Tuesday, April 01, 2008

Athletic acid reflux

If you work on the basis that gastroesophageal reflux is carbohydrate poisoning, you would expect a LC diet to provide remission of symptoms. Just reading through the abstract of this paper from g, that would appear to be the case. Six days is a pretty short period to sort our GERD and no doubt there would be further improvement with time. The other tweak would be gluten elimination, not that much would be coming through at 20g of carbs per day.

This goes nicely back-to-back with another paper which has been lying around on my hard drive for some time. There is a fairly large literature as to why exercise results in an omprazole deficiency in athletes, with lots of ideas floated around about pressure changes, hormones etc. I think it's reasonable to describe many endurance athletes, the ones worst affected, as indulging in "carb loading". Apart from furring up their coronary arteries with sugar, GERD would seem be (yet) another price that must be paid by athletes for this practice. I'm glad so say that I have no personal experience of GERD, though my wife could write a book bout it.

Peter

BTW Nice to see Grete Waitz doing well.

22 comments:

mess talker said...

Another interesting article. The topic interests me as I train to compete at a very amateur level on the bike and triathlon. The high carb aspect just doesn't appeal. Never understood how people would say the best fuel for the body is fat, now eat these bagels!
I love the studies that show athletes do just as well on fat as they do on high sugars exception being high energy sprints. It seems to take some time to adapt and I look forward to being confident enough to ride long distance or high intensity without bringing a "gel" (liquid sugar teeth rotting crap) with me.
The paleo diet for athletes still recommends carbs before events and always after to replenish glycogen in the "nutritional window." I hardly do this as kind of hope to be a kytogenic machine. I wonder though, if you're burning fat for your event and suddenly take on a gel, (or potato), would an insulin spike stop the body from using fat for fuel and use the sugars and then remain sugar dependent or bonk?
I have a big event coming up and I thought I could bring some fingerling potatoes with me on the bike and use them for fuel in extreme anaerobic conditions (hills, sprints). Sure would beat the gooey sugars. Also considering dextrose.
Ok forgive me for being a bit off topic but any thoughts on this would be appreciated.

G said...

Great post!! I can see why athletes may have GERD more often -- the breathing aspect may affect the LES juncture, the sphincter betw the stomach and esophagus. All the up/down motion on the diaphragm... red wine gives me GERD sometimes when I run :) *ha haa but it improves my vasodilation and blood flow! (or so I think at least....)

I don't do the gels -- I like the caffeine kick but found that the sugar spike nauseates (and reduces performance). That's awesome you do tri's!

Peter said...

Hi Mess talker,

I think Chris is really the person to ask on this one, he lives fitness where as I ride my bike up a hill occasionally and surf every other year!

He's here

Peter

migraineur said...

Well, I can tell you that on a low-carb diet with lots of aerobic exercise, my acid reflux was the worst it's ever been. It was the only time in my life I ever took meds for acid. When I stopped going to the gym, but stuck with LC, the acid stopped in a matter of days. I always thought it was purely mechanical, much the way g describes it - stop bouncing up and down, no more sloshing acid.

migraineur said...

P.S. My comment was meant to say, I don't think carb loading is the only reason that athletes get GERD.

Bruce K said...

I think GERD is mainly a symptom of overeating the typical modern diet: junk carbs and junk fats. I want to see studies that eliminate those so called foods. To define acid reflux as "carbohydrate poisoning" has too many assumptions. There are lots of other theories that can explain the facts, like food combining. Peter's theory seems to be that carbs cause acid reflux. Suppose the problem is due to refined carbs or over-eating or mixing foods together.

The low-carb dogma is a reaction to low-fat dogma. Both sides have bias and we don't get any help from lots of studies that fail to isolate all the variables involved.

Sven said...

Does anybody know how much muscle glycogen is used during high intensive excercise (like sprinting)? I mean for someone with a LC regimen. Can muscles get adapted to burn fat exclusivly even during anaerobic excercise? I am wondering if it makes sense for me to eat some carbs after excercising. I´m doing some tabata-protocol-like sprinting.

Peter said...

Hi sven,

You might find this link interesting.

At BSAVA conference at the mo so limited blogging.

Peter

Peter said...

Migraineur, it also looks like LC doesn't work for all acid reflux, with or without the exercise. It seems to work for most though...

Peter

Varangy said...

Hi Peter,

Sorry to off topic but Art De Vany has this to say about 'brain fade' when following his EvFit diet.

"You may have so much fat in your diet or in your trunk that you have elevated triglycerides that are poisoning your pancreatic cells or insulin receptors. Elevated tris can produce insulin resistance."

Would love to get your opinion.

Thanks in advance.

http://www.arthurdevany.com/?p=1000

Varangy said...

Shoot. Forgot to click the follow comments box.

Sven said...

