Quotations by Jonathan Aviv

When you eat and drink, your stomach naturally expands to make room for what you’ve just ingested, which can increase pressure on the lower esophageal sphincter (LES) and lead to a relaxing of this important muscle. Once this muscle relaxes, the doorway to refluxed acid has been precariously left open. One way to prevent the gastric distention that occurs after you eat from placing too much pressure on the LES is to simply go for a walk after meals. A post-dinner walk has been linked to reduced risk of stomach cancer. To help ensure that this walk prevents rather than provokes refluxed acid, it’s best to stick to a leisurely pace, which should be decidedly slower than the brisk or vigorous one you will aim for during exercise. [2017] - Jonathan Aviv

A study published in the American Journal of Gastroenterology revealed that abdominal breathing had a positive effect on reflux symptoms and reduced the need for reflux medication in people with GERD. To practice diaphragmatic breathing, first get into a comfortable starting position. This could be lying down on your back with your knees bent and feet on the floor, sitting on a chair that allows your feet to be flat on the ground, or standing with your feet hip-width apart. In either position, focus on keeping your spine erect as you place one hand on your chest and one hand just at your beltline. Inhale deeply and slowly through your nose, taking air into your belly. Exhale through your nose, feeling your belly as it sinks back in. Repeat five to ten times, alternating the position of your hands if you’d like.  [2017] - Jonathan Aviv

Yoga is for anybody who’s interested in gaining flexibility, strength, and balance. If you are a beginner, try hatha yoga (preferably at a smaller studio rather than a gym), which is a broad category of practice that focuses on learning yoga poses that promote stability, strength, and controlled breathing. Of these, the Iyengar style emphasizes proper alignment, which is crucial to master if you want to progress to more advanced practice, including the popular Vinyasa or Bikram variations. As a person with acid reflux, you must avoid certain poses, such as inversions. You should also pay attention to the most ubiquitous pose, the downward dog, to see if you notice any reflux symptoms. [2017] - Jonathan Aviv

If you try to exercise on a full or even partly full stomach, there is a greater risk that certain movements or types of movement will lead to increased pressure on the Lower Esophageal Sphincter (LES), which if compromised will let in gastric acid and tissue-damaging pepsin. To prevent this from happening, be sure to exercise only after at least two hours have passed since you’ve eaten, and three hours for larger meals. Depending on your schedule, this may require you to work out on an empty stomach before breakfast. Try to drink 16 ounces of water (about two glasses) upon rising to ensure that your body is hydrated before you start exercising. [2017] - Jonathan Aviv

When it comes to preventing reflux, the type of exercise you do is important. Movements that require intense strain of the abdominal wall, which is essentially your core, should be avoided, as should those that require a sustained crouched position and others that repeatedly put your head below your waist. These include heavy weight lifting, sit-ups, crunches, leg lifts, and similar abdominal exercises (though a properly done “plank” exercise may be well tolerated). Some reflux-safe exercises include cycling; brisk walking; gentle yoga; strength training (no heavy weights); and bodyweight training with short bouts of moderate to vigorous activity. [2017] - Jonathan Aviv

Many sports drinks, especially Gatorade, contain high amounts of citric acid, which can directly damage your esophageal tissue. You shouldn’t drink these types of beverages at all if you’re dealing with acid reflux, but especially not when you’re exercising and there could already be increased pressure on your Lower Esophageal Sphincter (LES). [2017] - Jonathan Aviv

A study published in the Journal of the American Medical Association on May 17, 2016, and the corresponding editorial, provided proof that refluxed acid initiates a deep-tissue inflammatory response, which sets off the release of a multiplying body of pro-inflammatory proteins. The link between acid damage and worsening systemic inflammatory symptoms, which I had witnessed in practice for so many years, had essentially been scientifically validated. [2017] - Jonathan Aviv

When a Danish study came out in May 2014 concluding that regular, long-term use of certain PPIs was linked to greater risk of developing esophageal cancer, the use of this popular acid-blocking medication was put into question. It was an alarming argument, but it’s not one you should give too much credence. The authors of the study were unable to control for significant risk factors for the development of esophageal cancer such as alcohol consumption. Nor were other lifestyle considerations, such as smoking or dietary habits, taken into consideration. [2017] - Jonathan Aviv