Learn everything you need to know about acid reflux and singing from top laryngologist Dr Reena Gupta.

Heartburn, hoarseness, regurgitation, vocal fatigue and reduced range – acid reflux can cause uncomfortable and unpleasant symptoms.

And for singers and professional voice users, there’s the added anxiety that chronic acid reflux could limit their ability to perform and earn a living.

So, here’s the lowdown on what causes the condition and some advice from LA laryngologist Dr Reena Gupta on how best to treat and prevent it.

What triggers acid reflux?

Potential triggers include all the stuff that you might associate with a big night out – alcohol, nicotine, spicy food – along with what might pep you up the morning after – caffeine, fatty foods and carbonated drinks (including sparkling mineral water).

Tomatoes, chocolate, peppermint, and citrus can also be triggers.

But it can be more complicated

Some people find it difficult to identify what triggers their reflux. For example, tomatoes may not pose a problem one day but kickstart heartburn the next. This is because some sufferers only experience the condition if they consume two triggers at once, such as tomatoes with salad dressing or fatty food washed down with an alcoholic drink.

Over-eating or eating late at night can exacerbate the condition.

What are the typical symptoms?

Heartburn is the most common symptom, but sufferers may also experience throat clearing within about 30 minutes of consuming a triggering ingredient or regurgitation.

And sometimes the symptoms may only be apparent the next day. If you have a late-night meal, you might experience symptoms in the morning, such as a sore throat or tightness in the chest.

Singers may also notice they have less vocal stamina, a reduced range, loss of falsetto, breathiness or hoarseness.

What is happening in the body when we experience acid reflux?

Over to the expert Dr Gupta to explain. “There is a sphincter, a circular, muscular band on the lowest part of your oesophagus, that opens to let stuff into your stomach and then closes again.

“However, specific triggers create a looseness in the sphincter so it rests open, meaning the stomach contents can regurgitate back up and stay low in your chest, in which case we get more heartburn, or really come back up.

“When the latter happens, you’ll get more laryngeal signs. The feeling of something stuck in the throat, throat clearing, hoarseness, chest tightness with breathing – what we call laryngopharyngeal reflux (LPR). When the contents stay lower, this is called gastroesophageal reflux disease or GERD.”

Tips to prevent acid reflux

• Avoid food or drink that trigger your symptoms and, as stress can be a contributing factor, ensure mealtimes are calm affairs.
  
  
• Unsure of your triggers? Keep a food diary to help you recognise links between what you consume and how you feel. Don’t just look at single ingredients; also consider how combinations of ingredients affect you.
  
  
• Stay upright after a meal (no heading off to bed or reclining on the couch). “If that sphincter is open and you’re laying down, you’ve just created an easy pathway for stuff to regurgitate,” Dr Gupta says.
  
  
• Avoid eating two to three hours before you go to bed, and when you do retire for the night, sleep with your head elevated.

Treatment options

“The biggest tip is avoidance of triggers with an antacid like Gaviscon Double Action with alginate being your ‘oops, I did it’ kind of rescue,” Dr Gupta says.

“But if somebody is really stuck, they’re doing everything they can and they’re still having episodes, it usually either means a medication – my least favourite option – or at the very least seeing a gastroenterologist who can check to see if there something that is predisposing the patient to this, like a hiatal hernia.”

Medication

“If we need to go down the medication route, I’ll always start with an H2 blocker like Pepcid [which has the active ingredient famotidine],” Dr Gupta says.

“PPIs are my last resort because studies have shown at about the five-to-ten-year mark, we have an increased risk of complications because we’re not absorbing minerals in the same way.”

What about alternative therapies?

Some people swear by the benefits of apple cider vinegar (diluted in water), although to date the research isn’t there to back this up. Others claim it makes them feel worse.

Researchers are also looking into manual therapy as an intervention to help with acid reflux. Here’s an article in the Journal of Singing by Lydia Flock and Stephen King.

Learn more

Listen to our interview with Dr Reena Gupta on the latest episode of Singing Teachers Talk where she also discusses:

• Nebulising versus steaming – Dr Gupta reveals her preferred option.
• The difference between an ENT and a laryngologist.
• Muscle tension dysphonia, polyps and nodules.

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