Musician Dangers And Prevention Of Gastroesophageal Reflux

Photo by Kathy LaBella, RDN, CDN, CSSD

Gastroesophageal reflux disease known as GERD is both uncomfortable and dangerous for anyone, especially for those who use their voice as a profession, or for musicians who play wind instruments. With GERD, the gastric contents of the stomach reflux back into the esophagus by way of the lower esophageal sphincter known as the LES. Under normal circumstances the LES has high pressure that prevents the backflow of stomach acid, mainly hydrochloric acid back into the esophagus, but with GERD the LES has low pressure, it’s weak and remains open allowing backflow of stomach acid that can lead to inflammation of the esophagus known as esophagitis. Erosion and ulcerations can occur, and at times strictures of the esophagus narrow the opening, and there is a higher risk for esophageal cancer. When people have GERD they often complain of heartburn after eating or after laying down too soon. For musicians, it is not only the discomfort, but the physical attributes leading to decreased vocals and performances because this can also damage the larynx. In addition to GERD there is laryngopharyngeal reflux, this is acid reflux into the larynx that can cause laryngitis, or a sore throat, or mucous, and in some cases reflux in general can make swallowing difficult.

There are several causes of GERD, one being a hiatal hernia; other common causes are excessive alcohol and smoking that irritate or exacerbate the condition of GERD by lowering the pressure of the LES. Additional irritants include increased amounts of coffee and tea due to the acidity, high fat foods, calcium, chocolate, spearmint, peppermint, citrus foods, and nicotine in general. Years ago I would often have people avoid many spices including pepper, cloves, and chili, today I often recommend spices as tolerated, but depending on the individual, the major offenders through my years of experience is excessive alcohol, coffee, smoking, and chocolate, and to a lesser degree spearmint and peppermint.

Nutrition prevention for GERD include foods that increase the pressure to keep the sphincter closed and the esophagus comfortable include higher protein content from lean sources other then fatty meats, or dairy due to the calcium content. Lean protein can include fish, skinless turkey or chicken, a lean roast beef, or vegetable protein. Consuming smaller frequent meals, decreasing weight as necessary if overweight, and waiting a couple of hours after eating before laying down, or propping yourself up with a pillow to prevent contents coming back up from the stomach. Consume plenty of fluids, preferably water, and avoid tight clothing. There are antacids, however I am not a personal fan of antacids because they decrease necessary hydrochloric acid needed to absorb B12, therefore I prefer to correct the problem rather than cover it up. In some instances, your physician may prescribe a proton pump inhibitor such as Prilosec or Nexium that unfortunately may have some long term side effects, therefore it is up to each individual to discuss this with his or her physician, and weigh out the options, or start with medication to ease the pain to stop the reflux pre-performances, and then work on diet to omit or decrease the medication as able.

For more information on healthy ways to include calcium, preserve bone health, or consume your favorite foods with GERD – stay tuned to Peak Performance RD as new programs about nutrition and health for musicians will be available soon! And as always, individual counseling sessions are available and covered by many insurance plans, please visit Nutrition for Musicians.