Gastro-Intestinal problems in Endurance Training and Competition?

About the author: William Sichelis a leadingworld-class endurance athlete. His achievements in Ultra-Runninginclude beingthe World # 1 for the Six Day event(2006) and the current Scottish 48 HourRecord Holder. In 2007 his world rankings were : SixDay Event -World # 3 and48Hour Event -  World # 12. Williamhas had a lifetime interest in nutrition for sport and years ofpersonalexperience as a world class ultra endurance competitor. Whilst Williamis a ScienceHonours Graduate he has no formal qualification in sports nutrition oras ahealth professional. The following information is based on his years ofpractical experience in his chosensport.

It’swellknown that large numbers of athletes suffer some form ofgastro-intestinal (GI)disturbance during endurance events. Insome long events GI problems can affect over 50% of the competitors.While thisarticle has been written mainly for the benefit competitors inEndurance Sportsand Ultra-Distance Events, it may be useful to anyone undertakingextreme formsof physical training and competition. We will look at some of thecommon GIcomplaints faced by those involved in endurance training andcompetition,consider a series of easy to implementstrategies to assess and control such problems and then ask how GIcomplaintsarise and most importantly, look at whatwe can do to solve these issues and improve performance.  

Do yousuffer from GI problems in training or competition?

Athletessuffering GI complaints may not at first even realise they have a GIproblem.The symptoms can range from mild wind, bloated feelings and diarrhoeathroughto indigestion, stomach cramps, nausea and vomiting. AnyGI problem - even just a minor symptom - can spoil and at worst ruin a performance, even when an athletemay have spent months preparing for an event.

Themotivated athlete will want to diagnose what went wrong, as quickly aspossibleand then attempt to rectify the problem and try again in their nextevent.

Unfortunatelydue to the complexity of long endurance events and the many variablesinvolved -including different courses, varying weather conditions, differentstates offitness and changing intakes of calories and fluids - it can be verydifficultto pin point exactly what went wrong in any situation.

Thisarticle isn’t going to try and provide an ‘off theshelf’ solution becausequite simply there isn’t one, duetothe infinite number of variations in physical, physiological andbiochemicalmake-ups.

However,what I am going to do is give some kind of framework for investigatingGIproblems in endurance events, garnered from my own problematic andlengthy buteventually successful experience.

Ittookme eleven years of painstaking trial and refinement to solve my stomachproblems which mainly manifested themselves as debilitating nausea andvomitingin ultra endurance events.  Ihad no suchproblems away from the stress of ultra racing.

SomeImportant Steps That Everyone Can Take:

ü Writerace / training reports. Record as muchdetail as possible – this may helpdiagnose the reason for problems. Include such things as weatherand course information; start and finishtime; and record - in as much detail as possible - everythingyou ate and drank(including solutionstrengths and amounts of food) and whenyou consumed it – if you can find a willing helper this canmake the job mucheasier and more accurate rather than trying to do it from memory afterthe event.

ü Trythings out in training but remember that youcan easily get ‘false positives’ during training.  Often you need the stressand duration of aproper event to truly test your nutritional strategy. So use low key events as a test bed, notmajor competitions. Considergetting advicefrom a sports nutrition advisor – sometimes they can give youpointers in theright direction, although event-specific advice may be beyond them.

ü Speakto your doctor in order to eliminateunderlying medical conditions that may be exacerbating your GI problemsinraces.

ü Consultwith others in your sport and/or watch whatothers do – you may get some ideas to analyse and cautiouslyexperiment with, thatmay help.

ü Scourthe internet for sources of knowledge andideas which may help. I found key piecesof information by doing this.

ü Considerjust changing one thing at a time, as thishelps pin-point what is an effective change and what isn’t.

Rememberthat it can take considerable time tofind practical solutions – it may not be easy butreal improvements onlycome with time and effort.

 These Are The ImportantQuestionsTo Ask:

Q - Areyou trying to take in too many calories?

Thegolden rule is to only take the caloriesthat you can absorb, whether they are in liquid or solidform.

Takingintoo many calories too quickly can slow the emptying of your stomachcausing abuild up of fluid in the stomach and resulting in cramps, nausea andvomiting.  

Don’tbe fooled by scientific research carried outin laboratories on treadmills or exercise bikes lasting probably 2 or 3hours at most and then recommending60g ofcarbohydrate (240 kCals) an hour. 

Manysportsmen and women extrapolate these results for multi-hourevents with disastrous consequences.

