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Trimarni is place where athletes and fitness enthusiasts receive motivation, inspiration, education, counseling and coaching in the areas of nutrition, fitness, health, sport nutrition, training and life.

We emphasize a real food diet and our coaching philosophy is simple: Train hard, recover harder. No junk miles but instead, respect for your amazing body. Every time you move your body you do so with a purpose. Our services are designed with your goals in mind so that you can live an active and healthy, balanced lifestyle.

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Filtering by Tag: GI issues

Endurance sports - why are GI issues so common?

Trimarni

 

Every endurance (and ultra distance) athlete wants to show up to an event/race feeling physically prepared. But what about being nutritionally prepared? 

A long distance event places a lot of stress on the human body. Extreme environmental conditions further exacerbate the physiological (and mental) demands during physical activity. While physical preparation can improve the chance of completing the event or setting a personal best time, gastrointestinal issues are likely to cause the body to underperform. Or even worse, you may not be able to complete the event due to a nutritional complication. 

Research states that around 30-70% of endurance and ultra endurance athletes experiences GI issues on race day. In other words, at an Ironman triathlon of 1500 athletes, around 1050 athletes will experience some type of GI issue. This is a very alarming statistic considering how money, time and effort go into preparing for an endurance event. 

I've worked with many athletes who have come to me after struggling with nutrition issues on race day.  While I can feel the frustration and sadness coming from the athlete (after the race that they prepared so much for, didn't go as planned), I typically see several common trends of what the athlete did before/during the race that contributed to the uncomfortable and performance compromising GI issues. 

With so many endurance and ultra distance events happening throughout the year, here are a few reasons why GI issues occur and how you can reduce your risk on race day.







Understanding upper GI issues on race day

Trimarni

Gastrointestional issues are very common among endurance athletes. Complaints are usually dividing into two categories - upper GI and lower GI. 

Most athletes are familiar with lower GI issues - gas, loose stool, urge to defecate, diarrhea, abdominal cramping. I've written several articles on the topic of GI issues but most of the gastrointestinal issues I discuss involve the lower GI tract. In working with hundreds of endurance athletes on race day nutrition, the common culprits of lower GI issues include dehydration and concentrated or poorly applied sport nutrition consumption. I find this area fairly straightforward when it comes to prescribing well-formulated sport nutrition products to minimize or alleviate lower GI issues on race day. 

When it comes to upper GI issues in endurance athletes, like belching, vomiting, reflux/heartburn, trouble swallowing and bloating, this area has been more challenging to fix. What makes it so difficult is that most of the athletes that come to me for nutrition assistance only experience upper GI issues on race day, specifically in the half or full distance triathlon. With no common source of complaints, I've done a lot of research in this area and have come to a few conclusions as to why some athletes only experience upper GI issues on race day. 

Before addressing some of the culprits of upper GI issues, it's important to understand a few conditions that are related to upper GI issues.

1) GERD (gastro esophageal reflux disease) or heartburn. 
GERD occurs when the cardiac sphincter relaxes and allows stomach acid to regurgitate into the lower part of the esophagus. The cardiac sphincter separates the lower part of the swallowing tube (esopghagus) from the stomach.

Common symptoms of GERD include: 

  • A burning sensation in the middle of the upper abdomen and chest. 
  • Burping. 
  • Regurgitation of food. 
  • The taste of acid in the mouth. 
  • Trouble swallowing. 
  • Persistent cough/throat clearing or hoarse voice/sore throat
  • Asthma 
2) Aerophagia - ingestion of air into the esophagus and stomach. 
Aerophagia occurs when a person swallows too much air.

Common symptoms of Aerophagia include: 
  • Bloating 
  • Belching 
  • Decreased appetite 
  • Diarrhea 
  • Gas 
  • Stomach noise 
  • Uncomfortable distension of the stomach 
In my experience, I believe that these are two of the primary causes of upper GI issues in endurance athletes. Based on the risk factors for aerophagia and GERD, it also makes sensee why some athletes only experience issues on race day - and not in training. 

3) Functional Dyspepsia - Indigestion. 
Dyspepsia is a term for the intermittent signs and symptoms of indigestion that have no obvious cause.  

