The reason I wrote this article is because I’ve subjectively noticed on repeated occasions, that the mere act of “talking” (i.e. speaking) significantly seems to worsen my laryngopharyngeal reflux (LPR) condition – even when stress is extremely low (relaxation is high).
How “talking” could cause or exacerbate reflux (Mechanisms)
Talking/speaking may significantly worsen reflux for select individuals via various mechanisms.
Mechanisms may differ significantly between individuals depending on the specific type and severity of reflux.
Abdominal pressure changes
It is known that coordinated contractions of the diaphragm and abdominal muscles (such as could occur during talking) might alter intrathoracic pressure to cause reflux.
If the abdominal region is significantly activated while talking – this could compress the stomach and put pressure on the lower esophageal sphincter (LES) to induce reflux.
Altered mucus flow
In the event that someone has preexisting reflux, talking might alter the flow of mucus in the nasopharynx (such as from postnasal drip).
This could be due to the act of talking OR increased inflammation resulting from talking (causing the mucus to become trapped more frequently).
Anxiety & stress
Talking can cause heightened anxiety/stress for some (e.g. those with social anxiety) – and this could directly alter esophageal function, induce hyperacidity of the stomach, and impair digestive processes – all of which might cause reflux to worsen.
Laryngitis, pharyngitis, & inflammation
Speaking may cause or exacerbate preexisting inflammation in the larynx (vocal cords), pharynx (throat), and specific structures (subglottis, epiglottis, trachea, etc.).
This inflammation might affect the movement of mucus and refluxate – such as to exacerbate preexisting reflux symptoms.
Perception of increased reflux while talking…
Included below are some of the things you may perceive while talking during a reflux episode…
- Increased globus sensation: This could be due to a combination of inflammation from reflux and speaking – along with
- Greater throat soreness: Talking may strain the throat and vocal cords (to some extent) causing the throat to feel sore (or sorer than usual if already sore).
- Stronger burning sensation: There may be a much stronger burning sensation (associated with acidity) in your chest, throat, nose, eustachian tubes, behind the eyes, or between the ears.
- Ear pains & eustachian tube dysfunction: These symptoms may become more frequent and/or severe as a result of talking during an episode of reflux.
- Stronger postnasal drip (mucus): It may seem as though your postnasal drip is way stronger when talking than when you refrain from talking.
- Sinusitis: It may seem as though sinuses are inflamed and/or that there’s some airway resistance while trying to breathe through your nose.
- Overall worse symptoms: The usual symptoms that you have might be more severe or noticeable when you talk a lot relative to when you speak less.
Variables influencing reflux severity/exacerbation from talking
Included below are some variables that I suspect could influence the severity of reflux exacerbations associated with talking.
These are based on my own self-assessment… I suspect others might make similar observations.
Total daily talk time: The more minutes/hours I spend talking per day, the worse my LPR symptoms become.
Long conversations: Long conversations (e.g. 30-60+ minutes) tend to be the absolute worst for my LPR. I’ve noticed that it’s better to have many short conversations throughout the day than one long conversation (at least for me) with regards to LPR symptoms.
Vocal stress & strain: The degree to which vocal stress and/or strain is experienced may influence the number and severity of reflux episodes that occur.
Vocal misuse & overuse: Any vocal misuse (e.g. screaming) or overuse (excessive talking) may influence the number and severity of reflux episodes that occur.
Lack of hydration: Dehydration can dry out the throat and may increase inflammation/damage to the area from acid. Furthermore, lack of hydration may enable acidic compounds (e.g. pepsinogens) to remain active for longer periods in the esophagus (causing
Posture: In most cases it’s best to be standing (rather than sitting) and to be “upright” rather than “hunched” forward. Both sitting and hunching may increase reflux episodes while talking.
Body mass index & body fat %: Talking may increase reflux more frequently in persons with a high body mass index and/or body fat %.
Talking right after eating: Talking immediately after finishing a meal or snack seems to worsen my reflux significantly. This could be due to the fact that food is still in the upper digestive tract and the act of talking alters esophageal function/pressure – making the food particles, stomach acid, and digestive enzymes more likely to “reflux” up into the esophagus.
