Managing GERD and Strength Training: Strategies for Symptom Relief

Balancing Strength Training and GERD: Tips for Minimizing Discomfort

As anyone who suffers from Gastroesophageal Reflux Disease (GERD) can attest, symptoms can be debilitating. Unfortunately, exercise, particularly high-intensity exercise, can increase the risk of GERD flare-ups. This is likely due to an exercise-induced reduction in closing pressure of the lower esophageal sphincter.

I have personally witnessed athletes I was coaching become incapacitated during weightlifting training due to a GERD flareup – it looked miserable. Here are some tips to arrange your eating pattern to minimize the likelihood of this happening.

Food and Exercise Timing Considerations

Before you work out:

I have previously written my recommendations for pre-workout meals. As a short recap, ingest pre-workout meals about two hours before training and make them reasonably small (<300 calories) in size. The makeup of pre-workout meals should be primarily low-fiber carbohydrates and a little (max 20g) protein. Avoid fat and fiber, as they are relatively hard to digest, so they will sit in the stomach longer, increasing the odds that you can have a flare-up.

And speaking of pre-workouts. Pre-workout drinks are really popular (see my series on them here), but if you have GERD, I recommend you avoid them, as they typically contain high doses of caffeine and sugar, both of which can irritate the GI tract. As an alternative, sports drinks appear to be well-tolerated.   

Right after you work out:

A common concept in the strength-training community is that it is vital to get some protein immediately after you train. The theory is based on the idea that this is a prime time to get amino acids from the proteins you eat transported into your muscle cells for optimum recovery and growth. In reality, it doesn’t matter! The best available evidence suggests that total protein ingestion throughout the day matters more than consuming protein within a specific post-exercise time window. 

The rest of the day: Daily diet considerations

Athletes who engage in regular strength training have a higher daily requirement for dietary protein than average. This presents a minor challenge for the strength trainer living with GERD, as high-fat protein intake (i.e., red meat) has been associated with worse GERD outcomes. Meat, oils, salt, and calcium are associated with an increased risk of reflux esophagitis (RE). 

However, there are options. High intake of lean proteins, carbohydrates, grains and potatoes, vitamin C, fruits, and eggs correlates with a reduced risk for RE. A fiber-enriched diet has also been associated with lower risk of GERD symptoms.

So, how do you get your protein while keeping your esophagus happy?  

1. Limit proteins with high fat and oils—namely high-fat meats and dairy products. Mix your protein shake with skim milk, low-fat milk alternatives, or water (if you can stand the taste).
2. When choosing protein supplements, such as bars or powders, make sure to select ones that are free from the ingredients notorious for triggering symptoms of reflux, such as chocolate, caffeine, peppermint, citrus fruits, and coffee, until you know which ingredients affect you personally. I have compiled a few reflux-friendly choices here, but generally, vanilla, strawberry, banana, mixed berry, or coconut are good flavors to consider (remember to watch the sugar alcohols, which may also contribute to symptoms).
3. One does not live by protein alone. Most protein-rich snacks will not have a lot of fiber. Make sure you get enough fiber throughout the day. Make an effort to consume at least 30g of fiber per day with a diet including fruit and vegetables.  

1. _{El-Serag, H. B., Satia, J. A., & Rabeneck, L. (2005). Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers. Gut, 54(1), 11–17. https://doi.org/10.1136/gut.2004.040337}
2. _{Kashima, H., Sugimura, K., Taniyawa, K., Kondo, R., Endo, M. Y., Tanimoto, S., Kobayashi, T., Miura, A., & Fukuba, Y. (2018). Timing of post-resistance exercise nutrient ingestion: effects on gastric emptying and glucose and amino acid responses in humans. The British journal of nutrition, 120(9), 995–1005. https://doi.org/10.1017/S0007114518002398}
3. _{Maddison, K. J., Shepherd, K. L., Hillman, D. R., & Eastwood, P. R. (2005). Function of the lower esophageal sphincter during and after high-intensity exercise. Medicine and science in sports and exercise, 37(10), 1728–1733. https://doi.org/10.1249/01.mss.0000175051.47170.33}
4. _{Mehta, R. S., Song, M., Staller, K., & Chan, A. T. (2020). Association Between Beverage Intake and Incidence of Gastroesophageal Reflux Symptoms. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 18(10), 2226–2233.e4. https://doi.org/10.1016/j.cgh.2019.11.040}
5. _{Morozov, S., Isakov, V., & Konovalova, M. (2018). Fiber-enriched diet helps to control symptoms and improves esophageal motility in patients with non-erosive gastroesophageal reflux disease. World journal of gastroenterology, 24(21), 2291–2299. https://doi.org/10.3748/wjg.v24.i21.2291} 
6. _{Schoenfeld, B. J., Aragon, A., Wilborn, C., Urbina, S. L., Hayward, S. E., & Krieger, J. (2017). Pre- versus post-exercise protein intake has similar effects on muscular adaptations. PeerJ, 5, e2825. https://doi.org/10.7717/peerj.2825} 
7. _{Wilson P. (2022). Sport Supplements and the Athlete's Gut: A Review. International journal of sports medicine, 43(10), 840–849. https://doi.org/10.1055/a-1704-3086} 
8. _{Wu, P., Zhao, X. H., Ai, Z. S., Sun, H. H., Chen, Y., Jiang, Y. X., Tong, Y. L., & Xu, S. C. (2013). Dietary intake and risk for reflux esophagitis: a case-control study. Gastroenterology research and practice, 2013, 691026. https://doi.org/10.1155/2013/691026}