Stomach Problems & Nausea

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Stomach Problems:
Experience From - Karl King #1, Jay Hodde #1, Karl King #2, Thom Ludwig, Karl King #4, John ?, George Beinhorn, Janice O'Grady, Nikki Robinson, Karl King #5 ,

Nausea & Vomiting:
Experience From - Susan Gimball , Debbie , Melody Varner , Unknown , George Beinhorn , Chris Dirtyshooz , Scott Rafferty , Rob Grant , John Medinger , Sylvia Gleason, E.R. Doc , Matt Mahoney , Karl King #6, Bill LaDieu , Scott McQueeney , Karl King #7 , Vida Morkunas , Karl King #8 , Mary Gorski , Paul Schmidt, Exercise Physiologist, M.S. , Blake Wood , Robert Youngren , Robert Thomas , Bob Steele , Jay Hodde , Robert Thomas#2 , Karl King #9 , Robert Thomas #3 , Tim Twietmeyer ,

Ginger :
Experience From - Karl King #10, John Prohira ,


Stomach Problems

Karl King #1

Subject: Stomach Problems

My experience is that taking a good amount of salt with too little water, like a swallow, can lead to a queasy stomach for a minute. I've never thrown up because of that. Taken with plenty of water, salt has not been a problem.

Quite the opposite. After a couple minutes my stomach feels really good. I must say though that what I've been using is not pure salt, but a blend of 5 different electrolytes that supply not only sodium, but buffers as well.

Kevin Setnes used my formulation while winning Ed Fitz, and found that they worked well for him. That was interesting to hear because Kevin can test them at a pace which I will never be able to maintain for an ultra distance. It is easier to avoid stomach problems at a slow pace like mine. Running at a race pace makes digestion a more difficult task, so Kevin's test was more stringent.


Jay Hodde #1

Subject: Stomach Problems

"Is it possible to ingest too much salt in a short period of time and cause vomiting?"

Personally, I've taken 1000 mg at a time with no problems. It seems to be enough to get the job done. I vomit when the fluid in my stomach doesn't empty. I've never had trouble when I've ingested large quantities of salt. I can't say what would happen if I took more than the gram/hour.


Karl King #2

Subject: Stomach Problems

Peter and Allan both expressed exasperation with their stomach's behavior while running. My contention is that throwing up is a sign of a major flaw in one's energy plan. Something you put in ( or didn't put in ) was wrong, and your body let you know in no uncertain terms.

While we don't have all the information about what you guys took before and during the run, the common thread to your list of consumables was very low sodium in all of them. Did you have other low-sodium food before the run, like a bagel and fruit juice?

Sodium is important for proper absorption of both food and water from the digestive tract. If there is too little in the stomach, sodium will transfer from blood plasma to the stomach to aid absorption. If there is too little in the blood plasma, possibly from heavy sweating, there's not enough to go into the digestive tract. The result is poor water and food absorption. Ultimately, that will lead to nausea and vomiting.

It sounds to me like Pete suffered that, and very low blood pressure at the same time. Corn chips and pretzels may taste salty, but they have far too little sodium to be effective. When you need 1000 mg/hour, a 30 mgm pretzel ain't going to cut it.

So, guys, don't assume that a weak stomach comes with the territory. Have a salty dinner the night before the run and have something salty for breakfast. You may find your digestion much happier in the long run.


Thom Ludwig

Subject: Stomach Problems

"Theoretical and probably stupid question. How is it we need salt to be able to absorb water but can't drink salt water?"
Hmmm. Good question. I believe the answer lies in the amount of salt in the water. Sodium is normally needed as a cotransporter to bring water, amino acids, glucose, etc. into the cells of the small intestine. Sea water, on the other hand, has so much salt that water is drawn out of the body and into the digestive tract via osmosis.


Karl King #4

Subject: Stomach Problems

Salt water has such a high concentration of salt that drinking a large volume of it would temporarily overload the body's ability to process it. The normal response to extremely high salt concentration in the stomach is to vomit.


John ?

Subject: Stomach Problems

Larry Phillips reports that he got nausea after eating lots of orange GU. It may be that the problem is the flavoring and not the GU. The orange and chocolate flavored GU both have fairly strong flavoring and, at some point after one gets really tired, the flavoring itself may set off a violent reaction. GU also comes in vanilla flavor, which I personally find fairly benign, and in unflavored, which merely has a slight sweet taste.

I can report that I managed the last 49 miles of Wasatch on nothing but unflavored GU and water without incident. This, from someone who has been known to spew chunks with great frequency. But try the unflavored variety before giving up on the product.


George Beinhorn

Subject: Stomach Problems

"Does anyone out there have stomach problems the day after an ultra? I have run two ultras in the past month - a 50-miler and a six hour run. During both runs I had no stomach problems at all, eating GU and sports drink and water and some cookies and miscellaneous goodies. In both cases, though, in about 24 hours I got severe bloating and discomfort which lasted about a day."
Just a personal observation. Please take it for what it's worth:

I've been helped immeasurably, both physically and mentally, by knowing my body type according to the ancient Indian healing system called Ayurveda. (Lots of books around now, including John Douillard's "Body, Mind & Sport" which also touts nose-breathing; which By The Way I love.)

Anyway, there are three basic body types:

Kapha (likes to loaf and joke around with friends, puts on weight easily, very sociable, constitutionally strong). People with this body type are more likely to handle GU and other caffeine-containing supplements okay.

