Dreaded Reflux!

Several years ago, if you’d mentioned the word “reflux” to me, I’d have conjured up images in my head of a flask containing a solvent, a heating source underneath, and a water-cooled condenser in the top. OK, so not everyone has spent the time in chemistry laboratories that I have. Nevertheless, reflux is increasingly being used to describe what several years ago might have been called indigestion or heartburn. Of course, heartburn is a symptom, whereas the description of “reflux” is trying to get closer to what is actually happening. In the case of stomach acid, reflux – or Gastro-Oesophageal Reflux – describes stomach acid moving upwards out of the stomach into the oesophagus. For most people, this happens if they (over) indulge in many of the things they enjoy; rich food, spicy food, alcohol. For singers, however, it is something to be obsessed about to the degree that living anything approaching a normal life seems entirely out of the question. Of course singers are the one group of people who will find something, anything, to obsess about. We know it, non-singers know it, and it’s quite easy to parody! https://www.youtube.com/watch?v=qR8Pfqe2Js4

The problem, insofar as it is perceived, is that the stomach acid can travel all the way up the oesophagus, and then start to work its way towards the larynx, causing irritation, swelling and other damage. Singers will often worry terribly about GERD (gastro-esophageal reflux disorder – the “E” comes about due to our trans-atlantic cousins’ somewhat eccentric approach to etymology 😉 ). The major worry is that this will lead to reflux laryngitis. Almost any vocal problem is assumed to be due to reflux. Hoarse voice? Reflux! Bit of catarrh on a morning? Reflux! Can’t remember the words to the final scene in Act 3? Reflux! OK, so I made the last one up, but you get the idea.

So, what if you actually have none of the other associated symptoms of reflux? It’s still reflux, but it’s “silent reflux”. What about if you have an already diagnosed medical condition that fits all of the symptoms better? Nope, it’s bound to be reflux! I only mention this last one as I had direct experience of it. In the early days of the internet, I was told by a singer who I’d never met and who had never heard me sing that my catarrh and slight chesty cough that I sometimes get on a morning were caused by reflux, and not by the asthma that I was diagnosed with at the age of 3, and have regularly re-checked and monitored.

So, what’s the downside of thinking you have reflux? Well, it’s mainly the huge list of food and drink that you must “AVOID AT ALL COSTS!” The list mainly consists of tomatoes, garlic, onions, red wine, cheese, wheat and chilli. Recently I’ve been told that I should also avoid coffee – especially strong black coffee. Let’s face it, what we’re being told is to entirely avoid an Italian diet. I guess that’s ok, because after all, what have the Italians ever contributed to the world and culture of singing?

More seriously, whilst I have an increasing worry of the willingness of young singers to jump on whatever fad diet is currently in vogue, it often appears to be a search for blame rather than ever to admit there may be something lacking, or more accurately something still to be learned, in the area of vocal technique. Many excellent singers will tell you that they can eat a wider range of things when they know how to sing properly. I suppose it’s similar to the sportsman who gets a few lucky breaks in a match, but observes that the more they practice the luckier they seem to get.

If we are to sing excellently, then we must constantly observe ourselves, practice, get a second opinion from a good teacher, practice some more, read about how various singers describe their own singing, practice, read works by great teachers, practice again, and then if we think there is also an underlying medical condition, get it diagnosed and treated correctly. Adhering to an incredibly strict diet may not be fun, and may take a lot of time and effort – time and effort that could go into the more constructive things I’ve previously listed. In some cases it may end up causing more damage than good, although I’m not going to speculate because I am not a medical professional. However, I’ll leave you with the thoughts of someone who is a medical professional. Dr James Thomas is a physician who works in the area of voice disorders. His thoughts on the damage to the voice if you actually have reflux may surprise many people, and will certainly challenge some of the commonly held beliefs.