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Singing and Immunity with Dr Sally Price

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Singing and Immunity with Dr Sally Price

Did you know that singing can help boost your immune system?

Today we are joined by functional medicine practitioner, Dr Sally Price to share with us her personal and professional experience with singing and the associated health benefits and challenges.

Sally highlights the overlooked connection between our voice and our immunity and how this is viewed from an Ayurvedic perspective. She also shares with us nutritional and lifestyle tips for what singers can do to keep their voices in optimal shape. 

Covered in this episode

[00:43] Welcoming Dr Sally Price
[04:56] The voice and the immune system
[06:40] Keeping the voice in prime condition
[08:53] Oil pulling
[10:51] Singing for vagal nerve stimulation and breathing
[14:56] Nutritional support for singers
[20:03] Lifestyle measures
[22:58] Herbal remedies 
[25:54] The benefits of singing for asthmatics
[29:31] Closing remarks


Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook. Joining us on the line today is Dr Sally Price from Western Australia. As well as her expertise as a general practitioner, she has interest in nutritional medicine and Ayurvedic medicine, and she's also a choir singer. Welcome to FX Medicine, Sally. How are you going?

Sally: Yes, good. Thanks. Thank you for the opportunity to talk today.

Andrew: Pleasure. Absolute pleasure. Now, tell us. You're a singer. How long have you been singing for?

Sally: So I did do a bit of singing at school. I was in the school choir and I grew up with my dad singing around the house. He was involved in the local choral society, and so I've been involved in singing for a long time. It was about 12 years ago that I got into local choirs in my local community. 

From there, I've really enjoyed both the community aspect of that, the joy of singing, and all the good things that we know that that does for ourselves for connection for our voice. There's lots of really good information that it synchronises breathing. It's good for heart rate variability. There's lots of immune factors in that. 

So it's a good all-rounder and, some of the choirs I was involved with, there were a lot of people with post-cancer and with other health conditions that really found it a good part of their week.

Andrew: Okay. So let's do a little bit of a backtrack here. Tell us about what you do as an integrative GP, what your work involves.

Sally: Well, I do the whole spectrum. So I know that some people specialise, they subspecialise in SIBO, or in thyroid, or in gut stuff. In the last twenty years…Twenty years ago, I learned about Ayurvedic medicine, which is a complete system and it did get written down in India but it's for everybody on the planet. So it's really for all sentient beings and it's based on really how things work in a body and how things get out of balance. 

From that grounding, then I went into functional medicine, nutritional and environmental medicine, lifestyle medicine. So I've learnt a lot along the way in the last 20 years. I was very lucky to be trained by Dr Igor Tabrizian on hair tissue mineral analysis, so that's part of my work. 

Andrew: Yeah.

Sally: As things have progressed, I did BioBalance and I've learned about nutrients for mental health. And then, with Bioscreen and Dr Henry Butt's lectures, I also looked at gut-brain links. And so I guess, in the last few years, it's really been looking at gut-brain links more predominantly. 

But because I see the whole spectrum when we spoke previously I didn't know what I had to contribute because I felt like I do a bit of everything. I don't have one special thing, and that's why I offered today that maybe the talk that I gave to some vocal students about five years ago, and I've just redone that for a composer/conductor friend of mine... made a podcast for them. I thought maybe this would be useful for other practitioners that might have singers and performing people in their practise. Because it's really about care of the voice and the throat and how we can optimise that so that we, A) don't get sick and how we, B) get over having a sore throat and that sort of thing quite quickly as fast as we can.

Andrew: Yes. I mean I used to work with quite a famous Australian singer, and her brother used to come in and buy propolis all the time.

Sally: Yes, yes. And that's a great all-rounder, isn't it? Propolis.

Andrew: As long as you can get past the taste. 

Sally: Ha! Yeah, yeah.

Andrew: Okay, so why is immunity so important for singers? I mean we can obviously think about the sore throat, but are they at greater risk of catching sore throats, or is it just something that's really important to them so they have to just keep their voice in tip-top condition?

Sally: Well… So in Ayurvedic traditions, the voice is really tied to the immune system. So it's really interesting that, when you've got a good, strong voice, we know that your immune system is in good shape. And of course for us, you know, in the Western world, it's just a portal of entry of viruses and bacteria into the body if we're breathing through the mouth or breathing through the nose. The nasal membranes should filter viruses out, and we should filter out bacteria and we shouldn't have a lot of overgrowth of bacteria in those areas.

