Most people just call it “reflux” or “acid indigestion.” No matter what you call it, we all know how laryngeal reflux feels, right?! You cannot believe how badly it burns your throat — so nasty and unpleasant, to put it mildly! What are the best solutions for laryngeal reflux?!
FYI, the medical term is “gastroesophageal reflux disease,” with the unattractive abbreviation “GERD.”
Common Cause of Laryngeal Reflux: Hiatal Hernia
Evidently there is a high percentage of people who experience a hiatal hernia without any symptoms whatsoever. Then again, there are many folks for whom a hiatal hernia is the main cause of acid esophageal reflux. This needs to be medically ruled out, so please ask your doctor. Here is a short video, with detailed anatomical images, to give us an idea of the way a hiatal hernia can cause reflux.
The YUCK Factor
Reflux, including laryngeal reflux, happens when food is not thoroughly digested in the stomach. For unknown reasons, the sphincter muscle at the bottom of the esophagus weakens. Stomach acid is not securely contained and is able to splash back up through the esophagus. This often reaches the throat. As you probably have experienced, acid reflux causes intense burning and discomfort. It also has terribly negative effects upon the vocal anatomy, causing hoarse voice and loss of voice.
When stomach acid reaches your vocal folds, it causes inflammation and disruption of the mucosal lining. We know that the body’s defenses swoop in, trying to repair irritated, inflamed mucosal lining, by flooding it with lots of thick mucus. Obviously, for a singer it is a miserable and upsetting situation.
Many singers react to laryngeal reflux with a hoarse voice and eventually laryngitis. Until you have excellent treatment, the problem is bound to persist and worsen over time. Repeated episodes of stomach acid splashing onto the vocal anatomy puts you at risk of permanent damage to your voice. No two ways about it: you must safeguard your irreplaceable singing instrument with the primary focus upon prevention.
The Reflux Must Stop!
Once the reflux is stopped, your body has a chance to heal, so your throat can clear. You don’t want to be in a position of feeling pressured about singing when your voice is hoarse. As mentioned in another post on this blog, forcing your voice through inflammation and hoarseness is always going to lead to voice loss.
Singers can feel pressured by the demands of performance contracts, believing that “the show must go on.” However, when you are confronted by an ailment that is causing you to be vocally ill, you should never feel alone. We are all flesh and blood human beings. Every singer occasionally suffers from one ailment or another, with unwanted effects upon the voice. You might or might not decide to cancel a singing engagement. And this decision is important for lots of reasons. But what matters even more is what you do next. Seize the opportunity for learning all you can from this ordeal. The knowledge gained from a tough physical challenge is exceedingly valuable. You will begin to understand more about your body and how to prevent recurrences. So the distressing problem of laryngeal reflux is not a breakdown but a breakthrough!
Some of the other posts on this blog discuss the other causes of hoarse voice.
But, this is our first post about laryngeal reflux.
Hotter than Hell!
Feels like your throat is on fire, right?!
What have you already tried for your symptoms? Prescription medication? Over-the-counter antacids? Natural remedies?
Right off the bat, it should be mentioned that numerous prescription medications have the side effect of reflux. Check the list of known side effects for any medications you take and let your doctor know you want to prevent acid reflux. It is always wise to inform your doctor that you are a singer and you want to avoid laryngeal reflux, because it is so harsh upon the voice.
And who should we trust for the best advice on natural remedies? Back in the mid-90s, I discovered the books of Dr. Andrew Weil, Harvard-educated MD and founder of the Center for Arizona Center for Integrative Medicine, in Tucson, AZ. My experience is you are on safe ground, trusting information and advice from Dr. Weil. Here is Dr. Weil’s outstanding advice for preventing and treating laryngeal reflux.
The Power of Gravity on Your Side
One important recommendation from Dr. Weil is to elevate the head of your bed. My own solution for this one is to sleep using a backrest pillow. Here is the exact bed rest pillow I use and personally swear by:
If you don’t want to sleep on a backrest, you can easily raise the head of your bed, six to eight inches. This will ensure gravity is on your side, to prevent reflux. You could also use a wedge shaped support cushion.
Preventing reflux requires that your entire upper body be elevated. Using extra bed pillows is not a solution, because it will elevate only your head and not your whole upper body. This will actually make your reflux worse!
Dr. Weil has a specific article on elevating your bed properly. However, he points out that elevating the bed is not the primary treatment that he recommends for treating reflux.
Licorice Root
In fact the main remedy Dr. Weil recommends for laryngeal reflux is the herb licorice root. People have been using licorice root for centuries, to treat inflammatory conditions. Licorice root has a soothing anti-inflammatory effect, as it works to heal the dried mucosal lining. And note that Dr. Weil typically advises to follow dosage instructions on product labels.
