Dreaded Stomach Issues

AJWs TaproomLately I have received an increasing number of emails requesting different types of advice for running 100-milers. I am not sure why this is is but I thought, as a result of the questions, I would devote a three-part series over the next three weeks to what I call the “Holy Trinity of Ultrarunning Hell” – stomach issues, trashed quads, and blisters.

The first article in this series will be on the dreaded stomach issues:

In my experience stomach problems are capricious and highly unpredictable. One race can go by with no problems at all while the next race things start going down early and the damage is done.

So, I thought I’d throw out a few things I’ve learned over the years that have helped me and perhaps these might help you as well. However, before I do, I should mention that in my 29 100-mile races over thirteen years I have experienced nausea in every one and have I experienced vomiting in 10 of them. Here are some things that seem to work for me:

1. Regardless of temperature or humidity I begin drinking chicken broth about four hours into the race and continue it throughout. I find for me that the heavy sodium content in chicken broth keeps me from getting sick.

2. If it’s hot I try to keep cool by dousing myself with water particularly on my neck, wrists, and stomach.

3. I don’t wear anything around my waist.

4. I eat all solid food during the first 50 miles so that the gels taste new and different during the second 50. I usually start with a 600-700 calorie breakfast and then eat something solid every 90 minutes or so. I try to eat going uphill so I can hammer the downhills without a full stomach. I usually eat yogurt, granola, peanut butter and jelly sandwiches, turkey, cheese and avocado sandwiches, pretzels, cookies, and Payday Bars. I also try to drink sports drinks (GuBrew, EFS, Cytomax, Succeed Ultra, whatever tastes good) during the first 50 miles to keep the calories flowing and then I usually switch over to all water during the second 50. Once I switch to gels I take them about every 30 minutes although as the race progresses I take them more frequently getting down to about one every 15 minutes for the last hour. Basically, as soon as my stomach feels empty I eat one (sometimes two).

5. If I get a little wave of nausea I take salt, drink a full bottle of water, and I try to slow down for about 10 minutes or until the wave of nausea goes away. If I am near an aid station I try to get there and then ask for (and hopefully get) ginger ale. For some reason ginger ale works very well for me.

6. In the event that I do begin vomiting I attempt to get as much out of my system as possible. It can be pretty gross but I find that if I completely empty my stomach I can begin filling it sooner and faster.

7. After vomiting I usually enjoy a post-vomit feeling of euphoria which allows me to run fast for about 15 minutes. After this fast section I then need to start eating and I try to start with something fatty and salty like chips and then move up to gels if possible. After the 15-minute burst I need to slow down to refill my stomach. If it goes well I can get back on track within 30 minutes of the “event.”

8. I try to stay as mentally positive during my vomiting episodes as possible. When you stop to think about it it’s kind of funny and I find having a positive attitude and saying things like, “Man, that was a full-blown rejection!” helps me forget about how bad I’m feeling. I find that many runners get in a funk after puking so I try to get motivated by it and laugh about it.

9. The most important thing I do, I think, is I always stay hydrated. I know it may sound obvious but in my experience bad things happen when I’m dehydrated. No matter what the temperature I drink 50-60 ounces per hour throughout the race and try to stay on top of hydration above all else. At Western States in 2006 when it was 114 degrees in El Dorado Canyon, I drank 120 ounces in one hour!

10. I keep telling myself, “It never always gets worse.”

Bottoms up!

AJW’s Beer of the Week

This week’s Beer of the Week comes from Philadelphia where I have been spending the last few days at the National Association of Independent Schools Annual Conference. Philly’s own Dock Street Brewery Rye IPA is a light tasting, smooth drinking, sessionable beer that I have loved since I lived here back in the early ’90’s. And, I hear even the most diehard Phillies fans (like Bryon) like it (second only to Yuengling).

Call for Comments (from Meghan)

  • Like all parts of ultrarunning (and life, I suppose), stomach issues are a study of one. In your experience, what’s made you puke-tastic and what’s pulled you out of the despair of nausea during a 100-miler?
  • And, what’s still an unsolved mystery when it comes to your guts and the long-haul ultras?