And so, when we get a bit rundown, our immunity runs down. I think that's when those pathogens can find a portal of entry and so it's really those basic things that we need to do. And in the singing community, of course, there's often evening work, so people may be late to bed and they don't get their full night's sleep. They may be stressed. Performance is often put on a whole bunch of performances in a row. They may not be eating the best. They may get dehydrated while they're on stage. So it's really about keeping the voice in tip-top condition because, of course, it's their livelihood.

Andrew: Yeah. So, Sally, what sort of commonly used secrets do singers use to keep their voice in tip-top condition?

Sally: Some of it is all the basics that we all know and love, which is keeping your nutrition up to scratch. So you want to eat your rainbow of plant foods, your six cups of plant foods every day, your 40 different foods a week to feed your microbiome. You need to sip water, and clean, filtered water, so we don't want those bisphenol A plastic water bottles. We want either a glass or stainless steel water bottle. And keep sipping every 15 minutes. And this helps to flush viruses down into the stomach where we hope the stomach acid will take care of them.

We want to have a good mindset, so peace of mind. And we want to stay in love rather than fear. You probably know that dipole of love versus fear. If we're in a good state of mind, keeping our mindful thoughts on track, that's going to be helpful.

We want to do our normal exercise, but it's critical to do nasal breathing as you probably know, Andrew, with exercise. It's important that we breathe through our nose wherever possible because it helps the filtering system and also it can expand the cardiovascular system and the base of the lungs opens up more when we're exercising with breathing through our nose from the nitric oxide mechanisms.

Andrew: Right.

Sally: Then, we need our sleep and our rest, and I talk about how it's important to make up for lost time. So, we know now from sleep information and studies that, if you have a couple of late nights, if you make those up during the following week, then you're probably going to be back on track. But if people are constantly staying up late, then their immune system does suffer.

And then, you know, there's more specific things. So, in terms of that, we want to make sure that we moisten and lubricate the throat very frequently. And, apart from drinking, we also want to use some oils. Oil pulling has got popular more recently but that's an ancient Ayurvedic tradition called gundusha. And gundusha is where you take about a teaspoon of oil and traditionally that would be cold-pressed sesame which we know now has a lot of zinc in it, and zinc being a good deterrent from viruses. And so you would swish that around in the mouth and the throat for as long as you can, say, up to 20 minutes. And the theory behind that is that that's pulling toxic material out of the blood supply. And if you can do it for 20 minutes, that all the blood supply to the body would have filtered through that area.

Andrew: Right, that's really interesting. So wasn't oil pulling also used to helped whiten teeth as well, getting rid of stains?

Sally: Yeah, so it's fantastic for the teeth and the gums, and the little crevices around there as well. 

Andrew: Right.

Sally: One of my dentists over here is an integrative dentist, and he recommends oil pulling with a little drop of thyme oil in the mix. He tends to recommend coconut oil, and I think there's definitely good thought behind that because, as we know, the caprylic acid is antiviral as well. And then, if you're using coconut oil and a little bit of thyme oil and swishing that around, that's very good for strengthening the membranes and cleaning in between the teeth and very beneficial in that area.

Andrew: Right. Just going back to stress, when you were talking about singing, the first thing that came into my mind was something that Emrys Goldsworthy taught me about stimulating the vagal nerve. And he said that singing was one of the best things. Now, if we take my example, it's more like wailing. But singing, and I'm also reminded of this incredible YouTube clip of Bobby McFerrin showing people that everybody knows the pentatonic scale. It's just inherent.

Sally: Yes, that's right.

Andrew: So everybody can sing, right?

Sally: Yeah, that's right. And that's what a lot of my colleagues who run choirs feel as well, is that we've all got our own capacity. And if you don't want to be listened to, of course you can do it in your car. You can do it in your shower. You can sing when nobody else is around. But it's a very beneficial thing and I think, at the moment, we're seeing people in Italy singing from their balconies and that sort of thing. It's lovely to see that happening in a community. 

