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Powerbar Practical Strategies

AVOIDING EXERCISE-RELATED GASTROINTESTINAL DISTRESS

Running

You're in the zone, running in peak form, when suddenly your digestive tract takes you out of the race at a critical moment. You're not alone: Gastrointestinal (GI) distress affects many athletes during or after training or an event. It's never helpful to have to make repeated restroom stops at an event, or have to run through major distress. Athletes sometimes have to abandon their events due to some type of GI symptom. The good news is that most GI problems are avoidable, and proper nutrition strategies can help ensure that you can stay active. An easy way to minimize the likelihood of having a problem is to practice your event-day nutrition strategies in training, and don't do anything new prior to and during your competition. By making careful selections of what you eat and drink both before and during an event, you can squelch any tummy troubles and stay in the game. We'll show you how you can prevent GI distress and run at your best.

Skiing/snowboarding

Your mind is on the slopes, but your body might have other ideas: gastrointestinal (GI) distress, which commonly affects many athletes during or after exercise.. It's never helpful to have to make repeated restroom stops at the lodge, or have to ski or board through major distress. Athletes sometimes have to abandon their events due to some type of GI symptom. The good news is that most GI problems are avoidable, and proper nutrition strategies can help ensure that you can stay active. An easy way to minimize the likelihood of having a problem is to practice your event-day nutrition strategies in training, and don't do anything new prior to and during your competition. By making careful selections of what you eat and drink both before and during your runs, you can squelch any tummy troubles and perform your best. We'll show you how you can stay on the snow and avoid GI distress.

Volleyball

You might have everything going for you in a match, but you're going to have a lot harder time spiking the ball for a winning score if gastrointestinal (GI) distress strikes. It's never helpful to have to make repeated restroom stops at a venue, or have to play through major distress. Athletes sometimes have to abandon their events due to some type of GI symptom. The good news is that most GI problems are avoidable, and proper nutrition strategies can help ensure that you can stay active. An easy way to minimize the likelihood of having a problem is to practice your event-day nutrition strategies in training, and don't do anything new prior to and during your competition. By making careful selections of what you eat and drink both before and during an event, you can squelch any tummy troubles and stay in the game. We'll show you how you can keep GI distress off the court.

Football

You deal with a lot of pain on the gridiron, just to play the game. But gastrointestinal (GI) distress is something else - and it can seriously reduce performance. It's never helpful to have to make repeated restroom stops at a venue, or have to play through major distress. Athletes sometimes have to abandon their events due to some type of GI symptom. The good news is that most GI problems are avoidable, and proper nutrition strategies can help ensure that you can stay active. An easy way to minimize the likelihood of having a problem is to practice your event-day nutrition strategies in training, and don't do anything new prior to and during your competition. By making careful selections of what you eat and drink both before and during an event, you can squelch any tummy troubles and stay in the game. We'll show you how you can take the field without needing to fight GI distress.

AVOIDING EXERCISE-RELATED GASTROINTESTINAL DISTRESS

BY CHRISTOPHER JENSEN, PHD, MPH, RD

You're out on a long training run. Your pace is strong. The last chilly vestiges of the early morning combined with the rising sun warming your back has you feeling like you could go on forever. The miles drift by. You're in the zone.

But around mile 7 you experience what feels like the beginnings of abdominal cramping. You keep going, trying to refocus, all the while hoping the sensation will pass. But the feeling doesn't go away. Instead, the cramps grow in intensity to the point where — forget training — you're now running for one purpose only: to find a restroom.

Sound familiar? Abdominal cramping is just one of a handful of symptoms that collectively are referred to as exercise-associated gastrointestinal distress. For short, we'll call it GI distress. Symptoms can include heartburn, burping, flatulence (the scientific term for passing gas), nausea, vomiting, abdominal or stomach cramping, the urgent need for a bowel movement, diarrhea, and/or gastrointestinal bleeding.

If one or more of these symptoms has ended some of your competitions or training sessions prematurely, or arrived with a vengeance within a few hours of crossing the finish line, you're not alone. In fact, these types of gastrointestinal complaints are very common among endurance athletes.

