In a previous post, I discussed allergy related issues. In this post, we’ll cover the other “silent killer” for singers, acid reflux.
Acid Reflux and GERD are two things with which singers often struggle and yet, it’s common that singers don’t even know they are suffering from the effects of these issues and end up attributing what they are feeling to vocal fatigue or bad technique.
Let’s first examine in detail what these afflictions are and what causes them.
Acid Reflux
Acid reflux or GERD (Gastroesophageal reflux disease) occurs when stomach acid frequently flows back into the “tube” (esophagus) connecting your mouth and stomach. The backwash, or acid reflux can irritate the lining of the esophagus.
Isn’t that just Heartburn?
No, heartburn is different. Think “I ate too many Thin Mints during Girl Scout Cookie Season” vs. “when I wake up I feel like there’s a hole in my esophagus.” Heartburn is a pain near the center of your chest, just behind your breastbone. It’s often worse after eating or when you are lying down. Heartburn is a symptom of GERD and is a less severe and non-chronic issue. For some, it can be so severe that it feels like you are breathing through a coffee stirrer.
Symptoms of Heartburn:
- A burning pain in the chest
- Pain that worsens when you lie down or bend over
- A bitter or acidic taste in the mouth
Symptoms of GERD or Acid Reflux:
- Hoarseness
- Excessive mucus or phlegm
- Throat Clearing
- Sensation of a lump in the throat
- Sore throat
- Wheezing
- Choking spells
- A sense of post-nasal drip
- Regurgitation of food
- Chronic cough
- Laryngitis
- New or worsening. asthma
- Fitful sleep
Often, acid reflux does most of its damage while you sleep. You won’t feel it happening, but you will feel the effects. You may not even notice that anything is amiss, especially if you don’t feel heartburn at all.
So, is really a big deal? Are you asking yourself: “can’t I just sing through that?” Maybe, but makes life very difficult for a singer. Here are some of the things you’ll deal with:
- Takes longer to warm-up
- Voice is very low or sluggish, especially early in the day
- Feels like there is a coating or cover over the vocal folds all day
- Decreased vocal stamina
- Acute vocal fatigue for no apparent reason.
- Limited range or no access to certain portions of your range
- Unexplained interruptions in the tone or the voice ceases up and phonation inexplicably stops.
- Inability to use different dynamics, everything is either your loudest or your softest volume, but not much in between. Messe di voce is almost impossible.
Well, doesn’t that sound fun? Some of you may be experiencing relief however, at the thought that some of your vocal afflictions are not in your imagination.
Ok, now to the part that matters.
What can you do about it?
- Avoid “trigger” foods
- Don’t eat late at night
- Don’t eat large meals
- Don’t eat right before bed
- Prop the head of your bed up a few inches.
- Reduce Stress (I know, hilarious)
- Lose Weight (I know, also, hilarious)
- Don’t wear tight clothing
- Don’t smoke
As you can see, much of this is diet related. Now consider your typical day as a singer. We do almost every single thing we shouldn’t do, on a regular basis. So what foods can you eat, then?
Acid Reflux Friendly Diet
Do Eat/Drink:
- Oats
- Blueberries
- Carrots
- Mango
- Chicken/Turkey/Fish (any lean meat)
- Quinoa
- Melon
- Bananas
- Couscous
- Broccoli
- Ginger
- Eggs (though some say the yoke triggers reflux)
- Avocados (use sparingly though, they are high in fat)
- Cauliflower
- Squash
- Skim Milk or Reduced fat Yogurt and Cheese
- Salt
- Canned Vegetables
- Honey
- Marshmallows
- Maple Syrup
- Baked Potatoes
- Plain pasta
- Rice
- Angel food cake, sponge cake, pudding or custard with low-fat dairy.
- Pancakes
- Bagels
- Corn Tortillas
- Nuts (in moderation, also very high fat)
Don’t Eat/Drink:
- Coffee
- Tea
- Carbonated Beverages
- Alcoholic Beverages
- Citrus Beverages or Citrus fruits (pineapple, oranges, lemon, grapefruit, etc.)
- Gum
- Mint
- Any spicy foods (Jalapeños)
- Any deep-fried foods
- Tomatoes
- Hard Candies
- Throat lozenges (especially those containing Mint/Eucalyptus)
- Cough Drops
- Mouthwashes
- Garlic
- Onions
- Whole Milk
- High-fat Breads or grains (doughnuts, croissants, biscuits, granola, muffins, pizza etc.)