Talking while eating: Talking while eating could cause food particles to get stuck in the esophagus and/or reflux upwards due to esophageal function/pressure changes during the act of speaking. (Stomach acids, bile, and other enzymes might also reflux during a meal if talking causes reflux by increasing stomach pressure.)
Singing (*): Although singing is obviously not “talking” – I felt it was appropriate to note that singing is a risk factor for exacerbating larynx inflammation and reflux conditions (LPR & GERD). Studies support the idea that singers are at higher risk for laryngeal disorders and reflux than non-singers.
Talking triggers and/or exacerbates reflux?
This has led me to believe that, for a subset of other LPR sufferers like myself, the act of talking might:
- Trigger reflux episodes (when none were occurring)
- Exacerbate preexisting reflux episodes (making them worse than they would’ve otherwise been without talking)
Note: Subjectively I’d say that I’ve experienced both #1 and #2 – but these were NOT objectively confirmed with pH-impedance monitoring.
Correlation & perception: Talking & reflux conditions…
Just because talking seems to subjectively: (1) trigger reflux episodes (when none were occurring) and/or (2) exacerbate ongoing reflux episodes – does NOT mean that talking is causally implicated.
Many people can easily trick themselves into believing that “A” (e.g. talking) causes “B” (e.g. reflux) on the basis of correlation (e.g. every time I talk a lot at night my reflux seems to worsen).
The problem here is that talking a lot at night might be confounded by the specifics of dinner (specific foods/drinks consumed, rate of consumption, number of calories consumed, specific dinner time, etc.).
We may later realize that this individual was eating an acidic food every dinner – or eating a large amount of food rapidly to cause a reflux flare up at night (while “talking a lot” at dinner with family and friends).
In this case, while talking may have contributed to symptom exacerbation – it’s more likely that “talking” was just a correlation. Perhaps eating a lower acid dinner and/or consuming less total food would cause this correlation to vanish.
Another thing that can happen is that we may perceive our reflux as worsening while talking – even if talking isn’t causing it to worsen. What might happen for some is that reflux was already severe (such as from overeating) and this caused increased inflammation, postnasal drip, burning sensation, etc.
The preexisting “reflux flare” might make it more difficult than usual to talk. And when you end up trying to talk – you mistakenly assume the talking is exacerbating the reflux rather than realizing the reflux merely makes it significantly more uncomfortable and difficult to talk – due to the presence of mucus from postnasal drip.
Note: I’m not suggesting that talking is incapable of causing reflux because I believe it probably can in select cases. However, I’m recommending that you think critically about correlation & perception before assuming causation.
Shouldn’t talking always trigger reflux (if it’s a real cause)?
One might think that if talking causes or exacerbates preexisting reflux conditions (e.g. LPR & GERD) – then it should do this consistently.
However, I don’t think that it makes sense that it would always cause reflux – even if causally implicated.
Why? There may be a certain threshold for: (1) total talk time & (2) degree of vocal strain – wherein when exceeded (e.g. 60-minute talk with severe vocal strain from yelling) – significant reflux flares occur.
Talking may not be a direct cause in everyone who notices it as a trigger.
For example, talking may exacerbate reflux symptoms (e.g. LPR “globus” or “postnasal drip”) if done during and/or immediately after a large meal – relative to zero or minimal talking.
In other words, causing may be capable of exacerbating symptoms – only if certain preexisting conditions are met (e.g. full stomach from overeating).
Another reason that talking may not always exacerbate reflux symptoms is due to proper administration of reflux-related treatment.
If a reflux condition is well-controlled from medication (e.g. PPIs & H2 antagonists) then perhaps talking will be less likely to trigger symptoms than if symptoms are poorly controlled (untreated or unresponsive to current therapy).
That said, there are likely select individuals who notice that talking: (1) induces and/or (2) worsens preexisting reflux episodes – on a consistent basis.
Which conditions are associated with worse reflux from talking?
Included below are some conditions that cause reflux and may worsen from talking.
Laryngopharyngeal reflux (LPR)
Laryngopharyngeal reflux affects the larynx (throat & vocal cords) – and is commonly associated with “globus sensation” and “postnasal drip.”
Many people notice that talking causes their LPR symptoms to flare up.
