What Masters Swimmers need to know about GERD
Do you have one or more of the following on a continuous basis? 
1.	Heartburn 
2.	Indigestion 
3.	Food regurgitation 
4.	Difficulty swallowing, choking
5.	Chronic sore throat, hoarseness
6.	Hiccups 
7.	Nausea 
8.	Coughing attacks occurring over a period of several weeks 
9.	Excessive dental erosion 
10.	Asthma 
11.	Sleep apnea, restless sleep, morning headaches
12.	Use three or more pillows to sleep - Some doctors rate the severity of 
	symptoms by the number of pillows used

 
You may have Gastro Esophageal Reflux Disease (GERD). A large percentage of 
people over the age of 40 (Masters swimmers included) have one or more of these
symptoms. GERD is a disease that occurs when reflux of stomach acid into the
esophagus is severe enough to impact the patient's life and or damage the 
esophagus. The tissue of the esophagus doesn't handle the acid well, causing the
symptoms listed above.

Stomach and esophagus

The end of the esophagus contains the lower esophageal sphincter (LES).  This 
muscle opens and closes to keep the food and acids within the stomach. The LES 
can lose tone due to the wrong diet or medicines or it can be affected by a 
hiatus hernia, which is an out-pouching of the stomach above the level of the 
diaphragm. Pressure from over eating, tight clothing, or excess weight around 
the abdomen can force acids past the weakened LES into the esophagus. Trying to 
sleep right after eating can aggravate GERD. Swimming, in contrast to most other
sports, is performed in the horizontal position. This allows acid to leak into 
the esophagus in those with a weakened LES, or if a meal is consumed within a 
couple of hours of swimming.

If you have several of these symptoms, make an appointment with your doctor to 
get a diagnosis. You want an evaluation of the condition of the stomach, 
esophagus, and throat. Over time, GERD is not just some minor discomforting 
occurrence; it can lead to complications that are far more serious. But why 
suffer the annoying effects mentioned above? The following list should be used 
as a guideline for daily use, after seeing a doctor:

1. Dietary Restrictions: No caffeine containing foods. Caffeine affects the LES,
   causing it to relax and allows for acid reflux. Chocolate, spearmint, 
   peppermint, onions, garlic, acidic citrus and tomato products also have this
   relaxing effect. Spices, coffee (even decaf) and condiments all allow for 
   excess acid to be produced. Carbonated drinks also allow for increased 
   pressure in the abdomen that makes GERD worse. While these items do not cause
   GERD, they seem to make symptoms worse.

2. No heavy meals or snacks within 3 hours of bedtime.

3. No lifting heavy weights and or intense abdominal exercises (crunches, etc) 
   within a three-hour period after a heavy meal.

4. Do not wear tight clothing, especially around the abdomen.

5.  Losing weight will reduce abdominal fat and help reduce pressure on the stomach.
	Consult your doctor before starting a weight loss program.

6. Raise the head of your bed 6 inches higher than the foot. 

7. Try and sleep on your LEFT side, which can help prevent acid from backing up 
   the esophagus.

8. Eat several small meals throughout the day instead of large meals.

9. If acid reflux happens and no antacids are around, simply chewing gum will 
   help reduce the acid. The saliva produced is alkaline and helps neutralize 
   the excess acid. 

10. Before swimming, take a product like Gaviscon, which foams with water to 
	provide a protective barrier into the esophagus. Also, concentrated antacids
	like Mylanta Extra Strength can act to coat the linings and help neutralize
	the excess acid. 

11. NEVER allow this condition to go untreated over time. Do not try and deal 
	with the discomfort in a "macho" fashion. Putting up with discomfort or pain
	seems to come with athletic training, but this type of discomfort can lead to
	complications that are more serious if not diagnosed and treated properly.

12. Tell your doctor if you smoke, drink alcohol, take non-steroidal anti-
	inflammatory medications (NSAIDS) such as aspirin and ibuprofen, take 
	decongestants, sedatives, or use asthma inhalers. All of these, and many 
	others, can weaken the LES and lead to GERD symptoms.
 
Wayne McCauley
SPMA Chairman
ASCA Level 5 Masters

Illustration reprinted with permission of AstraZeneca Pharmaceuticals LP."
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