- Bacon
- Cheese
- Nut butters
- Gravy
- Fried Potatoes
- Potato chips
- Coconut
- Vinegar
Did I just ruin your life? Probably. Now, here’s the disclaimer: None of the above foods are guaranteed to give you or not give you acid reflux. You will have to experiment to determine what works or does not work for you.
What are your acid reflux trigger foods? Which foods are safe for you?
I know a professional singer who drinks pineapple juice before every show. Sometimes coconut water with pineapple in it. He’s fine.
Another professional singer I know, can’t eat quinoa because it gives her crippling amounts of phlegm. However, that’s supposed to be on the “approved” list. Now that’s not necessarily acid reflux related, but I mention it to illustrate the point that every person is different, so what works for one, may not work for another.
When I go on a gig, I have list of about 6 foods that I know won’t give me issues. That’s it. It’s the worst. But sometimes, it’s worth it. for me to know that I won’t be complicating the already difficult task of singing, with external issues. Yes, sometimes I breakdown and eat a whole pizza piece of pizza, but on the whole, I stay on track, just to be cautious.
My “safe foods” are: oatmeal, blueberries, deli turkey, raisins, carrots, dried mango. Celery is on there as well, but I’d rather eat a garden hose, so I don’t worry about that one.
Medication
There are two basic kinds of medications that assist with reflux issues.
- Proton Pump Inhibitors
- Acid Reducers
Proton pump inhibitors are medications like Omeprazole, Pantoprazole Nexium, or Prilosec and Prevacid. Typically, these medications reduce the amount of acid created, so there’s not an overabundance sloshing around down there and creating trouble. These medications are taken over the course of a few weeks, after which you take a break and see how things feel. Some of these medications can be purchased over the counter and some require a prescription. A prescription of even those purchased over-the-counter, can provide you with a lower cost or a more accurate dosage.
Medications such as Gaviscon, Zangtac, Tagamet and Pepcid, are H2 blockers and help neutralize the acid or in the case of Gaviscon, line the stomach and prevent reflux. If you have ever taken Tums or Rollaids, the above medications are just a more substantial version of those. They also help to treat ulcers, and other acid reflux/ulcer related conditions.
Most of these medications can be found when traveling outside of America, but again, if you suffer from GERD or Acid Reflux on a daily basis, and your vocal success is dependent on having medication, that’s a big risk to take if you run out and can’t find it abroad, or you’re not close to a place where you can jut run out and pick some up.
Some suggest that apple cider vinegar also helps to neutralize the effects of acid reflux, which sounds odd, since it’s acidic itself, but many have found that it makes a difference.
Other Solutions
Bed Head:Though it sounds completely unimpressive, many have found relief in elevating the head of the bead just a few inches. For many, this provides relief as the acid stays lower and doesn’t come up and burn. the vocal tract and esophagus while you sleep. For some, this makes no difference.
Can you feel the burn: A number of people undergo acid reflux surgery as well. Laparoscopic anti-reflux surgery, also known as Nissen fundoplication (which just sounds like a fancy name for jumping tossing noodles), is used to treat GERD. It is minimally-invasive and creates a valve mechanism at the bottom of the esophagus. It can cost anywhere from $2,00-$5,000, estimates suggest. It tends to be very effective in most cases, and takes about 2 hours to perform the procedure.
Testing
Obviously, before undergoing such procedure as this, it might be helpful to know what exactly is going on, or how severe your case of reflux is. There are a few options:
Upper Endoscopy:
A tube with a camera is inserted down your throat to take a look at the inside of the esophagus. A biopsy can also be performed this way. to test for other issues.
Acid (pH) Test:
A monitor is placed in your esophagus to monitor when, for how long, and how much stomach acid comes up. The monitor is attached to a device that you wear around your waist or over the shoulder. There are a few different types of monitors. One is threaded through your nose, and the other is a clip placed in the esophagus during the endoscopy which then passes through your digestive system later.
Digestive System X-Ray:
This is exactly what it sounds like. You drink a chalky liquid that coats the inside lining of your digestive tract. This allows the doctor to see a picture of your esophagus and upper intestine. Sometimes, patients are asked to swallow a barium pill that can help diagnose a narrowing of the esophagus which may interfere with swallowing.
Esophageal Manometry:
I’ve never known anyone personally that has undergone this procedure, but it is a measurement of the rhythmic muscle contractions in the esophagus when you swallow.
All of these tests can help determine what is going on, anyhow severe your issue is, or if it is even acid reflux to begin with. Bottom line, if you’re really in pain, it’s worth further investigation, especially if you are a singer.