Bycomparison, the first time I ran in the 153 mile Spartathlon– the world’slongest point-to-point race - I consumed just 100kcals/hr and stillfinishedthe race strongly.

Soif youhave problems try reducing your caloricintake a bit and try to take your energy in liquid form ifpossible.  It iseasier to swallow, easier to digest andeasier to know what you are taking in. Solid food takes more time and energy to digest and whenyou areoperating at your limit, the GI system, often, just doesn’twant it and can’tcope with it.

Makeyour drinks up to no more than 6% carbohydrateconcentration.  The general recommendationis 6-8% but if youare having problems it’s best to stickto the lower limit at the most.

Q. Areyou taking in too much fluid?

Onceagain the golden rule is only drink whatyou are can assimilate and no more.   Very fewathletes can take in more than 600-800mlsan hour, at the most, when pushing themselves to the limit in hotweather.  Most ofthe time, the volume is 400-600mlsan hour.

Inmy owncase, even during the hottest part of the world’s hottestrace – the BadwaterUltramarathon through Death Valley in California, where temperaturesreached54°C – my maximum hourly fluid intake was 840mls(I’m 59kgs/9 stone 2lbs/128lbs and 1.63m/5’ 5” tall). I didn’t getdehydrated and I set a Britishrecordfor the event.  Thefluid included a goodelectrolyte level (see below).

Takingintoo much fluid can result in ‘stomach sloshing’ anda build up of fluid in thestomach and small intestine resulting in nausea and vomiting.

Q.  Do you have the correctelectrolyte contentin your drinks?

Mostcommerciallyavailable sports drinks are too lowin their electrolyte content and don’t have a correct balance ofsodium and potassium.  Thesodium:potassium ratio in sweat is about 3-5:1 - your drink shouldreflectthis.  The GI systemis highly dependanton the correct supply of electrolytes to maintain proper motility sothis is anarea you need to get right - especially in hot conditions when you alosing alot of electrolytes in sweat.

Besureto try a good mineral mix in your drinks such as the one produced bymyprotein.co.ukand you won’t go too far wrong. I usethis mix at 4% of the electrolytepowder (4g/100g of powder). This provides approx 1050mg of sodium and300mg of potassium per kilo of formula mix.

Q. Isyour drink ‘simple’ enough?Manycommercially available sports drinks just have toomany different ingredients in them for those with delicatestomachs. These may include caffeine, individual amino acids andcompleteproteins.  These mayall have a role butwhen you are having problems it’s best to leave them out.  You can always consideradding them back inonce you have a reliable nutritional plan worked out.

Everythingthat’s added to the drink increases itsconcentrationand mayexacerbate problems with, for example, stomach emptying.

Ifyou’rehaving problems consider diluting the drink powder much morethan recommended - this may weaken the flavour too much but this can becorrected by using the MyProtein range of powdered flavouring.

Anotherfactor to be aware of is that carbohydrate sources that containresistantstarch, may contribute to symptoms of gas, bloating, cramps, nausea anddiarrhea.  Resistantstarch is derivedfrom amylose often used to make maltodextrin which is widely used insportsnutrition products.  There is only one variety ofcorn grown that has no amylose, and that is ‘waxymaize’ corn.  Considerusing MP's waxymaize starch in your drink mix. Itis very light on the stomach but doesn’t dissolve as well assome othercarbohydrate sources, so just give it a good shake before drinking.

Giveseriousconsideration to the idea of making up your own simple, clean mixtureof justcarbohydrate powder and a balanced electrolyte mix. Because taste varies so much betweenindividuals and can even change during events, I suggest using apowderedflavouring system so you can flavour to suit your personal tastes.  Myprotein have anexcellent facility toallow customers to designtheir owncustom formulas – use it!  They also have anexcellent range of powderedflavourings with something to suit everyone.

Q. Isyour drink too acidic?

Duringexercise, excess stomach acid is produced and with little food beingeaten thiscan cause nausea and vomiting in some athletes - especially when theyarepushing hard.  Ineffect they aresuffering from ‘acid stomach’ - probably withoutrealizing it.

Ittookme 10 years of research before I realized that I was suffering from toomuchacid.  Simpleremedies include takingantacids such as Gaviscon (although the taste may be too much formany),crunching a TUMS or similar alkaline tablet or eating some solid food.  However, with regard towhat’s been saidbefore, these options may not be practical or convenient. 

Rememberthat many sports drinks are quite acidic– largely caused by the flavourings. Inorder to work properly flavours are usually acidic. If you are suffering from an acid stomach thelast thing you want to be drinking is a large quantity of an acidicliquid.

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