Why Am I Getting Heartburn When I Work Out?

Experiencing heartburn after overindulging on pizza is hardly a surprise, but when this familiar, unpleasant sensation visits during your workout, it just doesn’t seem fair. Exercise-related acid reflux, however, is a common occurrence. The root cause has to do with a group of muscles you don't consciously control -- those of the lower esophagus. Your lifestyle and activities, including some kinds of exercise, also may contribute to acid reflux and heartburn. A word of caution, however: It's best to take chest pain during exercise seriously. Always check with your doctor.

Causes of Acid Reflux

The familiar sensation known as heartburn is due to acid reflux. A band of muscles called the lower esophageal sphincter, or LES, serves as an anti-reflux valve between the stomach and the esophagus. It’s supposed to close tightly after you swallow to prevent backwards flow -- or “refluxing” -- of acidic stomach contents up into your esophagus. Pregnancy, dietary items and physical changes that you might encounter while working out can compromise the tight closure of this valve and lead to acid reflux.

Why Heartburn Likes Exercise

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Simply put, heartburn is likely to occur during exercise because of gravity. Just as you cause a splash when you slam a glass of water down on a table, those acidic digestive juices spatter upward into your esophagus when you engage in high-impact activities such as jogging or aerobics. Exercise that involves inverting your body, such as doing sit-ups on a slanted board or such yoga postures as downward-facing dog or headstands, can cause the contents of your stomach to plunge toward the esophagus and leak through the LES. Heavy exercise can compress the LES and cause it to open. Also, exercise causes the body to divert blood away from the stomach, so undigested food stays there longer, raising the odds of reflux.

Preventive Measures

In the long term, you’ll want to get to the root of the problem by taking measures to avoid acid reflux altogether. The good news is that exercise and weight loss, if needed, might actually help your acid reflux over time. Not all activities cause reflux, and you can easily modify your workouts to prevent an attack. Measures you can take right now to help prevent heartburn during workouts include the following: -- Temporarily omit high-impact activities such as jogging or aerobics. -- Avoid exercises that require you to bend over, lie head-down on an incline or turn upside down. -- Avoid eating for 3 hours before exercising. -- Avoid foods commonly known to cause heartburn, such as:

• caffeinated beverages
  
• chocolate
  
• alcohol
  
• mint
  
• onion
  
• garlic

-- Wear looser-fitting clothes and avoid body-hugging garments that can put pressure on the LES.

Treating Heartburn's Root Causes

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First, it is best to be sure that "heartburn" during physical activity is not really something else in disguise. Then, for many people, recurrent bouts of heartburn are easily managed with a combination of lifestyle changes and medications. Lifestyle changes include losing weight, elevating the head of the bed by 6 to 8 inches at night and avoiding meals right before bed. Medications known as proton pump inhibitors, or PPIs, are highly effective in suppressing stomach acid and allowing the esophagus to heal. Esomeprazole (Nexium), omeprazole (Prilosec) and lansoprazole (Prevacid) are available over the counter and are approved by the Food and Drug Administration for 2-week courses. All medications have potential side effects and interactions, so check with your doctor before starting a new medication. For more severe cases, doctors may prescribe acid-suppressing agents at higher doses and for longer durations.

Medical advisor: Jonathan E. Aviv, M.D., FACS