Stomach shut down solution needed

Jeff Horn

This will be long, but any help would be appreciated.  I'm 5'11, 175lb, 44 yo 
 
I began having serious stomach issues last year.  Tried to go to liquid nutrition last year for simplicity.  Prior to this I was "winging it" with Scratch and bars and was not that serious about finishing times.  Last year I wanted to improve my time.  I began using infinite (250 cal / serving) at start of season, trained with it, but at longer intervals (>3 or 4 hrs) had difficulty getting in full bottles in an hour, then become nauseated and out of gas and feeling like death.  In half IM events, infinite seemed to do just fine without stomach bloat or slosh.  Eventually I took any protein and amines out of the Infinit.  Lake Placid I had water melon belly a mile into the run after consuming 6 bottles and feeling pretty good coming into T2.  IM Chatt last year (horrible heat) after that had horrible stomach shut down and nausea at mile 66.  Couldn't take anything in.  Had to stop and lay in the ditch about every 10 miles after that just to feel ok.  At mile 92 got picked up by the ambulance and sent to the ER.  After this I switched to Sword (about 220 cal / bottle) on recommendation by a sports nutrition consult.  My first training ride of 4 hours, same thing happened with stomach shut down and nausea.  Felt drunk, woozy after quitting for the day.  This was on a much cooler day that IM Chatt so knew it wasn't an overheating issue.  Common denominator of these two mixes was maltodextrin - so I thought I was sensitive.  Then I switched to Tailwind with no maltodextrin.  I did great with this for a while.  Had a great IMFL on it with not much stomach bloat.  Trained with it into the next season.  IM Boulder came around and again I shut down at mile 70.  Barely made it into the T2 medical tent after laying in ditches again the last 30 miles.  Laid up in med tent for 30 minutes.  I apparently looked bad enough the med folks wanted to yank me out of race.  That was until I yakked my guts out.  Felt like a new man, and looked better so got out on run course and puked about every hour.  Tinkered with the concentration of Tailwind and had a few 5hr training rides on about 175-185 cal/ bottle.  IM Chatt came around again and did well until mile 90 where (I admittedly only took about 75% of my nutrition) and had to take a siesta at the aid station for about 50 minutes--didn't feel like biking, just wanted to lay down.  After some rest got back on bike and actually felt pretty good after that.  

With all this I am unsure where to go for nutrition help.  Anybody have this same kind of shut down?  Was considering going to EFS pro and liquid shot for next race.  At least I can get concentrated calories in with the liquid shot and not have to worry about so much volume, just drink to thirst.

For extra detail, I have been paying particular attention that I am not overdoing the bike.  Lake Placid was the first time I had this stomach issue and TSS was about 315.  Now I ride to NP and IF.  I keep heart rate in the 130's and power in the 170-180 range (FTP 255).  I also usually pee at halfway point of the bike.  

Paul Curtin

Hello @Jeff Horn -- seems like you definitely need something with low osmolarity on race day.  You didn't mention sodium but the drinks you tried should all have it.  Perhaps you need more sodium though, and even in the days leading up to the race.

Not sure what your pre-race diet is but consider that as well.  This year I switched to a low-residue type diet and simplified everything; it's made a big difference

Maybe also consider isolating everything on the bike: use only water for your fluids; only use gels and blocks for your calories; only Gatorlytes or similar for electrolytes

Jeff Horn

Thanks for the feedback Paul.  My pre-race diet I have altered about as many times as the on course stuff I take.  Doesn't seem to alter how I feel later in the bike ride.  I went from the Andy Potts muffin plan, to rice cereal, to oatmeal, to waffles and back to muffins.  I try to stay away from bread the entire race week.
As far as sodium goes, i liberally salt foot during meals and yes the drink mixes I use have plenty of sodium.  I am not a heavy sweater as far as that goes.  
One other note is that during IM Boulder at T2 med tent, blood glucose was normal.  And all my lab work after IM Chatt ambulance ride was stone cold normal as well.  Would have been nice to see something out of wack so I could so that it is hypoglycemia or hyponatremia, but neither have been present.

Shaughn Simmons

Tell us:

Your sweat rate at 80 degrees and 

Total Calories / hour you are ingesting on 5 hour training rides (not calories / bottle)

With that we can help you dial this in on your long trainings rides.

I weigh ~175 lbs and can provide you with my sweat rate / caloric intake / make up of those calories as well.

