Athlete with acid reflux affecting performance

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Thank you all for your help! It is very difficult to help her from far away.

@BunsenBurner - she has been tested for H. Pylori with a blood test that came back negative.

@adogwillbesad - thank you for mentioning non-celiac gluten intolerance. Definitely something to keep track of.

@parentologist - Thank you so much for your advice. I will recommend the 40mg omeprazole in the morning and Pepcid at night.

And yes, the sport is not giving her much joy right now. She is not happy with her performance which is stressful which makes the acid reflux worse which makes her performance worse, etc. She has mentioned dropping the sport after this year but it has been a huge part of her life and COVID wrecked her reaching one goal. So it is hard to move on without reaching it. But she knows academics is why she is at college. And she did amazing her first semester.

I do think everything, migraines and acid reflux, are caused by stress. Fingers crossed, she hasn’t had a migraine in months. We have found a therapist that she likes so hopefully that will help her alleviate the stress or learn some coping mechanisms.

I think trying to eliminate foods and keep a record of how she feels is the best step until she can see the gastroenterologist.

Thank you all! I just want her to be happy.

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Seems like trying to keep up with academics and the sport are causing stress. Stress has so many negative symptoms.

Of course I am not doctor, but I am sure your daughter has been made aware that all those medicines should not be taken long term.

I had silent reflux and still get it occasionally, which caused symptoms seemingly unrelated to each other. I didn’t believe it until a third doctor confirmed it. I temporarily used meds, but they are short term. I’m not saying your daughter has that by the way, rather that many of her symptoms can probably be alleviated without overusing the omeprazole, Pepcid, etc


The most effective long term changes were the most common sense ones:
No eating three hours before bed.
No heavy meals before exercise.
Elevating the head at bedtime using a wedge pillow.
No more orange juice or tomatoey products. (If I do have those things now, I will use some antacids afterwards, but I avoid those food mostly.)
Limiting use of NSAIDs.

Lots of other good suggestions above. Good luck to your daughter.

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I have severe GERD and my daughter, who has type 1 diabetes, celiac, migraines and seizures, has had severe GI issues (slow stomach emptying is called gastroparesis by the way).

To be honest, we did not find PCP’s or GI docs (with one exception) that helpful. We continued to use PCP’s of course, but as a complement to that care, consulted a functional medicine MD (a little different from integrative, but similar).

First, be aware that there is rebound to omeprazole and similar meds. The body says “oh I need to make more acid” so if you miss or stop dosing, you can actually have worse GERD!

Also the lungs and GI system (esophagus) abut and affect each other.

Could she have eosinophilic esophagitis? That can link with asthma. To help, you swallow a very small amount of what is usually an inhaled steroid. Diagnosis is by biopsy.

My kid’s GI workups kept coming up with negatives until a brilliant GI doc considered endometriosis. Symptoms were lower down than esophagus though. But as an example of unexpected diagnoses. Anything autoimmune like Crohn’s or ulcerative colitis?

I have done the following but this is for GERD:

-elimination diet: resulted in avoiding gluten, dairy, nuts, salmon, citrus- some improvement (also avoid “hot” spicy foods)

-avoiding omeprazole and using TUMS, then Zantac or Pepcid as needed if TUMS is not enough; I use those meds infrequently though (be aware that omeprazole is not really intended for long term use though it is prescribed that way; it can affect absorption and bone density I have been told)

-you can use Zantac or Pepcid to withdraw from omeprazole and then taper those too

-no eating after 5-6pm and no eating within an hour of exercise (for sports I would also avoid significant drinking of water or anything else)

-Gas-X for fullness and gas, used judiciously

-Flovent, swallowed and inhaled for esophagus and lungs respectively, infrequently

-I also avoid Zofran for nausea due to effect on heart, and have not taken Reglan though it was prescribed; my GERD is better by doing the above and I try to keep side effects down. Reglan is prescribed for both gastroparesis and migraines btw.

Migraine is not caused by stress. It is triggered by stress. There is a difference. Migraines can certainly cause nausea but you would see the pattern.

It is okay to have no appetite in the first hours after waking. She can take a snack with her perhaps. I get hungry at 10:30am. Neither of my daughters eats breakfast.