Gastroesophageal reflux disease (GERD)
Although gastroesophageal reflux disease doesn’t typically affect the larynx, some individuals may notice that talking frequently causes reflux or worsens preexisting heartburn.
As was already mentioned, this could be due to changes in esophageal function and intra-abdominal pressure during speech.
Unmanaged anxiety can induce hyperacidity and esophageal dysfunction for some individuals.
If the anxiety is social, then “talking” will cause anxiety to increase significantly – which logically could increase reflux episodes and the severity of each (due to stomach hyperacidity).
Functional GI disorders
Functional GI disorders are caused by dysfunction of gut-brain crosstalk (i.e. interaction).
Most functional disorders are associated with ongoing or former episodes of stress.
If stress increases while talking, this may exacerbate esophageal dysfunction (causing reflux) and acidify the stomach (causing the reflux episodes to “burn” more).
Did talking really worsen or cause the reflux?
Unknown. Likely depends significantly on the individual and physiological underpinnings of the reflux condition.
Also depends on whether the individual legitimately has acid reflux (i.e. was properly diagnosed by a medical doctor).
I questioned a couple of ENTs (otolaryngologists) as to whether talking can worsen acid reflux conditions like laryngopharyngeal reflux. My answers are below:
ENT #1: “Yes. Globus increases straining your throat. Voice rest is recommended.”
This isn’t necessarily implying that talking causes the reflux, rather, that the presence of globus increases throat strain while speaking – which is essentially a vicious circle feedback loop.
For example: acid reflux causes laryngeal inflammation & postnasal drip which put more strain on this region when speaking. Increased strain while speaking may amplify inflammation and further exacerbate postnasal drip.
ENT #2: “LPRD makes your vocal cords and laryngeal tissues hypersensitive to any type of strain (due to chronic acid induced inflammation). So threshold for fatigue is much lower. When you speak more tissues in your throat become fatigued and can induce globus-like symptoms.”
Gastroenterologist: “In 20% of individuals with GERD/LPR, half have hypersensitivity of esophagus” which could explain the worsening of symptoms from speaking.
Is there any science to support the idea that (1) talking and/or (2) voice overuse can cause or exacerbate reflux?
Most experts do NOT believe that vocal overuse (e.g. among full-time singers & voice actors) directly causes reflux conditions such as laryngopharyngeal reflux (LPR).
That said, there appear to be higher rates of laryngeal issues – including LPR – among full-time singers and voice actors relative to the general population.
This could be due to: (1) causality (increased vocal strain causes LPR in some individuals); (2) lifestyle associated with these professions (e.g. late night eating, intermittent fasting, high stress, etc.); and/or (3) more frequent medical consultation/examination for laryngeal function among individuals in voice-dependent careers (resulting in higher rates of diagnosis).
Robotti et al. (2021) (R)
Amateur choir singers (N=392) do not manifest a higher impairment connected to LPR (RSI score) but they do report a higher level of voice impairment & vocal tract impairment – relative to control subjects (N=514).
Lloyd et al. (2017) (R)
- Singing requires a high magnitude of recruitment and activation of respiratory and laryngeal structures.
- Tasks which emphasize coordinated contractions of the diaphragm and intercostal and abdominal muscles may place singers at an elevated risk for developing LPR due to high-magnitude changes in intrathoracic pressures that may occur during such maneuvers.
- During inspiration, the thoracic cavity expands and the diaphragm compresses the stomach, putting pressure against the LES, potentially causing stomach acids to reflux into the esophagus.
- There is a similar effect during prolonged expiration, as with singing, as the abdominal muscles are activated and exert pressure against the stomach wall as the thoracic cavity compresses.
- These pressures can affect lower esophageal sphincter (LES) opening & closing – potentially contributing to dysfunction.
- Individuals who engage in singing as a primary professional activity frequently have higher reflux symptom scores.
- Singing may alter other physiological processes in the GI tract – causing hyperacidity and/or dysmotility.
- Performance-related stress/anxiety and irregular eating habits (eating late at night following rehearsal/performances), suboptimal sleep schedules, etc. – could also increase risk of LPR among singers.
