Bulimia and the Voice: Words from Lady Gaga

About Dr. Reena Gupta

Dr. Reena Gupta is the Director of the Division of Voice and Laryngology at OHNI. Dr. Gupta has devoted her practice to the care of patients with voice problems. She is board certified in otolaryngology and laryngology and fellowship trained in laryngology, specializing in the care of the professional voice.

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When asked how she overcame bulimia, she said “It made my voice bad. So I had to stop.
The acid on your vocal chords [sic]– it’s very bad.”

Lady Gaga BulimiaI was quite surprised to learn that these words came from musical phenomenon, Lady Gaga. Though her words are simple, they carry great impact. She was talking to high school students, and in that group were the inevitable assembly of popular kids, jocks, drama geeks, those with body issues (such as the girl whose question prompted the above response).

Gaga honestly spoke about how she had suffered from bulimia, which affects 1-2% of young women and takes the lives of 4% of its victims. I hope students’ minds are changed by her insights (she openly stated “Every video I’m in, every magazine cover, they stretch you; they make you perfect. It’s not real life.”). However, the harsh reality is that many more young women will fall victim to these pressures before society changes.

But that does not mean her words were for naught. There are many messages in what she said. For one, it was inspiring to learn that as a young artist, she had such a strong passion for her vocal career. She had to defend this passion against her own psyche and demons, thinking that if she did not fight the bulimia, she would lose her voice. What Gaga said was true; bulimia is severely injurious to the voice. When I see young, aspiring singers who smoke or have bulimia, it saddens me that these illnesses are taking their voices and dreams away. I hope that by discussing these topics, some of these voice can be saved. For this reason, I want to talk about the real effects of bulimia on the vocal cords.

Those who have been reading about voice care here know about the effects of reflux on the voice. Bulimia is essentially equivalent to the most severe form of reflux.

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How are they different?

Reflux Bulimia
  • The valve in your stomach that keeps acid down is faulty, allowing some acid to come up
  • The valve is deliberately overpowered, causing irreversible damage to the valve so that reflux occurs constantly
  • A small amount of acid and stomach contents come up
  • The entire contents of the stomach come back up
  • Some acid coats the vocal cords, some is swallowed back down
  • All acid and food coats the vocal cords; none is swallowed
    back down


Acid on your vocal cords is not severely damaging if it happens occasionally.  However, in bulimia there are repeated exposures on a daily basis, which does not allow time for the vocal cords to heal from the trauma.  They become:

  • Swollen – swollen cords lead to a deeper sounding voice
  • Heavy – heavier cords are not able to reach higher pitches
  • Prone to injury – swollen cords are unable to heal from small injuries (coughing, shouting, etc).  When these injuries occur in bulimics, they are more likely to leave scars that are irreversible
  • Prone to masses – swollen cords that are unable to heal may also develop masses like polypsnodules, or granulomas among others

Worse still, even after recovery from bulimia, the valve that keeps stomach contents from refluxing is often permanent damaged.  This means that former bulimics often suffer from moderate to severe reflux for the rest of their lives. Chronic reflux inevitably causes voice changes that can end a singing career.

It is never too late to walk the path of recovery, though.  Whether or not you have avoided some of these complications of bulimia on the voice, now is the time to seek treatment.  The only way to know if you have suffered vocal injury is to have a videostroboscopy. With a voice team assembled,  your vocal recovery is even more likely to be successful.

It is a hard fact that many young people do not really understand the long-term complications of problems like bulimia. Luckily, for the voice, many of these complications are reversible with early detection.   Seeking evaluation and treatment is the first step to a long and healthy vocal career.

To learn more about Dr. Reena Gupta or the effects of bulimia on the voice, visit: http://www.voicedoctorla.com/