Anthony F. Jahn, M.D.

Articles and Tips

Libiamo! (Starbucks Edition)


While the usual discussions about “drinking” focus on alcohol and the need for hydration, I recently received the following inquiry from a reader:

I am a 46-year-old male and sing regularly as a contemporary Christian artist, but for the last six months I have noticed less control and flexibility in my voice. I am wondering if drinking coffee would have any effect on the use of my voice. I have only begun drinking daily in the past few years.

I have read enough to know that caffeine could be the culprit—and if so, do you have any other words of wisdom on keeping my voice hydrated other than lots of water? And would the caffeine have damaged my cords, or is that possible?

Well, yes. Coffee can affect your singing and your voice in several ways—and since most of us drink more coffee than alcohol, the answer merits a column. The active ingredient in coffee is caffeine, which has numerous important effects on the body in general, and on singers in particular.

Caffeine has a general effect on alerting the central nervous system, which is why many of us have our cup in the morning. However, excessive amounts can make one irritable and jittery (does anyone remember the old advertisements featuring “Mr. Coffee Nerves”?).

How does this happen? Caffeine makes the muscles more irritable and increases the tendency to contract. It does this by releasing more calcium into the circulation—and calcium is the ion that makes muscles contract. The calcium comes from your bones and, for this reason, there may be a tendency towards osteoporosis, especially if you are post-menopausal, drink excessive amounts of coffee, and don’t take calcium or medications to combat osteoporosis.

From the vocal point of view, increased muscle contractility translates into loss of control, possibly even muscle tremors. Any task requiring fine motor control and minute degrees of movement can be impaired by this tendency of caffeine to increase muscle contractility. For that reason, those of us who perform microsurgery have learned by experience to skip that morning cup before going to the operating room.

Caffeine is often thought of as a diuretic—you certainly feel the urge to run to the bathroom after a couple of cups. Some of this, however, may again be due to the effects of caffeine on muscle: the urge to urinate is a response to distention and stretching of the muscles of the bladder wall. If these muscles are more irritable, the need to urinate will occur sooner and more frequently.

Another result of this muscle effect is on the heart: coffee makes your heart beat faster and, in excessive amounts, can lead to arrhythmias (missed or irregular heart beats). Even if this has no serious medical consequences, the perception of your heart racing or skipping can certainly have an effect on your performance by heightening your level of anxiety.

Another effect of coffee with potential vocal consequences is that it can increase GERD, due to its effect on the gastroesophageal sphincter. If you are prone to acid reflux, be vigilant and moderate your intake of coffee.

A generally more welcome effect of coffee is on the muscles of the intestinal wall. Many people need that cup in the morning to stay regular. Some of this effect has to do with the gastrocolic reflex: when the stomach gets distended, this triggers a reflexive urge to evacuate your bowels. Without doubt, however, some of this effect also comes back to the muscular contraction potentiating effect of caffeine.

Of course, the alerting effect of caffeine on the central nervous system is something we seek, and even enjoy. Other beverages containing caffeine analogs (such as tea or cocoa) have a similar effect. While tea is considered less caffeinated than coffee, it can in fact contain even higher amounts, depending on the type of tea, the cut of the leaves, and how long you brew it or soak the teabag. Green tea, generally recommended for its antioxidant properties, happens to be especially high in caffeine. Even hot chocolate is a stimulant, since it contains theobromine, a chemical with some properties similar to caffeine. Although hot chocolate has been marketed as “soothing” and an ideal bedtime drink, in fact the opposite is true. In old Spanish California, nuns were forbidden from drinking hot cocoa, since it was believed to be an aphrodisiac, leading to “sinful thoughts.”

And what about caffeinated soft drinks? Many people start their day not with a coffee but a Coke. This is clearly a matter of personal choice. For singers, however, remember that while you probably have a better handle on how much caffeine is in that soda (and remember, not only colas are culprits here—there is caffeine in many other sodas, including Mountain Dew), you are also beating up your pancreas with a large sugar dose in that soda.

Even if you drink sugar-free or caffeine-free sodas, carbonation is also known to increase acid reflux. Those carbon dioxide bubbles must come out of your stomach (usually up, sometimes the other way), and as they make their way up the esophagus they open the gastroesophageal sphincter and allow stomach acid to rise also. So, if you need to caffeinate, coffee is probably better than a fizzy soda.

Much of what I have said about the effects of caffeine is couched in terms of “excessive” intake. But what is excessive? If you are a relative newcomer to coffee, like our reader above, even one cup may lead to adverse symptoms, due to the pharmacological effects of caffeine. If, on the other hand, you are up to several cups a day, you may not experience these effects. Why? Because caffeine is habituating (a word that lacks the pejorative connotations of “addictive”).

If you are still deluding yourself that coffee is an optional lifestyle choice, take a look at the morning line at your nearest Starbucks counter (which, no matter where you live, is probably only a few steps away). Without being too cynical, it bears some resemblance to an addiction clinic. And if you still doubt that caffeine is habituating, try stopping coffee “cold turkey.” You will, for several days, experience a sense of malaise and a low-grade headache that can be instantly relieved by the next cup of coffee.

Although caffeine is a potent pharmacological agent, there is no clear information on how much a regular coffee drinker gets. This is because there is wide variation from cup to cup, and from one coffee bar to the next. Even “decaffeinated” coffee contains caffeine, although in lower amounts. In fact, one establishment’s “decaf” may contain more caffeine than another restaurant’s “regular.”

An issue of personal concern for me is seeing young teenagers—children, really—lining up after school at Starbucks to buy high-caloric, over-sugared, caffeinated drinks. They are on the road to becoming habituated, not to mention fat, hypertensive, and diabetic. Like flavored cigarettes, sugared and flavored coffee appeals to the taste of children and can lead to a life-long coffee habit.

My suggestion to singers who enjoy their coffee? If you are healthy and enjoy it, by all means, have your coffee. But realize that caffeine is addictive and may have some negative effects on your vocal performance. As with anything else, be vigilant about what you put into your body, even if it’s just that morning cup of joe.

DISCLAIMER: Reprinted by Permission, Classical Singer Magazine. The suggestions given by Dr. Jahn in these columns are for general information only, and not to be construed as specific medical advice, or advocating specific treatment, which should be obtained only following a visit and consultation with your own physician.