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Reflux and the Singer

Reflux and the Singing Voice


Many singers suffer from the uncomfortable, vocally damaging condition known as reflux.   Reflux is also called GERD or Gastroesophageal Reflux Disease.  This condition occurs when a small valve (the lower esophageal sphincter or LES) between the stomach and esophagus leaks, causing digestive fluids and stomach acid to overflow from the stomach into the esophagus, and back up into your mouth.  This acid will irritate the esophagus, and in the worst case scenario, it can cause throat cancer, a serious consequence.  For the singer, reflux will pour stomach acids on to the vocal folds, drying and burning them, causing hoarseness and laryngitis, which is the singer's worst nightmare.  This condition, unfortunately, is very common. But it doesn't have to be, because with certain simple concrete behavioral changes we can stop reflux from interfering with or ruining our singing voices. 

What to do if you think you have reflux?

Change your eating habits and incorporate a stress management program immediately to  see if you can improve your health without drugs.  And if that does not work -

See a doctor, and only take prescribed drugs that will control spillage of stomach acids into the larynx, but not dry out the vocal folds.  For a list of more than 200 of the most frequently precribed drugs and their effects on the voice click on this link, but read on first.   

 Empower yourself through your own reading, starting here. Read and research as much as you can, and decide later how you will handle it.  Start with behavioral changes. 

Remember, if your behavior changes you may not need to take the drugs. Most people who take the drugs still need to change their lifestyle.  So here is what you can do to hopefully eliminate reflux (with or without drugs)..

I believe that singers are more inclined than some other professions to get reflux.  When singers support the vocal sound there is pressure within the core of the body.  Beneath the diaphragm is the stomach, which can be slightly displaced during the singers deep inhalation and the singers "supported" exhalation.  But, you can't give up singing!

1. Eat smaller meals of non-aggravating foods.  You can even eat frequently.

2. Avoid spicy and fatty foods, tomato and citrus fruits and juices (no orange or grapefruit juice), garlic, onion, nightshade vegetables (such as eggplant), chocolate, mints, coffee, tea, diet soda,  regular soda, wine, beer, and mixed drinks Some people are sensitive to nuts because of the oils. I find that almonds are among the easiest of nuts to digest. Some people are sensitive to dairy. Your specific sensitivities play a role in determining what foods are best to eat.   In regards to eliminating reflux fast - I think the two most aggravating items are alcohol and coffee.  Start with those two items if you only start with two. Start slow. 

3. Before a performance or gig eat light. , Small but balanced meals combining protein, fat and carbohydrates will nourish and sustain blood sugar.  A turkey, or white meat chicken sandwich on whole wheat bread or gluton-free bread, protein bar, sushi, tuna on whole wheat, fish (not fried), salmon is okay but not oily or heavy fish like Sea Bass. or anything not included on list number 2. 

4. In between sets or at an intermission, an apple might be a great snack if you need to eat
something because it is not acidic and gives you the lift from natural sugar and fiber.

5. Many people have undetected allergies to dairy, soy, wheat, corn, nuts, or yeast. If you have some allergic reactions, it could be from the common foods you are eating. A trip to your allergist, general practice doctor, or a licensed nutritionist could help you figgure this out. Some people experiment on their own first, and then see a doctor. Some people with suspected  food allergies do a food elimination test.  Essentially, eat the suspected food in the morning on an empty stomack and observe your body for immediate and delayed responses.  Some foods may immediately effect throat, causing a mucusy or ichy type of reaction.  Some reactions may occur later effecting you emotionally or physically.  Such reactions may include headaches, irritability, or stomach pain.  The best plan is to see your doctor or licensed nutritionist. There are many tests that can be performed by licensed health professionals.  I do not recommend "nutritional counselors" because they are not licensed and have limited educational background and may not be prepared to handle the complexity involved in the singers lifestyle.

6. Do not eat late at night especially opening night!   Do not go out to an opening night party and eat,drink, and talk loudly over music and not expect to have reflux during the night and a compromised or absent voice in the morning. 

7. In general, do not eat three to four hours before bed Do not eat anything, not even a snack, before bed or in the middle of the night.

8. Elevate the head of your bed 2 to 6 inches with wood blocks or bricks.  There are special chiropractic pillows containing Styrofoam that can elevate the head also.  Double pillows are not as effective.

9.  Do not lie down for at least two hours after eating.  So, if you take a mid-afternoon nap, do not do it until two hours after lunch. 

10. Stop smoking.  Smoking causes cancer anyway and is expensive.  But, aside from all the horrible side effects from smoking, it is a major contributor to reflux.  Quit smoking or at least decrease the number of cigarettes, cigars, or other substances smoked.

11.  Limit all coffee to 1 cup a day or not at all.  Both the caffeine and the oils  contributes to reflux. Caffeinated and decaffeinated tea has tannic acid which is irritating to the sensitive stomack of reflux sufferers.  I was able to quit all decaffeinated black tea, and now exclusively drink herbal tea.  It is just an adjustment, that is all.  At first you are resistant, but, later you'll enjoy the new habit and prefer it to that old habit. 

12.  If you go out to eat, and have a relatively hearty meal, do not have desert.  A small meal is fine.  Wait at least 30 minutes, and then have fruit. Or have your fruit first. This is ideal.

13. If you have a small meal and a small dessert do not mix dairy and alcohol.  A really bad combination is eggplant Parmesan, red wine, buttered Italian bread, coffee and desert. Another terrible combination, especially if you frequent Italian restaurants is foccacia, bread with butter, sea bass, penne alla vodka, alcohol, dessert, coffee.  Not just one but many stomach irritants in one meal - the formula for guaranteed reflux. Small portions of reflux-free food is a winner! 

14. Avoid or eliminate alcohol.  As you approach an important performance eliminate or reduce alcohol.  If you feel you really need some alcohol before a performance, take it with a neutral food such as brown rice crackers, but not wheat crackers if you are sensitive or allergic to it. 

15. Antacids can be taken before or 30 to 60 minutes after a meal.  For people with mild reflux antacids can be very helpful.

16.  Avoid tight clothing.  Tight belts and pants increase the pressure on the abdomen.  Supportive singing very actively uses the abdominal muscles, so to add tight clothing, will increase the pressure on the stomach and digestive system even more. 

17.  Weight loss.  Excess weight increases the amount of pressure on your stomach.  Even very small amounts of weight loss will help.

18. Do not exercise immediately after a meal, especially something strenuous like weight lifting, running, or a very fast after dinner walk. 

19.  Avoid stress, but that is easier said then done   Preparating for a gig, performance, or rehearsal, far in advance will decrease your stress.  Stress management and performance anxiety is another area, but worth investigating if you have chronic reflux since your stress is a  big contributor to your reflux!  Yoga is an excellent way of aiding digestion and relieving stress.

20. Also, of note, reflux ruins the enamel of your teeth which effects your smile.  It is not uncommon for bulemics to have compromised the enamel on the inside of their teeth.  So keeping  your healthy teeth white is  another incentive to avoid reflux. 

21, Be very aware of where you intend to breath in your songs, so you are prepared to take a relaxed, calm and deep inhalation as needed throughout your song.

                        Slow and steady wins the race!



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