Pitta (fiery, roars out of bed in the morning, loves a challenge, very self-motivated, doesn't need the support of a group; "Hey, if I can understand "how" to do it, I can do it. What's the problem?") These people tend to get over-wired on caffeine. It can get them through, but it affects their thinking and emotions adversely, hyping them to the point of over-aggressiveness, a little too edgy and sharp.

Vata (tend to be very mental--train with heart rate monitors, always calculating this or that; stomach problems common, have trouble sticking to routine, always chasing after some new idea, hate cold, often seen training in turtlenecks when it's 90 degrees in the shade)

Obviously, most people are a mix. However, by knowing my body type (mostly Pitta with a little Kapha), I was able to eat "balancing" foods that made me about 50% less irritable, more calm and expansive. GU and Coke just don't work for me. However, I have run side by side with jolly, sociable Kapha types who absolutely thrived on GU.

Runner's World hasn't discovered this stuff yet. Until they do it'll always be a mystery why some people can follow their food/supplement recommendations with success while others have no luck at all.


Janice O'Grady

Subject: Stomach Problems

What the experts have told me is that when your brain perceives exertion in the use of your limbs, it directs blood from your organs (including your stomach) to your limbs. Some people's brains do this more than others--mine does it a lot. Anyway, the stomach quits absorbing what's in it. It sloshes around, makes you nauseated, and finally you throw up. I've thrown up late in the day in an ultra and observed in the mess stuff that I ate early in the morning! It hadn't gone anywhere. It makes absolutely no difference what I eat or drink in The race, it just stays there. People started suggesting salt. I started nibbling rock salt, which would help for awhile, but then I would get so I just couldn't choke down any more rock salt. Then someone gave me salt tablets. At Run on the Sly 50 and Angeles Crest 100 I took the tablets on a regular schedule--every hour at Sly (too much, I think, as I got pretty dehydrated) and every 1-1/2 hours at AC. And voila--NO STOMACH PROBLEMS!!! It seems to be the answer for me, so you might want to try it. The tablets are called Thermatabs. Not all drugstores carry them, so you might have to look around. Experiment with the schedule. One tab every 1-1/2 hours seemed to work well for me at AC. Good luck!


Nikki Robinson

Subject: Stomach Problems

I too had stomach problems after my first ultra -- a 50 miler. During the race, I had no problems and ate and drank freely. The next day upon awakening, my stomach just hurt (sort-of like an ache). I was not nauseous but nothing sounded good. I went to a Cubs game and only managed to eat one hotdog and one beer -- well below the norm for me! :-) This persisted for 1-2 days, then I slowly regained appetite. I also noticed that I loss about 8 pounds (which I put back on over the course of the next couple weeks).

I had some correspondence with Karl King regarding that phenomena while preparing for my next ultra. Karl suggested that it was probably stress-related (in response to a first ultra) and that I would have no (or fewer) problems with additional ultras. This has proved to be true. As I recall, you are a relative newbie to the ultra game, like me. I hope that these symptoms will subside for you as you do a few more events.

In addition, you wondered if the bad stomach might have been due to too many fluids or too much Gu. Maybe. However during a recent 8 hour race, all I took in was SUCCEED! and Gu and salt (approximately 2 bottles of fluid, 2 packs of Gu, and 2 grams of salt per hour). No stomach problems afterwards -- swilled several beers after the race with my full plate of barbeque chicken -- much closer to the norm.

Hopefully, your stomach problems will just fade away with time.


Karl King #5

Subject: Stomach Problems

Bonnie Busch, Dana Roueche, Kevin Sayers,

The three of you have used SUCCEED! products, the B/E Caps in particular, with good results in many runs. You also had one or two runs this Summer where you lost your appetite to the point that you could not eat certain foods, or any foods.

As you know, I bugged you all with a bunch of questions to try and figure out what was going on when you ran into problems. By combining the responses I |have a good idea, but not proof of what was happening.

Kevin and Dana have used CLIP in many runs with great success. Was their problem related to CLIP? No, because Bonnie had the problem when drinking a Coke/Water mix. Was it an all-liquid diet? No, because Bonnie was eating various "real" foods with ample fiber when she experienced the problem. The problem can also be seen in many runners who aren't using SUCCEED! products of any type.

All of you used the B/E Caps. When the food problem came up, some stopped using the Caps. The problems did not get better. All were able to eat after the run was over. Kevin got revived at Leadville by a bowl of Ramen noodle soup with 13.5 miles to go. He was then able to run well to the finish.

The problem develops when there is a long run at fast pace and/or in the heat/humidity. While Leadville wasn't hot by most people's standards, I thought that the section from Sugarloaf to Halfmoon was warm and dehydrating in the direct sun and dry air. The symptoms point to electrolyte imbalance in the digestive track. How that imbalance developed may not be the same for all of you, so it isn't clear that there is one simple answer that applies to all.

The gag reflex when looking at food or drink is the body's way of telling you that it can't digest what you're looking at. Normally, that is a sign of too little sodium in the blood, and/or dehydration. However, since the digestive track is controlled primarily by a suite of hormones, stress is probably a contributing factor. Nobody seems to have any problems in slower paced ultras or training runs, or when the temperature is low.

What to do? If the problem is totally related to stress, the only answer may be to back off the pace for awhile. That may not be an acceptable choice due to competitive situations or cutoffs.

Stopping the Caps is probably NOT a good idea. All of you were drinking fluids ( CLIP, water+Coke ) that are very low in sodium. If you had a sodium excess, continued drinking and running would have fixed it very quickly. If the problem is insufficient sodium, stopping the Caps will only prolong the bad stomach. Note that Kevin's Top Ramen soup was extremely high in sodium.