Hocevar-Boltezar et al. (2012) (R)
- Laryngopharyngeal reflux affects choristers more often than the teachers or control subjects without vocal load at work.
- These results suggest that singing as the main professional activity can notably contribute to the development of the reflux.
- Vocal load without singing is probably not an important etiological factor for LPR.
What does this research suggest?
Singers may be at higher risk for development of laryngopharyngeal reflux (LPR) than non-singers.
Total vocal burden among non-singers does NOT appear to be a risk factor for reflux conditions like LPR.
It is possible that vocally-demanding professions (e.g. voice acting) and/or hobbies might increase risk of developing LPR and/or GERD in a specific “at risk” cohort (e.g. stressed, high body fat %, late-night eaters, etc.).
At this time there haven’t been any studies investigating the impact of total vocal usage on reflux-related symptoms – among persons with medically-confirmed reflux conditions (e.g. LPR, GERD, etc.).
This considered, it’s possible that frequent talking, vocal overuse, or excessive vocal strain could exacerbate reflux symptoms via inducing: (1) GI dysmotility; (2) esophageal sphincter dysfunction; (3) stomach pressure; and/or (4) inflammation.
How to manage worsening of reflux from talking…
Included below are some tips that I suspect might help a subset of individuals for whom talking seems to worsen reflux.
Treat anxiety & stress
If you have anxiety and/or stress along with reflux (regardless of whether it was around long before the reflux OR emerged after the reflux) – treatment is critical.
Why? Both anxiety and stress can exacerbate preexisting reflux even if they aren’t the underlying causes.
For some individuals, anxiety and stress are the underlying causes of “globus sensation” and many of these people self-diagnose with “LPR” (even though they don’t have true LPR).
- Daily walks (outside, nature, etc.)
- Meditation & prayer
- Breathing exercises (diaphragmic, paced, etc.)
- Medication: Anxiolytic agents that won’t add acidity OR adversely modulate esophageal sphincter function such as to increase reflux.
- Supplements: Anxiolytics but ensure they don’t add acidity OR adversely modulate esophageal sphincter function such as to increase reflux.
- Sleep: Focus on improving sleep as much as possible. Treat any sleep disorders with interventions recommended by your doctor (e.g. melatonin, CPAP machine, etc.).
Note: Even if you don’t think that you have anxiety and/or stress – engagement in relaxation shouldn’t worsen reflux and is worth testing. Some individuals may have psychogenic conditions wherein reflux is a component. Fixing the brain chemistry and emotional components can often eradicate the reflux.
Avoid excessive talking (rest larynx)
If you know for certain that talking worsens your reflux, simply talking less or avoiding excessive talking (such as long conversations) is recommended.
Why? Because talking might actually be exacerbating your reflux symptoms.
Moreover, it might take longer to recover from symptom exacerbations due to increased laryngeal inflammation resulting from long conversation.
Wait 30-120 minutes after meals to talk
I’ve noticed that if I talk a lot while eating OR immediately after eating – my LPR symptoms are WAY worse than if I wait at least 30-60 minutes post-meal.
Some individuals may benefit from waiting 2+ hours after a meal (e.g. dinner) before making a phone call or having a conversation.
No vocal strain (e.g. singing, yelling, etc.)
Straining your voice such as by singing, yelling, or even talking loudly – could increase laryngeal inflammation and exacerbate symptoms like globus sensation and postnasal drip in persons with LPR. Avoid noisy environments and speak normally.
Sip alkaline water
Don’t drink an excessive amount of water though – as this could expand the stomach and increase reflux episodes.
The idea here is to maintain adequate throat lubrication and hydration – while decreasing activation of acidic compounds (e.g. pepsinogens) in the laryngeal area.
Chew unflavored/plain gum (?)
Might make symptoms better for some by augmenting digestion, increasing saliva production, and altering esophageal function to some extent.
However, chewing gum might make symptoms worse for others – so proceed with caution here.
I recommend unflavored/plain gum such as to avoid damaging teeth or triggering reflux via gum ingredients.
Stand while talking
This won’t work well for everyone because some individuals actually have worse “upright” reflux relative to other positions.
However, most people with reflux will find that standing upright (rather than sitting/slouching/lying down) helps reduce the severity of reflux symptoms.
