Wednesday, June 8, 2011

Help me solve my GI issues at WS

Friend or Foe?

I almost never reach out to the masses for running advice. I basically go it alone in my training strategy and this has worked quite well for the most part in all racing and training. In this case though, I am trying to solve a thorny problem that oddly solely occurs on the Squaw to Auburn course.

My problem is located in the lower left of the above diagram, where the stomach joins the duodenum and small intestine. I am trying to find ways to not have my pyloric sphincter bind into a knot and shut down all subsequent digestion by the time I hit Michigan Bluff. All digestive absorption happens distal to the stomach in the small intestine, with very little real events in the stomach (except mixing) and in the large intestine (except some water absortion and mucus production). My nutrient absorption during races has normally been excellent, with a "cast iron stomach" I rarely to never have nausea, vomiting, and lack of fueling. But once I touch that dirt in the Sierra summer all bets are off. Even last year when pacing Geoff, after 25 miles I found the same thing happening, peeling off at Brown's Bar and then picking him up later at Robie Point. And it was "only"90 degrees last year. This has only occurred on the WS course, and never in any other, or even longer, adventure or running event.

So help me if you will with any and all tips. I am looking for the silver bullet the slay the GI vampire that lurks within. Do you know what this bullet consists of? I have asked advice of a few WS legends such as Craig Thornley and AJW, and they offered some excellent tips, historical perspective, and references to prior posts. But these guys for the most part get through WS on chicken broth, stew, turkey and avocado and cheese sandwiches for the first half, then switch to gels and conventional fueling later in the race. This wouldn't work for me, as I tried this kind of stuff (but much less of it) in 2004, leaving my stomach turned sideways on Cal Street while Jurek put an hour on me. I have a ton of respect for these guys and their ways, especially as they actually spend time on the course fine tuning and becoming intimate with it, but their fueling strategies are more traditional than mine.

Here are my options as I see them;

Metoclopramide: My ultrarunning science friend Charles told me her tried this pharmacological GI motility agent once, which left him asleep by the side of the trail. Not sure I want to go there.

Ginger: I tried capsules in 2009, but I may have tried them too late in the game as they didn't seem to work. But I was kind of sick that year anyway. I may supplement these early and see what happens. I know nothing about ginger extract though, except it is mostly alcohol mixing with liquid ginger.

Simplicity: Gels, Clif Bloks bananas, PBJ, water. I have only had success here in shorter races. I lean towards this simple tried but true way and not gumming the works.

Eating less: Risky. If there is less in the tank I may bonk and not catch up in fueling later.

Pacing smarter: Getting to Michigan Bluff doesn't win the race; getting to the track first does.

Feel free to post ideas. I need them! For such an experienced runner as I am, in this realm I feel as green as Karl Meltzer running a road 5K. Solving this GI thang is no reinvention of the wheel for many ultrarunners, but I am a neophyte at this distance and have the utmost respect for the years that are out there.


  1. Dave: I've never run Western States or even stepped foot on the course (yet), so I may be talking out of my arse here. I wonder if the heat isn't at the root of the problem. In 100s I've found that ginger works well for me in terms of settling my stomach, but I still occasionally battle GI distress. I do think too much simple sugar can cause problems, too. Maybe contact a few hot weather specialists like those who do Badwwater and see what they say since the canyons at WS are so punishing. Your problem surely couldn't be elevation-related since you're from Colorado. I also think Karl M. might have some good advice.


  2. Ginger Ale worked wonders for me the last 30 miles of Leadville. I lost my stomach at mile 55ish and about mile 70 after walking for hours I decided to try something different. I put Ginger Ale in one hand held and either water or Pedialyte in the other bottle. I ran the last 25 miles only 30mins slower than the 1st 25 miles, that was a good bounce back.

  3. I don't have enough data points to suggest a silver bullet, but will pass on my personal experience in case it's helpful. I too seem to battle unusual GI issues from Devil's Thumb on, and any other race where the temp got 90+ and I am 40-50 miles in.

    At the hot-and-steamy Burning River 100 last year, I diluted everything and had no GI issues. What I mean by this is that I never took in food/gel by itself, but always simultaneously with a ton of water (raccoon style). Not even "chasing with water", but soaking each bite with plenty of liquid before swallowing. Same with flat Coke, ginger ale, etc. - everything was at least 50% water. My GI tract seemed to flow much better and consistently as the heat and humidity picked up.