It may be that each of us figures out what is a workable Cap intake in training runs, but the requirement for sodium increases with the stress of hours on the trail and/or heat. In general, the suggested rate of Cap intake provides less sodium than is lost while running. That implies that somewhere down the trail the sodium level will fall below what is needed for good performance. If your run ends before that point, everything is fine. If not, you may need to spike sodium intake to get back above the level required for performance.

If you sense the gag reflex from food coming on, I'd suggest taking an extra Cap right away, and another 15 minutes later. Be sure to take them with water as the sudden load of electrolytes will give you a queasy stomach if taken dry. What we've seen is that if you continue on with same salt intake rate, or decrease it, the situation does not improve until the run is over. Hope this helps. Please give me feedback on your future runs if you get the gag reflex again.


Nausea & Vomiting

Susan Gimbel

Subject: Nausea & Vomiting

Several months ago I discovered a natural remedy for nausea developed during a run, and I am sharing it with the list in case it might help some of you. I have found that ingesting a candied ginger slice (crystallized ginger) when my stomach starts to flip flop during a run has produced relief 100 percent of the time. The "urge to purge" is gone within 2 minutes of ingestion, and my stomach is completely settled within 20 minutes. Because ginger is so pungent, I found that I have to drink quite a bit of water initially to reduce the spiciness left in my mouth. Candied or crystallized ginger can be purchased in most food stores and health food stores.

I don't have a scientific explanation for why ginger works, but it is frequently used in other countries to stimulate digestion, settle upset stomachs, and relieve motion sickness. The rhizome (underground stem of the plant from which ginger is made) is also known to contain antioxidants and have anti-inflammatory properties. Hope this is helpful.


Debbie

Subject: Nausea & Vomiting

I agree about the ginger but I use it in capsule form. It will settle my stomach in a matter of minutes with no side effects.


Melody Varner

Subject: Nausea & Vomiting

Although not as portable as the ginger candies, yet better on the stomach is, "Ginger Wonder" syrup works well. Found in health food stores- typically used for Morning sickness-of which I am glad to not ever get again, but will substitute it for a queasy stomach any day.


Unknown

Subject: Nausea & Vomiting

I find Emetrol (Over The Counter at drug stores) works good at settling stomachs. It is a phosphated sugar syrup--that is all. Mint flavor is best. Try it.


George Beinhorn

Subject: Nausea & Vomiting

I routinely use fresh, ground ginger and lemon juice in water. Don't get tummy trouble often, but this "always" settles it quickly.


Chris Scott

Subject: Nausea & Vomiting

Ginger + Water + (Carbonation) +?? = Ginger Ale -- works wonders for me. Unfortunately, by the time I take it, I've already booted, but it SURELY does speed recovery...


Scott Rafferty

Subject: Nausea & Vomiting

Magnesium and calcium are also necessary electrolytes. My stomach probs went away when I started taking Rolaids.


Rob Grant

Subject: Nausea & Vomiting

For the past 9 years nausea been my companion usually starting after 8 hours of running, when then by walking v-e-r-y s-l-o-w-l-y up every hill I've been able to hold off vomitting till 85 miles, enabling me to sneak to the finish. That was until last year when at Vermont it moved down to 60 miles.

At OD last weekend it started on the hill after the 50 mile mark. While taking a 2 hour lie down in the car at Edinburg Gap (56) I rested my hands on my stomach, nausea. I noticed if I pressed just below the sternum(centre) on a 4" diameter circle this produced nausea. I'm thinking is that why I have nausea only when walking uphill? Do the abdominal muscles tense more, putting added pressure on this offending spot? Running downhill I experience no nausea whatsoever. Are the abdominal muscles more relaxed? At Od I wore travel bands, took one Zantac 75 before the start & one at 2pm, also a Karl Cap every hour.

I saw my Dr. this morning, looking for that miracle I knew wouldn't be coming out of his office. He probed around, said everything's A OK inside. Prescribed prepulsid(cisapride), moves food through the stomach. Only side effect diarrhea. Great! now I'll leave a poop line along the trail. He said be sure to try it out before Vermont.

I'm afraid my confidence is low on this small white pill. The only result I can see is more will be coming out my bottom than my top. I've never had any burning in the esophagus but I'm putting the stop to coffee & beer utill after Vermont to see if that helps. I wonder if it's that blood is getting shunted away from the stomach to the muscles & the stomach will only tolerate that for just so long.

Travelling across North America to run 47 miles & then crawl 17 in 6 1/2 hours is fast losing it's appeal.


John Medinger

Subject: Nausea & Vomiting

Rob, hoo boy, a very common problem. There's a variety of literature on the subject, but the basics seem to be:

What to do? Well, a variety of things help directionally:

This stuff has worked pretty well for me. Good luck!

John (who now is puke free for 4 years)


Sylvia Gleason, E.R. Doc

Subject: Nausea & Vomiting

I think you may have meant "Reglan" instead of "Ritalin." Reglan is a pro motility agent. It stimulates the upper GI tract and relaxes the pyloric sphincter (outlet of the stomach) while closing the esophageal sphincter (inlet to the stomach.) The overall effect is better emptying of the stomach and forward transit through the small intestines. It effect basically is on the cholenergic nervous system. Ritalin on the other hand is a stimulant and acts on the sympathetic nervous system. It has an adverse effect on digestion. In fact one of the main problems experienced by kids treated with Ritalin for ADD is nausea, and anorexia.

