Exercise-Induced Acid Reflux: 5 Reasons Something So Good Can Be So Bad
Exercise is supposed to be good for you, but sometimes it can bring negative health effects. Exercise-induced acid reflux is one such effect.
Have you have experienced heartburn or a sharp pain in the chest during exercise? If yes, then there is a high chance that you were experiencing exercise-induced acid reflux. Many people experience it, but choose to ignore it. However, exercise induced acid reflux is something you should not ignore.
This article will walk you through the reasons why exercise induces acid reflux. It will also discuss the symptoms, how doctors diagnose it and the possible treatment options. Don’t miss the part about ways to avoid exercise-induced acid reflux at the end, too.
1. Exercise Increases the Chances of Reflux By Increasing Abdominal Pressure During Breathing.
When you swallow food, it travels through your food pipe or esophagus, and reaches the stomach. The stomach then releases acid to digest the food. A little muscle prevents this acid from leaving the stomach and reaching the esophagus. This muscle is the lower esophageal sphincter or LES. It is present at the base of the esophagus and acts as a valve.
It closes as soon as the food enters into the stomach and keeps the acid from entering the esophagus. This way, it helps esophagus protect itself from the damage gastric acids can cause. You do not have conscious control over this muscle. It acts on its own. When this muscle is not able to close, it causes a back flow or reflux of acid into the esophagus. This leads to a familiar heartburn like sensation.
This happens in exercise, too. Exercise makes this valve incompetent and acid starts to flow back into your esophagus. Breathing provides you the necessary oxygen you need to perform all your activities. When you exercise, your oxygen demands spike and your body needs a lot more oxygen than usual.
To meet these increasing oxygen demands, your chest starts to expand a lot more than usual. This increase in chest volume increases the volume of your lungs too. All these changes add up and you are able to inhale more air and extract more oxygen from it too.
This is how your body is able to compensate your increasing oxygen demands. But this way of dealing with things has its own limitations and side effects. One such side effect is an increase in your abdominal pressure. Let’s see how that happens.
When your chest expands, it needs more space to do so. The only way your body could achieve this feat is by pushing down on your abdomen and its contents. It is like you squeezing on a balloon. It distorts the shape of the balloon and increases pressure inside it. In a similar way, the pressure inside your abdomen increases, too.
At first, your LES tries to cope with this increasing pressure by holding its ground. But then a point comes when it is unable to do so and snaps open. When this happens, your stomach contents get an opportunity to leak back into your food pipe. This gives rise to a familiar feeling of heartburn.
A research conducted at the University of Southern California validates this fact. Researchers studied the effects of exercise on LES tone in 151 healthy subjects. Results showed that almost all the subjects experienced an increase in abdominal pressure with exercise. In 18 percent of the participants, the pressure rose to a level where it by-passed the LES tone and caused reflux.
2. Strenuous Exercise Increases Stomach Acid if You are Already Suffering From Acid Reflux Disease.
Moderation is the key to improve acid reflux symptoms with exercise. Excess of everything is bad and same is true for exercise, too. Mild to moderate exercise decreases stomach acid secretion. But, the acid production increases when you get into a session of strenuous exercise. This is especially true if you are already suffering from reflux or stomach ulcers.
Many studies show that you are more likely to experience reflux while exercising than at rest. Also, the chances are higher when you undertake a strenuous exercise. Such exercises include running, jogging or cycling.
A research project recently studied the effects of exercise on stomach acid secretion in 16 individuals with stomach ulcers. The subjects exercised for certain duration and their stomach acid levels where measured. The results revealed something astounding. Researchers found that the stomach acid production almost doubled in the subjects.
This explains why your reflux worsens instead of improving after strenuous exercise. The key here is moderation. The same research also revealed the benefits of mild to moderate workouts in controlling reflux.
Also, certain exercises need you to remain in a posture that can cause acid from the stomach to flow back. This article will get to the details of such workouts in the next section.
3. Some Exercises Entail Changes in Posture that Make You Susceptible to Reflux.
You have to get into certain postures in some exercises. For instance, you have to lay down flat on your stomach in certain yoga poses. Wait, doesn’t yoga improve reflux? That is right, but not all forms of yoga help with reflux disease. Some types actually worsen it. Let’s see how that happens.
When you lay down flat on your belly, it exerts significant pressure on your abdomen and its contents. This build-up of pressure increases the tension inside your stomach. When this happens, your LES starts to lose its grip and snaps open. The end result is acid sneaking back into your esophagus.
This happens with other exercises, too. These exercises include sit-ups or working out on a slanted board. For instance, when you work out on slanted boards, it puts your abdomen higher than the rest of your body.
How does that link to reflux? Here is how.