Common symptoms of Dyspepsia include: 
  • Pain or discomfort in the upper abdomen
  • Bloating
  • Belching 
  • Nausea 
  • Early feeling of fullness/satiety when eating

CAUSES OF AEROPHAGIA 
  • When swimming, your body is placed into a horizontal position. It's common to take big gulps of air when turning the head to breathe, especially in choppy conditions or at an effort higher tha what you are used to. Seeing that the majority of triathletes do not swim before the bike but only on race day and the swim can be unpredictable and chaotic....it makes sense why so many athletes experience upper GI issues only on race day - after the swim. 
  • Drinking from a straw (straw-based hydration systems). Each sip from the straw draws air into your mouth which is then swallowed. 
  • Breathing rapidly and deeply (intensity) In the upright position (ex. bike or run), air rises above stomach liquids and expelled as a burp. In the horizontal position (swim/bike), air may get trapped behind stomach fluids and is sent into the small intestine, causing pain and gas. 
  • Chewing gum or drinking carbonated beverages may cause you to swallow excess air. Gulping beverages (instead of sipping) may also cause you to swallow air. 

CAUSES OF GERD/DYSPEPSIA

  • Pre-race/race day stress and nerves - anxiety reduces pressure in the lower esophageal sphincter. Stress increases pressure around the stomach and pushes acid up. High anxiety may increase stomach acid production. 
  • Eating too close to the race start or consuming food/sport nutrition while transitioning from swim to bike or bike to run. After a meal, it normally takes ~2-4 hours for food to move out of the stomach and into the small intestines. Allowing time for food to pass from the stomach to the small intestines will reduce the risk of reflux during exercise. 
  • Exercise causes greater intra-abdominal pressure. Intense or jarring movements can force stomach acid into the esophagus, causing burning and irritation. 
  • Bouncing and jostling can irritate the lower esophageal sphincter. 
  • Tight fitting clothing, especially around the waist. 
  • Full bending at the waist causes compression on the stomach and upper GI tract (aero position). 
  • Lower esophageal sphincter (LES) losing its tone from the following substances: 
    -peppermint, onions, garlic, chocolate, acidic citrus, tomato products
    -coffee (caffeinate or not) increase stomach acidity and the caffeine acts to relax LES
    -alcohol - relaxes the LES muscles and irritates the mucous membrane of the LES.
    -medications - some asthma inhalers, common pain relievers, blood pressure meds and heard medications. 
    -adrenaline - a hormone secreted by the adrenal glands during times of stress
    -routine use of NSAIDs - inhibit protective prostaglandins and produce ulcerations in mucous membranes lining the stomach and the esophagus.

    Note: I've also looked into the citric acid in sport drinks as a culprit of upper GI issues and have not found a significant link. Even when I've switched athletes to a citric acid free drink, reflux still occurred. 

Troubleshooting race day GI issues

Trimarni


The gut is a very important athletic organ because it is responsible for the delivery of nutrients and fluids during exercise. The gut is highly adaptable and should be trained repeatedly in training - just like the muscles and heart. Unfortunately, many athletes are reluctant (or afraid due to body composition concerns, previous GI complaints and 'they sayers') to take in recommended amounts of carbohydrates, calories, sodium and fluids before and during long workouts. Sadly, this results in underfueling in training and far too common, overfueling on race day.

By practicing your pre-race and race day nutrition many times prior to race day, you can improve absorption of nutrition, improve gut tolerance and learn what works (and doesn't work) to reduce the chance of GI distress and to improve performance.

Although GI distress is common among endurance athletes, race day performance-limiting upper- and lower-gastrointestinal (GI) issues are highly preventable.

Although causes are diverse and symptoms vary, there are ways to reduce your risk so that you can perform to your abilities and not spend unwanted time on the side of the road, in the bushes or in the portable toilet.








Endurance athletes - what's causing those GI issues??

Trimarni


GI (or gastrointestinal) issues are no fun. GI issues are one of the most commonly blamed reasons for underperforming on race day. In some cases, gut related issues can result in athletes not finishing the event. 

