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How To Avoid Gastro Esophageal Reflux Disease For Cyclists
Toolbox: While feeling the burn of their leg muscles is the raison d'etre for most bicyclists, the burning of heartburn or gastro esophageal reflux disease (GERD) is not as welcomed, but something most of us have suffered through at some point.  Here's what you need to know to avoid it.

GERD occurs when the ring of muscle (cardiac sphincter) that separates the lower part of the swallowing tube (esophagus) from the stomach relaxes and allows stomach acid to regurgitate into the lower part of the esophagus.

Common symptoms of GERD include:
"Burning" sensation or pain in the middle of the upper abdomen and chest, especially when bicycling at a high intensity or in bent forward aerodynamic position.

Burping and/or regurgitation of food and acidy taste in the mouth.

Difficulties swallowing.

If more chronic, one will also notice the symptoms during and after eating and while lying flat. Moreover, one may develop associated symptoms of chronic coughing and hoarseness.

San Juan - Argentina - wielrennen - cycling - radsport - cyclisme - Vincenzo NIBALI (Italy / Team Bahrain - Merida) pictured during Vuelta a San Juan 2017 - 35th Edition - training - 23/01/2017 - photo IB/RB/Cor Vos © 2017

A number of strategies can be tried to prevent and/or reduce GERD symptoms during bicycling, including:

1. Timing of meals: When one exercises, blood is shunted to exercising muscles and away from the gastrointestinal (GI) tract. This slows the movement of food along the GI tract. Increasing the time between meals and exercise for even up to several hours can help prevent GERD by allowing more time for food to move down the GI tract.

2. Food type and amount: Avoid eating spicy foods, chocolate, citrus foods or foods/drinks containing caffeine (coffee and tea) prior to exercise as they are associated with causing GERD. Also, before exercise, eat smaller amounts of food and consider eating more easily digested foods, such as toast, bananas, yoghurt, smoothies, and shakes.

3. Bicycle riding position: Sitting in a more upright position on the bicycle can help to reduce compression on the stomach and upper GI tract. This can be done by raising of the height of the stem, increasing the steepness of stem or, if riding a road bike, avoid riding while holding onto the drops of the handlebar or using aerobars.

4. Clothing: Wear less compressive bike shorts and/or jersey to reduce pressure on the abdomen. Bib shorts, for example, do not have a waist band and thus, do not compress the abdomen.

5. Smoking cessation: Nicotine from smoking tobacco can cause relaxation of the cardiac sphincter, so stopping smoking is an effective way to stop GERD symptoms.

Pisa - Italia - wielrennen - cycling - radsport - cyclisme - illustration - illustratie food pictured during L’Eroica for biketourists - photo Cor Vos © 2014

If one's symptoms still occur despite the above strategies, then taking an oral medication could be considered. The types of medications used for treating GERD include:

Antacids: Over-the-counter antacid medications contain aluminum, magnesium or calcium combined with hydroxide or bicarbonate to neutralize acid that is in the stomach. Examples include: Alka-Seltzer, Gaviscon, Maalox, Pepto-bismal or Tums.

H2 blockers: These medications reduce acid production in the stomach by blocking histamine receptors in the acid-producing cells of the stomach. These medications start to work quickly after ingestion but may need to be taken twice daily for chronic symptoms. Lower doses of these medications can be purchased at a pharmacy without a physician's prescription. Examples include: cimetidine (Tagament), famotidine (Pepcid) or ranitidine (Zantac).

Proton pump inhibitors (PPIs): These medications also reduce acid production in the stomach but act by blocking proton pumps in the acid-producing cells of the stomach. These medications take longer to take effect after ingestion but their duration of activity can be for up several days. These medications usually require a prescription from a physician as they have may have side effects and can interact with other medications that someone might be taking. Examples include: dexlansoprazole (Dexilent), esomeprazole (Nexium), lansoprazole (Prevacid), or omeprazole (Losec).

Deciding on Medication
The type of medication that someone should consider taking depends on the frequency and severity of their symptoms:

Occasional episodes of mild GERD symptoms: Take an antacid or low-dose H2 blocker as needed

"Mild GERD symptoms only during exercise: Take an antacid or low-dose H2 blocker at least 30 to 60 minutes prior to exercise

"Mild GERD symptoms numerous days a week: Take a low-dose H2 blocker twice daily

Severe and persistent GERD: See a physician for consideration of a PPI medication. Further medical investigations such as an upper GI barium swallow or upper GI endoscopy/gastroscopy may be needed to visualize the degree of acid reflux, to see if there is any damage of the lining of lower esophagus and to ensure there are no other causes of one's symptoms, such as a hiatius hernia, gastritis, a H. pylori infection.

Lung and heart problems which may also have symptoms similar to GERD, so it's always a good idea a see a physician for ongoing and severe GERD symptoms.



WRITTEN BY: Dr. Victor Lun, MSc., MD, CCFP(SEM), Dip. Sport Med. is a Sport Medicine doctor who practices at the University of Calgary Sport Medicine Centre. He is the team physician for the University of Calgary Dinos Football team and several winter and summer sport Canadian national sport teams.

Medical Advice Disclaimer
The information included in this article is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult their healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this article does not create a physician-patient relationship.


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