The plant chemical name for licorice root is glycyrrhizic acid, meaning “sweet root.” This is the same substance used to make licorice flavoring and candy. (By the way, glycyrrhizic acid — licorice root — is not at all the same as the acid produced in the stomach.)
When to Ask Your Doctor
Important: Do not use licorice root if you have high blood pressure. For normal adults, my research indicates this is safe to use, but for no longer than about 6 weeks. Although licorice root is a recognized helpful treatment for acid reflux, there is some controversy about possible safety issues, especially at higher doses. Please be sure to have your own doctor look this up and specifically advise you, on whether or not licorice root is the best remedy for you.
Medical Evidence Favors Melatonin for Laryngeal Reflux
This next article is from 2010 but has information about using the hormone called melatonin for acid reflux. Melatonin, available over the counter, can be an effective sleep aid, particularly useful for jet lag. There are medical studies demonstrating that patients with reflux also have a sleep disorder. And I am now reading wonderful medical evidence showing that melatonin works beautifully, to prevent reflux!
Here is Dr. Weil’s article about using melatonin to help with acid reflux.
Super Specialist ENT Doctor for Singers: Dr. Joseph Sugarman
When you need to be evaluated by an ENT (ear, nose, throat) specialist doctor, finding one who has great experience and interest in treating singers, specifically. As a resource guide, this post on how to get rid of laryngeal reflux, would not be complete without including a fabulous article, by a famous ear, nose, throat specialist, Dr. Joseph Sugarman of Los Angeles.
Don’t miss this one, as it is very sympathetic to your special needs as a singer.
Foods to Avoid
It is well known that some foods can make laryngeal reflux worse. But the truth is not every one of these foods will likely trigger reflux for you. Listen and observe what happens in your own body and begin keeping a journal or at least a list of foods, medications, and anything else that you discover is irritating your own reflux. Your journal should also include what you have discovered is helping the problem. Now you are on your way to some real prevention!
Because we are focusing on which foods to try and which to avoid, one undisputed fact is any form of nicotine definitely will aggravate reflux. Please stay away from all forms of nicotine!
A Partial List of Foods Known to Trigger Laryngeal Reflux
Fatty foods
Spicy foods
Acidic foods, like tomatoes and citrus
Mint
Chocolate
Onions
Coffee or any caffeinated beverage
Alcoholic beverages
Carbonated beverages
In general, it is recommended not to eat huge meals. It is also best to avoid eating for at least 2-3 hours, before lying down to sleep.
Low-Tech Natural Antacid
One old-fashioned home remedy I like is to stir a small amount of baking soda into a cup of water (8 -10 ounces). Take small sips and it begins working fast. For me, this works well to prevent laryngeal reflux.
Try Candied Ginger or Ginger Tea
This is another herbal remedy for reflux, which Dr. Weil recommends. Ginger has been used for many centuries to reduce inflammation and is especially good for the stomach.
As a singer who loves to eat, and as a woman who has been overweight for more years than I care to admit, the problem of acid reflux is something I’ve had to deal with, almost constantly. Preventing ailments requires a lot more time and work, as opposed to just waiting until the problem is in your face, screaming for your attention urgently.
Ask me about private singing lessons! You are welcome to email me directly: Gretchen@SingingAndYou.com. Details are available on request and I’m eager to hear from you!
The Peppermint Debate
Let’s talk next about peppermint. The list above includes “mint,” so we have to assume this includes peppermint. Do you enjoy a good debate? Lots of qualified people feel strongly that peppermint is an outstanding remedy for general stomach health and digestion. Other respected medical people say that peppermint will actually weaken the sphincter muscle at the bottom of the esophagus, triggering reflux.
I enjoy peppermint tea and have found it helpful to actually settle the stomach, in addition to being a nice relief for minor headaches. But once a gastroenterologist doctor (stomach specialist physician) advised me that any form of mint can aggravate reflux.
My recommendation on this one is if you are already struggling badly with reflux, avoid mint in all forms. However, if your case of reflux is not terribly severe and you would like to try peppermint tea, drink a little of it as a small experiment. It would be best if you can keep yourself vertical, not lie down, for at least 20 minutes or so, after drinking peppermint tea. And please remember the general recommendation to not lie down after eating for about 2-3 hours.
Here we have an interesting article that examines the question of whether or not peppermint is helpful for laryngeal reflux.