I live in Dallas TX and have some experience training/racing IM in the heat.

Mike Roberts

Hey @Jeff Horn -- I think this is solvable. I'm as far from a doctor or nutritionist as one can get, so take any/everything with a grain of salt, but I have played the LC tri game for a while.  The biggest culprit to your situation is likely one or more of the following: eating the wrong things, consuming too many calories, drinking too little, too little sodium and/or biking too hard.  I suspect that your issues are the result of one or more of these causes.  Thus, I break it down into three simple pieces: what does my body need, how much can it effectively digest, and how do I get out of the way and let digestion occur?  From everything I've read and tried, I primarily need carbs, hydration and sweat replacement.  If you have real food allergies or sensitivities, that's way above my pay grade.  But assuming your don't, I would put aside the type of carbs for the following discussion and focus on the how much.  Cutting out most forms of protein, fat and fiber starts 2-3 days before the race.  Then, I start with the Core Diet principal of 0.6 grams of carbs per pound of body weight per hour and test it in training.  That comes out to 85g or carbs per hour for me, and through hundreds of hours of practice, I know my stomach can digest that.  I've also experimented hundreds of hours on salt intake and know that my body tolerates it fine (just a lot of salt on the skin, no bloating or swelling or stomach distress), so I hyper-hydrate before a hot race and definitely go higher than 1,000mg/hr on those hot/humid days.  Again, practice.  Finally, regardless what my stomach can digest in an hour, if I re-direct blood destined for the GI tract to leg muscles that are over-working and/or to the skin to cool on really warm days, then my stomach isn't going to do its job.  And GI distress will occur.  The only way to determine what IF will allow your stomach to still do its job is . . . again, practice.  Some people can easily push 72% or higher on race day and still digest their nutrition; I can't.

Do a real sweat test.  Yeah, it's a pain, and you indicate that you sweat normally, but your situation calls for a real solution.  If you do sweat at a high rate, you've got to dig in deeper and come up with a customized solution.  Perhaps even consult with Core Diet or someone similar who understands this crazy game we play.  If your sweat test really is "normal," I would start with a low-calorie/high hydration and salt test (indoors) and see if you really bonk.  I am quite confident that a vast majority of LC athletes overeat on the bike, afraid of a bonking situation that just isn't going to materialize.  Then, they compound the problem by under-drinking and riding too hard.  For a really hot IM last week, I took along three packages of chews and three gels, planning to eat them all.  But because I was going through 2.5 bottles of Gatorade Endurance each hour due to crazy heat (that's more than 100g per hour), I had to start mixing in water, and I only ate one chew and one gel - over 5.5 hours.  That's 25 calories of "food" - a sugar packet - each hour.  But I got off the bike with plenty of caloric energy.  

If I were at 175lbs like you, I would start with the base line of 105g of carbs per hour.  Again assuming your sweat test comes back normal, try riding indoors while consuming one bottle of GE (44g), two gels (50g), up to 12 oz of water and any extra salt to make sure you're getting 1,000mg every hour.  I propose GE simply because that's what you're going to see on race day.  Did you get hungry?  When?  Did you need to take a pee break?  When?  How many times?  What IF did you ride across the entire wko?  Keep notes, adjust the following week until you absolutely nail a 3- to 4-hour indoor ride, finish feeling strong and no distress.  Does this turn cycling into a lab test, sucking all the fun out of it?  Maybe.  But once you dial in what you need and what you can digest over a 5-hour ride, you can hopefully leave the GI issues behind and start focusing on the fun race stuff.  And when/if you have a GI distress day, hopefully you can compare that ride's data, isolate the cause (i.e., rode too hard in Hour 3, too little salt, etc.), and fix going forward.  Best of luck.

MR

Jeff Horn

Thanks a lot Mike and Shaughn.

First off I haven't formally done the sweat test.  I literally just joined EN this week and it is on the to do list that Patrick sent me.  
Shaughn, the bottles that I am mixing with various products come in any where from 200 cal / bottle (Tailwind) up to 285 cal / bottle (Infinit).  I have real trouble getting in any more than about a bottle every 1:15 to 1:30 on the bike.  I have also taken the calories / bottle down a bit to 175 /bottle range and seems to be more tolerable (osmolarity issue?)  All in all I average about 150 calories / hour.   It seems like I just can't get that kind of volume in that some do -- two bottles / hr makes me wanna hurl just thinking about it  (maybe a lack of practice...I'll bet the Nathan's hot dog eating guy would tell me that).  I don't take in anything supplemental other than the liquid calories (gels, chews, bars).  I am pretty careful not to overcook the bike...pay close attention to HR, Power, IF and keep it all within planned range for the race / ride.  The fact that I just wanna get off my bike and lay down makes me think that it is under fueling (under calorie) issue.  But one of the races I did have this problem, my BG was normal go figure.