Graphic Bonus Video (from Bryon)

Good stomach management sometimes requires an ultra reset. Witness one 20 seconds into the following graphic video. (It’s only vomiting folks.)

There are 86 comments

      1. Gina

        Vomiting releases endorphins which can, of course, improve pain tolerance and create euphoria. No wonder ultrarunners find a good puke to be beneficial. It seems our bodies know just what we need to get back on track!

    1. Alicia

      Ondansetron + Tums has been a winning combination for me lately. The only problem is that the ondansetron only seems to work for maybe half an hour to an hour, so I try to save it for what I think is going to be the worst of the vomiting…which doesn't always turn out to the worst.

      1. Dave M

        Ondansetron can make you really sleepy and should be experimented with. Charles Corfield on Ondansetron(aka Zofran) curled up into a sleepy ball at Leadville one year. I found in WS 100 2011 it kept my stomach intact but my brain slowed me down with inability to rally when needed; still got 8th but could have done better without it I think. Could try Domperidone, which does not make you sleepy but isnt available in the US.

  1. Charlie M.

    I tried to read this post from the vantage point of both: (a) an alien from the future; and (b) a nomad from the distant past. In either case, I think they would be amazed and confused! But good points all, nonetheless.

  2. Brandon

    I absolutely hate to vomit and usually try to avoid doing so at all cost. Never had stomach issues to where I was going to puke during an ultra, but my stomach issues usually decide to come out the other end. I get the post 15 min burst of speed as well after I empty my bowels. Sorry for sharing. haha.

    1. Jeff

      I get the same thing! (Usually in training, not in a race.) I think that 15 minute boost comes from the sudden weight loss :)

  3. Shelby

    Your pukefest was inspirational!

    I haven't done a hundo, but I learned from my road marathoning days that lowering the intensity only delays the recovery. Best to get it out, reset and get on with things. Thankfully, puking seems much more socially acceptable in trail running…

  4. Pete

    Thanks for the advice. Ginger ale is really a key. While I haven't run a 100 yet (will do so in July) I plan on experimenting with ginger in general in my training when things warm up. Ginger is really suppose to help settle a stomach hence why it is common when people are sick in general. All the other points seem helpful as well I guess only time will tell.

  5. Andy

    50-60 oz per hour? Wow, I definitely need to drink more. Does that include beer?

    I have heard that some folks swear by the sea-band around on the wrist. Have tried it once in a sub-100 with seemingly good result, but it's an imperfect experiment. Ginger chews are also good.

    As for the increasing requests for 100-mile advice, the reason is clear: 100m is the new marathon. Lots of newbies, lots of advice seekers. A little nausea and vomiting is probably a good thing to deter at least a few and prevent even more overcrowding :-)

    1. Jason

      I don't think 100m is the "new marathon". Yes, it's getting more popular, but I doubt Oprah and hordes of local saturday morning "training programs" will be converging on too many 100 milers. Overcrowding at the big races is a problem, but deterring "newbies" from taking on a new challenge only perpetuates the perception of elitism that exists in some ultrarunning communities. Just my .02.

      1. Andy

        Was meant to be taken as somewhat facetious, hence the :-). There is, in fact, a surge in popularity of ultrarunning and, with it, the hundo. But I was attempting a little literary exaggeration. Sorry if I offended.

  6. art

    for me, I believe gels were a significant cause of my regular stomach issues. I have swithed almost entirely away from gels, replacing them with Perpetuem (Hammer).

    Stomach issues are greatly reduced.

    While my solid food plan is just the reverse of AJW (liquid first 50, more solid 2nd 50), I always eat a cookie or two at each AS to help sop up any stomach acid.

    1. Sophie speidel

      I did the same thing years ago– after various stomach issues as a newbie ultrarunner, I tried Perp and Hammergel, and now that's what I use exclusively to start, then switch to solids (eggs and burgers are particularly good late in a 100).

    2. dave

      on the other hand, i've had nothing but problems with perpetuem. i really do think this whole thing is an experiment of one.

  7. Jeff

    I've never thought about #3 – but it makes sense. I wonder if taken to the extreme that could create a market for running bib shorts.