Keep A Reflux Journal
Once again, we discover an excellent reason you should keep a journal. Make someone notes along the way, about your episodes of laryngeal reflux. Write down what triggered each one. Write down what is helping to avoid them, etc. Keep all of this valuable information in a journal, specifically designated for helping to treat your reflux.
At some point this blog will offer a free printable journal for your convenience, to keep these important records. Then if you need to see a doctor, your journal notes will be enormously helpful for taking your treatment plan to the next level. And it is a certainty your doctor will be very pleased that you kept such a journal!
Can You Count to 4-7-8?
Stress is a known trigger for reflux. Nearly every one of us needs to manage stress better. The recommended breathing exercise, very powerful for stress management, is found here.
Singers have particular and specialized needs, obviously, as we live with the responsibility to constantly look after not only our vocal anatomy, but our whole bodies, our whole minds, our humanity. If you learn one thing from this blog, please let it be this: Your whole body-mind is your singing instrument.
When You Need Immediate Relief
For reflux and for any other ailment, prevention is the goal. We each have to work on preventing laryngeal reflux. However, for anyone depending upon the health of the vocal anatomy, if you are woken up with an episode of burning laryngeal reflux, this requires immediate care. As quickly as you can following an episode of reflux, you should take liquid antacid.
Chewable antacid tablets have long been available for Pepto-Bismol, Rolaids, and Tums. More recently, chewable forms are available for antiacids such as Gaviscon, Mylanta, Maalox, Milk of Magnesia, and Alka-Seltzer, etc. Bear in mind that for urgent relief, liquid antacids work best by far.
A liquid antacid will spread faster, more quickly providing relief to the area of your worst discomfort. My experience, plus specific recommendations from a stomach specialist doctor, is that the best liquid antacid is Gaviscon. This brand does not contain aluminum, which you should avoid. And Gaviscon actually helps form a seal, effective for stopping the backsplash of stomach acid.
Your Call
When you have a medical emergency, you must immediately call 911. And be sure to inform your doctor as always.
For instant relief, your first priority is stopping the severe burning and calming the stomach. Keep a bottle of liquid antacid at your bedside. If you are woken up by the burning of reflux, first prop yourself up, so you are not fully reclined. This allows gravity to work in your favor. Instantly swallow your liquid antacid. BREATHE and give the medication a minute or two. If you need to take more of your liquid antacid, you should go ahead and take it without hesitation. This presumes no allergy to the medication itself and no conflicting previous advice from your doctor. If in doubt, check with your doctor, absolutely.
Focus on Prevention
Liquid antacid should be used only for urgent moments, when an episode of acid reflux is burning in your throat. If you use liquid antacid every day, it is likely there will not be enough normal acid in the stomach, necessary for digestion. This causes reflux to worsen. Your answer is to develop a prevention routine that suits you personally.
Once you are beyond the urgent episode, now we work on prevention, because no one wants to be woken up with an attack of laryngeal reflux! Your sleep will be badly disturbed, and you must mobilize urgently to deal with the firestorm of stomach acid, splashed up into your throat.
As mentioned, this is a serious risk to your vocal health and will commonly cause a hoarse voice. Hey, no thanks to any of this, right?!
The Root of the Problem
One main cause of reflux is actually the lack of stomach acid, necessary to digest food. Normal stomach acid also eliminates bacteria and viruses in the stomach, protecting your body from infection.
Here is a good article on the deficiency of normal stomach acid.
Some people swallow a tablespoon or so of apple cider vinegar immediately before meals. This tends to aid digestion, especially if your stomach is not producing enough normal digestive acid.
If the main cause of reflux is a deficiency of hydrochloric acid, then the last thing we want to do is to further reduce stomach acid, by using antiacid products. This includes medications that work to block stomach acid (called H2 blockers).
Over-the-counter meds, such as Tagamet, Pepcid, Zantac, Prilosec, Nexium, Prevacid, and others, are intended to reduce or block stomach acid. We certainly should question whether a short moment of temporary relief is worth aggravating the underlying cause of laryngeal reflux.
This is a question and conversation to have with your primary care doctor or with a specialist doctor (gastroenterologist).
What are your specific concerns, your experience with acid reflux? How do you prevent reflux? Is there a certain medication your doctor has ordered, which you are finding is actually a positive or a negative experience for your case of reflux? Do you follow a certain diet. Or do you know about treatments for reflux, not mentioned in this post?
Your Comments Make it Real
This post has been a fairly deep dive into the causes and natural remedy treatments for laryngeal reflux. The most valuable knowledge base of all is made possible when you contribute your thoughts and suggestions, your experiences, relevant to our topic. Please leave your comments below and let’s all listen and benefit from relating to each other, as a supportive community!
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