Many athletes have come to me expressing great frustration and discomfort from nausea, bloating, gas, bloody diarrhea, loose stools, cramping, stomach pain, abdominal distention or vomiting during training and competition. While these complaints can have a negative effect on performance, they have an even bigger impact on physical and mental health. 

Thankfully, several research studies have discussed the reasons why endurance athletes are at great risk for GI issues. There is also good research discussing how to mitigate these issues during exercise - especially in the heat, at high intensity or during long duration. 

Reduced blood flow to the intestines during exercise is one of the main contributors to GI symptoms. These issues are only exacerbated when the body is dehydrated. Because blood is diverted from the gut and to the working muscles, the lack of blood flow in the gut slows gastric emptying. As a result, the delivery of nutrients and fluids to the muscles gets delayed and may cause gut discomfort (and a lot of other uncomfortable side effects). Reduced blood flow to the intestines may also contribute to increased permeability of the gut wall, which may trigger an inflammatory response resulting in GI distress. 

Because the consumption, digestion and absorption of calories, carbohydrates, electrolytes and fluids are all important components of the training adaptation process and the ability to perform well on event day, minimizing the risk for GI issues is critical.

The takeaway: The gut is an extremely adaptable organ. Don't wait until race week (or race day) to figure out your fueling strategy. Training your stomach is just as important as training your muscles.  








How to avoid GI issues on race day

Trimarni

Photo by Deuce Bradshaw.

Unwanted in training and competition, GI issues frequently impair performance and recovery. The three main causes of GI symptoms include physiological (reduced blood flow to the gut), mechanical (bouncing/jumping) or nutritional (diet/sport nutrition). For example, during exercise, blood flow to the digestive system is impaired so the stomach may reject ingested food or fluids, sending them out of the body - either up or down.

Common upper and lower GI issues include:


UPPER GI ISSUES
LOWER GI ISSUES
Nausea
Intestinal cramping
Vomiting
Side stitch
Stomach pain/cramps
Gas
Bloating
Loose stools/diarrhea
Belching
Intestinal bleeding
Heartburn/reflux
Urgency to defecate

Severity differs depending on the athlete and sport.

For example, the high-impact nature of running may jostle the gastric system, contributing to lower GI issues. In cycling, posture on the bike may increase pressure on the abdomen causing upper GI issues. Among swimmers, swallowing air from short and rapid breathing may cause belching.

Additionally, using a straw-based hydration system or gulping fluids (especially carbonated drinks) may cause aerophagia – which is a condition of excessive air swallowing, contributing to GI issues.

To reduce the risk of GI issues during exercise, follow these practical guidelines:

  • ·     If you get gassy with dairy and fructose, consider a lactose or dairy-free alternative and avoid grapes, apples, asparagus, melon and juices when gut flow may be compromised (ex. high-intensity training, competition day).
  •       Reduce/avoid high-fiber food such as cruciferous veggies and high-fiber cereals/grains and replace with potatoes and plain breads in the 4-24 hours before intense or long duration activity.
  •       Avoid high-fructose foods such as soda, candy and juice, as well as carbonated drinks around workouts/competition.
  •       Stay well-hydrated before, during and after exercise. Dehydration can exacerbate GI symptoms. Drink frequently in smaller amounts on a schedule throughout your race instead of big gulps randomly occurring when you feel overly thirsty to reduce the risk of a sloshy stomach.
  •       Allow 4-6 weeks to train your gut to improve intestinal absorption with ingested foods and fluids. Don't wait until race week to try out your race day nutrition plan. Consider the formulation of your sport nutrition products to ensure optimal digestion and absorption. In other words, don't concentrate your products.
  •      Trial and error to figure out what works/doesn’t work before and during training/competition. Keep your pre race and race day fueling and hydration plan simple so it's easy to execute under pressure/nerves/stress.
  •       NSAIDs and aspirin are associated with an increased risk of GI complications, mucosal bleeding and ulcers. Avoid as much as possible, and avoid before and on competition day.
  •      Stay calm and relaxed. Stress can exacerbate GI issues. 

GI issues and sport nutrition

Trimarni

                                       A throwback to Kona '18 and Acai bowls - yum yum.