For this reason, it makes sense that standing up while talking could help reduce reflux exacerbation associated with talking.
Monk mode (zero talking)
Going full blown “monk mode” (zero talking) may promote recovery from reflux if the reflux was caused or exacerbated by the act of talking.
Some individuals may find that “zero talking” for a specific number of days reduces symptoms to a significant extent.
Avoid smoke (all types)
Smoke of any type is horrible for reflux for a variety of reasons.
Smoke exposure has been shown to induce transient lower esophageal sphincter (LES) relaxations, irritates the larynx & esophagus (dryness & inflammation), and makes it more difficult for your body to efficiently clear “refluxate” (refluxed material) from the esophagus.
This means no smoking, bonfires, air pollution, or excessive cooking fumes.
Formally diagnosed with a reflux condition vs. anxiety disorder and/or self-diagnosed
Included below are 3 specific types of individuals who complain that “talking” worsens acid reflux.
Type 1: Talking worsens “globus” associated with anxiety (no actual reflux)
There is a significant problem on various “reflux” forums (e.g. Reddit) wherein a significant percentage of individuals claiming to have reflux conditions such as GERD & LPR – are self-diagnosed (not formally diagnosed by a medical doctor).
Although a percentage of these self-diagnoses may be accurate, there’s likely a significant percentage that are inaccurate.
Severe anxiety alone (such as in hypochondriasis) can convince some individuals that symptoms such as throat tightening and chest tightness (somatic manifestations) – are related to an “acid reflux” condition such as LPR & GERD.
Many individuals with anxiety disorders experience throat tightness and difficulty speaking from the physiologic underpinnings of the anxiety… but this does NOT mean that they actually have reflux.
These individuals may report a significant worsening of “globus sensation,” “postnasal drip,” or “acid reflux” (LPR) while talking/speaking.
The reality is that individuals with anxiety may experience an uptick in anxiety while talking/speaking (particularly if social anxiety) and this may amplify the throat/pharyngeal tension such that these patients conclude that talking/speaking is worsening their “reflux” (a condition which hasn’t been medically confirmed).
It would be more accurate for these individuals to claim that talking/speaking is worsening their “globus sensation” – and this makes logical sense (anxiety/stress amplifies physical symptoms resulting from anxiety/stress).
Note: Patients with high anxiety should still be examined for reflux – as many of them likely have legitimate reflux. However, if no actual reflux is found – then this is not true reflux.
Type 2: Talking worsens reflux (medically-confirmed reflux)
Among individuals with medically-verified acid reflux conditions (LPRD, GERD, etc.) – it is certainly possible to experience a worsening of reflux as a result of talking, even if these individuals have no significant anxiety or stress.
This is because talking could: increase intra-abdominal pressure, increase inflammation in the throat, and/or cause mucus (from postnasal drip) to shift around into other tangential regions (e.g. eustachian tubes, sinuses, etc.).
Type 3: Talking & anxiety worsen reflux & globus (anxiety & reflux patient)
Among individuals with co-presenting, medically-verified: (A) anxiety/stress disorders & (B) reflux conditions (e.g. LPRD & GERD) – talking may cause significantly more episodes or exacerbations of reflux than in persons without both of these conditions.
Why? The anxiety component could cause hyperacidity and/or functional esophageal disorders – each of which can exacerbate and cause reflux episodes, respectively.
Anxiety can also cause throat tension/tightening which may worsen reflux as well.
Add “talking” to the equation and this could increase: inflammation in the throat/vocal cords, intra-abdominal pressure, alter mucus flow (in those with postnasal drip) – all of which could cause further anxiety.
Ultimately this can become a vicious circle wherein talking could increase anxiety while simultaneously exacerbating reflux.
The exacerbation of reflux might further increase anxiety – which in turn could further worsen reflux symptoms.
Note: Many armchair “experts” on various forums assume that everyone with worsening of reflux from talking simply has anxiety. While this can be true in some cases – it’s not always the case and shouldn’t be assumed as the cause.
My experience with worsening LPR from “talking”
I’ve noticed intermittent bouts of significantly worse laryngopharyngeal reflux (LPR) symptoms while talking or after talking.
