Since February is under the sign of Aquarius, it seems appropriate to discuss diuretics and their effects on the singing voice. Diuretics are substances that drive water out of the body. They may be taken as medication, for specific medical conditions, or ingested inadvertently as part of your regular diet. Since hydration and lubrication are important for clear, effortless singing, you should be aware of what these substances are, what they do, and how to minimize their effects on the voice.
Water, which makes up most of our body weight, is held in the body by being bound to ions, predominantly sodium. When we eat salt, we get thirsty and increase our water content. This is why in those old Foreign Legion movies the soldiers were forever popping salt tablets–to retain water and avoid dehydration. Reducing your salt intake reduces your water retention. Most diuretics (the thyazide group, for example) work by increasing your excretion of sodium. As you get rid of sodium, it draws the water out with it. Strictly speaking, these are not diuretics, but natriuretics (Natrium being the chemical term for sodium).
There are many medical reasons for taking diuretics, the most important being high blood pressure and heart disease. By reducing the fluid volume in the body, the blood pressure and workload on the heart are also reduced. Diuretics may also be used for reducing the fluid volume in specific conditions, such as Meniere’s disease of the inner ear. If you need to take diuretics for a medical condition, this may take precedence over other considerations.
There are, however, a number of diuretic substances that all of us ingest daily in our diet, often without being aware. These include sugar, caffeine, and alcohol and work differently from prescription diuretics. For example, sugar pulls water with it as it is excreted (called an osmotic effect). The more sugar you eat, and the less is metabolized, the more you excrete. Caffeine, present in coffee, tea, cola, and other soft drinks, can also cause some dehydration. Alcohol has a hormonal effect resulting in diuresis. You know what happens when you have a couple of beers. As water is reduced, it is lost both from the vascular tree (circulation) and from the tissues. You can see this as your rings get less tight, and your ankles become less swollen. These effects are beneficial.
For the singer, however, excessive dehydration has deleterious effects on the voice. Muscles and ligaments become dryer and glide less easily. The vocal folds lose some of their tissue tone. Mucus and saliva become thicker, stickier, and less lubricating. The voice turns husky and is difficult to sustain, particularly singing softly in the upper ranges. As the vocal folds come together, they no longer glide against each other on a film of mucus, but rub directly. Over time, this can cause irritation and a tissue reaction, which may lead to swellings.
How to handle diuretics? As a singer, you need to drink as much water as possible (8-10 glasses a day). This is especially true during the winter, when the air is dry, and we exhale and evaporate a great deal of moisture. Whether you need to take diuretics or not, keep drinking. If there is a good medical reason for the diuretics, you obviously need to take them. It may be possible, however, to change to another medication, e.g., for hypertension, which is not so drying. Speak to your doctor.
Since we don’t think of “food” as “medicine,” it is psychologically harder to keep to a low salt diet than to pop a pill, and yet it may be better for you. Keeping a strict low-salt diet, however, may help you to avoid or cut down on the need for diuretics. Of the non-prescription diuretics, limit these, and remember to rehydrate. A glass of orange juice, high in sugar, is not a substitute for a glass of water and can actually dehydrate you further. Apple juice is similar, and most other fruit juices contain white grape juice as a sweetener. Don’t let the tart flavor fool you. The same warnings apply to caffeine drinks. Tea is not always lower in caffeine than coffee, and “decaffeinated” really means low in caffeine, rather than no caffeine. If you take herbal diuretic tea, or a mild, over-the-counter diuretic, limit this to the days you really need it, such as the week before your period.
In summary, know what you ingest and what the effects are on your state of hydration. Explore with your doctor alternative medications for managing medical conditions. If you do take diuretics in any form, remember to rehydrate with water or herbal tea. And keep your recitativo secco, ma non troppo.