Beware of psychological explanations like stress and anxiety even when present. In young women, this often leads to an end to exploration of causes which can affect health. In our experience the medical community tends that way with adolescent females (and concerned mothers). This is not to say don’t address anxiety.

I am obviously not a doctor but another person with this issue. I have not detailed my kid’s extensive issues with similar problems to your daughter. She ended up with multiple causes so it may not be one simple answer but instead require approaches from many directions: , food allergy, including gluten or dairy intolerance; yeast/gastritis/dysbiosis from anitbiotic or NSAID use;; migraine; asthma/hypersensitive airway; eosinophilic esophagitis; eating/drinking too late or too close to a game, and many others


It would be good to get her off omeprazole as soon as that is possible, using an H2 blocker to ease the withdrawal and then taper those.

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Well said. I want to scream this from rooftops. Is it too much to ask the medical community to stop doing this?!

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So my celiac also has GERD. You can use Nexium (and that class of PPI) for 2 weeks max per the OTC instructions. Can’t remember whether the gastro put him on it for longer but he did switch him to omeprazole which can be taken longer term. Maybe switch to Nexium for two weeks and then switch back? Even omeprazole has side effects if taken too long. My kid is very sporadic about it which may be good because some of the side effects (including B12 deficiency) may overlap with malabsorption issues with celiac.

Hope she finds some relief.

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I’m sorry - these problems sound terrible. So many have mentioned stress but I’d like to point out that it is common for high achieving female students to have health problems that are viewed by others as the result of stress. Stress can be over-relied on as a “cause” for this group.

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Omeprazole is also supposed to be prescribed for two weeks, but is so often continued indefinitely.

Here is the prescribing information from the insert that comes with the med:

OTC omeprazole should be taken for only 14 days in a row. It may take 1 to 4 days before your symptoms improve. Allow at least 4 months to pass before you start a new 14-day course of treatment.

The insert also notes malabsorption of nutrients like B12 and calcium, and risk of fractures with long term use. This would especially affect a younger female building a bone bank.

H2 blockers like Zantac and Pepcid can be taken more acutely, as needed. And there is always TUMS.

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:dart:

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Yes that is right - I can’t keep them straight. He was prescribed generic Pepcid for a short time. Then switched to generic Prilosec. Gastro said he could take that for an extended period. Still has continual issues and we don’t know if it is GERD or contamination for celiac as they have the same systems for them.

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@VirginiaBelle PM’ing you so as not to create a tangent here :slight_smile:

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Was just about to say the same thing. Doctors may not consider this because she doesn’t fit the stereotype of a gallbladder patient. My daughter had her gallbladder removed when she was 17. Her GI kept throwing reflux meds at her which did not help (so then they’d throw another prescription at her and tell us to call in a month) until I insisted on further tests. She lost a lot of weight because one of the only ways to control her symptoms was to eat small, low fat meals (which makes sense since the gallbladder helps digest fats).

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Did she have a long break from school, academics, swimming over xmas? Did her gerd stop during that long break?

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One more thing to keep an eye out for would be an atypical eating disorder. There is a type of eating disorder called Avoidant Restrictive Food Intake Disorder (ARFID) which is NOT about intentionally losing weight. ARFID can take many forms. One rare subtype of ARFID is the avoidance of food due to fear of pain or nausea. This often starts for a medical reason (a stomach bug, migraines, GERD etc.) but then continues even when the initial medical trigger has been treated. A person can lose significant weight, and inadvertently get themselves into a malnutrition situation. Basically the body starts to think there is a famine in the land because the person is eating less often and smaller amounts. Then the body switches into “famine digestion” where the gut slows, often causing delayed gastric emptying (called secondary gastroparesis), uncoordinated intestine pumping and sometimes constipation. Because this causes a person to feel lousy, they may eat even LESS, causing a vicious cycle. Eating can be made even more complicated by all the well-meaning advice that various people give regarding what foods to avoid (go on an elimination diet, avoid spicy foods, avoid FODMAPS, avoid gluten, avoid eating within 3 hours of exercise or bed, avoid acidic foods etc
eventually there becomes no time and no food item that feels “safe” to eat!) Adding to the complexity, is that young women especially may be praised by their peers for the weight loss!

