Over the past few years, I have received a lot of emails from athletes expressing issues with reflux/heartburn, belching, nausea and bloating when exercising. Interestingly, for many of these athletes, issues are only (or most) noticeable on race day.
Although poor sport nutrition application is often at blame for the majority of fueling and hydration issues among endurance athletes, I started to notice patterns, similarities and trends among the athletes who reached out to me for nutrition assistance regarding their "reflux" issues.
Despite adjusting fueling and hydrating products, training the gut and following specific fueling/hydrating guidelines, athletes were still having issues - primarily on race day and often near the middle of a long distance race.
This got me thinking outside of the box. Is nutrition the primary concern or is it something else?
I started to think about what is different on race day (non-nutrition related) compared to training.
Stress. Pressure to perform. Duration. Intensity.
As I started to investigate more into this issue, it occurred to me that on race day, athletes are breathing a lot more and often than in training. While this may not come as a surprise or a concern, the primary muscle used for breathing is the diaphragm. And when the diaphragm is weakened or doesn't function properly, this can cause issues. Most athletes know about a side stich or adominal cramp (which is when the diaphragm spasms) but rarely is the diaphragm discussed when it comes to upper GI issues.
With so much focus on strengthening the arms, core and legs, don't forget that your diaphragm is a muscle. Like any other muscle in your body, you can help make your diaphragm work better and more efficiently. Since performance can suffer when breathing muscles are fatigued, it makes sense why athletes experience more GI related issues on race day. You are breathing more often, harder and longer than in any training session. If you can improve the strength and endurance of your diaphragm, not only will this have a positive influence on performance and may reduce the risk of upper GI issues but learning how to breathe better can change your neurological programming. As a result, your brain (which controls fatigue) will do a better job recognizing that you are not in a life-or-death situation and it won't try to limit or protect your body by sending out fatigue signals to get you to slow down or stop.
What is acid reflux?
Reflux is when stomach contents (ex. acid) flows up into the esophagus, which is the tube that carries food from the mouth to the stomach. This can happen when the lower esophageal sphincter (LES), the ring of muscle fibers at the bottom of the esophagus, doesn't close properly. Heartburn is the burning feeling in the chest caused by stomach acid traveling up towards the throat (acid reflux).
What are the main symptoms of acid reflux?
- Heartburn
- Unpleasant sour taste in the mouth
- Burping or hiccups
- A hoarse voice
- Bloating
- Feeling full quickly when eating
- Nausea
- Pseudo-asthma - wheezing, coughing, shortness of breath
- Coffee, tomatoes, alcohol, chocolate, fatty or spicy foods
- Smoking
- Overweight
- Hunched over/poor posture
- Pregnancy
- Stress and anxiety
- Increase in hormones - progesterone and oestrogen
- Stomach ulcer
- Bacterial infection in stomach
- Hiatus hernia
- Anti-inflammatory painkillers (ex. ibuprofen)
- Eating before going to bed
- Strenuous/intense exercise
- Hard breathing
- Dehydration
- Abdominal pressure
- Drinking from a straw
- High impact activity
- Gulping air
- Drinking quickly
- Eating too close to a workout
Most reflux symptoms during exercise occur during hard or long sessions (less likely during mild or moderate sessions). Exercise can increase intra-abdominal pressure which can lead to the lower esophageal sphincter (valve between esophagus and stomach) failing and reflux occurring. Additionally, the esophageal contractions become weaker and less effective, moving food down toward the stomach during exercise.
How your breathing impacts reflux
Diaphragmatic breathing (belly breathing) is when the abdomen expands during inhalation, while the chest remains relatively still. This is the proper way to breathe yet many people don't do it correctly. Belly breathing has many benefits. It can help slow the heart rate, increase oxygen uptake, improve mental clarity, decrease stress and muscle tension, lower blood pressure, sharpen focus and lower the fight-or-flight response. Shallow, upper chest breathing is when the diaphragm moves up when you inhale (the chest contracts during inhalation and the abdomen pulls toward the spine) and the lungs can't expand as much. Stressors from everyday life and the habit of "sucking in" the stomach can lead to shallow "chest" breathing. Chest breathing can cause a fight-or-flight response, which can be helpful in certain situations but it is usually a stress response - which isn't always helpful during athletic performance.
To improve the function of the lower esophageal sphincter (LES) and to reduce the risk for reflux while exercising, you need a strong diaphragm. Diaphragmatic breathing (or belly breathing) can help strengthen the diaphragm muscle. This will also help improve lung capacity and take in more oxygen.
