As if lack of time, equipment and motivation weren't enough reasons to make you want to dodge your workout altogether, exercise-induced heartburn can send you right back to the couch.
Heartburn — which can feel a lot like someone lighting a small fire under your chest that's slowly burning through to your throat (pleasant, isn't it?) — is relatively common during or after exercise, especially if you're doing an intense workout.
"Exercise can cause greater intra-abdominal pressure, leading to greater reflux and acid reflux-related symptoms during or after running or lifting weights," explains Atif Iqbal, MD, medical director of the Digestive Care Center at MemorialCare Orange Coast Medical Center in Fountain Valley, California.
Exercise can cause the lower esophageal sphincter, a muscular ring at the end of your esophagus, to relax. This can allow stomach acid to flow in reverse, explains Rita Knotts, MD, a gastroenterologist and assistant professor of medicine at NYU Langone Health.
"The lower esophageal sphincter is sort of the pressure valve between the stomach and the esophagus," Dr. Knotts says. "Exercise can relax it and cause a reflux of gastric contents or acids to come up. And that can definitely cause some heartburn."
Technically, that's known as gastroesophageal reflux (GER), according to the Mayo Clinic, and it can cause the burning sensation known as heartburn in the chest, as well as abdominal pain when bending over and a bitter or acidic taste in your mouth.
While heartburn during exercise can happen to anyone, Dr. Knotts says people living with obesity or overweight tend to have a predisposition to reflux. "Those who have a lot of abdominal obesity are prone to reflux because you are basically compressing your stomach. It's similar to pregnant women," she says. But shedding excess weight can help with symptoms, she adds.
In fact, in a December 2016 study in Neurogastroenterology and Motility, more than 15,000 people with obesity saw an improvement in reflux symptoms after losing about 4.4 pounds or more.
That said, if you're experiencing heartburn during exercise, health experts recommend evaluating your lifestyle. For example, making some changes to your diet and the timing of your workouts can help you find some relief.
Here are some reasons you might be experiencing heartburn during exercise and what you can do about it.
Heartburn feels different than chest pain, which could signal an underlying heart problem or a heart attack.
If you have chest pain accompanied by shortness of breath or sweating, seek medical attention immediately, Dr. Iqbal says. Pain that spreads to the chest, jaw or shoulder could also be a sign of a heart attack, he adds, while "heartburn is primarily located in the middle of one's chest."
1. You Need to Rethink Your Pre-Workout Fuel
Spicy foods, tomato-based dishes, snacks or meals higher in fat and fiber and carbonated beverages can all relax the lower esophageal sphincter and trigger reflux, Dr. Knotts says.
That's because spicy foods have a compound called capsaicin, which can delay gastric emptying and increase pressure in the lower esophageal sphincter, according to a July 2017 study in the Journal of Neurogastroenterology and Motility.
Moreover, fatty and fried foods, like french fries and cheeseburgers, sit in the stomach longer and increase abdominal pressure, so stomach acid can leak into the esophagus, per Harvard Health Publishing. You'll likely want to avoid all of these too close to exercise.
Many people may have a cup of coffee beforehand to get a boost from caffeine, but Dr. Iqbal says the caffeine and acidity content in coffee can sometimes also cause heartburn.
In fact, a November 2019 study in Clinical Gastroenterology and Hepatology, which included more than 7,000 women, found those who drank more caffeinated beverages like coffee, tea and soda reported symptoms of GER more than once a week compared to those who drank water, juice or milk. Keep in mind some pre-workout drinks also contain caffeine.
Drinking a protein shake right before you exercise can also cause heartburn, Dr. Knotts says.
"Unless you're used to it, you're not going to feel great when you have a protein shake and immediately start working out. It's just going to sit in your stomach, so I would be mindful of what you're consuming before working out," she says.
Avoid any food that increases the likelihood of acid reflux to help prevent heartburn during a workout, says Sarah Pelc Graca, a National Academy of Sports Medicine-certified trainer and weight-loss coach.
According to Johns Hopkins Medicine, some of the best foods to prevent heartburn are complex carbs, such as whole grains, fruits and vegetables, as well as water-rich produce, like watermelon, cucumbers and celery.
For example, if you work out in the morning, try eating some overnight oats or low-fat yogurt with non-citrus fruit instead of fatty breakfast meats, such as bacon, ham and sausage, per Harvard Health Publishing. It's also best to drink plenty of water instead of coffee and other caffeinated beverages before you work out.
2. You're Exercising Too Soon After Eating
You can help prevent heartburn during exercise by not eating for at least three hours prior to your workout.
"It's better to just wait a little while after you eat, especially if you're going to eat a spicy burrito, and then go work out," Dr. Knotts says. Dr. Iqbal recommends waiting three hours after eating a meal to sweat to help prevent heartburn.