Because of its stimulant effect Ritalin would be considered a banned substance in most athletic events. Reglan however is probably considered no different from Zantac or other GI agents. Be warned however Reglan can have side effects such as drowsiness. The most serious , but rare, side effect is Tardive Dyskinesia which consists of uncontrollable muscle spasms, often of the neck face or tongue. If you plan to try reglan try it before you actually race to make sure it agrees with you.


Karl King #6

Subject: Nausea & Vomiting

Matt Mahoney wrote:

Many years ago I learned to avoid nausea by eating my normal diet during ultras (actually Ironman length triathlons) instead of just carbohydrates. You will need to walk some to allow time for the food to digest. Carbohydrates alone are OK for events up to about 6 hours.
More good advice. Carbo-only messes up the normal process in the small intestine. Ingesting some fat and protein during the run will keep things going normally, and that is what Matt is getting by eating his "normal" foods.

Walking ( cutting the pace ) allows some return of blood flow for digestion. If you've eaten quite a bit at an aid station, it makes sense to walk for 5-10 minutes after you leave the station.

Throwing up costs the body a lot of necessary electrolytes and fluid, so your body would prefer to not suffer that loss. If you have to vomit, it is a sign that you have screwed up big-time in your energy/fluids/electrolyte/pacing strategy. If you do throw up, be sure to get some water and electrolytes in as soon as you can stomach them.

The advice from Rich and Matt will help you in *preventing* the need to vomit. In 10+ years of training for and running in ultras I've never come close to throwing up. Do the right things, and you won't need to vomit.


Bill LaDieu

Subject: Nausea & Vomiting

As one who experienced alot of nausea the past few years I have learned that whether you experience nausea is related to your state of fitness and how smart you are running. That is, if you train smart, run within your fitness and manage your diet, fluids and electrolytes you don't get sick.


Scott McQueeney

Subject: Nausea & Vomiting

With a control group of 1 it is easy to come to inaccurate conclusions for others. Just because one does not get sick after running ultras for a number of years does not mean those who follow his guidelines will have the same results.

Karl King and others have some good ideas for avoiding nausea but they are not the end all. My experience is closer to Bob Sweeney's in that I feel better if I do the finger down the throat than waiting for the inevitable to happen. After I get sick I take some salt/cytomax and what ever looks good at the aid station. This has worked for me but I am also a control group of one.

By The Way for those of you who hate to loose any time stopping to puke you can, or at least I could run and puke at the same time. My running partner learned that I like to turn my head to the right :-) He now always runs on my left side.

When I ran 5/8/10k races I ALWAYS dry heaved at the end. Not sure why but people sure move out of your way quickly at the finish line.


Karl King #7

Subject: Nausea & Vomiting

For those who think that they are forever condemned to nausea in an ultra, here are some questions. They may help you find a nausea source you weren't aware of.

  1. Do you suffer frequent nausea when you are not running? If so, then it would be logical to expect it when you run. If you don't suffer nausea normally, then something is going on when you run.

  2. Consider the energy drink/sources you use while running. Do they contain fructose as a main ingredient? Sometimes this can be hidden among "corn sweeteners". Do they contain a lot of table sugar (sucrose)? Those simple sugars can cause intestinal upset in some people.

  3. Consider the sodium to potassium ratio of the drink/foods you take. The label for your sportsdrink/beverage should list the mg of sodium and mg of potassium per serving. Divide the sodium number by the potassium number. Is the number less than three? Is it less than one? Sodium and potassium function differently in the body and they are not interchangeable. A sportsdrink with a sodium/potassium ratio of less than one can cause nausea after many hours of use.

  4. Is your drink very tart ( acid )? You may be overloading your body's ability to compensate for increased acid intake. A bottle of very acid soda or fruit juice may be simple for the body to handle once, but taken over and over for many hours may lead to stomach upset or irritation.


Vida Morkunas

Subject: Nausea & Vomiting

Karl wrote:

"Divide the sodium number by the potassium number. Is the number less than three?"
Is this a golden ratio that we should be looking for? Just curious - I do not get nauseous from running, not since (1) I started to take succeed supplements and (2) since I traded my WS no-bounce water 2-bottle holder for a UD Aquifer. I used to get mighty nauseous on the third hour of my long runs as I would prepare for an ultra. Not anymore.

Hmmm.. Perhaps that could also be a factor - a water belt cinched too tight to prevent bounce?


Karl King #8

Subject: Nausea & Vomiting

Vida wrote:

I wrote: Divide the sodium number by the potassium number. Is the number less than three?

Vida wrote: Is this a golden ratio that we should be looking for?

Consider that during an ultra the body is working to maintain an appropriate blood plasma electrolyte status where the typical sodium to potassium ratio is 35. The largest electrolyte loss is likely to be sweating. The sodium/potassium ratio of sweat is about 10.

The sodium/potassium ratio of one oft-mentioned sports drink is 0.53 - not a problem if you're running a 10K or a marathon, but not really a rational formulation for an ultramarathon that can last 6 to 30 hours.

There's no gimmickery or magic in these considerations; the biochemistry of the human body has been the same for thousands of years. Give the body the right stuff and it will take care of the rest.


Mary Gorski

Subject: Nausea & Vomiting

Just my two cents on the nausea discussion. I totally agree with the folks who are encouraging people to figure out what works for them in training so they won't nauseous in a race (things feel different after four or five hours+ of running than they do in only three), BUT...

I've done that, and hey, sometimes what worked in your ten previous long runs (on hot days, cold days, tired days, feeling ready to run days) just doesn't work in the race. And yes, I've tried running faster and eating in training... and it's worked. And I've tried going slower in a race and sometimes it hasn't worked. And I use the SUCCEED! pills, and every other little nugent of advice that Karl passes our way.