Thanks Peter. Interestig read. But I would suspect that an endurance athlete (lc) doesn´t need that much glucose. I am not so sure about HI-training.

Peter said...

Hi varangy,

I'm not sure I follow this. As far as I'm aware elevated triglycerides are a feature of insulin resistance rather than a cause.... Elevated non esterified fatty acids (NEFA) also occur in insulin resistance (and during weight loss). These NEFA do enter muscle cells and contribute to intarmuscular triglyceride accumulation, which (in non athletes, doesn't apply to athletes) renders the muscles insulin resistant. Certainly short term exposure of the pancreas to NEFA increases insulin secretion per unit plasma glucose but after 24-48 hours this effects stops and is replaced by decreased insulin secretion per unit glucose elevation.

There's a summary here, though I disagree with conclusions, the physiology is probably correct. It's increased NEFA in plasma, increased tri's inside pancreas/muscle.

This is logical. High tri's in the plasma are esterified within VLDL or chylomicron particles and cannot get in to cells without being broken down to NEFA by lipoprotein lipase in the process.

Kwasniewski suggests increasing carbs if transition makes you feel rough, also if you get cramps (most people suggest this is Mg or K depletion but....)

So I'm not sure exactly what Art De Vany means here. There are reports of elevated tri's in weight loss on LC diet but I believe it's quite rare and anecdotal.

Peter

JohnN said...

Varangy and Peter,
The symptoms of brain fade, vague headache and fatigue described by the adherents of EvFit are classic over consumption of lean protein that can be cured by upping fat or carbohydrates. I'd increase the fat to minimize the insulin production by the pancrea.

Varangy said...

@Peter and John N

My gut feeling is that Art, while a great source of opinion and perhaps even thought leader in EvFitness, is still a bit prejudiced against fat, and especially saturated fat.

I'd love some more discussion about protein and insulin resistance.

Chris said...

There is a good study here on athletic performance on a ketogenic diet

http://tinyurl.com/26tfts

dotslady said...

Obese celiac here with experience alleviating GERD, so I thought I'd share. First heartburn occasion was during pregnancy at age 28 - baby was pressing on stomach. GERD worsened through the years but I didn't pay attention.

Gastroenterologist asked what I was eating last time I had heartburn: whole grain bread. After celiac diagnosis I turned to gluten-free substitutes. I gained weight "trying" gf cookies, cakes, breads - 22 lbs in 4 months. My GERD was horrendous with the gained weight (from 250 to 272 lbs). I got meds from doctor but wouldn't take them because I knew they caused malabsorption and I'd had enough of that. I stopped grains, save some gf crackers, altogether, ate smaller, less acidic meals (again, grains) and therefore upped veggies and fruit. With the weight loss and smaller more alkaline diet I rid myself of GERD.

Only once have I pigged out - gluten-free and grain free (well, I had a ton of popcorn) and the GERD returned in full bloom. I took a Nexium since I had them, and it worked after the fact - thank goodness, as it was the worst. Full stomach and acid environment is what I think caused mine.

I just discovered your blog. I've been grain free for months and just now learning about metabolic syndrome as to why I haven't been able to lose weight on veggies and fruits and protein. I'm just getting the fat thang. Thanks for what you do (even though much is above me at the point, you have to start somewhere!).

Peter said...

Hi Dotslady,

Yes those gluten free foods are usually pretty grim. In the UK a positive coeliac disease diagnosis, with all the boxes ticked, gets you free junk food for life on the NHS. No free meat and eggs, just gluten free "bread" and "biscuits". Sugar seems to be a good trigger for GERD too.

Interestingly my wife seems to be gut tolerant of corn flour but not skin tolerant... But I guess there is not always a correlation between gut damage and gut pain.

Good luck with the grain elimination. It's worth it. Real food is much better...

Peter

Bris said...

I also suffered from extreme reflux which was uncontrolled by medication. After a week or so on a <20g carbohydrate diet the reflux disappeared.

Dr Wolfgang Lutz in 'Life Without Bread' noticed that reflux was often the first symptom to resolve on a LC diet.

Bris said...

It is no coincidence that HGs nearly always hunt on an empty stomach. They eat after they have done their running.

Dr. N said...

Peter,

I'm late to the party on this post but GERD for the majority of patients is actually an autonomic disorder resulting inadequate gastroesophageal sphincter function as well as poor gastric emptying.

Accumulating evidence of either weight reduction or straight carb reduction results in improvement of a variety of autonomic function including not only gastric motility but bladder function and blood perfusion to the brain as well.

PMN

Dr. N said...

Peter,

I'm late to the party on this post but GERD for the majority of patients is actually an autonomic disorder resulting inadequate gastroesophageal sphincter function as well as poor gastric emptying.

Accumulating evidence of either weight reduction or straight carb reduction results in improvement of a variety of autonomic function including not only gastric motility but bladder function and blood perfusion to the brain as well.

PMN