Wowzer - five weeks until IM 70.3 Haines City. I'm so excited to race I can hardly contain myself.
My training is slowly increasing in training volume - specifically bike and run. My typical swim distances are between 3800-4600 yards (~1-1:15hr swim) and I swim five times per week. I also bike about five times per week and there's never an easy bike workout. As for the run, I also run about 4-5 times per week and while I have some solid brick run sessions (my favorite - I love love love running off the bike), my other runs are all about efficiency right now (around 45-65 minutes). With a long season ahead (20 weeks until Ironman Canada and 30 weeks until IM Kona), I'm being patient with my run volume/intensity (per the methods of my coaches).

I'm lucky that I don't suffer from GI issues in training and on race day. Neither does Karel. I believe much of this relates to the daily diet, always fueling before our training sessions and always using sport nutrition during workouts. There's also a proper application to using sport nutrition products and I find that many athletes struggle with knowing what products to use (and when) and are very inconsistent with when/how products are consumed.

GI (gastrointestinal) problems are very common in athletes, specifically endurance athletes. It's probably one of the most common reasons why athletes reach out to me for sport nutrition help. Although many athletes suffer from GI issues in training, the prevalence for GI distress is amplified on race day, especially as racing duration continues and in hot environmental conditions.

GI issues may be due to several causes including physiological (reduced blood supply to the GI tract), nutritional (pre-race diet and race day fueling methods) and mechanical (ex. bike fit, jostling of organs while running, breathing issues).

From my professional experience, athletes describe many different types of GI issues that are bothersome in training/racing and many of which can disrupt the ability to train normally.
Flatulence or belching are two very mild lower and upper (respectively) abdominal symptoms that probably won't impair your physical performance. For most athletes who complain of gas and burping during racing, these symptoms are typically uncomfortable and annoying, but tolerable.  
However, heartburn, lower abdominal cramps, side stitches, diarrhea, nausea, vomiting, stomach pains, bloating and bloody stools will not only affect your race day effort (if you make it out of the port-o-potty) but are extremely health threatening. I've worked with several athletes who have experienced the above issues, only to end up in the medical tent or hospital after the race. It's certainly not the way you'd imagine finishing your race.

Keep in mind that GI symptoms during exercise are highly individualized and often circumstantial. However, the gut is an organ that can be trained, just like your muscles. 

Many athletes are predisposed to GI issues, relating to genetics, biomechanics, anatomy, age, diet and health issues (to name a few). For the athlete who has a long (or on and off) history of GI distress, it’s quite possible that you are not adapted to fluid/calorie ingestion during training, you do have an ideal formulation of carbohydrates, electrolytes and fluids for your fueling strategy, your fueling timing is off or you are racing at too high of an intensity to properly fuel and meet your planned (or perceived) effort. Menstruation, breathing issues and dehydration can also be blamed for GI distress.
To reduce the risk of GI issues on race day, do not wait until last minute to formulate your perfect concoction of liquids, electrolytes and carbohydrates to meet your race day effort needs.  Once you have the right fueling products (flavors taken into consideration for your taste buds), it can then take at least 4-6 weeks to feel "less full" when fueling and exercising and improve intestinal absorption - both of which correlate to improved tolerance of sport nutrition during training. This is why it's important to use sport nutrition products during training sessions, especially high intensity and longer distance sessions. 

As a reminder, a sport drink (or fueling strategy) is only effective if it is emptied from the stomach and can be quickly absorbed through the walls of the small intestine. Additionally, electrolytes (ex. sodium) are needed with water as they will encourage retention of fluids, reduce urine output and promote absorption from the intestine.

Happy fueling athletes!

Racing weight - do you have one?

