Acid reflux on an empty stomach?

February 13, 2009 10:17 AM

Seriously affecting my morning workouts: gas or acid reflux in the mornings, before anything is eaten and only water has been drunk. WTF?

So I generally go to bed at 12 or 1 and have my last meal, which is small (salad, fruit salad, or veggie wrap) at about 1030, when I get home from work.

I wake up at 8, drink a few cups or water, and go to my workout, which is across town, for 930. I do my warmup fine, but about 5 minutes into my proper workout, I start burping, or feeling like I have to burp, which of course affects my activity and breathing, throwing everything else off (I do crossfit, in a group of people, under a clock).

How can I stop this problem? And why is it happening?

Note that after asking a few people about this, each recommended eating something. I tried that; it didn't work and just made me feel like I was gonna barf.

posted by You Should See the Other Guy to health & fitness (20 comments total)

Sounds like GERD. Talk to a doctor.
posted by damn dirty ape at 10:24 AM on February 13

How about sleeping on a slight incline? You put blocks under the front legs of your bed, which makes it slightly harder for acid to come up the upper GI tract.
posted by UrineSoakedRube at 10:25 AM on February 13

Try an antacid like Tums or Rolaids when you wake up. Berry is my favorite.
posted by nitsuj at 10:26 AM on February 13

Well, damn, you took my suggestion out. I've had experiences like this, but nothing ever consistent. Mine more or less went away by itself.

What was the "something" that you were eating pre-workout? I generally find something bland, plain toast, plain oatmeal, or a banana helps, especially if eaten about a half an hour before the workout helps me.

The other option, if at all possible, is to move your workout times to later in the day or the evening and see if that does anything for you.
posted by rand at 10:30 AM on February 13

What's your workout like? I have had GERD problems in the past. They're not active now, but the minute I start doing abs-intensive workouts, they come right back. I think it also might be connected to doing workouts lying down on the floor (at least for me). I've never tried abs-intensive upright workouts.
posted by cadge at 10:41 AM on February 13

Do you drink cold water in the morning on an empty stomach? That can irritate your stomach, especially if you're gulping it down. This was my experience a few years ago when I was having stomach problems, anyway. Try drinking more slowly with room temperature water.
posted by bluejayk at 10:44 AM on February 13

What did you drink the night before? Also, having a meal at 10:30 is quite late, if you also wake up early--meaning you'll go to bed shortly after you've had a full meal. Many people have trouble with this. Try eating earlier. Give yourself some time to digest before you sleep.

As others have said, this sounds a lot like GERD, which is what my grandfather deals with. Over the years, he's found that sleeping on an incline (as someone else mentioned) helps him a lot. Also, when it was at its worst years ago, he would go on days where he would eat very bland foods--white rice, soups, veggies--and only drink water. This helped him a lot.

If you end up going the drug route, most of the people I've met who've struggled with acid reflux and the like have sworn by Prilosec.

What do you eat at other times during the day?
posted by metalheart at 10:50 AM on February 13

Have you tried drinking less water before your workout? I mean, obviously you want to be hydrated, but with all that liquid sloshing around in your stomach without any food to soak it up, I'm not surprised that it might cause a problem as you bounce around the gym.
posted by vytae at 11:06 AM on February 13

I have GERD and gastritis. What you have sounds like it could be both or either. If antacids don't seem to help at all or even make things worse, you may have a serious case. Both GERD and gastritis can have serious consequences if left untreated (we're talking cancer here) so be sure to tell your doctor about it.

Yes, I am really fun at parties and my wife does find me a joy to be around, why do you ask?
posted by Pollomacho at 11:09 AM on February 13 [1 favorite]

When I've had troubles like this at the gym, I found that mixing baking soda with water and drinking it about 15 minutes beforehand helped a lot. You'll feel quite bloaty right after you drink it and you'll burp a lot while it neutralizes your stomach acid, but then it'll subside and the pressure/burning should be gone.
posted by hayvac at 11:17 AM on February 13

I have a similar case to Pollomacho. What you eat in the morning doesn't particularly imply you don't or can't have acid reflux, which for many people is very bad at night but by the morning time, the symptoms have cleared up but the condition is still there. That means you may not be feeling all acid-y in the morning but you still might be in for it as soon as your body's digestive system gets moving again (usually after that first drink of water). See a doctor.
posted by arimathea at 12:21 PM on February 13

So I generally go to bed at 12 or 1 and have my last meal, which is small (salad, fruit salad, or veggie wrap) at about 1030, when I get home from work.


IANAD. Best to consult an internist or gastroenterologist. If you are diagnosed with GERD, as other posters suggested, you may find that by eating your final meal earlier in the evening (say, before 7PM) to allow your food to fully digest through the night, you won't experience reflux-related symptoms when you exercise.*

*The repetitive diaphragmatic pressures may be provoking the belching.
posted by terranova at 12:22 PM on February 13

...sworn by Prilosec.