And although I cannot be 100% sure the talking is a trigger – it sure seems like it is (at least on occasion).
- I’ve been formally diagnosed with laryngopharyngeal reflux (LPR) by an ENT.
- My anxiety & stress levels are low and my sleep is good quality.
- I’ve tested various anxiolytics (alprazolam, dimenhydrinate, clonidine, gabapentin) just to see if it would help with LPR or reduce the “globus sensation” & “postnasal drip” – made ZERO difference.
- I also meditate every day and walk outside in nature to keep stress low.
Talking during meals: Occasionally I’ll get a phone call while I’m eating and I’ll answer to have a conversation. I have no anxiety/stress while speaking, however, my globus sensation and postnasal drip worsen substantially (such that I no longer talk as much while eating).
Talking right after meals: Talking immediately after eating, especially lunch or dinner, seems to cause a significant increase in my postnasal drip. I end up with more total LPR symptoms and more severe symptoms (e.g. ear pains, eustachian tube blockage, more noticeable globus, dizziness, etc.).
Long talks: The longer I end up having a conversation, particularly in close proximity to meals, the worse my LPR symptoms become. I recall having a ~60-minute conversation that had both my ears in pain and caused extreme dizziness to the extent that I had to hold objects while walking.
In a nutshell, my LPR worsens significantly from talking (there’s a strong and consistent correlation) – relative to not talking. On the days that I barely talk, my symptoms are usually more tolerable and less severe.
Note: I am NOT ruling out mere correlation here and realize that perceptual changes (greater difficulty talking during severe reflux episodes) may account for my subjective experience more than talking as a “cause” or “exacerbator” of symptoms.
How to investigate whether talking affects your reflux…
Use pH-impedance monitoring to determine the specific times at which your reflux flares up.
Track the specific times at which you talk a lot and determine whether they correlate with data from the pH-monitoring (e.g. major symptom flare up at 2 PM during a business call).
Ideally you’d want to check reflux episodes on days when you talk a lot vs. days on which you intentionally don’t talk much and see how they compare. pH-impedance monitoring is the most objective way to track reflux symptoms.
Track everything you do throughout the day in a notebook. Write down times, reflux symptoms at various intervals, and feeding schedule.
Next schedule one day to “talk a lot” and another day to “talk minimally” (or stay silent) – and compare symptoms on each day.
Combined tracking (pH monitoring + subjective tracking)
You could do a full day wherein you maintain the exact same routine/regimen – but the only thing you do differently is talk way more on one day than the other.
Track objective reflux episodes/severity with pH monitoring & track subjective symptoms in a diary.
Determine whether there is any correlation between symptom severity and the day on which you talked a lot.
Have you experienced worsening reflux from talking?
If you’ve experienced significantly worse reflux from “talking” – feel free to share your experience below in the comments.
- Mention whether you have any anxiety/stress that may be contributing to the worsening of your reflux.
- Do you think your reflux is “objectively” worse after talking – or do you think it could be “subjectively” worse such as due to flare up in somatic symptoms of anxiety?
- Have you considered that the worsening of reflux might just be a correlation with “talking”? For example: You talk more while eating a large meal or after a meal – and the meal itself was the trigger of your reflux rather than the talking.
- Which specific mechanism(s) do you think play a role in your reflux worsening after talking?
- If talking is significantly worsening your reflux – have you ever tried an experiment wherein you talk significantly less, minimally, or not at all for a certain amount of time to determine whether your condition improves? (If you’ve already done this experiment, let us know how it went.)
Remember that it’s ultimately difficult to know with 100% certainty whether talking actually causes reflux to worsen.
In some cases, there may be a strong correlation between talking and reflux, but there may not be any causality despite you thinking so.
For example, reflux may significantly worsen while talking to friends at dinner – leading you to think that the talking is making the reflux worse.
However, worsening reflux may actually be due to the specific foods you ate, the amount of food consumed and/or the fact that your reflux always flares up around meal times.
In other cases, it might just seem like talking is causing reflux to worsen – when in reality your reflux was already flaring up and talking makes it more noticeable than if you talk less (due to inflammation and/or the movement postnasal drip in the nasopharynx).