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Puking Primer
Why runners suffer race-day nausea, and what to do about it.
ByJeff Gaudette[3]Sunday, March 10, 2013, 12:00 am
The 1996 men's Olympic marathon trials was one of the most memorable in trials history. Yes, the race winner set a course record (2:12:45), but that isn't what made the race unforgettable. At 22 miles, just as Bob Kempainen began to drop his two nearest rivals, he began to vomit. And he kept vomiting for another 2 miles. Luckily for Kempainen, the vomiting didn't slow him down, and he held on for the victory.
While his unfortunate situation made for TV drama, experiencing symptoms of nausea and vomiting while racing isn't uncommon, and, unfortunately, most runners who struggle with throwing up before, during or after races aren't as lucky as Kempainen. Vomiting during a race is often devastating to a runner's performance. A 1992 study in the International Journal of Sports Nutrition found that 93 percent of endurance athletes experienced some type of GI symptom (e.g., acid reflux, nausea and vomiting) during their races. Forty-five percent of those athletes reported that their symptoms were severe, and 7 percent said they were forced to abandon the race due to their symptoms.
What are the causes of nausea-related symptoms associated with hard races and workouts? More importantly, if you're a runner who struggles with this issue, what steps can you take to prevent it from happening again?
PRE-RACE NAUSEA
In one scene from the running classic Without Limits, Steve Prefontaine stands under the Hayward Field bleachers before the 1972 Olympic trials and vomits as the crowd roars his name. While most runners may never experience the fear of trying to make an Olympic team, many have dealt with the same nerves and queasy pre-race stomach Prefontaine felt that day.
Pre-race nausea is most commonly caused by the nerves and anxiety that big races and high-pressure situations put on a runner. And those nerves are nearly universal for competitive runners. "Nerves are a stressor that almost every athlete encounters that can spike and affect an individual's adrenal system," says Taryn Sheehan, assistant cross country coach at the University of Louisville. "Very rare and special is the athlete who does not get nervous prior to competition. Even prior to some of our signature or key workouts, I'll find some athletes get a little anxious or excited."
Anxiety is a physiological and psychological state that is typically related to situations perceived as uncontrollable or unavoidable. "The most common reasons runners get nervous are because they put internal and external pressures on themselves that can't be controlled, like time goals, weather, and trying to fulfill what others expect them to achieve," says Sheehan.
Physically, the nausea-like symptoms of anxiety are the result of the release of adrenaline. Adrenaline disrupts the stomach because it pulls blood away from the intestines and sends it to the heart, brain and skeletal muscles. Without proper blood flow, the body can't move food through the digestive system. Moreover, anxiety and stress can also cause muscle tension in the abdomen, tension that may squeeze the stomach and result in vomiting.
PREVENTIONS
1) Focus on what you can control.
Since anxiety is typically caused by fear of the uncontrollable and the unknown, Sheehan works with her athletes to "shift their pre-race mindset from the outcome and external pressures, such as opponents and the weather, to specific elements they can control like the warm-up, pre-race meal and race mantras."
In the months and weeks leading up to a big goal race, Sheehan suggests runners practice the exact same warm-up before every workout. On race day, repeat the exact routine you used for every workout and focus on each of the steps rather than the race. Implementing this tactic before a race wraps your mind in a comfort zone with a familiar set of steps that has worked many times in training and keeps you calm on the starting line.
2) Pay attention to your pre-race diet.
Because adrenaline and anxiety disrupt the digestive process, runners who struggle with vomiting before races should take extra care with their pre-race meal. Emily Brown, a registered dietitian and elite runner, recommends that runners switch to a low-fiber diet two to three days prior to race day. She suggests they reduce their intake of fruit and vegetables, eat more processed, low-fiber foods, and drink more juices. In addition, Brown also suggests that runners who struggle with throwing up before races test themselves for food allergies or general food intolerances. "What sits well in the stomach of your running partner might not work for you," she says. "For example, runners with mild peanut allergies, who might not otherwise notice nausea symptoms, can experience significant stomach distress if they put peanut butter on a bagel when nervous or before running hard."