Marni Sumbal, MS, RD


Yes, I am pouring ice down my shorts at Ironman Kentucky (2009). This was one of my favorite races because it was great to be in my home state. I loved the rolling hills on the course and I always like to see nature/wildlife when I am racing. I have been known to say out loud "Hello" to the cows and horses that I spot along course - I am sure they say hello back but I am too busy riding fast on my bike. 
This was also a favorite race of mine because it was my Ironman PR - a hard definition to use in racing because I have PR'd in separate races for each the swim, bike and run but here I put it all together for a "fast" Ironman at 10 hours and 53 minutes. But as we all know, you can't compare race to race for every race is different. I will take my 10 hours and 57 minute finishing time as my "best" race at IMWI for it was super challenging and likely the hardest IM I have ever "raced". In Kona 2011, I PR'd on the bike but I have yet to learn how to "race" that race so hopefully I will have the honor to race there for the 3rd time in the future (hopefully with Karel).

As far as racing weight goes, I hear a lot from athletes who feel as if reaching a certain weight will allow them to race better. I understand that we should not be carrying more weight on our body than is needed for that can increase risk for injuries. But in terms of a healthy weight vs a racing weight, how can we figure out what is our ideal weight for performing well on race day?

Here's how I see it  - from both a coach, an athlete and someone who has worked with many athletes on race day/race week eating along with sport nutrition and weight loss. 

If you are a newbie, you likely have no idea what is an ideal racing weight. Focus on your training and getting stronger with consistent  performance gains. A number on a scale or comparing your body composition to others will not give you a PR. Your work in the pool, on the bike and/or while running will give you the race performance you trained your body to do by race day. As for wanting to lose weight and being a newbie? That is fine and likely why you started a new sport in order to "get healthy". Never should a workout be compromised or life be extreme just to "lose weight". Create a healthy foundation diet that will nourish your body and leave you satisfied and then prioritize nutrition around (before, during and after) workouts. This can be done best with someone (ex. sport RD) providing feedback to nutrition logs to tweak the diet for better nutrient timing and of course, learning how to not over/under-eat.

Here is the big reason why veterans talk about "Racing" weight. Someone who refers to a past weight and explains that "at x-weight, I performed the best ever so that is my racing weight" is simply identifying the weight as the highlight of the training. In other words, it wasn't the weight loss or change of body composition that happened first (or in the off-season or while doing nothing) and then the performance gains but instead, the change in body composition and "ideal" racing weight was the result of training. You didn't perform well on race day because you stuck to a diet plan and sat on the couch doing nothing but instead, you likely provided your body with the right fuels at the right time to make performance gains and your body took care of itself. It got stronger, faster and perhaps leaner and you performed well on race day. Now you are likely more efficient and may be struggle with getting back to that weight but in hindsight, it wasn't that specific weight that made you have a great race but instead the training that came with it.

IMKY was a PR but I was also at my "heaviest" for IM racing. I do not perform well with a low body weight and also, it isn't fun because I don't like to feel hungry or restricted so that's a choice I make as I will take performance over a number on a scale. I don't like my body weight going under 108lbs (I'm 5 feet "tall" and I create muscle very easily thanks to genetics and good nutrient timing) and that weight only occurs during IM training. Throughout the year I hoover around 111-112. I'm fine with that as I feel energized, satisfied and most of all, healthy and balanced. I know that if my weight gets to 115 - no biggie but more than that, risk of injuries goes up for me and I am aware of that so to be respectful to my body, I need to adjust something with training/diet to get back to a healthy weight. So although at IMKY I was heavier than most IM's, I performed the best ever and at the end of the day when writing my race reports, it wasn't the weight that hopefully inspired others to reach personal health goals but rather my attitude, performance and approach to a fun, active lifestyle. Hopefully you can do the same. 

If you are an athlete or fitness enthusiast, you likely are using your body to perform. If you are a swim suit, cycling shorts or running top model, you are using your body for a picture. There's nothing wrong with either one but from my perspective as an athlete, I would rather use my body in my swim suit, cycling shorts and running top to get to finishing lines and feel fueled and strong along the way. 