Sheila Leard

@jeffhorn - great advice in comments above. Some things to consider is getting fructose out of your fueling plan. Some athletes don’t efficiently metabolize fructose.

Also, what is the health of your gut?  Do eat yogurt or take probiotics? Do you experience bloating or  GI issues in daily eating? 

You may not be able to do liquid calories because it’s setting you up for dehydration. Gastric emptying is being slowed down from either dehydration or too concentrated of calories. EFS Pro might work for you but don’t go with several scoops. Keep osmolaity below 270.

As for how many calories to take in will always depend on conditions. A place to start is .8-1 gm of carb / kg body weight/ hour. You are 80 kg. So approximately 65 -80 gm/ hour or 255 -320/ hour. That’s a rough estimate and considered a doable amount to digest and absorb. 

Jeff Horn

@Sheila Leard Thanks for the reply.  
I don't have GI issues on a daily basis.  
I am suspicious about my gut health after listening to recent podcast with Grace Lieu.  I have not sent my stool for testing but may help in the long run.  
I will take all fructose out - i think it is FODMAP anyway.  
I tried probiotics earlier in the year, but didn't seem to change the course of events.  I will certainly try yogurt and probiotics, certainly can't hurt anything at this point.  
As for the EFS pro I think 3 scoops gets you an osmolarity of 290 acc to their website.  If I go with two scoops osmolarity is 240, but calories is 120.  I think that is per 12 oz.  So I can mix a bottle with 4 scoops in 24 oz and get 240 cal / bottle.  If I can digest it better (as website claims) hopefully I can get one bottle in an hour.  Supplement with the EFS liquid shot I suppose.  
I have one more long ride this weekend to experiment, I hope it goes well.  Will let you know.

Sheila Leard

@jeffhorn - this is a handy FODMAP chart. I'm a Sports Dietitian and advise clients to create their own FODMAP list. It's not black and white. I shouldn't be advising on specific probiotics without a health history but a good broad spectrum, easy to buy and not a massive dose is: https://www.renewlife.com/everyday-probiotics.html/  It's always best to heal your gut with veggies and fermented foods. Food first!

Jeff Horn

Thanks @Sheila Leard I've got a couple weeks to weed some things from the diet.

Jeff Horn

Went on 100 mile training ride last weekend to the Silver Comet trail outside of Atlanta.  It sucked for a lot of reasons.  Guess I didn't know what to expect, but it was certainly not flat, and certainly not a great surface to ride aero for long periods of time.  (trying to get ready for Florida monotony).  Weather was cool in low 60s to start.

Tried EFS drink and liquid shot.  200 cal / bottle.  Drank every 10 minutes, and hit the liquid shot on the :15 and the :45.  Drank first bottle by 1:30 into ride.  Second bottle was a bit bigger and it was gone by 3:15.  Managed to get in a third bottle by mile 85.  All total took in 1 1/2 liquid shots over that time.  Also took in a whole bottle of h20 while washing down the liquid shot.  Stomach felt pretty good.  I think total calories in was 1100-1200.  No massive bloating or nausea 4 hrs in.  I kept power at 170 W (IF of 0.70), and HR at 125-135.  

At mile 85, it was like someone hit a switch...no energy, no power, brain drifting, wanting to quit and sell my bike on ebay.  Could barely keep 120-130W for last 15 miles.  Had to stop twice to sit down.  I guess this is technically a "bonk".  When I finally got to the car just had a terrible total body feeling...urge to lie down and rest.  

After Saturday bonk, i got back on bike Sunday for a "sweat test."  Rode 2hrs, and calculations showed that I sweat about 30oz / hr.
I suppose next thing I will tinker with is trying to take some solid calories on the front end (first 3 hrs).