  8. Paul F.

    http://www.irunfar.com/2012/07/waterlogged-a-dogm

    Hmmm.

    This links back to an article based on Noakes' book (Waterlogged: The Serious Problem of Overhydration in Endurance Sports). This condensed iRF piece is a good starting point for those interested in the subject (there is also a second, iRF follow-up (props, Joe Uhan). The actual book is solid, too … though longer than a Tweet …

    I can only imagine drinking 50-60 oz. per hour when I am attempting to crush a bar stool (with ready access to a urinal).

    WARNING: I DEFER TO AJW ON ALL THINGS RUNNING-RELATED. I AM ONLY GOOD AT SLEEPING, WATCHING TV, AND EATING. RUNNING IS AN EVER EVOLVING MYSTERY WRAPPED IN RIDDLES.

    Peace. March on!

    Paul

    1. Pete

      I think this comes full circle with different things work for different people. Does seem like a lot of water. I think the main point is to stay hydrated. Obviously temps on race day will dictate this as well.

      1. matt

        Always important to drink to thirst, while staying hydrated. Stay thirsty my friends.

        It's a difficult subject to debate, as many of the sport's top runners have been following the prevailing wisdom (prescribed fluid consumption) for years and finishing atop the podium; hard to argue with "results". But could those same runners achieve better results with less physical stress by following Noakes' advice to "drink to thirst"?

        The science behind Noakes' book is compelling. Definitely worth a read. When juxtaposed against stories like AJW's vomiting episodes and Scott Jurek's account of his 1999 WS100 race in Chapter 11 ("Are you peeing?), one must wonder if prescribed drinking might cause the body to revolt.

    2. Luke Garten

      I agree that drinking that might be too much for some (especially me), but everyone tolerates and needs different amounts. Not that I have run a 100 miles race yet, but nausia seems to come from a hard pace for a long time. Then trying to put food into a stomach when all of your bodies blood is being used for muscles and cooling. Although putting more water in your stomach than it can process can only make things worse. It seems like giving nutritional advice for ultras is like giving advice on what running shoes should be worn. Everyones feet are different.

  9. Jay

    I'm intrigued that you eat on uphills. I have always avoided eating on uphills because of the blood being drawn away from muscles and to the stomach. I even remember reading something Tony K. wrote about making the "rookie mistake" in a race of eating a gel at the base of a climb.

    Now, I haven't done a 100 yet. Perhaps the slower pace and lower intensity on climbs make this less of an issue?

    Curious to hear thoughts on this.

    1. olga

      At my first WS100, actually, a camp prior to it, Gordy told me: when walking or hiking uphills – don't waste your time, eat and drink and pop salt, do stuff that's more difficult to coordinate/think about while running flats or especially downhills. Ever since, unless timing is really wrong (like, I just ate a gel), I open my gels on the ups while hiking. Of course, for those who RUNS ups, it's more complicated…

      1. Pete

        I have not run a 100 yet. However just in training and running 50k's and 50 milers I have found it easier to eat at the bottom of a hill or as I am progressing up it. I find that eating on the downhill is hard just because I am moving faster and have actually tripped while trying to eat on a downhill.

        1. AJW

          At WS I have learned that the downhills are the best places to make up ground. The uphills are all pretty standard and I find losing a minute or two to eat at the bottom of the canyons means I can hammer the downs without having to worry about eating. Also, 2 minutes after Cal 2 you hit Dave Mackey Hill which is absolutely the perfect place to hit a gel!

            1. AJW

              No, Dave Mackey Hill is in a class by itself because when we did the Memorial Day Training Run on Cal Street in 2004 we all walked the hill like normal people do while Dave ran it. You may recall he ended up finishing 2nd to Scott Jurek that year so we like to think our walking and gel eating had an impact. Six minute hill is a different matter all together as that is the short but steep dirt road climb you get to 14 minutes after you leave Cal 2 70 miles into the race. It's one of those climbs that kicks you in the teeth. AJW

            2. Craig Thornley

              Just to clarify. The Dave Mackey Hill is a couple minutes out of Cal 1. Or as Greg S likes to refer to it as, Dardanelles. We were on the run that AJW recalls and Dave had been going slow with the rest of us mortals all day long. I distinctly remember telling Dave that there is a good walking hill after we had passed Cal 1 "that nobody runs." He said nothing but ran the whole damn hill as the rest of us walked and played with our gel packets.

