Delayed Gastric Emptying

[Wahine]

So I've had this problem at 2 races now and I've done a little homework to try to sort things out. Here's the best information I've been able to find so far.

From Triathlete Online:

Delayed gastric emptying (DGE): The importance of ingesting an adequate amount of fluids, electrolytes and energy sources during prolonged periods of exercise is well understood by most athletes. Unfortunately, not everything that is swallowed is subsequently absorbed by the body -- particularly when an athlete is exercising at greater than 70 percent of his or her max heart rate. Such a scenario may lead to a feeling of fullness and bloating and may even cause nausea and vomiting. More importantly, as less fluid is delivered to the intestines dehydration can ensue. As an athlete becomes dehydrated he or she experiences a further decrease in gastric emptying, which can escalate the dehydration cycle. In addition, environmental conditions such as high heat and humidity can negatively affect the rate of gastric emptying and promote even more rapid dehydration.

DGE can have significant consequences and negatively impact performance. Unfortunately, there is no way to completely prevent this, nor is there any rapidly effective treatment. The best preventive measure is to ingest a balance of high- and low-energy fluids (i.e. a mixture of water and sports drinks), to keep the concentration of sugars from getting too high.

Once DGE becomes apparent, the only viable remedy is to decrease the effort of exertion to a level below 70 percent of aerobic capacity and avoid high-carb sports drinks in favor of plain water. This should restore a more normal rate of gastric emptying. Once the symptoms have abated, a trial of higher levels of exertion may be undertaken, but pay careful attention to fluid intake.

In my last race, I was hitting the electrolytes hard because of the heat and I was definitely over 70% of max HR for the first 15 miles on the ride... more like 80%.

Hope this is useful to some others out there.

[Kimmyt]

This is great, thanks. The Boy had symptoms like this during the tri.

How long have you noticed the symptoms after it's initial occurrence?

[Veronica]

Do you use Sustained Energy or anything like that on the bike? It's what I use on my double centuries. I have not had a long enough training day to scope it out for a tri. I'll probably put some in my bottle for my next race (Olympic distance) to drink on the bike. If it sits okay during the run I'll use it for the HIM.

V.

[salsabike]

Thanks for that, Wahine. I wanted to understand it better.

[Pedal Wench]

Hmmm... last week on Ride the Rockies, I had what might have been this situation. Every morning, I would hit the continental breakfast, load up on high-sugar stuff and within 15 minutes be on the road, nauseous, bloated, and just feeling like crap. When I'm home, I usually have a bagel on the drive to my weekend rides, but that's usually 30 minutes before I start riding.

I wonder if this could be my problem. I'm doing another weeklong tour in Colorado in August and was going to experiment with just skipping breakfast and going with my Sustained or Perpeteum bottles instead.

[Wahine]

V - I don't use sustained energy but I might start. I usually use cliff electrolyte drink, shot blocks and accelerade gels. This has always worked well for me until I got strong enough to push into a higher HR faster and stay there. then all of a sudden things stop moving. My plan is to take out the shot blocks, keep the electrolyte drink but dilute it and stick with the gels. I also need to back off a bit for the first 10 miles I think and let myself warm into my pace a little slower maybe. I might try Sustained energy and some other things. I had Heed on the run this weekend and that tastes horrible but worked pretty well. I can go long at a low effort and eat hamburgers.

Kimmyt - the two times this has happened the symptoms became really noticeable at about the 25 to 30 mile point. That would be about when I would start to suffer from the lack of nutrients and fluids. Then I'd become aware of my distended belly because it starts to get uncomfortable every time you try to drink which is exactly what you want to do because you're getting dehydrated etc. The symptoms stay until I can back off enough and long enough to get things moving again. At this last race, it was amazing how quickly that happened. At mile 5 on the run I suddenly started to feel better and within 15 min I had to pee and life was good. At Ironman, I don't think I completely recovered for a week.