It's definitely beneficial and people acquire...if they go to a regular choir, we all share the same things. We feel like, "Oh, you know, I’ve just got home from work, and I've got to really get out there and go to choir, and I don't really feel like it today," sometimes. But we all feel fantastic afterwards. It's the breathing, it's being in a group. But singing definitely improves that vagal nerve balance, I believe.

Andrew: Right. And also a point about the breathing as well. Obviously, the more strenuous breathing you're going to do, you're going to get into oxygen debt. So how do you maintain that breathing in through your nose? And I'm assuming that it's okay to breathe out through your mouth, is that correct or not?

Sally: Yeah, yeah. That's right. So I think, as you breathe through your nose, what my understanding is, is that the blood then gets… So there's sensors at the bottom of your diaphragm, and these sensors then open up the bases of the lungs, and the blood gets diverted into that area. So, by breathing through your nose initially when you start to walk or sing, you'll then get better capacity through your whole lungs, so you're using the whole lung rather than just the top bit that we usually are breathing out of and that is more associated with anxiety and so forth.

Andrew: Yeah. And when you're teaching patients about this diaphragmatic breathing, do you talk to them also or show them about how their belly should inflate?

Sally: Absolutely. A really good trick is, if people want to practice that, I get them to lie on the floor and put a book on their tummy and see if they can breathe in and get that book to go up and down. At choir, we often put our hands on the sides of our lungs so that we can actually feel that expand as we're doing some breaths during warm-ups and so forth.

Andrew: Yes. It was really evident to me, recently, we did it actually as a family, and it was really evident just how prevalent rib breathing is. And how it's almost unconscious—and how you really have to concentrate on belly breathing. It was quite incredible. It was a big learning curve.

Sally: Yeah. And I think that’s… With the popularity of yoga and people doing a lot more of that, it's a great practice. And of course these days there's a lot of people with… Breath work seems to be exploding at the moment. And, with Wim Hof, I'm sure you're aware of some of those techniques where it's different ways of breathing and it has different benefits.

Andrew: Got you. So let's get back to a few more of these things that you use in your practice with singing, with helping singers to maintain their immunity. Now, we've mentioned oil pulling, that's high in zinc, what about other minerals like, say, selenium?

Sally: Yeah, so I do have a list of minerals. 

Andrew: Okay.

Sally: I tend to always start with zinc. I think that selenium is also a critical one because we know of its antioxidant capacity and its antiviral properties. Vitamin C, of course. We all need probably somewhere between at least 1 and 3 grams of that per day, and of course that helps the immune system, and it's antiviral and so forth. 

What I found really interesting was learning a bit about genetics in the last couple of years. There's a whole range of different underpinnings of people's DNA and people's capacity to pull in vitamin C and to use vitamin C. And I find that some people, it doesn't really work that well to take tablets, but the more oil-based, the liposomal types are very beneficial.

Andrew: Okay.

Sally: And that of course is another thing that you swish around your mouth to get into your system.

Andrew: Right, okay. And we mentioned propolis, but what about good, old honey? For mucositis, there's just a really cheap...you call it a "swish and swallow" with honey and coffee. I don't know if that's used for singers. They might get a bit hyped afterwards.

Sally: Singers aren't so into coffee because, of course, of its dehydration properties. So we tend to avoid dairy and we avoid coffee and really keeping very well-hydrated. And then omega-3 oils are of course important for our mucous membranes..

Andrew: Yep.

Sally: So we want to make sure that we're optimising those and the fat-soluble vitamins as well.

Then I guess we've got actual gargling. So I think Datis Kharrazian also talks a lot about gargling for balancing the vagus nerve…

Andrew: Yes, yes.

Sally: …and of course you can have just plain salt and water, or you can use something that's got some essential oils in there as well, or people sometimes use a whole range of antimicrobial-type gargles. I rather suspect that simple is better because we don't want to delete or destroy some of our good commensals in terms of the oral microbiome.

Andrew: Or indeed choke.

Sally: Yeah, yeah, that's right. That's right. Yeah, and then we've got some...we have a "singer's potion." 

Andrew: Right.

Sally: Yes. So one of my colleagues I was chatting to last weekend was saying that he uses this potion. If he wakes up with a scratchy throat of any description, he gets into the hot water with some lemon. So a couple of slices of lemon, a really good dollop of honey plus some ginger and turmeric. And we tend to use about a quarter of a teaspoon of each of those spices into a cup of hot water, and that is a really good thing to just sip all day. He sings for opera and that sort of thing, so basically he reckons if he gets into that first thing in the morning he still can go that evening to do his work, basically.

