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.
http://drhyman.com/blog/2013/09/26/7-steps-reverse-acid-reflux/
http://www.drcarney.com/blog/entry/say-goodbye-to-acid-reflux
http://articles.mercola.com/sites/articles/archive/2014/04/28/acid-reflux-ulcer-treatment.aspx
http://foodmatters.tv/articles-1/heartburn-indigestion-acid-reflux-how-to-kick-and-over-acid-diet

Another late rehearsal, tech week coming up followed by a week of performances. Or maybe you are singing another gig at the local club. Either way, the singer’s peak performance time is in the evening. You get home late and need time to unwind, so you aren’t getting to bed until the wee hours of the morning.  The next day you have to get up early to make it to work for your other job or maybe an appointment or an audition...  Whatever your particular situation may be, if this schedule sounds familiar it may well be you are not getting enough sleep.  Though we can do this for a short period of time a consistent sleep deficit will eventually lead to serious consequences to the health of your mind and body.

How much sleep should you be getting?  With a wealth of research on the subject, The National Sleep Foundation recommends that adults should be sleeping 7-9 hours every day. This is a personal thing, so just saying getting 7 hours for the sake of an extra two when you really need 9 hours of sleep won’t cut it.  See how you feel after a night’s sleep of different lengths.

Some things to assess are:

• Do you feel energized or groggy?
• Do you need caffeine or other stimulant to get you through the day?
• Do you feel drowsy while driving?
• Are you overweight?
• Are you experiencing sleep problems?
• Are you productive at work?

Just like exercise and diet, sleep is critical to your overall health. And just like exercise and diet, sleep needs to be a priority. You need to plan and schedule it, don’t stay up to complete everything on your to do list, your health is more important. Here are some tips to getting a better night's sleep:

• Stick to a regular sleep schedule, even on weekends.
• Exercise daily.
• Have a relaxing bedtime ritual (bath, generally getting ready for bed, reading, listening to some soothing music – whatever works for you)
• Make sure your environment is comfortable (mattress, pillow, temperature, lighting, etc.)
• Avoid alcohol, caffeine, big meals or other stimulants.
• Turn off electronics before going to bed.

Still, for some of us, our schedules become irregular, especially if long distance travel is concerned (traveling will be the subject of a future article). For an irregular schedule, aside from sticking to a regular sleep schedule, all the tips above should be adhered to.  In addition, assuming you will have a late night followed by having to go out the next morning:

• After the performance, avoid the late night drinks with the other performers.
• At home start your bedtime ritual right a way, this will be your wind down time.
• Try to arrange a later start time at work for those days that you perform or have a late rehearsal.  Many employers nowadays are more flexible with their hours. 
• If you are feeling sleepy at work and not performing your best, try to get in a short nap. It can leave you feeling refreshed and re-energized. But no more than 30 minutes, otherwise you may end up feeling groggy and unproductive. If you made it through your workday, you may want to take a short nap before you head out to your gig.

If you do continue to experience sleep disturbances or other problems on a regular basis, make sure you go to see your physician about it.

Sleep is such an important time for our minds and bodies to heal, to flush away toxins, to clear our minds, to rebuild.  As singers who need to be alert to all that’s going on around us and within us during a performance, we really cannot afford to be skimping on sleep, so find a way to prioritize it and make sure you are getting enough!

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The past 10 days I’ve spent in Vancouver for a music teachers’ conference followed by a little R&R. Being away from home can throw a wrench into your workout schedule (and many singers do spent a great deal of time traveling), but with planning and creativity, there’s no reason why you should shelf your workouts while traveling.  Here are some of the things I did to maintain my fitness followed by a list of things anyone who travels can do.

The first few days I spent at the Airport Sheraton.  They have a wonderful fitness facility. I did strength training and treadmill runs there daily in the mornings before the conference started. Unfortunately the pool was too small to get a good swim workout in. I’ve gone 10 days without that or cycling, so now that I’m home I’ll have to concentrate on those a little more to get ready for my August triathlons.  After the conference, I stayed with a friend, so my workouts consisted of a mixed bag of activities. One day consisted of lots of walking while sightseeing (we covered 12-15 km on foot). There was a very nice park with a nature trail nearby, so one day we walked it and another day I did my interval run there. The nice thing about running in the area for this prairie girl was that there were plenty of hills to add more challenge.

On my final day, I tackled Grouse Mountain on the infamous Grouse Grind. This is 2.9 km up. They say the average time is one and a half to two hours to complete. Since I’m in pretty good shape I did it in 70 minutes, but still far from the female record of 35 minutes.  The male record is 25:01. You would have to run up to get those times. I just plodded along enjoying the moment, but still sweating and feeling my quads burn.

Throughout my stay, I also threw in some streaming online workouts from Beachbody on Demand.  These are great because they are structured and will give you more balance whole body workouts, so I could work on my core and upper body.  These are the workouts that you can try out in The Fit Singer Fit Club 30 Day Challenge.

So what can you do if you are traveling and need to get you workouts done? 

If you are planning a vacation or will have free time during your professional trip, try to make it as active as possible. Walk a lot, but briskly. Strolling through a market stopping at every stall or checking out museum exhibits doesn’t count.  Many destinations have bike rentals. In fact, bike vacations are a great way to see some countryside and stay fit.

If you are staying in a hotel, most have some sort of fitness facility.  Check it out. The most basic will have a treadmill, a bike and a universal machine. More upscale facilities have more equipment that can also include free weights and stability balls.

If you need specific equipment that your hotel facility doesn’t have, check out if there are any gyms in the area where you can get a week pass or pay a drop-in fee.

If you don’t have access to a fitness room/gym, feel uncomfortable going to one or you are pressed for time, then you can keep your workouts in your room. You can try basic body weight workouts or pack a resistance band (takes up so little space). If you want something more structured try the Beachbody on Demand programs, most are 30 minutes or less, so you can get your workout out of the way and get on with your day anytime, anyplace.

So there is no shortage of options to continue working on your fitness goals while you are away from home. No excuses! If you want more information or advice on workouts while you’re away, feel free to contact me.