(28-02-07) NSCA?s Performance Training Journal: A free publication of the NSCA.

Training Table
Exercise Related Acid Reflux
By Debra Wein, MS, RD, LDN
Gastro-esophageal reflux disease or GERD is a common problem among runners, cyclists, and weightlifters. GERD is the "passage of gastric contents (predominantly acid) retrograde into the esophagus" which can result in damage to the esophageal mucosa (4). The symptoms, which include nausea, vomiting, bloating, heartburn and chest pain can all limit an athlete's performance yet can be relieved with certain lifestyle modifications. GERD affects from five to seven percent of the total population with nearly 58% of athletes reporting these types of upper gastrointestinal symptoms (2).
Why is this common in athletes?
The site where GERD occurs is in the lower esophageal sphincter. The lower esophageal sphincter is the closing that separates the esophagus from the stomach, and with low pressure, GERD can occur. Athletes may experience a lessening of pressure to the sphincter due to deep inspirations, increased respiratory rates, or decreased intra-thoracic pressure (4). A large meal, tight fitting clothing, and strenuous exercise are also reasons for the sphincter to relax. Not only can stomach acid in the esophagus cause heartburn, but it can also cause esophagitis, ulcers, strictures (narrowing), and can increase the chance of cancer of the esophagus (1). Although this condition is uncomfortable for the athlete, there are ways to alleviate symptoms in order to continue exercising.
What can athletes do to minimize or prevent GERD?
First, a diagnosis of GERD is important in order for a physician to be best able to develop a treatment plan. While GERD is often diagnosed via one of several medical tests, it can often be treated with diet modifications. The first step to take is to keep a food diary. This can help you to recognize those foods that cause discomfort, the times of day discomfort occurs, as well as activities that trigger discomfort. GERD is exacerbated in heavier athletes, so weight reduction is beneficial as well (4). A Scandinavian study found that people who are overweight or obese may be up to six times more likely to have GERD (2). See Tables 1 and 2 for nutritional strategies to alleviate GERD as well as a list of foods which are likely to aggravate GERD.
In summary: If symptoms of heart burn, nausea, or vomiting are interfering with your workouts, speak with your health care provider and follow a modified diet to alleviate symptoms. While certain medications may lower the pain associated with GERD, weight reduction and following a modified diet is often sufficient treatment.
Table 1. Nutritional Strategies to Alleviate GERD
Eat smaller meals.
Eat regularly spaced meals.
Eat a lighter meal in the evening.
Take fluids between meals instead of with them.
Lose weight if you are above your ideal weight.
Try to relax while eating.
Limit chewing gum and the use of straws to avoid swallowing air.
Stay upright after eating.
Refrain from vigorous exercise right after eating.
References
1. American Gastroenterological Association. (2006). Heartburn: What are the Complications of Long-Term Reflux and Heartburn? http://www.gastro.org/wmspage.cfm?parm1=848 Retrieved May 10, 2006.
2. Collings KL, Pierce Pratt F, Rodriguez-Stanley S, Bemben M, Miner PB. (2003). Esophageal reflux in conditioned runners, cyclists, and Weightlifters.Medicine and Science In Sports And Exercise, May, 35(5): 730 ? 735.
3. Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J. (2003). Obesity and estrogen as risk factors for gastroesophageal reflux symptoms. The Journal of the American Medical Association. 290(1):66 ? 72.
4. Sharma A, Levey J. (2003). Gastroesophageal Reflux Disease in Runners. The Journal of American Medical Athletic Association. 16(1): 7 ? 19.
About the Author
Debra Wein is on the faculty at The University of Massachusetts Boston and Simmons College and is the President of The Sensible Nutrition Connection, Inc. (www.sensiblenutrition.com). Debra has worked with athletes and/or coaches of the United States of America Track and Field Association, National Hockey League, Boston Ballet as well as numerous marathon training teams.
Table 2. High and Low GERD Aggravating Foods
The most common foods that aggravate GERD include:
Alcohol
Citrus fruits and juices
Tomatoes and tomato sauce and juice
Carbonated beverages
Coffee and colas with caffeine
Chili powder and other spices
Chocolate
Garlic
Oregano
Mints
Safe foods
Apples and bananas
Green beans, carrots, broccoli, and baked potatoes (as long as they don't have a high fat topping)
Most grains and cereals
Low-fat cheese including feta and goat cheese
Low fat candies like jelly beans, gummy bears or sucking candies
Fish, London broil steak, meat cooked on a grill

Source: http://www.nsca-lift.org

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