6 easy steps to avoid stomach issues

New paper outlines six strategies that can prevent nausea and pit stops for runners.


by Amby Burfoot
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Bill Rodgers once quipped, “More marathons are won or lost in the porta-loos than at the dinner table.” We are not surprised. Rare is the distance runner who hasn’t had some stomach or bowel distress during a race. And even though marathons aren’t often televised, there have been several famous cases of on-camera elites vomiting or ducking off course en route.

In fact, studies have shown that 30 to 90 per cent of endurance athletes suffer from some form of stomach/bowel distress, with the percent increasing with longer distances.

A new summary in Sports Medicine reviews what’s known about on-the-go gastrointestinal complaints, and what you can do to avoid such problems. We’ll spare you the discussion about abdominal angina, splanchnic perfusion, gut mucosal permeability, gastro-esophageal reflux, and the like, and cut straight to the chase.

Here, paraphrased, are the best ways to avoid problems.

1. Avoid high-fibre foods for several days before your event.

2. Avoid aspirin and NSAIDS like ibuprofen, especially if you have a history of stomach issues while running/racing.

3. Avoid high-fructose foods, particularly sports drinks that are sweetened only with fructose. Somewhat paradoxically, drinks that contain some fructose along with other sweeteners such as glucose appear to be less troublesome.

4. Avoid dehydration. Practice drinking in training to improve your comfort with fluids on board. Don’t over drink in races simply because there are so many water tables and sports drinks available.

5. Don’t use overly sweetened drinks or mix sports drinks, gels, bars, etc. Yes, more sugar means more calories for energy, but it also means increased risk of stomach distress.

6. If you’ve had problems in the past, practice new nutrition strategies, both pre-event meals and drinking while running. An interesting though still speculative hypothesis indicates that nitrate supplements might ease stomach problems during exercise. This is an intriguing approach because nitrate might also improve performance, at least in non-elite runners.


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I found that avoiding any food with dairy in it for 4 days before a long run stopped my tummy issues. I don't have a lactose intolerance normally but I seem too when running 20 miles or more.


Posted: 30/05/2014 at 19:58

One thing I was surprised not to see there- caffeine.

I used to do short runs and take some caffeine pills or have a coffee beforehand. It provided a useful push, but even then occasionally threatened, er... gastrointestinal problems.

It became more of a big deal as I started doing longer runs, though, to the point it was threatening to derail things altogether. I decided to cut out drinking coffee before I went running (having already tried changing what I ate), and it *vastly* cut down on the problem.

Granted, there were some mornings I was tired and could have done with the caffeine push, but the vast reduction in the worry and inconvenience more than made up for it.

Seems like there are lots of causes of gastrointestinal issues, and different ones seem to affect different people, but caffeine is definitely worth bearing in mind as a potential cause.


Posted: 02/06/2014 at 01:00

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