My point (sometimes I actually have one): sometimes it seems that the body rebels even when you are doing what seemed perfectly agreeable only weeks before. Luckily, this hasn't happened to me much, but the few times it has, it's been disheartening. For me, I think sometimes it might be my head which tosses things around in my tummy -- I'm keyed up about a race because it is important to me (or, in the case of my first Birkebeiner ski race -- I was nervous about crashing into a couple thousand other skiers) and get more worked up about it than I should. I rarely have stomach discomfort in training and think this could be a factor. A totally unprofessional opinion of course.


Paul Schmidt, Exercise Physiologist, M.S.

Subject: Nausea & Vomiting

Unfortunately, I have experienced nausea and vomiting in all of the 100 mile races (#27) that I have run in. I have studied this problem and I have even consulted Professor Tim Noakes about it on several occasions. I still have not completed a 100 miler without getting sick, but the problem has become more manageable. I estimate that for about 10-15 % of us, this is a difficult problem that is related to sodium and fluid intake, and possibly some motion sickness. Here is what I do during a race over 50 miles (written in order of importance). I hope that it helps!

  1. Ingest 600-900 mg of sodium/hour (hotter=more salt).

  2. Do not drink any sports drinks made with fructose.

  3. Take in 200-300 kcal/hour (usually from a gel).

  4. Add some fat & protein every few hours (drinking ensure or boost type supplements).

  5. Drink less than 30 oz/hour of fluid per hour.

  6. Try to keep your body temperature down via dousing yourself with cold water or immersion in a stream when possible.

  7. Slow down in the heat of the day.

  8. When all else fails I take a nap for 40+ minutes and then try to eat something.

  9. Keep moving it may get better!


Blake Wood

Subject: Nausea & Vomiting

Nausea during the night has always plagued me in hundreds. I finally licked it at Hardrock last month - the first time ever I haven't felt sick during the night. Here's what I did different from previous races:

  1. I went light on the food in the afternoon. I know this flies in the face of conventional ultra wisdom, but I suspect your stomach normally shuts down during the night, and if you stuff it full of food just before dark it won't handle it properly. I had a couple large sandwiches early in the race, but starting at Virginius (33 miles, 3:45 pm) I only had soup, Succeed Ultra, some dried apples, and candy. Over the final 20 miles, I only had water, Ultra, and candy.

  2. I had heard that ginger is good for nausea, so I mashed a piece of fresh ginger root about the size of my thumb and put it in my water bottle, replacing it about 11pm and 3am. It added a nice flavor to the Ultra I kept in that bottle.

  3. I had heard vitamin B6 is good for nausea, so I took one at Ouray and another at Sherman. Every time my wife was pregnant, she was violently sick for nearly 7 months. In her first pregnancy, she took the anti-nausea medicine Bendectin, which made life tolerable again. By her second and third pregancies, the manufacturer had pulled Bendectin from the market due to liability concerns. However, it turned out that Bendectin is simply B6 and the active ingredient in the sleeping medicine Unisom, so Rebecca made her own. I carried some Unisom at Hardrock to use as a last resort, but never needed it.

  4. I took a Succeed electrolyte capsule every hour, thinking that my nausea might be due to my electrolyte balance getting out of whack.

I can't say which of these four new things I tried was the magic bullet that prevented my nausea. It may have been a combination of several or all. But it did work, and I certainly plan to continue doing all four in future ultras.


Robert Youngren

Subject: Nausea & Vomiting

Just some tips I've picked up on, hope any or all help...


Robert Thomas

Subject: Nausea & Vomiting

I had a few additional thoughts on nausea.

I have found if I not in top shape that just making a very hard maximum effort for a few minutes can cause some stomach distress. If I am in shape this does not happen.

During ultra events one thing most people do I have notice is eat things they normally don't eat at home or in training.

The stomach can become sensitive during a long event and adding strange food on top of it can really do you in.

I find eating Top Romin soup, that is sometimes served during events, causes me to have a nearly immediate stomach purge. This has happened to me a few different times, so I know it's the soup.

Here are some general thoughts on food and electrolytes, there are lots of details you could get into and of course personal variations need to be considered, so there can be exceptions to any general discussion.

Assuming your healthy and well nourished at the start of an ultra event. I don't like foods or drinks that contain high amounts of added electrolytes other than salt. Usually its sports foods or drinks that think they are helping you by adding large amounts of various electrolytes into their products. Sports companies have a thousand ways to tell you that you need their products and why. When it comes to electrolytes added to sports products what works and what someone thinks will work can be two different things. Even if you don't agree with what I say here, look how various products are formulated very differently, everyone is not right.

Some sports foods and drinks have very unbalanced electrolytes in their products, the worst offenders have very high potassium levels in relationship to salt. These products perhaps could be fine if used in moderation, but an ultra takes a long time, so you may use a large amount of a sports product that has a lot of added or unbalanced electrolytes, over time this can cause some problems. You need to examine what your eating and what is in it.

I like having foods or drinks that have some added salt but no or very little other added electrolytes. That's not to say I eat or drink electrolyte free foods. I just prefer electrolytes other than salt are contained in the food not added to the food. One example would be the Maltodextrin contained in a sports drink. Maltodextrin contains potassium, magnesium and other trace electrolytes. If you ingest large amounts of Maltodex in your sports drink you get a fair amount of Potassium and these other trace electrolytes, I then feel you don't need to add anymore electrolytes other than salt too sports drinks that have large amounts of Maltodex. Taking into account your eating other real non sports foods during an ultra event that also contains electrolytes.

