Taming the Acid Beast: Voice Care Tips for Reflux Sufferers
22/11/2024 & Updated on 16/12/2024
If you found out that you’re a reflux sufferer – for example by following the advice I shared in last week’s blog post Diagnosing the Acid Beast: Are You a Reflux Sufferer?, here’s everything you need to know about the causes of this voice nemesis and how to deal with it!
In 2020, I created 3 webinars on SOS Voice, covering what to do (and not do) to keep your voice in top form, which are now part of the The singsing! Sofa Library.
In Part 2, we took a deep dive into reflux: What it is, how it affects your voice, and what you can do to manage it effectively.
Part 1: Vocal rest – Effects of meds on your voice – The common cold – Allergies – Airway infections – Hydration – Herbs & supplements
Part 2: Reflux – Voice & hormones – Safety measures for intubation
Part 3: Warm-ups, Cool-downs & Emergency aid
Causes of Reflux
Reflux isn’t one-size-fits-all. What triggers symptoms for one person might not affect another, so self-awareness is crucial.
You probably already know that eating habits can contribute to reflux.
- Triggering foods: Spicy foods, citrus fruits, chocolate, caffeine, alcohol, carbonated drinks and fatty foods are all well-known culprits. But triggers can vary, so pay attention to how your body reacts to different foods.
- Overeating: Large meals put pressure on the lower esophageal sphincter (LES), the valve that keeps acid in your stomach where it belongs.
- Lying down after eating: Gravity plays a role here; reclining too soon after a meal allows acid to flow upward.
However, there are other common triggers that you should know about:
- Stress:
Emotional stress can exacerbate reflux by affecting digestion and increasing acid production. - Physical factors:
Overweight, a tongue tie, a hiatal hernia, heightened pressure in your belly due to obstipation or forceful coughing and pregnancy can increase the likelihood of reflux. - Lifestyle choices & Habits:
Smoking, your sleep pattern, tight clothing and bending over often can all trigger reflux. - Medications:
Certain medications can trigger or worsen reflux by relaxing the lower esophageal sphincter (LES). When the LES becomes too relaxed, it allows acid to travel upwards, which can lead to reflux symptoms.If you must take medication, talk to your healthcare provider about voice-safe alternatives, especially if you’re a professional voice user.
As the possible effects of medications on the voice is a very important topic, I have invited phoniatrician & laryngologist Dr. Lieve Delsupehe to lead the webinar What You Should Know About the Sometimes Unexpected Effects of Medications on Your Voice on January 15, 2025. 
SALE Discounted price if you enroll before the end of 2024!
How to Manage Reflux and Keep Singing
Reflux can have multiple causes, and understanding yours is key to effective management. In the webinar, I discussed many ways to deal with reflux. Here are the most important ones:
Food is Your Friend…or Foe
- Finding a balance between listening to your hunger cues and being disciplined with your diet is crucial. Before a gig, avoid foods that trigger your reflux.
- Portion control is key:
Overeating can exacerbate reflux. Stick to smaller, manageable portions, especially before performances. Your voice (and your stomach) will thank you.
- Mindful eating habits: Eat slowly and chew thoroughly. Avoid lying down or bending over immediately after meals. Give your body time to digest properly and reduce the risk of acid traveling upward.
- The time between your last meal and going to bed
I recommend aiming for at least 3 hours between eating and going to bed. This allows enough time for your stomach to partially empty and prevent silent reflux in particular. - To eat fiber or not to eat fiber?
We discussed in the webinar how eating enough fiber can be beneficial for managing acid reflux. It helps regulate digestion, which may help prevent the build-up of gas and bloating that can exacerbate reflux symptoms.However, try not to eat a lot of fiber-rich foods for dinner! Fiber-heavy meals often take longer to digest, which can increase pressure on the stomach and make reflux more likely while you’re sleeping. Eat your fiber-rich meals earlier in the day to give your body ample time to digest.
Sleep smart! What you do right before bed is not the only factor that can help you manage reflux. Here are some smart tips about what you can do in bed:
Raising your upper body during sleep creates a gentle incline, which helps prevent stomach acid from traveling up into the esophagus while you sleep. Gravity is your friend here, use it to your advantage! Elevate the bed frame or use a wedge pillow tailored to your body, rather than simply propping up with pillows, as these can lead to poor alignment, possibly worsening your reflux.