  10. Lisa

    Ha! Loved the video! I did that for the first 100km of the Spartathlon a few years back. It was crazy because I otherwise felt fine. It was hard to stay hydrated but I did, and in the end it was one of my best races ever. That's ultra…yep. :)

  11. Wyatt Hornsby

    The thing about Leadville, as captured in the video above (which has made the rounds for years), is that it has a way of making everyone puke. If you do Leadville, the odds are extremely good that you're going to puke at least once, so it's important to stay positive as AJW suggests in his article. My problem in 2010 was that I went hypothermic after puking in Mayqueen inbound, but a little rest in a cot and zero-degree sleeping bag did the trick for me. I puked in 2011 but laughed it off, as AJW says on here.

    Anyway, I have a file where I keep really great insights on this crazy sport. I'm definitely adding this article to that file. Well done, AJW!

    Wyatt

  12. Ed C

    I switched to tailwind nutrition with great success, after trying gels, carbo pro, hammer Perpetuem, bars, gatorade (because its on the course), solid food with scratch, etc over the past 10 years. 2.5 scoops/hour means no more fumbling with salt capsules or any wrappers. It's the only drink I can even enjoy the day after a race. Typically, any drink I use turns my stomach after racing with it. Not so with Tailwind.

    1. Andy

      Had never heard of it, but checked out the website — some impressive testimonials! How come it hasn't gotten wider publicity? At $2 for enough to make a 24-oz bottle it is a bit pricey, but worth a try. Thanks!

  13. Martha

    My only vomiting episode was heat-induced (Vermont 100). Not pretty. I've been lucky otherwise. My current ultra fuel is UCAN — great stuff — plus it seems to work well for runners with stomach issues (for best results, give up the sugar-filled gels & drinks, too).

    1. Sara

      Martha, what is in UCAN? Intrigued, as sugar seems to be taking more than it gives lately. Does it give you enough energy, etc? Thx for any info.

  14. Shine

    Great puke! Never vomited in a race…….yet, but I do get the post-vomit euphoria. Great article as usual and hilarious video and how he recomposed himself right after it. :)

  15. adam

    Man, I wish i could get my stomach under control in races. Lungs and legs don't get you to the finnish line…. "an army marches on its stomach."

  16. Speedgoatkarl

    you drink waaaaaay too much water..even at Western. You eat too much solid food early=too many variables. You eat going uphill (in most cases). You need to speak to the master….:-) I haven't puked in 9 years. And it wasn't from running.

    See in Auburn. I'll have a beer waiting for ya. :-)

    Can't wait to see what "part 2" says.

      1. Speedgoatkarl

        :-) after watching the entertaining video, it was evident you puked up all water, at least it looked like that. I don't have a crazy secret, I just don't change anything, or eat different foods. Gel, water and salt caps…..all the way. Not many folks can do that, but if you look at who's he fastest out there. Killian, DAkota….they eat gels and water. One thing to think about maybe for ya is to think about external cooling. Instead of drinking alot to stay cool, pour some over your head, ice down the back, on wrists. I know you mentioned this too, but for me, it keeps me cooler and allows me to drink less. Keep in mind, I am a freak, I ran the Moab Red Hot 50k two weeks ago. And although it was 40 degrees, perfect for running, I drank ONE bottle the entire race. My secret: I'm a camel with no humps. Baaaahhhhh

  17. Paul

    thanks for the tips. be careful with how much liquid (both water and sports) you drink. if you drink too much then you end up flooding your body, and your sodium concentration goes down which causes Hyponatremia.

  18. UltraDad

    Well timed article for me, I had my first run vomit today, actually 25 miles into a 30 mile race. surprising I did feel better and run better after that. Wasn't as bad as I thought it might be.

  19. Jason

    My stomach issues surface down the line (ie sudden urge to poop my pants). Any advice to avert this disaster, I mean besides wearing an adult diaper?