I, too, have GERD and Prilosec OTC has changed my life.
posted by ericb at 1:03 PM on February 13

Since you're familiar with Crossfit, you should search their message board for GERD, reflux, heartburn, etc. Pay particular attention to anything by Robb Wolf. Basically, he recommends removing all grains and gluten-containing foods from your diet to fix digestive/stomach problems. It's a big dietary change, but it's worth trying at least for a couple weeks.
posted by Durin's Bane at 1:19 PM on February 13

Apple Cider Vinegar. You can get it in tablets, do so because it tastes vile. Take some before bed, preferably with that last meal.

Seriously. Yes, visiting the doctor to cover your bases is wise, but I tried that after experiencing symptoms like these after losing my gall bladder... even getting scoped produced no solid answer. Started taking that and I went from having everyday issues to maybe once every month or two -- immediately.

Won't hurt you, so give it a shot.
posted by Pufferish at 1:28 PM on February 13

I used to be able to eat dinner at any time of night right up to bedtime and it didn't bother me. Now if I eat late, it's certain to be an uncomfortable night and morning. Try eating nothing at all for the 4 hours before going to sleep (water or juice is ok), try it for a week - it might take a few days for your body to adjust to the new pattern, so that it stops telling you "I'm hungry" - good luck.
posted by peter_meta_kbd at 2:51 PM on February 13

My reflux is always worse when a) my stomach is empty and b) I exercise. The two together is a guarantee for reflux (this is pretty common). So your post doesn't really surprise me.

You don't necessarily have GERD, that's when the reflux gets bad enough to cause other symptoms (primarily changes in esophageal morphology). However your reflux definitely should be treated so you don't progress to GERD. Your current situation actually sounds pretty mild to me (one specific trigger) but it definitely won't stay that way (and yes, cancer is a possible result), so best to get this sorted.

Sleeping propped up would be good if you're refluxing during your sleep but isn't going to so squat for the reflux during exercise. Apple cider vinegar is totally unproven pseudoscience and a waste of your time. Ignore those suggestions.

I agree that eating first would definitely help but I also know what you mean about it making you feel sick. You could try different foods, I find yoghurt is pretty good for suppressing the reflux without increasing the nausea, but it that may not work.

So you probably need to take medication to suppress the acid production. You may still reflux but it won't be acidic and thus won't burn (preventing GERD). Proton Pump Inhibitors like Prilosec or Losec is the first line of defence and they do work very well. They can also have side effects in some people (which are rare and usually mild). If so the second option is H2 receptor antagonists like Famotidine (Pepcid), which are somewhat less effective but more widely tolerated. A straight antacid like Tums or sodium bicarbonate won't be very effective and for noticeable reflux like yours is likely a waste of time (plus will make you bloated). Go for the good stuff. You may be able to get something like Pepcid over the counter and that may be enough to stop your problem, otherwise talk with your GP and get a prescription. You'd probably want to take a dose as soon as you wake up, in my experience 1.5 hrs is plenty of time for them to be working and giving your protection. If you can't get on top of this then a gastroenterologist is your next step, but start with your GP.

I'm not a doctor. I am a digestive physiologist, am up to date on the scientific literature, have had reflux for going on 16 years (including developing GERD last year although it's gone now) and have discussed current medications etc fairly extensively with my doctor in the last three months. You do need to deal with this, but it should be doable.
posted by shelleycat at 3:45 PM on February 13

The two together is a guarantee for reflux (this is pretty common).

I meant for people with reflux to find these things are triggers. Not that I often exercise without eating.
posted by shelleycat at 3:47 PM on February 13

And why is it happening?

Sorry for the multiple posting but I missed this bit the first time around.

When you're sleeping your digestive system also slows down a lot (as does your whole metabolism). This is why breakfast is a good idea, it helps wake everything up and get your body working and alert again. Also when you exercise you burn calories. So your stomach becomes more active, telling you to eat food and replace those calories. Both of these processes can increase stomach motility and acid production. In addition I read the other day that exercise can increase stomach acid production because of biochemical processes elsewhere in the body (due to respiration), but I haven't looked further into that yet to see how (or if) it works. Lastly, the physical act of exercise can put pressure on your stomach in different ways, e.g. bouncing it around, squashing it while bending, etc.

Reflux occurs when your stomach contracts but the valve at the top of the stomach isn't fully closed, so the pressure from the contraction forces stomach contents back up your oesophagus rather than squooshes it around your stomach or expels it into your duodenum. In some people that valve is outright faulty (doesn't close all the way, opens and closes at the wrong time, is screwed up by something else like a hernia, whatever) so reflux happens often. heh, this is me. In other people it's more like the valve isn't quite as good as it could be so extra pressure from something like exercise forces some contents through. Having overly acidic stomach contents can irritate everything making the valve more likely to open. You're probably more in the latter group if you never get reflux at any other time.

So you're waking your stomach up and making it all acidy (which is why you're burping, the new acid is reacting and producing carbon dioxide) then you're putting everything under mechanical and chemical stress so that reflux occurs. If you're only getting burps then a mild otc medication like Pepcid could be enough to help. If you're actually getting a burn then you may need something stronger. Either way food would definitely help because it soaks up the acid making your stomach less irritated, but again you need to find something you can tolerate.
posted by shelleycat at 4:03 PM on February 13

Thanks everyone for your answers. I will see my doctor.
posted by You Should See the Other Guy at 10:04 PM on February 13