    Lots of theories on why this was the case, but the results were all I needed - my negative split was the first ever for a 100.

    Hope that helps!


  4. Matt Carpenter put his gels directly into his water supply, either a water bottle or bladder. This gives your body a steady small supply of fuel with your fluid intake. It makes more sense then dumping a whole bunch of food into a stressed stomach. I know this method works, I use it myself. Since WS has a ton of aid stations, you should have no trouble having an ample supply of water. Three gels per 20 oz bottle over the course of 1 hour gives you all you need.

  5. Sugars (especially simple) are bad for me. Chicken noodle soup, less water works. Per hour I think 200-250 cals with no more than one gel making up those cals is key later in the race. The sugar can make you nauseous and if you're slightly heavy on the water with sugar, then diarrhea is certain. If I were faced with that heat and the descending, I'd probably take in less of everything and even out at about 1 gel, 1 s-cap and 15oz water/hour at the effort you'll be putting out at mile 70-100 as a base. Then add chicken noodle soup to taste (tolerance) as you can.

  6. Of course, I have a speck of sand to your beach of experience but this works for me. Less is often better.

  7. This comment has been removed by the author.

  8. This is great feedback. I am undecided about the role of simple sugars in ultras. In non-WS races simple sugars in my Clif Blks settle in quite nicely without any trouble at all; it is only the fats in other foods that I can't handle. However, at WS 2009, I ate alot of melon and fruit, which is basically simple sugar, and it didnt work.
    I like the all fluid and dilution suggestions. It makes perfect sense that this would save the energy in stomach peristalsis in mixing solid food.
    I will give ginger ale a try too. In 2004 pacer Roch Horton offered ginger candies, which seemed to help, or at least it coincided with the start of my recovery for the last 20 miles.
    I want to retract my comment about Karl and 5ks; he eats 5k's for breakfast every day and eats them fast.

  9. Hey Dave

    The issue with the fruit is that our GI tract can only handle a limited amount of fructose per hour and it is lower than we think. Like you, I have had crummy results with fruit.

    On the flip side, our GI tract can process 300 to 400 cals an hour of maltodextrin. I have gone as far as to make my own preparation consisting of malto and a little sugar free coolaid for flavor. That was a rock solid energy source with no GI issues. Just do the math so you are taking in around 300 cals an hour. Then I supplement my salt just as I would normally. This has worked well as far as 100s go. The other strategy I use well which I am sure you have tried/seen is just a gu every 20 min with water and salt as needed.

    I am an anesthesiologist and was thinking about your reglan idea. I dont think I would go there because though your stomach might empty faster, then movement through the rest of your gi tract might be too fast to adequately absorb the nutrients and fluids required.

    Bill Walz

  10. Scott Jurek might also have some great suggestions on WS nutrition.

    Regarding Matt Carpenter's brilliant nutrition tactics, as the saying goes, the solution to pollution is dilution. In this case, some foods can be a polluter in 100s. If these foods are dilluted in water, the pollution effect will be diminished or even eliminated altogether, while allowing you to benefit from hydration and calories. Almost anything Matt Carpenter does is in my book close to gospel. I'm going to try gels in water. I also heard Carpenter disolved PowerBars in water when he broke the Leadville record.

  11. Dave, you could shoot Scott Jaime an email. He's been working on this (dilution for gels) for a while and I think he likes it. So far it isn't for me, but I may need some practice getting it to dilute right. I seem to handle the gels just fine, but haven't raced in true heat yet (nor do I have much desire...).

  12. Cucumber. Makes me a little burpy at first, then everything is smooth for hours and hours. Altitude, heat, you name it, cucumber settles my stomach better than ginger.

  13. Footfeathers, yeah I prob should not go with the simple sugars as much. It seems the concensus in the comments is such. Have a great race at SD this weekend. Chicken soup I may keep as a last resort. 15 oz per hour of water seems too little for me; I will have to drink twice that in that heat.
    Bill, I've had great success with fruit, but not at WS, especially in 2009, where basically nothing worked. I may need to cut it down though for WS and go with the easiest calories to digest. Yeah the SE's of Reglan worry me a bit; Domperidone doesn't cross the blood brain barrier and is another option but is not available in the US.
    BTW I used to be an anesthesia tech before PA school; loved the science side of it. I would have liked to go into anesthesia but didnt/couldn't deal with med school at my age.
    Patrick, I will get in touch with Jaime. Cool as he is, he may not be wanting to help me though as he and I and Dan Olmstead are tied for the Cup.
    Cucumber.. cool Dominic. I like the thought; do you know of other runners who use it? Don't shave your 'stache.
    Wyatt, I am for sure going to go with all liquid, except for a few exceptions, like PBJ. Matt did have a tough crash at Pb before he ste the CR, but that may be due to other reasons. I saw on your blog that you eschew simple sugars in general; have you felt better overall d/t this?