Since we are in a society that is stuck between "healthy eating for health" and "healthy eating for weight loss", I thought I'd share an article (or parts of it) from one of my favorite nutrition journals as athletes are always quick to remove food to lose weight or follow a fad diet (heavy on products or "bad" food) and I find that nutritional irresponsible and often times disrespectful for the body that we expect to be 100% all the time. For me, I'd rather work with an athlete to identify strengths and weaknesses in the diet alongside lifestyle habits that may be affecting the timing, amount and types of nutrition before assuming that that athlete has to go to any great lengths in terms of restrictive eating when it comes to meeting personal weight and performance goals. I have heard many athletes blame certain foods for GI upset and feeling 'unhealthy' but for me, I'd rather find any triggers for the reasons behind not feeling well during the day or during training rather than blaming a food source and removing it without it being the true cause.

Nutrition Action Healthletter Jan/Feb 2013 issue.
GUT MYTHS: Clearning up confusion in the GI tract.

(there are several myths listed on pg 3-5 so I will share one of them)

MYTH: Got gas? Beans, vegetables and milk are the main culprits.
Beans, cabbage, Brussels sprouts, milk, bran. Those are some of the usual suspects when people are trying to figure out why they're experiencing, ahem, gas. Ant those foods can cause gas.
But most of us overlook a growing source of the problem: inulin, or chicory root extract, one of the most popular ingredients in "high-fiber" foods.
"Of all the fibers added to foods, inulin is the one that probably causes the most intestinal gas, " say fiber expert Joanne Slavin, professor of nutrition at the University of Minnesota. "Inulin contains sugars that our digestive enzymes can't break down."
The enzymes do just fine with sugars that have only one or two basic units (called saccharides). Sucrose, or table sugar, for example, is a disaccharide, that is broken down in the small intestine into fructose and glucose.
But when it comes to sugars made up of three or more units - often called oligosaccharides - our enzymes are useless. So the sugars end up as food for the bacteria in the gut.
"Inulin is quickly and completely fermented in the large intestine," explains Slavin. And when your bacteria finish fermenting it, you get stuck with the gas they give off.
"Beans are notorious for causing gas because they have sugars like raffinose and stachyose," notes Slavin. Raffinose has three sugar units. Stachyose has four.
"If you look at literature on treating or cooking beans to make them less gassy, it's mostly t get the oligosaccharides out of there," she adds.
(Beano tablets can prevent gas because the contain an enzyme that breaks down raffinose and stachyose).
Whether inulin is a problem depends on how much you eat and who you are.
"Our review of studies found that inulin is generally well tolerated at levels up to 15g a day," says Slavin. But at around 20 grams, flatulence or bloating is more likely. "So does is a big issue and there is also individual variability."

Each serving of FIber One 90 Calorie Bronies, Fiber One cottage Cheese and Yoplait LIght with fiber has 5 grams of fiber and much of it is inulin.
Some Fiber One Chewy Bars have up to nine grams.
"If you have a serving of beans you'll get about 3 grams of oligosaccharides, not nine grams," says Slavin. "Any they're more manageable in a real food because they're digested more slowly and usually mixed with other foods."

Another hidden source of gas: sugar alcohols like sorbitol and maltitol. "They're low-calorie carbohydrates because they're not completely digested and absorbed," explains Slaving. "Typically if you are eating sugar-free candy or gum, your exposure to sugar alcohols is low, but if people eat the whole bag of candy, it can cause gas."
Sugar alcohols aren't all equal, though. In small studies, some people complain of gas when doses of sorbitol reach 10-20g but few complain unless they get at least 30-40 grams of maltitol.
Most foods don't have that much. Breyers Vanilla or chocolate CarbSmart and No sugar Added ice creams, for example, have 4-5 g of sorbitol per half cup, but many people start at a whole cup. And Baskin Robbins No sugar Added Caramel Turtle Truffle ice cream has 25grams of maltitol per scoop..

Of course, some people may eat more than one food with sugar alcohols during the course of a day. And people vary. "Most people can tolerate normal doses, but not everybody is the same," say Slavin.

On the plus side, sugar alcohols have fewer calories than sugar and inulin spurs the growth of Bifido bacteria, which may be good for gut health (that's why it is called a prebiotic). But the more bacteria in your gut, the more gas they give off.

"Scientists argue that gas isn't bad for you, but most people say it's not acceptable," say Slavin. "If you hve gas, you should definitely consider what you're eating. If it's a lot of fermentable fiber or sugar alcohols, that could be the explanation."