  20. Aaron Sorensen

    A substitute for chicken broths high sodium is some nice cold pickle juice.

    It works wonders especially in the humidity.

  21. David

    Wow, read through all the comments and can't believe nobody brought this up: Andy – you da Man, but c'mon…how about cleaning up the diet?? "yogurt, granola, peanut butter and jelly sandwiches, turkey, cheese and avocado sandwiches, pretzels, cookies, and Payday Bars" No wonder you get nauseous every race! Cutting out the dairy (which causes inflammation in the body for many people) and processed sugar could make a big difference. Instead consuming stuff like more bananas and baked sweet potatoes might help. Also I've found the new gels from Vi Endurance are super clean, digestible and easy on the stomach. – vegan runner, never puked (but only a couple hundreds :)

      1. KenZ

        That's what I'm thinking. Which, as I noted above, also explains his ridonkulously huge intake of electrolyte tabs. It all makes sense now…

        1. AJW

          OK, well the people have spoken and it's obviously time for me to quit drinking:)

          Thanks for all the comments everyone and stay tuned for my Trashed Quads article this Friday.

          AJW

    1. MonkeyBoy

      Karl, I've run with Andy a bunch and his rate of sweat and consumption of body fluids and sodium is pretty dialed. He listens to his body and adjusts consumption and intake based on the conditions and intensity. I think he balances his intake and volume pretty well. He rarely has weight issues and maintains his blood volume and digestion throughout his races.

      the rest of you have a lot of nerve telling someone who is as accomplished as Andy about what he "needs" to do. this isn't your fantasy football league or talk radio.

      to the vegan commenter who suggested Andy needs to clean up his diet, nausea can come from intensity of exercise as well. it's not all dietary. I think Andy knows what works for him and he has evolved his diet. His total number of calories over a 17-18 hour race that come from solid foods are very small and each serve a purpose. Also, not to nitpick, but i didn't read anywhere in the article that he gets nausea every race. In fact, in many miles of racing and training together, I've rarely seen him experience nausea. In the cases where he did? he solved his problems and kept from puking and digested the contents of his stomach. most important, his high glucose intake during sustained exercise allows him to maintain muscle power and output. his sodium and potassium intake, along with his fluid volume, allow him to digest this intake and use it.

      everyone is different. find what works for YOU and do it. if it doesn't work, keep looking.

      MonkeyBoy

      1. Speedgoatkarl

        he must have it pretty figured out, in general, cuz' he'd have super sausage fingers drinking that much water, hour in and out. I've found with sweat rate, personally, that if I drink more fluid, I sweat alot harder. When I start to get a bit dehydrated during a 100 miler, I won't be sweating as much, it's like my body excretes the water thru my skin to tell me if I need it or not.

        Most folks I know that claim to be heavy sweaters, drink ALOT of water, maybe there is a correlation here? It is what it is, it'll be interesting to see how I handle Western, not having run in heat at ANY race, for that long. I'm sure I'll be baking and fried like everyone else. It's not that far though, it's only 100 miles on a track. :-)

        1. David

          MonkeyBoy, his quote above was "I should mention that in my 29 100-mile races over thirteen years I have experienced nausea in every one and have I experienced vomiting in 10 of them." I know it was a crazy idea, that the foods you eat can affect your gut during exercise.

          1. Craig Thornley

            Andy, so does how hard you run and how hot it is. If your blood is shunted to your skin to cool you off and the rest is going to your working muscles, well, not sure it really matters what kind of food you put in your stomach, it is going to be difficult to digest. AJW puts it out there in every single 100 miler he has run. Well, except for his practice year at WS :-)

          2. MonkeyBoy

            fair enough. yep, i read the same thing. nausea can be caused by intensity, altitude, low blood pressure and blood volume, temperature along with, yes, dietary considerations. if you knew andy and he thought that cleaning up his diet was going to make him a better 100 mile runner, he would have done it 15 years ago.