Gravity is a factor that keeps your stomach acid from flowing back into the esophagus. When you are standing, gravity attracts the fluids in your stomach towards the ground. This prevents their back flow. It also strengthens the grip of the LES, but when you invert yourself in a workout, the effect of gravity becomes opposite. Instead of keeping the stomach acid away from the LES, it starts to push the acid towards the LES. This way, the chances of fluid leaking back into the esophagus increase.
How to avoid that? The details of this are in the later sections.
4. Exercises Decreases the Flow of Blood to Your Stomach.
High-impact exercises disrupt the functioning of the LES in several ways. One way is that exercise takes the blood away from your stomach. How that happens and why it makes you susceptible to reflux? Let’s discuss the details.
When you exercise, your muscles use up a lot of energy. The energy demands of your muscles can increase tens of times than normal. To keep up with that, your body redirects a lot of blood from other body organs to your muscles. Abdominal organs receive the greatest hit and a lot of their blood makes way to your muscles.
Here is the next part of this puzzle. When your stomach gets deprived of its share of blood, it starts to become sluggish. Its contractions slow down and its contents become stagnant. Your stomach always produces acid that is proportionate to the food content inside it. So the more food you eat or the longer food stays inside your stomach; the more acid will your stomach produce.
This is what happens when you exercise, too.
With the stomach contractions becoming sluggish, food remains undigested for a long time. This stimulates acid production. An increase in acid production then increases the risk of acid backlash.
5. The Stomach Contents Splash and May Go Back into the Esophagus When You Exercise.
The cause of exercise induced acid reflux is not always too scientific or fancy. Sometimes the cause is pretty straight forward. Acid reflux also depends on how much food you have in your stomach while you exercise. Exercising on a heavy stomach can easily lead to acid reflux.
It is same as you slamming a glass of water on a table. The water in the glass will splash and may spill over as well. When you exercise after meals, your stomach is like a filled glass. Its contents splash and may spill back into the esophagus if you continue to exercise.
What are the symptoms of exercise induced acid reflux?
Exercise-induced heart burn may manifest itself as some or most of the following symptoms:
- Pain in the upper abdomen or chest.
- Fluid splashing up into your mouth.
- Bitter or acidic taste in your mouth.
- A feeling of something stuck in your throat.
- Getting a taste of the last meal you ate.
- A feeling of stomach or chest heaviness during workouts.
- Nausea or vomiting.
- Burping more than usual.
- A feeling of fullness and lethargy.
How do doctors diagnose exercise induced acid reflux?
Exercise induced acid reflux is a common problem yet it is easy misdiagnosed. The following is how your doctor may diagnose exercise induced acid reflux:
- Your Medical History: Your doctor will start with your history and will ask you about your symptoms. Your doctor may ask you the following questions about:
- About your pain. The nature of your pain and site of your pain.
- Your symptoms. If you experience any of the above mentioned symptoms, other than abdominal pain, they will need to know.
- Your diet and lifestyle habits. And if there is a pregnancy happening or other physical changes can lead to acid reflux. Your doctor will make sure that your symptoms are due to exercise and not due to these factors.
- The type and intensity of your workouts. Exercise induced reflux is worst with high intensity workouts. It is also common with exercises that need you to jump or get into postures other than up-right.
- Physical examination: The next step in making a diagnosis is physical examination. Your doctor will make sure that your symptoms are due to reflux and not due to something else. A misdiagnosis can have serious repercussions. Your doctor may differentiate your symptoms from following conditions:
- Asthma episodes. Especially during or after you exercise, but do mention any other times, as well.
- Esophageal distention from aerophagea. It is a condition in which you may end up with heartburn symptoms due to swallowing too much air.
- Esophageal dysmotility. It is a condition in which your esophagus fails to move properly and you end up with reflux like symptoms.
- Esophageal hypersensitivity. In this condition, you develop reflux like symptoms due to sensitivity to some foods.
- The third step in making a diagnosis is appropriate laboratory tests. Your doctor may advise you undergo the following tests:
- Electrocardiogram (ECG): ECG is a measure of your heart health. This is one way doctors differentiate between reflux and heart disease.
- Ambulatory pH Monitoring: One way to measure the quantity of stomach acids is by detecting stomach pH. pH is the measure of acidity. Higher pH means higher acidity. In ambulatory pH monitoring, your doctor makes you swallow a probe tied to a thread. This probe detects your stomach pH for 24 hours. High readings, especially during exercise, are confirmatory for exercise induced reflux.
- Endoscopy: If you have had reflux long enough, your doctor may recommend you endoscopy. In this, doctor passes a tube inside your food pipe. The tube has cameras and shows the inside of your esophagus and stomach. This way, your doctor is able to see if your esophagus has any strictures or cancerous changes.
Is exercise induced acid reflux bad?
Besides giving you heartburn, can exercise induced reflux have other side effects too? Yes, it can have a lot of serious complications, especially if you turn a blind eye to your symptoms.