Salt is what the body most needs in large amounts during long ultra events. If you ingest higher salt containing food or drink products from the start you help preserve the potassium in your body and help aid and speed absorption of food and water from the stomach. After some hours of running, your stomach and body needs real food. That is foods that are complete, containing protein, fats and carbohydrates. How long you can go without real food is variable. The stomach lining in particular has a very high turnover rate of tissue and needs to be feed just like the working muscles. Carbohydrate is not the food the stomach is looking for, in particular the stomach feeds on Glutamine. This is generally found in protein containing foods like meat. In my own personal sports drink I like to add a lot of Glutamine. Sports products sold to the general public ether don't contain Glutamine or just a trace amount so they can put it on the label. It takes several grams of Glutamine per hour to really make any difference.

What you can do is start eating small amounts of real food along with your high carbohydrate foods and drinks after a few hours of running and keep eating these real foods through out the entire event. Don't wait half a day to start eating real foods. If you do wait this can stress the stomach. The other added benefit of eating real foods is they contain normal amounts of electrolytes, trace vitamins and minerals. Additionally eating real foods can help keep you from eating or drinking over electrolyte loaded or electrolyte imbalance sports food and drinks.

I don't mean to say all sports products are bad, just check their labels. Know what your getting and why, only buy proven products and try them out in training first and use them with some real food your system is very use to eating.

Back in the dark ages before all the sports foods and drinks flooded the market I always liked Cokes or Pepsi and never found them to be a problem. Even now I like the odd Sprite during an ultra event, even at the end of a hundred, it seems much easier on the stomach than cokes. Everyone use to drink sodas like water back twenty years ago when I bike raced and everyone seemed to like them as much as I did. But these events where short 2-4 hour events. The stomach goes through a lot of stress in a 24 plus hour event and you need a lot more than Cokes.

MCT have also been shown to upset the stomach of a few people in small amounts and upset the stomach of many people if used in large amounts. Large amounts are not found in normal sports food products but if you add any to excesting products or are unusually sensitive to MCT be warned.


Bob Steele

Subject: Nausea & Vomiting

My most violent nausea attack came shortly after ingesting salt on an empty stomach on a hot day. This was back before buffered salt/potassium caps (thanks Karl) and straight salt was the only game in town. Be sure if you are ingesting raw salt to have plenty of fluid/food in the stomach to prevent irritation.


Jay Hodde

Subject: Nausea & Vomiting

Some of this is confusing to me (read: doesn't make sense) and I'm asking for clarification / justification.

Robert Thomas wrote"

"Here are some general thoughts on food and electrolytes, there are lots of details you could get into and of course personal variations need to be considered, so there can be exceptions to any general discussion."

SNIP

I like having foods or drinks that have some added salt but no or very little other added electrolytes. That's not to say I eat or drink electrolyte free foods. I just prefer electrolytes other than salt are contained in the food not added to the food. One example would be the Maltodextrin contained in a sports drink. Maltodextrin contains potassium, magnesium and other trace electrolytes. If you ingest large amounts of Maltodex in your sports drink you get a fair amount of Potassium and these other trace electrolytes, I then feel you don't need to add anymore electrolytes other than salt too sports drinks that have large amounts of Maltodex. Taking into account your eating other real non sports foods during an ultra event that also contains electrolytes.

A quick look at the electrolyte analysis for a typical preparation of maltodextrin (which is essentially carbohydrate) shows the following profile:

Chloride 1500 parts per million
Sodium 950 parts per million
Magnesium 125 parts per million
Potassium 50 parts per million

If I calculate correctly, that means that the potassium content in maltodextrin is 0.00005% or 0.5 micrograms/gram of maltodextrin. Correct me if I'm wrong, but isn't that a tiny amount in the whole scheme of things? It seems so to me.

The stomach lining in particular has a very high turnover rate of tissue and needs to be feed just like the working muscles. Carbohydrate is not the food the stomach is looking for, in particular the stomach feeds on Glutamine. This is generally found in protein containing foods like meat. In my own personal sports drink I like to add a lot of Glutamine. Sports products sold to the general public ether don't contain Glutamine or just a trace amount so they can put it on the label. It takes several grams of Glutamine per hour to really make any difference.
I think I'd like some references to this because it doesn't make intuitive sense to me, nor does the comment "takes several GRAMS per hour" sound persuasive. I wasn't able to find any references to back this up, so I'm wondering the basis for the statement.

What I DID find: Isolated cultures of gastric mucosal cells can use glutamine for fuel; whether or not this holds in the acidic milieu of the stomach doesn't appear to be reported. I also found that glutamine synthetase activity in the stomach is high (this enzyme forms glutamine) but that the stomach's ability to break down glutamine is very low. Glutaminase (breaks down glutamine) activity is highest in the small intestine. Glutamine can be stomach-protective.

If the stomach doesn't possess the ability to break down the amino acid for fuel, should I expect its need for that amino acid to be high?

True: The stomach lining and intestines have a high turnover rate. Since people can survive for months on water alone, I would hazard to guess that the stomach can tolerate "starvation" (or should I more clearly state: "lack of real food") for 30 hours or so during an ultramarathon.

What I don't readily agree with is the stomach's need for this much glutamine. Enterocytes, the chief epithelial cells lining the small intestine (function is absorptive in nature), have been shown to use glutamine as a primary source of fuel. This cell type is not normally reported to exist in the stomach. If I am wrong, teach me.

