relaxed. Your body will start pumping out stomach acid at the beginning of your meals. If you are starting your meal with protein instead of greens and veggies, stomach acid production may increase even further. I recommend that you eat your salad and vegetables along with or after protein, instead of starting with a salad. 

Lower Your Stress Levels and Get Better Sleep

Lowering your stress level and sleeping better are critical for improving histamine intolerance, acid reflux, and silent reflux. Chronic stress and poor sleep can both add to your histamine bucket and increase histamine intolerance. They may also contribute to reflux issues. 

According to a 2007 study published in the Journal of Clinical Biochemistry and Nutrition inflammation may contribute to or worsen acid reflux and silent reflux (15). Beyond diet, chronic stress and poor sleep are some of the major causes of inflammation. A 2018 study published in the European Archives of Otorhinolaryngology has found a link between poor sleep, sleep apnea, and silent reflux (16). Poor sleep can also contribute to chronic stress and chronic stress can cause poor sleep leading to an endless cycle of stress and poor sleep unless you address both players.

To reduce your stress levels, I recommend practicing meditation, breathwork, guided visualization, positive affirmations, gratitude, journaling, yoga, Tai Chi, and Qi Gong. Spending time in nature and moving your body regularly may also help to lower stress. Taking an Epsom salt bath is another great way to relax your muscles, calm your mind, and detoxify your body. Seek out a supportive community and time with friends and family. Don’t forget about some me-time though. Even if it’s just 10 minutes in your busy day, it’s important to have some time for yourself.

My recommendation

I recommend that you sleep at least 7 to 9 hours a night. Invest in a supportive mattress and pillows and comfortable bedding. Create a calm and peaceful sanctuary in your bedroom where you can unwind, relax, and sleep well. Organic candles, essential oils, a salt lamp, dim lights, and your favorite books are just some ideas. Avoid electronics a few hours before going to bed and leave electronics outside your bedroom. Instead of using your phone, invest in an actual alarm clock so you are not tempted to check social media or the news before going to sleep or upon waking. Try some blackout curtains or an eye mask to create a dark space supporting your sleep.

Reduce Your Histamine Bucket

High-histamine foods are the number one common culprit behind histamine intolerance. However, they are not the only factors that can contribute to histamine intolerance. Chronic stress, poor sleep, a sedentary lifestyle, environmental toxins, and other lifestyle factors can fill up your histamine bucket and lead to histamine intolerance and related symptoms, such as acid reflux and silent reflux.

We have already covered the importance of reducing stress and improving your sleep. Moving your body regularly is another way to reduce inflammation, decrease stress, and lower your histamine bucket. Move your body throughout the day. Dancing in your living room, stretching and shaking out your body, and playing with your pets and kids are just some fun ideas to sneak some movement in.

For exercise, I recommend resistance training to a level that makes you feel good after, not exhausted. I also recommend trying to get between 10k – 15k steps per day. Going on a walk date with a friend, joining a walking group, scheduling family walks or hikes, or passing time with an audiobook or good music are great ways to have a good time while getting your steps in. However, a solo walk with silence can be a calming and meditative experience, especially in nature.

Exercise should be fun. Experiment with different workouts until you find what brings you joy. But remember, strength and resistance training is non-negotiable to maintain muscle mass, protect your bones, feel energized, and have a toned, youthful body. 

Besides improving your sleep, reducing stress, and exercising regularly, reducing environmental toxicity is also incredibly important for reducing histamine intolerance. Environmental toxins can contribute to inflammation, cause histamine release, and result in chronic symptoms. Toxins can hide everywhere though from your food to your cleaning products.

My recommendation

I recommend that you choose organic produce and food to reduce exposure to pesticides, herbicides, and hormones. Drink filtered water instead of tap water. Check your home for mold and if you find any, get it professionally removed. Use a high-quality HEPA air-filtration system to clean your indoor air. Switch from chemical-filled conventional cleaning, hygiene, and beauty products to organic, natural, and DIY options instead. Opt for cloth bags, glassware, glass containers, bamboo bowls, stainless steel bottles and pans, and silicone zip lock bags instead of plastic bags and plastic products.

Try Supplements for Histamine Intolerance

I recommend HistoRelief to support your recovery and to alleviate the symptoms of interstitial cystitis This supplement is a synergistic blend of nutrients that provides natural support to balance your immune response. This blend features, Tinofend®, a patented and clinically researched extract derived from the plant Tinospora cordifolia, which has a powerful ability to support immune regulation and immune response. As a result, it boosts your body’s ability to fight interstitial cystitis symptoms.

HistoRelief also includes quercetin, nettle leaf, vitamin C, and bicarbonate salts. Quercetin is a powerful bioflavonoid with anti-inflammatory and antioxidant properties that naturally inhibits histamine release. Research has shown that supplementing with quercetin may help to decrease pain in those with interstitial cystitis. Bicarbonate salts also help to maintain normal histamine metabolism, while nettle leaf and vitamin C further boost your immune system and are often recommended to fight interstitial cystitis

Avoid Antacids, Apple Cider Vinegar, Lemon, and Lime

Lastly, I want to touch on antacid. When experiencing acid reflux or heartburn, it is easy to reach for antacids to relieve pain, burning, and discomfort. Please, don’t do this. Antacids can put a bandaid on your symptoms for a while by reducing acidity. However, eventually, they will stop improving your symptoms. Even worse, they can make your problem worst by reducing stomach acidity. As you know, low stomach acid can lead to acid reflux over time (7). 

By reducing stomach acid with antacids, you are essentially throwing fuel to the fire and making matters worse. Antacids may also deplete your body of essential nutrients, such as B vitamins, vitamin C, iron, magnesium, and calcium (17). Instead, support your body with a healthy, low-histamine diet and lifestyle following the strategies in this article.

Moreover, if you have histamine intolerance or MCAS, certain natural support strategies are not right for you. I’ve already mentioned that though fermented foods and fermented drinks may be beneficial for people without histamine intolerance, if you have you have histamine intolerance, they will cause further digestive problems and other histamine-related symptoms. 

Many practitioners recommend drinking apple cider vinegar water, lemon water, or ginger tea with lemon or lime to relieve acid reflux. Unfortunately, vinegar, including apple cider vinegar and many citrus, including lemon and lime, are high in histamine. Some people, however, do tolerate them. These strategies may be beneficial for the general population, but if you have histamine intolerance, they are not right for you. The good news is that ginger is low in histamine and doesn’t act as a histamine-liberator. You may drink ginger tea to relieve your symptoms just don’t add lemon or lime to your drink.

Final Thoughts

GERD, acid reflux, and silent reflux can come with uncomfortable symptoms. If you’ve tried to improve your symptoms without luck, histamine intolerance may be the missing piece. I recommend following a low-histamine diet and my other strategies to improve your health naturally.

If you are dealing with GERD, acid reflux, silent reflux, or symptoms of histamine intolerance, I invite you to schedule a consultation with us. We can help identify the root cause of your condition and recommend a personalized treatment plan to repair your body and regain your health and well-being. Schedule your consultation here. You can also get started on your own with my Histamine Online Program.

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Hi, I am Dr. Becky Campbell. I work with men and women who’ve had a health set back and are willing to do whatever it takes to reach optimal health so they can perform their best in their careers and be fully present with their family again.