  14. cutting back on food intake for a full day leading up might be an idea. if i eat reasonably for a few days beforehand and maybe up my percentage of calories from carbs, a single day of restrained eating will not effect my stored energy at all. it does seem to keep my shit in check.

    i always wonder about sodium concentration. does too much or too little in the body lend itself to GI issues?

  15. I had a horrible year in 2010, due to injuries. The only thing that worked well was the gels in water. You get no highs or lows in food intake. Keep in mind, you must be drinking for this to work. A sip every 5 min out of a 20 oz bottle seems to be about right. GU roctain has the BCAA for the proper protein content. I take S-caps at one per hour, but have used other brands that don't have the 400 mg amount of sodium. In cooler weather you don't need as much, as it gets warmer take a couple extra caps. Everyone sweats differently. Its all finding your personal balance.

  16. Choose one type of gel and just take that, not even mixing brands. Yeah its boring, but it works, ask Roes...

  17. Dave, I had constant GI issues and actually Karl M. helped me solve a lot of them. Usually start an ultra 50K-100m with one immodium. Later throughout the race after gels every 25 minutes and S-caps every hour I will "chase" any GI distress from gels or S-caps with chewable pepto tabs. What I notice about chewable pepto is that it has "ums" like magnesium and calcium which mitigate seizing in they cut stomach issues and limit leg seizing. I know one immodium, chewable pepto, s-caps, and gels sounds like a lot to ingest but it is the magic cocktail. The heat at parts of WS will cause dehydration and endless cycles of GI distress unless you trap in electrolytes with s-caps and pepto. Hey,BTW, see you at UROC100k, James

  18. Overall I like the simplicity track that is being emphasized by these excellent suggestions. Thank you for the advice.
    In retrospect, I was able to get away with mixing many different fueling sources and electrolytes at the shorter races, because the effort required to compete at these distances (<100K) is less. Simple has always been better in many parts of life, and hopefully including WS for me. See you guys in Auburn..

  19. Maybe I'm just a weirdo with a moustache that runs well on cucumber, but I just noticed that my post dinner runs were a lot less difficult when I had some cucumber in my salad..

    Though they're mostly refreshing cucumber water, they also have a small amounts of other good stuff like vitamin K (protein digestion), omega 3 and 6 fatty acids, and folate that seem to all go together well for me.. I don't eat a ton, a couple bites at an aid station to settle things.. but definitely try it out on an upset stomach one day.

  20. Most importantly, thanks for being a regular guy. Next, I hope you'll post a follow-up on what you decide before, and then how it goes during WS. I haven't solved the fueling/hydration problem at that race either. My suspicion is that the combination of heat, aridity, and early elevation causes a special problem for those who are better adapted to low, humid, wooded environs. In particular, I don't think I correctly interpret the heat/thirst cues I get out there, because they are different from the ones I get over here on the right half of our continent. Based on the feedback you have gotten, I will likely try again to rely more on a maltodextrin solution for calories during hot 100s. I also like Scott's suggestion to pre-wet food. That will solve a perennial problem I have late in races of my mouth getting too dry to chew and swallow solids. One last note: you are a front runner. I recommend you run that way. Fueling be damned!

  21. This comment has been removed by the author.

  22. Dave, We will be rooting for you- hope something works out....
    just keep those fluids going in....

    the mojo clan

  23. Gels are dehydrated energy drinks, so diluting gels is basically drinking an energy drink with the same sugar (good idea either way). The simple sugars in gels like maltodextrin is a starch and is ready to be used by the muscles, so if you can get in, you are there. I would limit fructose, like others have said. But I would try the dilution/energy drink thing. If it makes you hit the woods, take imodium. If it makes you puke, sorry I can't help.

  24. I think that it is great that you are looking for advise. Because most of your readers and supportive and quite knowable in those topics.