The primary epithelial cell types in the stomach are mucous cells, parietal cells, peptic cells, and G-cells. These cell types protect the stomach, regulate the production of gastric juices, and produce enzymes to breakdown foodstuffs. The stomach is primarily a reservior in which digestion begins. Absorptive functions are limited when compared to the intestine.

Doesn't the stomach, like most other organs, get most of its fuel delivered to it via the bloodstream?

If you do wait (to eat real food) this can stress the stomach.
Like I said above, I don't agree with this statement on the level it has been presented. I don't believe it's a "starvation" issue. I believe stomach nausea is a normal response to the daily feeding cycle and involves factors (such as autonomic response) not mentioned here. Robert certainly has a point when he says that a lot of nausea is exagerbated by eating "uncommon" foods.

Back in the dark ages before all the sports foods and drinks flooded the market I always liked Cokes or Pepsi and never found them to be a problem.
Note: Many people cannot tolerate the fructose in Coke and/or Pepsi. Proceed with caution!


Robert Thomas #2

Subject: Nausea & Vomiting

Jay wrote:

A quick look at the electrolyte analysis for a typical preparation of maltodextrin (which is essentially carbohydrate) shows the following profile:

Chloride 1500 parts per million
Sodium 950 parts per million
Magnesium 125 parts per million
Potassium 50 parts per million

If I calculate correctly, that means that the potassium content in maltodextrin is 0.00005% or 0.5 micrograms/gram of maltodextrin. Correct me if I'm wrong, but isn't that a tiny amount in the whole scheme of things? It seems so to me.

Taking Jay at his word "a quick look" I understand why he does not have the correct facts.

According to the maltodextrin manufacturer Grain Processing Corporation data sheet there are 5 milligrams of potassium in 100 grams of maltodextrin. According to the facts stated by Hodde there are 50 micrograms per 100 grams of maltodextrin. This is a great difference between my stated facts based on the information provided by the manufacture of the maltodextrin I use and this "quick look".

Additionally I state that the potassium provided by maltodextrin is a part of the total electrolytes provided by all foods used and that you need a high maltodextrin content in a drink for the drink to provide any useful amount of potassium. I have made drinks where you ingest 100 grams of maltodextrin per hour.

The points raised about Glutamine and the stomach have some merit. I didn't want to get over technical in a general point of view post. I use the term stomach generically in my own mind to also include the overall digestive track. Nausea can focus on the stomach but I feel intestinal discomfort can be connected with stomach nausea and intestinal discomfort can have its own debilitating effects.

Any reading of the pertinent technical literature will reveal the know facts concerning Glutamine use by the body. The overall effects can be positive and some of these effects concern the intestines and the stomach. All possible nutrient effect under all situations has not been researched, let alone all nutrient effects while ultrarunning. Some evaluation of the known facts and personal experience comes into play with what anyone recommends about anything. I have found the effect of including Glutamine in my drink to be positive and most people who have used my drink find the drink beneficial. The included Glutamine is one small part of what in my experience makes my drink superior to other sports drink products. One aseptic of this superior performance is how very easy on the stomach my drink is and I feel the Glutamine I add helps in part with this effect.

My point about real foods is that the body is adjusted to eating what you normally eat. Just because you're doing a long ultra run doesn't mean you should change your diet completely. I think you should eat some foods that are normal for you during very long runs and that you should start eating these normal foods early in a long run. When I say a long run I mean 100 milers plus. It seems possible to eat almost anything sometimes in a 50 mile run. Of course even in a 10k your stomach can go bad. Different factors can effect the stomach over different time periods, the longer the run the more time these different factors can effect the stomach.

MY ORIGINAL COMMENT:

Back in the dark ages before all the sports foods and drinks flooded the market I always liked Cokes or Pepsi and never found them to be a problem.
JAY'S REPLY:
Note: Many people cannot tolerate the fructose in Coke and/or Pepsi. Proceed with caution!
The comment on using Cokes is taken out of context. I mentioned Cokes in a general way because of some other comments on Cokes and how you need to be careful drinking them. I raised the point how I liked them when I biked raced in the distant past and how just about everyone back then used them without any problems, for short 2-4 hour races and how I still like the odd Sprite soda during long ultras. I never recommended using Cokes or Pepsi during an ultra run, even though I personally do sometimes.

I don't see the point of taking a comment out of context and implying how it's wrong, when I had the same summation in the total original comment.

Lastly as far as starving goes there is little correlation between maximizing athletic performance, minimizing stomach nausea and very long term starvation. I would not want to be the one to tell the Donner Party that they only needed to buck up and drink their water because they could survive for months without eating and their stomachs would be fine. People sometime die just from eating food when they have been starving for long time periods, because their stomachs and total body systems are in complete ruin.

True: The stomach lining and intestines have a high turnover rate. Since people can survive for months on water alone, I would hazard to guess that the stomach can tolerate "starvation" (or should I more clearly state: "lack of real food") for 30 hours or so during an ultramarathon.
Who in the world would feel and do their very best only drinking water during a 30 hour ultra run. "Hazard to guess" is not exactly how I like someone to express their opinion about what I would eat during an ultra run. Because I believe based on facts and experience that you would do better eating something with your water. I look at why that is and examine the total diet during the total run. If you do this you can break down what foods help you do your best and when to eat or drink them. Thirty hours of starving does effect how you feel, yes you can run for this time without food but you will not do your best in my opinion. You can also try and do a 30 hour run with just sports foods. This of course is much better than just water. Depending what the sports foods are and your own body reactions to the sports food you use, you may do just as well without using "real food". It's just much harder over all to plan a proper diet that works for a long ultra using just sports foods.