Andrew: You know, it's really interesting how singers, they really do...I mean it's almost like they can't do without these things. Like, it'd be interesting to speak to Adele or something like that. The person I was… I shouldn't mention them but they're quite famous in Australia, and it was really interesting how important it was for them. If the propolis wasn't there, it was a real stressful period for them because it was like, "Oh, no, I need this stuff. I can't go on without it." 

Sally: Yeah, yeah.

Andrew: There was also... I think another one had flat...I know you're not going to like this, but flat Coca-Cola...

Sally: Really?

Andrew: ...yep, was a another one.

Sally: I guess that cleans things out. I mean we know that that's probably...like, that's very antimicrobial because of all the nasty pesticides and things that are in it. So it well may be that that kills a whole load of things off.

I know a friend of mine, who is a mum that I knew at school, and when the school went for a fish and chip thing, that was the only time that she had a certain soft drink because of the amazing acidity of it to wash down the incredible amount of fats that would be consumed. So I guess it's got its place. I know it's used as a toilet cleaner and for degreasing engines as well.

Andrew: Now, talking about lifestyle measures, what about things like getting enough sunshine and vitamin D?

Sally: Absolutely. Vitamin D is a critical modulator of the immune system, isn't it? 

Andrew: Yeah.

Sally: So, you know, again, learning genetics, I found there were a lot of people that, whatever they did, even if they did get their sunlight, they can't seem to get their D off the floor. And I've seen vitamin D's right down to 19 but of course we really want our D in the sort of 100 to 150, or even some of the ranges now go up to 200.

Andrew: Now, that’s in nanomoles per litre. If you're from America, you have to convert that to the American...is it deci? Gosh. Micrograms per decilitre, I think.

Sally: Okay. Yeah. So I mean I do recommend… I think we need to start a new trend with that. You know, a little bit of sun in the middle of the day if we could get all office workers and people to just strip off a little bit, or get their belly and their back out to the sun at about midday and just have that 5 minutes, just out of the office. I think that would make a huge difference to the immunity of the population. So, if we can start that as a trend, that would be fabulous. 

We know that we need to get the exposure between 10 and 3 when it's UVB rather than the UVA that damages the skin. And obviously, when we can manage to do that, we need somewhere between 5 and 20 minutes so that it's not burning the skin but it is providing that vitamin D. And of course we get so much more from the sun than just the vitamin D, don't we? 

Andrew: Yes, that’s right.

Sally: I mean everybody's sort of focused on the vitamin D as the reason to do that but I'm hopeful that people would also recognise there's so much more. And I believe there's other nutrients, or vitamins, or things that our body produces because I mean somebody said, and it's a lovely quote, where we're actually houseplants with complicated emotions. We should be outside. We really need to be out there like our ancestors. And at least if we can get a bit of that, then that's going to all help.

Andrew: Look, absolutely. And you know, in these difficult times of COVID-19, we are in a blessed position that we have a rather small population for a rather large landmass. So, at least we can get that social distancing while we're going outside and getting that important sunlight and relaxing and connecting back with nature, taking our socks and shoes off, preferably not in winter or mud. 

But what about herbs? Like, you mentioned thyme before and turmeric or curcumin, but what about things like Echinacea which has a particular effect of having that raspy, sort of tingly, burny sensation at the back of your throat? Do singers like that, or hate that?

Sally: They enjoy that if they know that it's doing them good. So I think… I mean, I'm not really a herbalist but I think things like licorice have got that mucilaginous capacity. 

Andrew: Yeah.

Sally: We’ve got things that also go along with that that can help the whole gut system. Certainly Echinacea and...is it andrographis? I always get these two mixed up.

Andrew: Yes. Yes.

Sally: Andrographis, isn't it? That can be really beneficial for the immune system. And also all the medicinal mushrooms that we're seeing now. I feel that people that have slightly less resilient mucous membranes throughout the gut… So, if we have people that have the FUT2 gene, for example, or negative blood groups, then I feel that having the medicinal mushrooms or even just mushrooms that are really beneficial and getting a good variety of those. And did you hear the thing about, if you put your mushrooms in the sun, they'll also...

Andrew: Make vitamin D.

