What to Do About It
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Online fitness trainer and nutrition coach Ivana Chapman loves weight lifting, but weight lifting doesn’t always love her back. Even though Chapman competes in Masters National Physique competitions, she often struggles with exercise-induced GERD during training. A self-described natural athlete, Chapman switched to bodybuilding after competing internationally in karate for 14 years when GERD made martial arts maneuvers nearly unbearable.
“When my GERD is bad, I have to avoid any high-impact activities like running, jumping, or skipping rope,” says Chapman.
For athletes like Chapman who engage in high-intensity workouts, exercise-induced GERD is fairly common. Studies show elite runners often experience acid reflux after a workout. But you don’t have to be ultracompetitive to experience reflux symptoms during exercise.
“There are certain activities that can trigger reflux, and exercise is one of them,” says Sumona Saha, MD, a gastroenterologist and an assistant professor of medicine at the University of Wisconsin School of Medicine and Public Health in Madison.
Like Chapman, who changed sports, it’s important for those with GERD not to give up exercising. And for the general GERD population, exercise can actually help reduce symptoms. If you’re overweight or obese, a 10 percent weight loss has been shown to reduce reflux and heartburn, says David Levinthal, MD, PhD, the director of the neurogastroenterology and motility center at the University of Pittsburgh Medical Center.
One study followed 15,295 generally obese patients and abdominally obese patients who self-reported GERD symptoms for several years and found that those who reduced their body mass index (BMI) by 2 kilograms (4.4 pounds) or more and their waist circumference by 5 centimeters or more improved their GERD symptoms.
Why Do You Experience Heartburn After Exercise With GERD?
During reflux, the lower esophageal sphincter (LES) muscle, which serves as a barrier between the stomach and the esophagus, opens, allowing stomach acid to travel up into the esophagus and cause heartburn. Any exercise that increases abdominal pressure, such as heavy lifting, stomach crunches, or high impact workouts, can trigger reflux.
“In reflux, whatever material is in the stomach will only come back through that barrier if the pressure in the stomach exceeds the pressure of the barrier,” says Dr. Levinthal.
If you have GERD and a hiatal hernia, that’s a double-whammy. Half of those with reflux have a hiatal hernia, even if they don’t know it, says Levinthal. “In that circumstance, the stomach may actually push up a little bit into the chest through a larger opening. It doesn’t make as close a seal.”
Pregnant women may also need to adjust their workout. At least 50 percent of women report some GERD in their pregnancy, usually in their third trimester when the fetus is almost fully formed, says Dr. Saha. “There’s mechanical pressure that’s applied to the stomach and there’s an upward motion of gastric content.” In early pregnancy, too, hormonal changes will cause weakening of the LES. “That doesn’t mean we don’t want women to exercise during pregnancy, they just need to find the exercises that suit them,” Saha adds.
While there are few rigorous studies on how exercise affects GERD, commonsense precautions can help reduce your heartburn while working out.
- Reconsider eating before exercise. “The less material that’s in the stomach, the better. An empty stomach can’t reflux, essentially,” says Levinthal. Otherwise, wait one to two hours before exercising. “Not eating within two hours will give enough time for food to pass from the stomach to the small intestine. When food material has moved through the stomach, there’s less likelihood that someone is going to reflux while they’re exercising,” says Saha.
- Choose food wisely. When eating before exercise, avoid foods that trigger GERD for you. Choose simple carbohydrates. Your stomach metabolizes these foods quicker, a process known as gastric emptying. People with diabetes may experience slower gastric emptying and should avoid high-fat, high-protein foods before exercise, which take longer to empty, says Saha. “Even two hours after eating a meal, their stomach may still not be clear of food and will reflux as a result.”
- Eat slowly. Chapman says she needs to watch not only what she eats, but how, making sure she doesn’t eat too much or too fast. “I’m not always perfect with these things, so it can trigger symptoms.”
- Avoid lying flat. Interventions to prevent reflux during sleep also apply to exercise. If you want to do crunches, do them on an incline bench. “When I’m experiencing moderate to severe acid reflux symptoms, I also need to avoid weight training while lying down,” says Chapman. “So I stick with seated or standing exercises at a slow pace. Too much jostling of the stomach makes the issue worse.”
- Adjust your workout. “My general advice for clients who suffer with GERD is to listen to their bodies and start slowly,” says Chapman, who recommends walking and controlled weight training in a standing or sitting position. High-impact, high-intensity workouts, such as running, cycling, or rowing, can potentially cause reflux. Acrobat maneuvers and gymnastics may also jostle stomach contents. “The key thing would be avoiding exercises that would really taunt the lower esophageal sphincter’s barrier function. Things that put you in odd positions, upside down, or that defy gravity,” says Levinthal.
- Skip the straw. Straws aren’t just bad for the environment, they’re bad for reflux, too. “When we drink through a straw, we actually swallow a lot more air. People find that they burp more because we’re taking in air with each sip of drink,” says Saha. Chewing gum causes aerophagia, too.
- Dress in loose, comfortable clothing. Tight waistbands can put additional pressure on your abdomen.
- Hydrate right. “You don’t want to get dehydrated, but take it easy on prehydration. If all that fluid is in your stomach, it’s the same rationale; it could potentially reflux up,” says Levinthal.
- Take up yoga. “Yoga has actually been shown to improve digestion in some studies,” says Saha. One case report found that six months of yoga while on a proton pump inhibitor significantly reduced stomach acid and improved esophagitis. Just be sure to avoid positions that exacerbate GERD.
If lifestyle modifications don’t improve your GERD during exercise, ask your doctor about taking acid-suppressing medication, says Saha. “Exercise is so important not only for weight loss, which may improve their GERD, but also for general well-being.”
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