        2. SkyDog

          Karl, I've read you take in chicken bouillon cubes as well. You mix that in water or chomp on at a particular time frame? Truly the stomach of a goat…;)

  22. Darka

    Great advice Karl,

    I'm a very new ultra runner but I've learned to try to keep my food simple (gels and a very small amount of solid food) and to drink far less than I thought I would, drinking only when thirsty works for me (so far)…

  23. KenZ

    I'm with Andy- that is an inordinate amount of water. Yeah, I get that a) you're (AJW) 20x more experienced than I and b) everyone is a bit different. Still, that's like double the max I would ever take (25oz/hour), which is turn a bit more than most do. It could be possible that this is why you seem to need so much salt (see prior Tap Room discussion on the Ray Miller…): You need the extra salt to help your stomach/digestive system even remotely cope with absorbing such an enormous amount of H20. Ever try doing less water (like: 25oz or less/hour), much less salt, and see if that helps the nausea? Cripes, if I took down almost 2L/hour as my normal intake, I'd puke too.

  24. Van Horn

    Pay very close attention to what Karl is saying. His advice is more valuable than what is in the article. I have been training with no water on 10-15 mile runs – uphill, and no gels or anything else. Of course, it's been cold as hell around here, and when it gets hot I will certainly need water, but hopefully I will have trained to be able to go on less water, and to use a 100 cal gel more effeciently.

  25. Steve L

    Just wanted to agree with MonkeyBoy on encouraging people to "find what works for you", and say thanks to AJW for sharing his insight on the "Dreaded Stomach Issues". :)

  26. Anonymous

    I agree; I wouldn't recommend experimenting with medications (or nutrition/ gear for that matter) on race day. I haven't experienced somnolence as a side effect and I actually prescribe it pretty routinely as it is less sedating than older antiemetics (promethazine, prochlorperazine, etc…).

  27. Paul

    highly recommend reading Waterlogged by Timothy Noakes. He has spent several decades studying fluid intake during sports. Drinking too much can be deadly.

  28. SkyDog

    Karl, one quick question. I like your training philosophy on low weekly mileage, 15-20 mile long days max and running on feel. But how many days off do you give yourself per week? Thanks.

  29. Speedgoatkarl

    Skydog, Low weekly mileage is all relative, and it depends on the individual. This time of year, I run about 50 per week, and that's an average, Thing is, I don't run "weekly". I run on feel, so the actual distance "reported" weekly varies. On average, I'll run as many days in a row, until I get tired, and want a day off. it's about 6 days in a row, which does work like it's a week. Sometimes I"ll run 10 in a row, sometimes only 3. It just depends.

    When talking about "long" runs, keep in mind, I race about 10 races a year, usually about 6-8 100s, then a few shorter 50's or 50k's. I consider those my longer runs. It's good practice for me to go to a shorter race with no pressure and just run em', and make sure I run strong to the end, which is about 95% of the time. When I run a race, even 100s, my goal is to NOT get passed by anyone after mile 40 in a 100, maybe mile 25 in a 50. this way I train myself to ALWAYS finish strong. I've been able to guage my pace early in a race so I don't blow too early. Run Rabbit Run was the classic example. Bandera and Moab this year, same thing, I never got passed once we got going.

    Running on feel is the ticket if you can teach yourself to do it. It's not easy, it's just experience.

    But to answer your question….about 65 miles per week, with almost 20,000' of climb. I think the climbing makes up for a few miles. If it were flat, I'd probably easily run 90 or so.

  30. Russ

    Agreed.

    Everyone is different in ALL aspects with fueling, water intake, training, and race strategy.

    But we ALL can agree, appreciate, and thank the Pros/elites for the insight and tips on what works for THEM.

  31. Jason C

    Dave,

    Interesting release this week:

    "European Union (EU) drug regulators announced yesterday that they have begun a review of domperidone, an antiemetic, because of concerns about adverse cardiac events, including QT prolongation and arrhythmias"

  32. Robert Self

    Really happy to see that someone else has independently hit on the food that really works for me during an ultra: Soup. It's got everything you need- liquids, salt, fats, calories. I try to get some rice or noodles in it to add some carbs. In general it is much easier to drink something than to eat something after ten hours or so of running. . Plus I find that most foods lose their taste after a while, but soups continue to be at least somewhat delicious….. For me, sweets and sweetened products such as gels and sports drinks, begin to taste rather awful after a while.

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