Sally: ...generate some vitamin D for you. So you're kind of double-dipping there getting the vitamin D as well as the medicinal capacity of the mushrooms.

Andrew: Indeed, I think it was a researcher...he's certainly a vitamin D supporter.Oh, forgive me, a mushroom supporter. And I think there's this guy, very colourful fellow, but he was involved in something where they irradiated a slice of a Portobello mushroom, a slice, and got 50,000 or something IU out of it. Like a massive, I mean, that’s a stoss dose. 

Sally: Wow. Yeah.

Andrew: So these foods can carry a heck of a lot of vitamin D.

Sally: Yeah, yeah. Which, you know, I mean, we learn all this technical information, don't we? We learn about the gut microbiome. We learn about DNA. But essentially it's just bringing us back to go outside, eat real food, do things as nature intended. I'm hoping with COVID-19 that we're getting this surge of people gardening like in the war, that people... "Oh, my goodness. I'm going to have to actually grow stuff myself just in case." So I think there are some good things that could potentially come out of this.

Andrew: If there is one small mercy, it will be that people will get back to nature and grow more of their food.

Sally: Yeah, yeah, and slow down.

Andrew: Yeah, absolutely.

Sally, just a last question on asthmatics, people who suffer from asthma and the benefits of singing. Does it help them control their breathing? Does it have any effect whatsoever on medication use or is it just something that's "good for their lungs"?

Sally: I don't know any studies on that, but I would imagine that that would really help asthmatics. And I think it would help them with the control, and I think it would help them with using the lower lungs.

My understanding for asthmatics is that Buteyko breathing is a really useful technique to learn and I do know from another practitioner that they've had patients that have done Buteyko for asthma. And I think a lot of people gain, at least good benefit, if not no longer needing their puffers and things like that from an asthma perspective. So I think if people have asthma, then that's a way out of it.

I think, as far as singing is concerned, taking big breaths into your lower lungs and getting that breathing capacity and also all the vagal effects would all be beneficial. And I sense that people with asthma are often upper lung breathing and in that stress factor. And of course asthma is a very dangerous thing and it can kill you. So, if you at least know how to manage the situation when you, in the circumstances where you can, I wouldn't tell anyone to come off their puffers of course because, if you need them, you need them. 

Andrew: Yeah.

Sally: But the thing is that you can certainly mitigate the situation with Buteyko breathing is my understanding.

Andrew: Yeah. Look, I think, you know, notwithstanding that we can't do spirometry every week. It's too expensive and we just don't have the equipment but even something simple like a peak flow meter. As long as you train yourself to make sure that you're giving a true blow into that device, it's just like a fuel gauge. It doesn't tell you how many litres of fuel you have. It tells you whether you're on full, half, or empty, and whether you're going up or down. 

Sally: Yeah.

Andrew: This was actually taught to me by a thoracic physician many years ago and he said, "I don't care if you're standing on your head with one finger in your ear singing 'Oklahoma'. If your peak flow is going up or maintaining a high level, fine. But if whatever you're doing, if it's going down, you need to change course." So it was really salient advice from an expert in that one. And he's pretty open with his patients about what they would use and take. So I think, as long as we learned from that one, we're on a safe track.

Sally: Absolutely. Yeah, and I think the thing is that the effects that we have from these things that were normal for us to just sing in groups and so forth, it's that community kind of feeling, that feeling of safety, that feeling that we're not so stressed, and so it affects every level, doesn't it? 

Andrew: Yeah.

Sally: It affects the guts as well and the gut biome and the oxygenation of areas that may not be so well-oxygenated at times.

Andrew: Yeah, that's certainly going to present its own challenges when dealing with social distancing with COVID-19 and coronavirus situations.

So, Sally, I've got to say, I don't know what that's going to present for you as a singer yourself in the coming months, but I do wish you well and thank you so much for taking us through at least some of the things that singers can do to improve their immunity today on FX Medicine.

Sally: Great. Thanks for having me.

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.



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FX Medicine is at the forefront of ensuring functional and integrative medicine gains the recognition it deserves and ultimately establishes itself as an integral part of standard medical practice. Hosted by Andrew Whitfield-Cook, our podcasts are designed to promote research and evidence-based therapeutic practises, acting as a progressive force for change and improvement in patient health and wellbeing.