In this article we'll explore GI distress, which athletes tend to get which symptoms, what are likely causes, and most importantly, what you can do to steer clear of the problem and keep your gut happy.

GI DISTRESS IS COMMON AND SYMPTOMS VARY BY SPORT



Frequency estimates vary, but GI distress during or just after exercise is more common than not. In a study of individuals who trained for 18 months in preparation for a marathon, 25% reported symptoms of GI distress during a 25-km race 12 months into their training, and 52% complained of distress symptoms during the marathon itself.

In a another study of well-trained endurance athletes, researchers asked the athletes to report whether they'd experienced symptoms of exercise-related GI distress during the preceding 12 months:

  • Among runners, 71% reported lower GI tract symptoms, such as side aches, abdominal cramping, urge to defecate, and diarrhea. In contrast, 36% reported upper GI tract symptoms such as burping, nausea, and vomiting.

  • Among cyclists, the incidence of lower and upper GI tract symptoms were similar, at 64% and 67%, respectively.

  • Reports from triathletes confirmed the symptom patterns observed in runners and cyclists. During the cycling leg of triathlon competitions, lower and upper GI tract complaints were reported in 45% and 52% of athletes, respectively. During the running leg, lower GI tract complaints were reported by 79% of athletes, while upper GI tract complaints were reported by 54% of athletes.


  • In the most recent and largest study to date, elite and recreational runners competing in an event that included distances of 5, 10, 21, and 42 km, were asked to complete a questionnaire related to GI distress symptoms. A total of 45% of the runners had at least one GI complaint during their run, and almost 3% reported symptoms in the 24 hours after the competition. These findings indicate that GI distress is common across endurance sports, and that the nature of the symptoms tends to vary from one sport to the next.

    CULPRITS AND CAUSAL FACTORS



    The causes of exercise-associated GI distress are not yet fully understood. But a variety of causal factors seem to be at work, including some that are inescapable and others that you can do something about.

    FACTORS YOU CAN'T CONTROL



    The fact is that digestion is a process that takes place best when you're at rest. Exercise throws a wrench into the works.

    When you're exercising, blood flow to the digestive tract is severely restricted, the gut may incur mechanical trauma due to the motion associated with exercise, and there's a boost in the secretion of key hormones that increase gut motility - the process whereby the contents of the digestive tract are moved through the system. Together, these exercise-related changes can wreak havoc on the digestive process, resulting in the range of GI distress symptoms that athletes report. The evidence also suggests that the higher the intensity of exercise, the more disruptive it is to normal digestive processes and the greater your chance of suffering GI distress symptoms.

    Although you can't really do much about the mechanical trauma or the physiological changes that occur in the digestive tract in response to exercise, understanding that these factors exists underscores the importance of making adjustments to those causal factors you can control.

    FACTORS YOU CAN CONTROL



    Digestion is the process whereby the food and beverages that you consume are broken down so you can absorb necessary nutrients and eliminate waste. If GI distress is making it impossible to be at your best during training sessions or competitions, altering what and how you eat and drink before and during training and competitions may be your best shot at a solution. The following are strategies to consider:

    Change Your Pre-Exercise Meal and Snacking Regimen



    If you've got a sensitive gut, don't tax your digestive tract in the hours before exercise.

    Practical strategies:

  • Consume your pre-exercise meal 3-4 hours before training or competing to allow more time for digestion to take place.

  • Consume liquid rather than solid food as a pre-exercise meal. Solid food generally requires a longer amount of time to be digested and absorbed. A fruit smoothie and a meal replacement drink are good examples of liquid meals.

  • Steer clear of high-fat and high-fiber foods in your pre-exercise meal. Fat and fiber are slow to digest and/or process. Stick to easy-to-digest carbs and a moderate intake of protein for your pre-exercise meal.

  • For carbs and fluids as you near the start of training or a competition, use a well-designed sports drink, such as POWERBAR ® ENDURANCE sports drink, instead of fruit juice or a soft drink, which are typically too high in carbohydrate concentration.

