Woman holding throat due to acid reflux

Acid Reflux and Your Voice: Help for a Common Singing Problem*

As a voice teacher, I work with students every day who are experiencing
singing problems due to health issues rather than their vocal technique, and none is more troublesome than acid reflux! As a professional singer myself, I have had more than a few bouts with it at various times during my career, ranging from mild to severe.

What is it, and why is it a problem for singers? Acid reflux, and specifically laryngopharyngeal reflux (LPR) is when stomach acid backs up into the throat, causing vocal cord irritation. The result? A hoarse vocal tone, vocal breaks between the registers, and discomfort when singing and talking. It can also cause sinus congestion when acid gets into your nasal passages, affect breathing, and disrupt your sleep as well. Many singers don’t realize they have reflux, because they often don’t have the classic heartburn symptoms of burning in the chest. I certainly didn’t! All I knew was that my voice was not cooperating, and since I knew I had good technique, something else had to be wrong!

What causes it? This is a complex question with a lot of different answers. For singers, just the act of pushing out and down into their breath support muscles can sometimes cause reflux. More general causes for reflux can be caffeine, alcohol, and smoking; being overweight, an acidic diet or eating specific foods that trigger excess acidity; eating late at night and then going to bed (your digestive system is working, and the resulting acid backs up when you are lying down); even wearing tight clothing that presses on your stomach. Chronic stress certainly doesn’t help (does it ever help any condition?).

What to do about it? First of all, if you suspect that you have LPR, go see a laryngologist (an Ear, Nose and Throat doctor who specializes in treating conditions of the larynx) for a definitive diagnosis. Often the doctor will prescribe a proton-pump inhibitor (which reduces the amount of acid you stomach pumps out) and/or antacid medications, which neutralize the acid that is produced. Both these approaches may be helpful, but there are many more lifestyle hacks that can help combat reflux, and hopefully keep it away for good:

1. Foods to avoid. Remove fried, fatty and spicy foods from your life, at least until the condition improves. Avoid chocolate, peppermint and spearmint (mint relaxes the esophageal sphincter, which can allow acid to wash up into your throat). Also avoid citrus fruits, tomato-based foods, and whole milk and cream. As mentioned before, reduce or eliminate caffeine and alcohol.
2. When to eat. Most doctors recommend your last meal or snack to be at least three hours before you go to bed. This is a tough one for a lot of us, especially musicians, who tend to have nighttime rehearsals and concerts, then eat, and then go to bed. But, it’s important!
3. Eat smaller portions and meals. Our stomachs are not terribly large, and yet our “supersized” restaurant culture has skewed our perception of what normal portions should be. Eat slower to give yourself a chance to actually feel full. Do eat enough to be satisfied, but don’t overload!
4. Lose weight, if applicable. Studies show that enlarging the stomach results in a shorter and weaker lower esophageal sphincter muscle, allowing acid to flow up into the esophagus more easily.
5. Avoid tight-fitting clothing. Tight clothes press on the abdomen and can force acid up the esophagus as well.
6. Stop smoking! The nicotine from smoking causes the lower esophageal sphincter to relax, resulting in the acid moving up into the esophagus.
7. Avoid activities that press on the abdomen, such as bending over, which forces acid up from the stomach.
8. Adjust your sleeping position. Raising the head of your bed about 6-8” from underneath with blocks will help keep the acid from reaching your throat. Don’t just use more pillows— it can cause you to bend and actually put more pressure on your stomach that way! Also, lie on your left side, which also puts less pressure on the digestive system.
9. Alkalinize your diet. Alkaline is the opposite of acidic. Nutritionists have been warning for years about the effects of an acidic diet on health, but I’ve talked to doctors that just shrug when I mention this idea. I’ve found that drinking alkaline water can be helpful (buy it already prepared, or make your own at home using baking soda, lemons or ph drops or sticks.  Consult a qualified nutritionist to find the right method for you).  My nutritionist also recommends making sure you have at least half of each meal you eat be from the fruit and veggie groups (which generally create alkalinity in the body), as grains and meat cause body acidity. (Consult complete lists of alkaline versus acidic foods online). I also take alfalfa pills with each meal, which has helped with this acid/alkaline balance as well.
10. Gaviscon, a huge help! Multiple studies show the benefit of taking antacids that contain an alginate, which is a mineral extracted from seaweed. This forms a foamy barrier which keeps the acid from attacking the throat. Gaviscon Extra Strength Antacid tablets contain alginate, and also other minerals which help neutralize stomach acids as well as forming the protective foam barrier. It is especially effective after you have eaten your last meal of the day, so you can sleep through the night with the benefit of the barrier protection. During my bouts of reflux, I have found this practice extremely helpful in preventing vocal hoarseness and irritation.

There is no doubt that LPR is uncomfortable and frustrating, and if left untreated, can lead to even more serious issues for singers and non-singers alike. See your doctor right away if you suspect that this may be at the root of your vocal issues. Armed with your doctor’s help and and some effective lifestyle changes, you can win your battle against LPR, and be singing pretty again very soon!


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