Do you find that after meals you get heartburn or even the feel of something coming up your throat? Do you find yourself propping yourself up on pillows at night just to avoid that feeling of acid coming up at night? Do you find your vocal quality changing? Or maybe you just have a constant tickle in the back of your throat or persistent throat clearing? All of these could mean that you have acid reflux.
What is Acid Reflux?
Acid reflux, as laryngopharyngeal reflux (LPR), is one of the most common contributors to vocal disorders. It can range from just a slight tickle in the throat to laryngeal cancer. There is also gastroesophageal reflux disease (GERD), which can range from mild discomfort or heartburn to esophageal cancer. First of all let’s review what reflux is. It’s the seepage of gastric juices, primarily made of hydrochloric acid, out of the stomach and up the esophagus due to the failure of the esophageal sphincter, located at the bottom end of the esophagus, to close properly, thus keeping the stomach contents sealed off. What is the difference between LPR and GERD? LPR affects the larynx and pharynx as the acid makes it’s way up to these structures. GERD happens when the lining of the esophagus is irritated from the acid. LPR can occur without GERD being evident since the vocal fold tissues are much more delicate than the thick lining of the esophagus.
What causes acid reflux?
About 44% of the population suffers from heartburn at least once a month. 25- 35% suffer from reflux on a regular basis. There are many factors that can contribute to reflux. Dietary factors are among the main culprits including food allergies and sensitivities, trigger foods (spicy, fatty, citrus and tomato-based, dairy, caffeine, alcohol, gluten) or a highly acid-forming diet. Stress can be a major factor, as well as other lifestyle choices such as smoking or eating right before bed. Obesity, pressure on the abdomen exerted my tight clothing or singing, and reclining positions also can affect the integrity of the seal between the stomach and esophagus. Other factors can be those that will affect your gut health: bacteria or yeast growing in your stomach, if you have taken antibiotics, hormones or other medications, excess sugar. One gut bacterian is particulat, H. pylori, has been linked to reflux in many people.
What can you do to minimize acid reflux?
In dealing with a diagnosis of reflux you SHOULD NOT jump to take a little purple pill. There has been much advertising in the United States for proton pump inhibitors (PPI) such as Prosilec and Nexium. Currently acid reflux is the third leading cause of drug prescriptions. These drugs have many side effects, can create dependencies and there is little if any clinical information on use beyond a year. These drugs are really only meant for the most severe forms of reflux after all other methods to control it have failed.
The first thing to consider is your diet. Though you can check many conventional sources that will tell you which foods to avoid (like those mentioned above), we really should be looking at our overall diet. Certainly you want to eliminate triggers from your diet especially caffeine, alcohol and nicotine and any foods you may be allergic or sensitive to, but it goes beyond that. In the Standard American Diet (SAD), we rely too much on processed foods, meat and dairy (and dairy is a trigger food), which can reek havoc on our gut bacteria and the alkalinity of our bodies. Our bodies like to be slightly on the alkaline side at a pH of 7.35 (remember your high school chemistry – a neutral pH is 7.0). We want to maintain our diets on the slightly alkaline forming side to maintain this. We have to understand that the pH of the food outside the body is different from the changes that occur in the body, so say an orange is acidic, but in the body it is alkaline forming, due to the ash that is left after metabolism. The slightly alkaline environment is most conducive to healing and repair in the body.
The most highly acid forming food include: refined wheat flour, white rice, beef, pork, poultry, cheese, milk, white sugar, artificial sweeteners, coffee, roasted peanuts, prescription drugs, soy protein isolate and whey protein isolate.
We want to counter this by eating alkaline forming foods. The most highly alkaline foods include: asparagus, beets, bell peppers, broccoli, carrots, cauliflower, celery, cucumbers, dill, green beans, leeks, all leafy greens, parsley, parsnips, sprouts, zucchini, grapefruit, lemons, limes, mangos, papaya, gingerroot and green tea.
So eat up on your veggies!
Another dietary step you can take is to include fermented foods, which provide probiotics, beneficial gut bacteria. You can get this through fermented vegetables such as sauerkraut and kimchi, and fermented beverages such as kombucha and kefir.
Other strategies that can help alleviate reflux are the use of apple cider vinegar, ginger or chamomile tea, aloe juice and slippery elm.
The second course of action is to consider your stress levels. Increased stress can cause a host of chemical imbalances and can affect the nerve function of the stomach, which can result in the inappropriate relaxation of the esophageal sphincter. Exercise and relaxation techniques such as yoga, tai chi, chi gong, biofeedback, meditation/mindfulness-based stress reduction can reduce the stress contributing to reflux. Also any other activity that you enjoy can help with stress relief.
Thirdly, if you find you are experiencing reflux at night this may be due to eating too close to your bedtime. Try not to eat within 3 hours of going to bed. You may also want to elevate your bed to prevent the acid from rising up.
One other thing to note is that quite often the cause of reflux is actually too little acid in the stomach, so over the counter anti-acid treatments may actually exacerbate the problem.
Working with a Functional Medicine Doctor can help you find the root cause of your acid reflux with out the intervention of prescription medications, which only mask the symptoms. If symptoms persist or get worse then see your medical doctor. It is imperative that you do have regular check ups and any tests that may show a more serious underlying condition.
If you would like to learn more about how diet can affect your health then join me for my next Fit Singer Clean Eating Masterclass. Sign up here.
Stay fit and keep singing!
Websites and resources:
Joel S. Edman, Lauren B. Kondrad, and Birgit Rakel, "The Use of Nutrition and Integrative Medicine or Complementary and Alternative Medicine (CAM) for Singers, Part 2", Journal of Singing (January/February 2012): 291-297.
Martin Spencer, "Laryngopharyngeal Reflux and Singers: Diabolus in Gula?", Journal of Singing (November/December 2006): 177-184.