- Sleeping on your left side can prevent stomach acid from flowing back into your esophagus, thanks to the anatomical positioning of the stomach and esophageal sphincter.
And what about the other culprits?
- Breath Management
:
I explained in the webinar why singers are particularly prone to reflux, if they don’t apply balanced breath management. Watch the webinar on Breath Management in The singsing! Sofa Library to apply this particular tip!
- Stress Management
:
Stress is a sneaky contributor to reflux. Learn techniques like mindfulness, meditation, or yoga to stay calm and centered. Your voice and overall health will benefit!
A Reminder: Every Body is Different. Managing reflux is highly personal. What works for one person might not work for another. Keep experimenting and consulting professionals to find your perfect balance!
Proton Pump Inhibitors (PPIs)
Proton pump inhibitors (PPIs) are often prescribed to manage reflux, as they reduce the stomach’s acid production. While they can be effective in the short term, there are some important risks to consider with their long-term use.
Over time, PPIs can interfere with your body’s ability to absorb nutrients like magnesium, calcium, and vitamin B12, which are essential for overall health and energy. This can lead to problems such as weakened bones or fatigue, both detrimental for singers who need their bodies to perform at peak capacity.
PPIs may be associated with an increased risk of conditions like heart attacks, especially when used for extended periods. While the exact mechanisms are not fully understood, some studies suggest that PPIs could impair the production of nitric oxide, a molecule that plays a crucial role in maintaining healthy blood vessels and circulation.
Addendum by dr. Filip Baert, gastroenterologist: I agree 100% that PPIs are being overused. Whether they really increase the risk of cardiovascular disease and mortality is not at all certain in my opinion. There is certainly an association but not necessarily a causal relationship. For example, it could be that obese people have more reflux and therefore take more PPIs and obese people naturally have a greater risk. In recent years, the so-called risk has also been mentioned less in the literature.
There is a slightly increased risk of gastrointestinal infections, which is logical, because stomach acid is our first barrier against infections. They can also disrupt the gut microbiome and in this way interfere with various health processes.
Such long-term risks are however very difficult to trace and isolate from other so-called ‘confounding’ factors.
They are overused and I always encourage my patients to reduce, but this is not always possible or feasable for everyone. The alternatives, especially the H2 blockers (e.g. ranitidine – ex Zantac®) are no longer available in Europe. They had other side effects and were clearly less powerful.
In my blog post How Do You Take Care of Your Voice?, I explain why the possible disruption of the gut microbiome by PPIs is still a reason for singers to be cautious with them.
PPIs don’t address the root cause of reflux; they merely mask symptoms, leaving underlying issues unresolved. For these reasons, I recommend using PPIs cautiously and exploring alternative solutions like lifestyle adjustments and stress management to minimize dependency on medication.
Managing reflux requires patience and a tailored approach. Pay attention to how your body reacts, and don’t hesitate to seek professional help. Specialists like nutritionists, laryngologists and gastroenterologists can help create a plan that works for you. Always consult your doctor before making changes to your treatment plan!
What To Do When It’s Too Late?
If you have not yet found a solution for your reflux symptoms and you notice the effects on your voice, read my blog post How Do You Take Care of Your Voice? for general tips on how to soothe your swollen and irritated vocal folds.
Consider canceling your gig, if your symptoms are too bad. If they are manageable, adapt your performance. Maybe switch up your songs, adjust the keys, or create a more intimate, less physically demanding version of your setlist. You’ll save energy and protect your voice.
Reflux is just one piece of the puzzle when it comes to vocal health. To dive deeper into this topic and many others, subscribe to The singsing! Sofa Library and get immediate access to the 3 webinars on SOS Voice!
Whether you’re dealing with reflux or other challenges, there’s a wealth of practical advice and tips waiting for you.
Here’s to taming the acid beast and keeping your voice in top shape. Now, go sing your heart out (without the burn)!
Sarah Joyce - Singer & Voice Teacher
As always, feel free to send me your thoughts, questions, and feedback in the comments below this blog, via the contact form or in the singsing! online community 
Cordially,
Sarah