  • Consider whether caffeine ingestion is contributing to your gastric woes. For many athletes, some caffeine before and/or during exercise can provide a much-needed boost. But there are individuals who develop GI symptoms from caffeine. Experiment with and without caffeine during training sessions to see what works best for you.

    Get Your Bowels to Move Before Starting a Race



    If your typical GI distress symptom happens to be the very uncomfortable urgent need to defecate when training or competing, get the bowels to move before you get to the starting line.

    Practical strategy:

  • A light carbohydrate snack with a warm beverage and a bit of gentle exercise can help stimulate a pre-race bowel movement.

    Avoid Dehydration and Overhydration During Exercise



    You can't do anything about the severe cutback in blood flow to the digestive tract during exercise. But you can make sure that dehydration doesn't make matters even worse. If you don't adequately replace the fluid and sodium you're losing during exercise due to sweating, you can become dehydrated. When this occurs, there is even less blood circulating to the digestive tract, and this can make the symptoms of GI distress even more severe. That said, don't push your fluid consumption during exercise to the point where large quantities of liquid are sloshing around in your digestive tract and making you nauseous.

    Practical strategies:

  • Try to avoid losing anymore than 2% of your body weight due to fluid loss during exercise. For a 150-lb (68-kg) athlete, a 2% weight loss equates to just 3 pounds (about 1.4 kg). Monitor the effectiveness of your hydration plan by weighing yourself before and after exercising.

  • Use a sports drink to rehydrate with and minimize fluid loss during exercise. For training sessions or competitions that extend much beyond an hour, or any time you're exercising in the heat or humidity, a sports drink that provides carbohydrates, fluids, and sodium, such as POWERBAR ENDURANCE sports drink, is a better option than plain water when it comes to managing GI distress. There are a number of advantages. A sports drink not only provides carbohydrates to fuel your muscles; it also provides a carbohydrate concentration in the optimal range to minimize GI distress. The sodium and carbs in a sports drink cause the fluid in the beverage to be absorbed more quickly, so there is less fluid sloshing around in the digestive tract. The sodium helps maintain your drive to continue drinking fluids and helps you retain the fluid that you've consumed, so that dehydration doesn't exacerbate the already-significant reduction in blood flow to the GI tract. Finally, athletes freely consume more fluids when their hydration beverage is flavored, as is the case with a sports drink.

  • Implement and refine your during-exercise hydration strategy during training sessions, and find that gut-happy medium where you're in your hydration zone and GI distress symptoms are avoided.

    Consume the Right Carbs in the Right Amounts During Exercise



    For endurance exercise of an hour's length or longer, consuming carbohydrates during exercise can delay the onset of fatigue. During exercise, appropriate carbohydrate sources are primarily sports drinks and energy gels taken with water. If chewing is feasible, sports bars and energy chews are options.

    Practical strategies:

  • When using sports nutrition products during exercise, consume those that offer multiple transportable carbohydrate sources, such as POWERBAR® products featuring POWERBAR ® C2 MAX (POWERBAR ENDURANCE sports drink, POWERBAR ® GEL energy gels, POWERBAR ® PERFORMANCE bars, POWERBAR ® ENERGIZE bars, and POWERBAR ® GEL BLASTS energy chews). C2 MAX is an energy blend that features a 2:1 ratio of glucose to fructose. Each type of carbohydrate is absorbed via its own unique intestinal transport system. This POWERBAR innovation allows carbohydrate fuel to be absorbed at a faster rate, without overwhelming the carbohydrate absorptive capacity of the GI tract.

  • During endurance exercise lasting 1-2 hours, consume carbohydrates at the rate of 30-60 grams per hour. Refine your rate of intake during race-pace training sessions.

  • During endurance exercise of 2-3 hours or more in length, consume carbohydrates at the rate of 45-90 grams per hour. Refine your rate of intake during race-pace training sessions.

    Consume Adequate Fluids With Your Energy Gels



    Another option for rehydrating and refueling during exercise is to consume an energy gel and chase it with plain water. Make sure to select an energy gel that provides sodium along with carbohydrates, such as a POWERBAR GEL energy gel. These gels provide the carbohydrate and sodium of a sports drink.