Here is the list of complications that can sprout from exercise induced acid reflux:
- Barrett’s Esophagus: Many athletes experience chronic heartburn, chest-pain and food regurgitation during exercising. This causes discomfort and prolonged symptoms can mean many ill-effects on the body. If you don’t seek treatment, it can lead to a condition known as Barrett’s esophagus. Barrett’s esophagus is a pre-cancerous condition, which can progress into esophageal cancer.
- Esophageal Strictures: Same as an acid or heat leaves scars on your skin; stomach acids leave scars on your esophagus. The cells crumble and collect-up, which results in esophageal strictures. This narrows the esophagus and makes swallowing difficult.
- Bleeding from Esophagus: Prolonged acid reflux may damage the blood vessels in your esophagus. This may result in you coughing up or throwing up blood.
- Cancer of the Esophagus: This is the most serious but inevitable consequence of prolonged acid reflux. The cells in your esophagus start to grow in an abnormal way and turn into a cancer.
- Heart Disease: This is another thing you should look out for. Remember that symptoms of reflux and heart disease are quite similar. It is easy to neglect the symptoms of heart disease for something ordinary as heartburn. At times, even doctors tend to misdiagnose heart disease as innocuous heartburn. So you should not neglect your symptoms. Instead, you should take them seriously.
How can you treat exercise induced acid reflux treated?
Exercise induced acid reflux is like other forms of acid reflux. The treatment is quite similar too. The first thing you should do is eliminate reflux itself. Once your reflux disease is gone, you will not experience symptoms during exercise too.
Here are some ways you can fix the reflux issue:
Preventive Measures: Before going to a doctor, you should try some old-school preventive measures. These measures are effective, time tested and proven to work. Here are some tips for you:
- Eating right is the key to preventing many diseases. In case of acid reflux, avoid taking:
- Caffeinated drinks
- Dark chocolate
- Spicy foods
- High protein diet
- Losing weight is another good way of minimizing the chances of acid reflux. Reflux disease is directly related to obesity. Your doctor may also ask you to lose weight if you are overweight.
- Your doctor may suggest you some changes in your sleeping posture to prevent acid reflux. Elevating the head of the bed by six to eight inches (15 to 20 centimeters) helps reduce acid reflux attacks.
- Avoid meals right before bed. It can help reduce the chances of experiencing acid reflux.
- Take chest pains seriously. See your doctor in case you experience any chest pain or heartburn during exercise.
Medical Treatment: If these measures do not work, you should go see a doctor. Your doctor may prescribe you following medicines:
- Proton Pump Inhibitor (PPI): PPI therapy is the mainstay of reflux therapy. Your stomach is lined with cells having proton pumps that produce stomach acid. PPIs are a group of drugs that help to produce less of these gastric acids, easing acid reflux in return.
- Histamine H2 Receptor Blockers: Your doctor may also administer H2 receptor blockers as an alternative to PPIs. These drugs interfere with the acid of stomach acid instead of decreasing its production.
Some of these drugs are available over the counter. But since they have potential side effects, you better consult your doctor before taking them. Your doctor may also prescribe acid suppressants in higher doses and for longer duration in severe cases.
Surgical Treatment: It is the last line of treatment when nothing else works. In severe cases, your doctor may suggest that you undergo surgery. Reflux surgery is called Nissen Fundoplication, which is a reliable treatment. Through this surgery, a gastric wrap is constructed at the base of the esophagus. This wrap then acts as a barrier for the acid in the stomach. This method is safe and has low complication rates.
How can you exercise without getting reflux attacks?
Here are some tips for you to continue your workouts without having to experience reflux:
- Not all types of exercises cause acid reflux. You may also try altering your workout routine. Try not doing an exercise that requires you to bend, incline or lie flat on the ground.
- You may also try avoiding vigorous exercises. These exercises include running, jogging or aerobics. Even if you decide to continue with these workouts, do not push yourself. Try to keep your workouts mild or moderate.
- Wear loose fitting and comfortable clothes while exercising. Tight fitting and uncomfortable clothes disrupt the posture of your body and increase the chances of reflux.
- Also avoid eating just before exercising. You should ideally exercise three hours after a meal.
- Try eating something soothing before your exercise. For instance, eating a cup of yogurt is a nice idea, as it suppresses acid secretion.
- Avoid sweetened and caffeinated energy or soft drinks before, during or after workouts. These drinks promote acid secretion; therefore, they increase your risk of having exercise-induced acid reflux.
- Here is natural remedy that may help. Take a glass of water and add half teaspoon of baking soda in it. Drink it before your workouts. It should help suppress acid secretion.
You can expect heartburn after a high-calorie meal, but it seems unfair to have it when you are trying to do something good for your body. Giving up on exercise is not a wise option. Exercise is always good for your health. The key here is to do the right type of exercises in a right way. Following the tips mentioned in this article, it is possible to exercise without experiencing acid reflux.