Exercise-induced gastroesophageal reflux disease (GERD) is a condition where physical activity provokes symptoms like heartburn or regurgitation. It occurs when stomach acid flows back into the esophagus during exertion. This issue is not limited to elite athletes; it can affect anyone, from those performing high-intensity training to individuals engaging in casual fitness routines.
The Physiological Link Between Exercise and Reflux
During physical activity, several internal changes can lead to reflux. One primary factor is a significant increase in intra-abdominal pressure. Exercises that engage the core or involve heavy lifting compress the stomach, and this pressure can overwhelm the lower esophageal sphincter (LES), the muscle that acts as a gate between the stomach and esophagus. When the pressure inside the stomach becomes greater than the pressure exerted by the LES, stomach contents can be forced upward.
Intense exercise also causes a decrease in the tone of the lower esophageal sphincter. The body redirects blood flow away from the digestive system to the working muscles. This diversion of resources can impair the normal function of the digestive tract, including the esophagus, resulting in a less effective barrier.
The type of movement involved in a workout contributes to the problem. High-impact activities, such as running, create a jostling effect on the stomach’s contents. This physical agitation can promote the movement of acid into the esophagus, especially if the stomach is full.
High-Risk vs. Low-Risk Exercises
Certain physical activities are more likely to trigger GERD symptoms. High-risk exercises include:
- Running and jogging, which cause significant jostling of stomach contents.
- High-intensity interval training (HIIT), which often involves movements that rapidly increase abdominal pressure.
- Heavy weightlifting, especially exercises such as squats or deadlifts that compress the abdomen.
- Abdominal exercises like crunches that put direct pressure on the stomach.
In contrast, some exercises are better tolerated by individuals prone to reflux. Low-impact activities such as walking or using an elliptical machine avoid the jarring motions that can agitate the stomach. Swimming is a suitable choice because the horizontal body position and low-impact nature of the activity place less pressure on the LES. Stationary cycling, particularly when performed in an upright posture, is another effective option that minimizes abdominal compression and the risk of triggering heartburn.
Strategies for Managing Symptoms
Properly timing your meals is a step in managing exercise-induced reflux. It is advisable to finish larger meals at least two to three hours before beginning a workout. This allows sufficient time for the stomach to empty, reducing the volume of contents that could potentially reflux.
The composition of your pre-workout snack also matters. Opt for small, easily digestible options that are low in fat, fiber, and acid. Complex carbohydrates can provide sustained energy without sitting heavily in the stomach. Foods and drinks known to trigger reflux, such as citrus fruits, tomatoes, caffeine, chocolate, and spicy or high-fat items, should be avoided before physical activity.
Hydration practices can influence symptoms as well. While it is important to stay hydrated, chugging large amounts of water immediately before or during exercise can distend the stomach and increase pressure. Instead, focus on sipping small amounts of water consistently throughout the day and during your workout.
Simple modifications to your workout routine and attire can offer relief. If you perform exercises on a bench, such as a chest press, using a slight incline rather than a flat position can help keep stomach acid down. Choosing lower-impact alternatives, like the elliptical instead of the treadmill, can also reduce symptoms. Additionally, wearing loose-fitting clothing around your midsection avoids external constriction on the abdomen, which might otherwise contribute to internal pressure.
The Weight Management Paradox
A potential point of confusion is the relationship between exercise and GERD, as physical activity can both trigger and alleviate symptoms. While certain exercises can provoke immediate discomfort, regular physical activity that leads to weight loss is a highly effective long-term strategy for controlling chronic GERD. Excess body fat, particularly in the abdominal region, places constant pressure on the stomach and the lower esophageal sphincter.
Studies have shown that even a modest weight loss can lead to a significant reduction in the frequency and severity of reflux symptoms. The focus is on finding a sustainable and comfortable routine that delivers the health benefits of physical activity without inducing heartburn. By adapting your approach, exercise can transition from being a trigger for discomfort to a tool for long-term health and symptom management.