I always look forward to any replies good, bad or ugly. If I seem a little defense in this reply to my post it's because I feel it's warranted based on previous posting history between us.

"Brain cloud" best sums up my writing abilities. When you all where going too school learning to write in junior high school and beyond, I was cutting classes to train on my bike all day long hoping to make the Olympics and turn professional. A complete lack of any natural physical talent helped with a complete lack of any support by anyone kept me from attaining my early athletic goals. What I gained was a tremendous experience base derived from ten serious years of bicycle racing and training followed by completing difficult triathlons, dozens of weeklong self supported mountain runs and of course 10 plus years of ultra running, completing hundred mile ultra runs. I may not always express myself correctly, but I have paid my dues.


Karl King #9

Subject: Nausea & Vomiting

Robert wrote:

According to the maltodextrin manufacturer Grain Processing Corporation data sheet there are 5 milligrams of potassium in 100 grams of maltodextrin. According to the facts stated by Hodde there are 50 micrograms per 100 grams of maltodextrin. This is a great difference between my stated facts based on the information provided by the manufacture of the maltodextrin I use and this "quick look".
Jay's figure of 50 ppm is equivalent to 50 mgm/1000gm, or 5 mgm/100 gm, matching the figure given by GPC.

For non-chemists, let's take a practical example.

If you have 160 calories from malto in a 20 ounce bottle of drink, that's equivalent to 40 grams of malto. That means that the malto supplies 2 milligrams of potassium, a rather small amount.

The drink manufacturer must report on the product label the total potassium supplied from ALL the ingredients in the mix. So, the consumer needn't give a damn which ingredients supply potassium. Just look at the label for the composite result.


Robert Thomas #3

Subject: Nausea & Vomiting

Thanks Karl for the clarification.

I like to add that even though I don't generally like taking a lot of extra added electrolytes besides salt and that's because of my overall approach to what I eat during an ultra. I can see and understand the value of a well formulated electrolyte produce like the electrolyte caps for people who need them.


Tim Twietmeyer

Subject: Nausea & Vomiting

Let's set the record straight. If you haven't puked in an ultra, you're sandbagging. It's a natural rite that before you become a seasoned ultrarunner that you blow chow during in ultra. But repeated episodes is very bad form. I'd have to agree with Tropical John in that most puking is due to not eating enough, not drinking enough, or not enough salt, or a combination thereof. The later in the race, the more likely the puking. California street seems to be a popular venue. One thing that happens to me when I get dehydrated (or low on salt) is that my ears ring, then my ears pop and I feel like I'm running in a tunnel. My feeling is it's due to more low sodium than low fluids because it's happened when my weight hasn't been that low. Soup's a great neutralizer because it's mostly salt with some broth thrown in. Without explicitly eating salt (or taking pills) it's difficult to get enough during the race. This is most noticable after the race when you resume drinking and most of it goes right through the system until an adequate amount of salt is digested with it. One other note, if you're going to puke, get it over with and then keep moving. Most of the time you feel a heck of a lot better after puking except that you need to get some liquids down. It's of no benefit to fight it for a couple of hours, then puke. Just get it over with and you'll feel much better.

Guidelines for puking:

  1. Don't puke on your pacer

  2. Don't puke in an aid station

  3. Don't puke on yourself (you smell bad enough already)

  4. Remember where you puke, it's a great trigger for story-telling (like about 5 miles into California street, I remember the time....)

  5. Don't be embarrassed, it happens to everyone

  6. Don't model after Bob Kempinen, no big rush when we're out there as long as we are. Not only that, if you're pacer's behind you they'll never pace you again.

Ginger

Karl King #10

Subject: Ginger

Rich Schick wrote:

"Not all these summer time blues appear when folks are behind on fluids, the prompt resolutions of symptoms if the afflicted persons stops for a few minutes argues against the problem being fluids or electrolytes also. Those things just don't correct that easily. The times I have had stomach problems, I have always felt very hot, the quickest cure I've ever found was a stream to lie down in for a minute or two.
Indeed. Such problems can be pace related. When the combination of heat and running hard rob the digestive system of blood there is bound to be some nausea. If you take away the heat ( the stream, or ice )or cut the pace, the blood flow can normalize and the nausea will clear. If that doesn't do the trick, then look for electrolyte/fluid problems. If fluids and electrolytes are maintained within acceptable limits, then the stomach controls what pace the runner can maintain.

Ginger has a long history ( mainly from Asia ) for settling a queasy stomach. It has been investigated in regard to treating patients on chemotherapy and found to be effective in 10-15% of the people. Where it works, it is a simple and safe choice. For the last few years I've carried ginger capsules with me in ultras of 50 miles or more but have not had stomach problems and haven't been able to test them on myself.


John Prohira

Subject: Ginger

I've used crystallized ginger for an "upset tummy". Works nicely. It seems to address the distress on many levels. I've gotten in the habit of carrying a couple of pieces with me on all my long training runs and ultra events. I "pop" a piece or two into my mouth and allow it to melt, it quickly soothes my stomach, the taste is strong, making me thirsty and inspiring me to drink (which of course is a very good thing), I wonder if the nausea is a sign of dehydration. As an added mental or spiritual "boost" the ginger's flavor reminds me of the attention given me by my mother when as a kid I complained of nausea. Her remedy included "kind words" and a glass of ginger ale. Sweet memories like these help when running through "bad spells" in the middle of the night.