So long story short, keep a close eye on her weight. If she has lost weight, she shouldn’t be exercising. She may need to take a break from her sport until this all gets worked out.

Best wishes. You are doing a good job with a tough situation!

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I am trying to take deep breaths as it is all so overwhelming.

Thank you @Lindagaf @compmom @parentologist @CheddarcheeseMN @fiftyfifty1 and everyone else for your advice!

She did not have a long break over Christmas. She is a swimmer which means she practiced almost every day.

She did have a couple of days over break when her appetite was normal. She actually finished her dinner before the rest of us. But then it went back to her taking half an hour to eat.

She did lose about 10 pounds this Fall due to nausea, terrible vegetarian options at the dining hall, and small appetite. She is not anorexic or bulimic. She usually can only eat small meals (for a swimmer) and has to eat frequently in order to try to get enough calories. Luckily she can walk to a grocery store so she is supplementing the dining hall food with frozen enchiladas, alfredo pasta, etc. She hasn’t lost weight since November. I do wonder about ARFID.

And yes, it is so easy for a doctor to say all her symptoms are due to anxiety and put her on anti-anxiety meds without bothering to look deeper. When I mentioned the PCP recommended anti anxiety meds to her neurologist, he recommended a therapist instead if we were looking to reduce stress.

As a vegetarian swimmer who needs SO many calories everyday, trying to eliminate dairy and gluten is impossible right now. She wouldn’t have anything left to eat : ) But I am going to try to get her to see when she feels good and when she doesn’t and try to identify more triggers.

She does drink a protein shake 2 or 3 times a day to make sure she is getting enough protein.

I think I should see if I can go with her to her gastroenterologist apt.

Thank you all!

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I agree. Having a family member at the appointment can make a huge difference!

In my experience, there are 2 styles of gastroenterologists: those who “nibble” on the work-up and those who get the work-up done in one fell swoop. Those who “nibble” do 1 test at a time and/or try one remedy at a time, waiting weeks in between to see the outcome. Basically they are more conservative and more patient. This can be a fine way of doing things under normal circumstances, but I don’t think it serves busy college kids well, especially if they have lost weight (even a modest amount) and haven’t be successful in gaining it back. So with college students, I prefer gastroenterologists who just decide to be aggressive about the work up, getting all needed tests (endoscopy, imaging, emptying studies, bloodwork etc) out of the way quickly.

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Does swimming in chlorinated water pose any problems? Or breathing while swimming? One of mine gets asthma swimming in a pool, not sure why.

I have been off gluten and dairy for years and have plenty to eat :slight_smile: But I understand the context and age and how difficult it might seem. I will say I was surprised at the benefits I experienced giving those up but that might be irrelevant here!

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Thank you for the information on 2 types of gastroenterologists. I agree the one that orders all the tests would be much more convenient for her.

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I am going to be in the minority here. I think she should drop the swimming, that is what I would suggest if it was my daughter. Have her swim for fun non-competitively, instead. Swimming is a great lifetime activity that she can enjoy until she is old, but may not want to if she burns out swimming in college. The transition to college is difficult and stressful. You need to know your kid.

My kid had a lot of academic stress (perfectionist, high achiever), so she didn’t do any sort of time consuming or competitive extra curriculars in college. She did fun clubs and groups ( cooking club, craft club, book group, etc). She still made friends and had stuff to do besides study. My daughter had TMJ issues in college, which were pushed off by doctors as stress (TMJ like gastro issues can be hard to figure out). It made her realize that she didn’t want a stressful life (like working as a consultant after graduation).

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Again, I would ask that a GI doc consider gallbladder issues. Sometimes weight lose can trigger gallbladder problems.

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Hi, has she been tested for EoE? Eosinophilic Esophagitis? It’s SOOO common.
Basically any food or environmental or chemical(chlorine etc) trigger can inflame the cells. She may not be allergic to certain foods however she can be sensitive to some that can cause EoE. She may not even know it.
My youngest has this (has several food allergies) and exercise and singing can flare it. My son just gets the reflux with his, not the vomiting or food impaction etc. But when it flares, it really hurts.

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