    Practical strategy:

  • Consume a gel every 20-45 minutes during exercise, and don't skimp on water. Take a few gulps of water with each swallow of the gel to properly dilute its carbohydrates.

    Consider Some Dietary Changes a Day or Two Before Competing



    Lactose is the sugar naturally found in dairy products such as milk. Lactase is an enzyme in the small intestine that breaks down lactose into sugars we can readily absorb. Some people have plenty of the lactase enzyme. Some people don't have enough and are lactose intolerant. When lactose-intolerant individuals consume dairy products, the lactose can't be broken down. Instead, it moves into the large intestine, where microbes feed on it. As they chow down, these microbes produce lots of gas and organic acids, which quickly produce symptoms such as bloating, flatulence, burping, cramps, and rapid-onset diarrhea. People that are lactose intolerant clearly need to avoid lactose-containing dairy foods.

    There is a third category of individuals that have moderate levels of the lactase enzyme. As such, they may be able to tolerate a small amount of lactose under normal circumstances, but not during times when the gut is stressed, as it is during endurance exercise.

    Practical strategies:

  • If you suspect that lactose from dairy products may be contributing to your GI distress, try switching to lactose-free dairy products for a day or two before a competition or an extended training session.

  • The same 24- to 48-hour avoidance strategy can be applied to any food or foods you suspect may be contributing to your symptoms. For example, if you rule out lactose-containing dairy foods as a culprit, try cutting back on high-fiber foods for a day or two before a competition or extended training session to see if it makes a difference.

    SOLVING SIDE STITCHES



    Side stitches are common occurrences in distance runners, as well as in swimmers and athletes in team sports. In medical circles, these side aches are referred to as exercise-related transient abdominal pain. The cause of these debilitating stitches hasn't been firmly established, but the conventional wisdom is that they aren't necessarily a digestive problem. Some theories as to their causes include: taking shallow breaths with the chest during exercise, rather than taking deeper breaths with the diaphragm; stretching of ligaments that hold internal organs in place; pain that originates from the mid-spine, but shows up as a side ache; and irritation of the membranes that line the abdominal cavity.

    Prevention is the best remedy, and in his book, Lore of Running, physician and exercise physiologist Timothy Noakes, says stitches may be prevented by breathing with the diaphragm during exercise and strengthening the abdominal muscles.

    For stitches that occur when running, Noakes advises trying two measures: exhaling very deeply to stretch the diaphragm, or breathing out when you land on the foot opposite the side where the stitch is felt.

    Of course, there are no guaranteed solutions. Other anecdotal suggestions include placing your hand into your belly on the side where the stitch is, just under the ribcage, lifting up slightly, and inhaling and exhaling evenly as you push up. Stretching may help, as well. Raise your right arm straight up, lean to the left, and hold for 30 seconds. Then do the same stretch on the other side. And, of course, slowing your pace until the pain subsides is the tried-and-true option.

    REFERENCES

    Brouns F, Beckers E. Is the gut an athletic organ? Digestion, absorption and exercise. Sports Med 1993;15:242-257.

    Fallon K. Athletes with gastrointestinal disorders. In: Burke L, Deakin V. Clinical Sports Nutrition. 3rd ed. McGraw-Hill, 2006;721-738.

    Noakes T. Lore of Running. 4th ed. Oxford University Press, South Africa, 2001.

    Peters HP, Bos M, Seebregts L, Akkermans LM, van Berge Henegouwen GP, Bol E, Mosterd WL, de Vries WR. Gastrointestinal symptoms in long-distance runners, cyclists, and triathletes: prevalence, medication, and etiology. Am J Gastroenterol 1999;94:1570-1581.

    Rehrer NJ, Janssen GM, Saris WH. Fluid intake and gastrointestinal problems in runners competing is a 25-km race and marathon. Int J Sports Med 1989;10 Suppl 1:S22-S25.

    Ter Steege RWF, Van Der Palen J, Kolkman JJ. Prevalence of gastrointestinal complaints in runners competing in a long-distance run: An internet-based observational study in 1281 subjects. Scand J Gastroenterol 2008:1-6.