Then, start with a dynamic warm-up to ease your way into exercise, Graca says.
It's not necessary to eat before you start exercising unless you're hungry or feel like you need something small to hold you over. Even if you do enjoy a small snack, it's best to give your body some time to digest it before you hit the ground running.
If that's not possible, Graca recommends eating foods that are more easily digested than fatty or fried foods, such as ones higher in complex carbs like bananas, oatmeal or crackers. In other words, try to have a snack instead of a full-blown meal right before you work out, if you're trying to take the edge off hunger.
Other great pre-workout snack ideas include Greek yogurt with fresh berries and granola, a slice of whole-grain toast with peanut butter and a trail mix made with nuts, dried fruit and whole-grain cereal.
"Drinking plenty of water before and during a workout can also help prevent heartburn," Graca adds.
3. You May Want to Dial Down the Intensity
"The more intense the workout is, the more intra-abdominal pressure and the more likely the reflux," Dr. Iqbal says. Any high-impact activity, such as running or jumping, can increase the likelihood of heartburn, Graca says.
But doing heavy weight lifting may lead to more reflux than other types of intense exercise because of the increase in pressure in your stomach, Dr. Knotts says.
A small but frequently cited May 2003 study in Medicine and Science in Sports and Exercise compared the prevalence of heartburn among runners, cyclists and weight lifters. Results showed weight lifters experienced more reflux than runners and cyclists, likely due to the increase in intra-abdominal pressure during strength training.
You don't need to skip intense workouts altogether, but you may need more rest. "Taking breaks between exercises or drinking enough water before and after will also help prevent heartburn," Dr. Iqbal says.
4. You Could Have GERD
When heartburn becomes more chronic — about two or more times a week — it may be a sign of gastroesophageal reflux disease or GERD, per the Mayo Clinic. This is a more serious condition than occasional heartburn because over time it can damage the esophagus and may lead to precancerous cell changes, a condition known as Barrett's esophagus, according to NYU Langone Health.
If you're experiencing regular heartburn during workouts and afterward, you may need help from a health care professional to pinpoint the root causes of your symptoms. In addition to frequent heartburn, other symptoms of GERD include difficulty swallowing, coughing, wheezing and chest pain, per the Mayo Clinic.
Talk to your doctor about your symptoms and their frequency. GERD is usually treated with over-the-counter and prescription meds.
5. You Might Have a Hernia
A hernia is caused by fatty tissue or an organ breaking through a weak spot in the abdominal muscles, and it can predispose you to acid reflux, Dr. Knotts says.
People who have hernias have many of the same symptoms as someone with GERD, like heartburn, abdominal pain and a sour, acidic taste in the mouth, according to the Cleveland Clinic.
Hiatal hernias, a condition that happens when the upper portion of the stomach bulges into the chest cavity through a small opening in the diaphragm known as the hiatus, are especially likely to lead to heartburn. In these cases, the lower esophageal sphincter is moved above the diaphragm, Dr. Knotts explains. When that pressure valve moves, acid is more likely to come back up, causing heartburn.
Hernias can also be caused by not engaging your core muscles when lifting heavy weights. Coughing from conditions like chronic obstructive pulmonary disease (COPD), straining during a bowel movement and vomiting can also cause a hernia, per NYU Langone Health.
If you suspect you could have a hernia, talk to your doctor right away.
To prevent these injuries from happening in the future, make sure to do heavy lifts with proper form and to gradually add load when you feel ready. Don't lift anything beyond your fitness abilities.
- Current Opinion in Clinical Nutrition and Metabolic Care: "The Impact of Physical Exercise on the Gastrointestinal Tract"
- Mayo Clinic: "Acid Reflux and GERD: The Same Thing?"
- Cleveland Clinic: "Hiatal Hernia"
- NYU Health Langone: "Types of Hernia in Adults"
- Harvard Health Publishing: "What to Eat When You Have Chronic Heartburn"
- Neurogastroenterology & Motility: "Weight Loss and Waist Reduction Is Associated With Improvement in gastroEsophageal Disease Reflux Symptoms: A Longitudinal Study of 15,295 Subjects Undergoing Health Checkups"
- Journal of Neurogastroenterology and Motility: "Foods Inducing Typical Gastroesophageal Reflux Disease Symptoms in Korea"
- Clinical Gastroenterology and Hepatology: "Association Between Beverage Intake and Incidence of Gastroesophageal Reflux Symptoms"
- Johns Hopkins Medicine: "GERD Diet: Foods That Help with Acid Reflux (Heartburn)"
- Medicine & Science in Sports & Exercise: "Esophageal Reflux in Conditioned Runners, Cyclists, and Weightlifters"
- NYU Langone Health: "Diagnosing Gastroesophageal Reflux Disease"
- Mayo Clinic: "Gastroesophageal Reflux Disease (GERD)"