Brown recommends runners who suffer from pre-race nausea consider a liquid pre-race breakfast, which is digested quickly, as opposed to more solid foods. Finally, avoid the use of anti-inflammatory drugs like ibuprofen. Recent research points to a strong correlation between nonsteroidal anti-inflammatory drug use and vomiting during endurance events.
SICKNESS DURING RACES
The most common cause of vomiting and nausea during hard workouts and races is the shutting down of the digestive system as exercise intensity increases. "As the need for oxygen-rich blood in the running muscles increases, the body begins to shunt blood away from non critical resources, such as digestion, to help feed the muscles," says Melanie Schorr, a former Dartmouth All-American now in her doctoral residency program at Harvard's Brigham and Women's Hospital in Boston. Research has demonstrated blood flow in the splanchnic system (which is responsible for the signals sent and received by the abdominal digestive organs) declines from 1.56 L/min at rest to 0.3 L/min during intense running.
Running in hot conditions decreases blood flow to the digestive system as well. However, the outside temperature doesn't need to be hot for runners to experience heat-related vomiting and nausea. Exercising, even in cold temperatures, naturally raises the core body temperature, Schorr explains. At first, this rise in temperature aids performance by increasing blood flow to the working muscles. However, as the intensity and distance of a run increases, the body reaches a critical temperature threshold, usually around 101 degrees, and begins to divert blood from the digestive system to the skin in an effort to cool itself down.
PREVENTIONS
1) Pay close attention to what and when you eat.
This includes before and during your run. If you plan on consuming fluids or fuels during a run, make sure you have a carefully orchestrated strategy that you've practiced in training.
When taking gels or other simple sugars during a race, make sure to take them with water and not another carbohydrate drink. "In the absence of water, the digestive system will have to work harder to break down the gel into usable energy," Brown says.
If you take an energy gel with a sports drink, you run the risk of ingesting too much simple sugar at once. Taken together, they could deliver close to 60 grams of pure sugar. Even when fully functioning, the digestive system can have a hard time processing that much sugar. Likewise, Brown recommends runners don't consume gels too quickly. "Simple sugars are absorbed into your blood stream as glucose," she says. "The sugar will stay in the blood stream until absorbed by the working muscles or other organs. Too much sugar in the blood stream will make you sick, the same as it would if you ate too much candy."
2) Avoid dehydration.
Dehydration can lead to overheating and can also slow stomach emptying. We've all heard the concerns about hyponatremia, warning against ingesting too much water without necessary electrolytes. Excessive intake of sodium, potassium or other electrolytes, however, can lead to bloating, nausea and vomiting. Therefore, develop a detailed hydration strategy that you implement and experiment with in training, while running hard.
3) Try antacids and probiotics.
If normal dietary precautions don't seem to help, you can try antacids or Pepto-Bismol. If that proves ineffective, research on ultramarathoners has shown that 800mg of cimetidine, a drug sold under the name Tagamet for acid-reflux, alleviated nausea and vomiting symptoms when taken an hour prior to the race. Another recent study found that regularly ingesting probiotics, found in yogurt and probiotic drinks like DanActive, Yakult, Lifeway Kefir, Kombucha and GoodBelly (which is lactose free), can improve athletes' stomach health and reduce irritation and nausea.
VOMITING AFTER A HARD EFFORT
While many runners might not be as concerned about vomiting after races because it doesn't impact performance--and some hardcore runners feel that a workout isn't hard enough unless it leaves them retching--throwing up after running can be harmful to your body. Dr. Schorr cautions that "vomiting brings up stomach acid that can damage your esophageal lining, which causes pain and affects your digestion." You should not accept throwing up after an intense workout or race as typical.
Vomiting after hard workouts and races can be caused by the sudden change in effort as you stop running hard, particularly if this immediately follows an increase in intensity as you kick to the finish. As you cross the finish line or end that final interval, your brain, lungs and heart may not be ready for the rapid change in exertion, and your stomach may continue contracting, which can make you feel ill--similar to the feeling of seasickness.
PREVENTION
Ease off gradually.
Make sure you have a thorough cool-down and avoid sitting immediately after a race or hard workout. As soon as possible after finishing, continue to walk around or jog lightly to give your body a chance to adjust to stasis level and prevent stomach cramping.
Tags:RT March 2013[4]
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10/24/18