[lph]

Hey - it has a name! I've experienced this several times and it's VERY uncomfortable. I chalked the bloating down to too much salt/sodium, since it improved once I switched to just water. Thanks for the info.

[Eden]

So it sounds like the sugars are the culprit? I usually use a sports drink (Cytomax) and a sugar free electrolyte (NUUN). I'm generally fine for anything thats short, but I do a 105 mile road race every year and I've found I tend to get nausea and a feeling I don't want to/can't eat at around mile 75-90. From what I'm reading here, I may need to back off on the Cytomax and hit the NUUN harder. Do you think I need to put more plain water in there too or the electrolytes without the sugar are OK?

[colby]

Sounds a little familiar to my IM experience... but I had no nausea. Felt more like the flu - hot, a little dizzy, strange cold sweat, diarrhea, uncomfortable but not yet cramping. It did take me several days to feel like I could eat like a human again afterward - I did feel some bloating there. I sure am glad I stopped running and at least had the sense to stop consuming for a while. Next time I'll try just water to reset the system faster.

Makes sense... our bodies weren't exactly made to absorb so many liquid calories, especially sugar calories. I just can't stand to eat solid food while exercising, so I guess it's a matter of finding the perfect balance.

[jesvetmed]

Thanks, Wahine.
I had read that somewhere -- I think the gal I ran with this weekend was experiencing this. She said the last several big workouts / races she'd been having troubles. Hmmm... wish I had her email / or even her name!
Jes

[han-grrl]

great article find! thanks

[teigyr]

Very interesting.

I accidentally had Heed this weekend and OH it was heinous. I was expecting water though so it was kind of a shock.

I'm the same way re low effort and hamburgers.

My friend's husband had something like that happen on a HIM he did. I don't remember what was recommended for him but I can find out.

I'm strange. Maybe I don't exert as I should but I can eat/drink anything and be ok. Don't even ask about the Aunt Jemima pancake sausage sandwiches before the half marathon...then again I don't do anything too strenuous or competitive. I usually use Cytomax and as a complimentary alternate, I have Endurox. Shot Blocks, to me, aren't as effective as gel. They taste better but they are more of a treat than a remedy. Caffeine helps tons but then again that might just because I'm almost lazy. The most exertion I've ever done was 570 miles in 7 days (on the bike) and I lived on plain food and Cytomax.

Wahine, that's pretty scary. I've read about the effects of too much of one thing and not enough of another. I am SO glad you listen to your body though. It isn't worth it to push through, not at the expense of hurting yourself. I am so much in awe of people (such as yourself) who compete and actually compete.

Colby, not that I'm trying to be flippant (because part of me, the very scary part of me, wants to do an IM some day) but oh my gosh you put yourself through some things that normal bodies don't do Unfortunately, I can eat solid calories anywhere and everywhere.

It's very interesting to see what people drink. I don't know how I got started on Cytomax but I like it. I heard Endurox was good for people who couldn't tolerate heat (was told this when I was training for my San Francisco - Los Angeles cycling trip) due to amino acids. I guess everyone has their favorites though it's good to see what the scientific results are.

[Wahine]

So it sounds like the sugars are the culprit? I usually use a sports drink (Cytomax) and a sugar free electrolyte (NUUN). I'm generally fine for anything thats short, but I do a 105 mile road race every year and I've found I tend to get nausea and a feeling I don't want to/can't eat at around mile 75-90. From what I'm reading here, I may need to back off on the Cytomax and hit the NUUN harder. Do you think I need to put more plain water in there too or the electrolytes without the sugar are OK?

This is what I found most interesting about the article. It's not necessarily the sugars. I avoid sugars in my fluids too but use electrolytes heavily because I am a very salty sweater. So it turns out that the potassium etc can shut the stomach down too if it's in too high a concentration. So what I'm taking from this is that I need to water down my electrolyte drink more, make sure I take in some plain water with my endurolytes and watch my effort level in the early stages of the ride. Sounds like a similar thing for you. I used to use Cytomax but after a while it started giving me lower intestinal problems.