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Column 14, March 2009
Minimising Runners Digestive Complaints
As many as 60% of runners experiencing gastrointestinal (GI) problems like nausea, reflux, stomach cramps, diarrhea and bloating. This is not only uncomfortable, but performances can be reduced due to toilet stops, and pain.
The problem partly occurs when blood is diverted from the GI tract to the muscles during exercise, but it is also exacerbated by the impact force of running itself, jostling the GI tract.
Dietary change can definitely make a big difference in certain individuals, but it is important to be aware of the many other possible contributors.
Contributors to Gastrointestinal distress in runners
Hard workouts races
At greater intensity, even less blood flows to the gut as more blood is diverted to the working muscles. Cells in the gut wall may even die (ischemia) leading to blood in the stools.
Many experience cramping after hard sessions or races. The good news is that the body does seem to start to adapt, and as an individual becomes more fit, symptoms tend to lessen.
Heat & dehydration
In one study, 80% of runners who lost at least 4% of their body weight during exercise because of fluid losses experienced GI symptoms in the bowel.
Medications/supplements
Anti-inflammatories eg aspirin and Voltarin, medical strength iron supplements, antibiotics and antacids, can all create additional GI problems.
Mental stress - including pre-race nerves!
Food & fluid
training diet, alterations to dietary patterns during traveling, food eaten the night before a race, the pre-race meal content & timing, sports drink concentration, hydration levels and particular foods and fluids can all contribute to GI distress.
Pre-existing conditions
such as irritable bowel syndrome, lactose intolerance and many other medical conditions.
Tips to minimise Gastrointestinal distress
Prepare mentally for races
Familiarising yourself with race layouts, location of toilets, taking extra toilet paper, and having some form of race game plan can all help to reduce nerves and associated diarrhea.
Give yourself plenty of time to warm-up and stretch, and learn how to breathe to relax.
With heartburn and nausea,avoid foods and fluids which increase stomach acid production.
Alcohol, peppermint, caffeine and spicy or fatty foods can aggravate heartburn & nausea. These substances either increase stomach acid production or relax the valve between the esophagus and stomach allowing acid to flow back into the esophagus.
Establish a routine with bowel habits by eating a high fibre breakfast first thing each morning with plenty of fluid.
Skipping breakfast or eating on the run creates very erratic bowel habits and problems with constipation. Establishing routine will make it more likely that you clear out your bowels before a race too.
Use Coffee and caffeine wisely
One cup of coffee with breakfast can be advantageous to get the bowels moving. If you have a sensitive gut, or drink too much however, you may be forced to stop for urgent toilet stops. The best way to find out is to experiment before a hard training run.
Minimize dietary change when traveling to races.
Stick as closely to your normal diet as possible when traveling. Take foods with you that may not be available for example in foreign countries. Shop and prepare most of your own meals while away rather than relying on unfamiliar restaurant foods.
Don’t try and “carb-load” with one meal!
Effective “carb-loading” takes 3 days. Trying to carb-load by eating a huge pasta meal the night before racing will have little effect on muscle glycogen, and can leave you feeling bloated on race day.
Boost up your carbs 2 and 3 days out from an endurance event, then graze the day before a race, and keep “the last supper” to a light meal.
Allow 3-4 hours to digest the pre-race meal.
A smaller snack 1-2 hours out is generally tolerated however.
Limit fiber, fat and protein in the pre-race meal.
Consuming fiber-rich foods in the pre-race meal will commonly cause stomach cramps. Protein and fat slow the release of a meal from the stomach, so increase the chances of stomach discomfort, reflux, and the urge to vomit.
Stay hydrated
Drink plenty of fluids with the pre-race meal, and continue to take on fluids at regular intervals (every 15-20mins) during endurance runs. This will minimize gut ischaemia and resultant diarrhea and cramping.
Use isotonic sports drinks
This will usually be stated on the bottle, but in general a sports drink containing 5-7% carbohydrate and including maltodextrin (glucose polymer) on the ingredient list are isotonic.
Consuming hypertonic drinks, such as coke (10% carbohydrate) during races can result in severe stomach ache and vomiting in susceptible individuals.
Consume water with sports gels
Consume water with sports gels. Taking on such a concentrated carbohydrate source during races without water can have the same effect as drinking a hypertonic drink (see above).
Limit gas - forming foods & fluids
If bloating is a major issue for you try limiting ‘gassy foods’ eg legumes (beans, lentils and dried peas), and brassica vegetables (broccoli, brussel sprouts, cabbage, cauliflower, spinach) which increase gas production in the bowel.
Recent research also indicates too much fructose (found in fruit and honey), fructans (found in wheat and some fruit and vegetables) or the artificial sweeteners known as “sugar alcohols” (sorbitol, mannitol, xylitol) can also cause gas production.
Carbonated beverages may also exacerbate symptoms.
Test for lactose intolerance
if you have regular problems with diarrhea.
Remember that a wide range of factors can be responsible for GI distress in runners. Dietary change can certainly help in many cases, but needs to be trialed during training. A Dietitian can be particularly useful in tailoring individual dietary strategies. If symptoms continue for more than 2 weeks or if GI bleeding is present it would be wise to seek medical attention.
Here’s to much more enjoyable running!
Enjoy!
Marnie Oberer
Shoe Clinic are proud to have... Marnie Oberer as an Expert columnist.
Marnie is a nutritionist and athlete and has been the host of Eating Well on TV One for the past two years. She is a trained dietitian and has a degree and two postgraduate diplomas from the University of Otago. By 28 Marnie had set up her own business consultancy, advising high performance athletes and teams. Marnie started competitive aerobics and caught the ‘marathon bug’ running in Australia, UK and USA.
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