Sheila Leard

@jeffhorn did you start the ride well fueled? Absorption and gut emptying is very trial and error. Calories looked adequate. It's definitely worth a try to add a low fiber bar or even chews on the front half instead of the liquid shots. Did you get taste fatigue with all that EFS?

Another product that helps when fatigue sets in is EFS Prerace  https://firstendurance.com/nutrition/prerace.htmlbut 
I usually save it for the run but you could see if it helps on the bike. The capsules are easy to carry. 

Shaughn Simmons

@jeffhorn

1100 - 1200 Calories in 4 hours = ~400 cal/hour =  ~100g carbs / hour if you assume only protein and carbs which convert to 4 calories for every gram burned. Fat requires 9 calories for every gram burned therefore you are prob closer to 105-110 carbs / hour given your nutrition most likely has some fat in it.   

For a 4+ hour ride, I think @Sheila Leard is right, how well did you fuel prior to the ride and the night before?  

.70 IF says you paced it right and have some room to stretch there.  How about caffeine? I can't tell if the shots you took included caffeine, however, I do take in caffeinated Power Gels on the back half of those long rides to help stimulate my nervous system.  

Additionally, how many times did you have to pee during the 4 hour ride?

It does get better with consistency.  After 2 - 3 of these long rides, your body will begin to adjust, your endurance and ability to push mentally will advance and your slow twitch muscle fiber base will grow.

SS

Sheila Leard

@Shaughn Simmons have you ever tried the EFS Pre-race? The ingredients are synergistic so you don't feel jittery.  I'm sensitive to caffeine and the anhydrous caffeine in the tabs is just enough with the taurine to make me come alive.

@jeffhorn - Good question on frequency of peeing.

Shaughn Simmons

@Sheila Leard Will definitely give it a try.  I was out in NY one time, ran out of fluid, bought a can of regular EFS at a bike shop I passed and was impressed with it.  Will try the pre race stuff at some point....

Jeff Horn

And to clarify, the total ride time when I hit mile 85 was about 5 hours, so just under the above calculations.
I peed once at mile 35, and then again at the end of the ride.

@Sheila Leard I did start well fueled.   and did not experience taste fatigue from the EFS.  I will certainly give the PreRace stuff a try, as I like that companies products.  Sounds like I could use the jolt towards the second half.

@Shaughn Simmons I did not take caffeine during the ride, the liquid shots don't have it.  

Next experiment will be this weekend.  I have some EFS-Pro solution (will tone down the calories and osmolarity), and made some Skratch cookies.  Gonna try combination of liquid and solids, more solids on the front half than the back half.  Oh I hope this works.  Race is coming up quick.  Ack.

Shaughn Simmons

Jeff, at 5 hours, you were under nourished and felt the effects of that around the 4 hour mark and forward.  Post the link to your last ride if you can.

Do what I do, set the timer on your watch to go off every 15 minutes and drink 1/2 bottle of sports drink.  Then, follow the below schedule as I do religiously during the first 2 - 3  hours taking in a caffeinated gel at 10 mins on the hour and 1/2 power bar at 40 minutes.  This guidance is posted at the link below in the wiki online.  All of this nutrition can normally be found on an Ironman course.

Drink more water if needed such that you are peeing a minimum of two times on the bike and at least once by mile 40.  After 2.5 - 3 hours drop all solids and go strictly liquid. 

http://members.endurancenation.us/Resources/Wiki/tabid/91/Default.aspx?topic=Course+Nutrition+(Baseline)+-+2013+Edition

Bike Fueling Plan Schedule

Time Interval	Food Source	Serving	Carbs	Calories	Sodium
0-60 mins	Ironman Perform	2 bottles	86 g	350 cal	950 mg
:10 min mark	Powerbar Gel	1 packet	27 g	110 cal	200 mg
:40 min mark	Powerbar	1/2 bar	22 g	120 cal	100 mg
Hourly Total			135 g	580 cal	1250 mg

Practice this on the next long ride like your life depended on it and report back.  As long as you are getting enough sodium, adding salt pills where additional water is taken in and shutting down solid food after 2-3 hr mark, you should be good.

You can change up the different types of calorie sources, but if you are not putting in enough of the right calories in total at the right time, you are going to get the same results every time.

SS

jimmy augustine

This isn't great stuff. After having gotten dehydrated on my rr yesterday I feel like I am going back to the drawing board myself.
for next I am going to try a concentrated feed bottle in an aero bottle on the down tube. I figure 3hrs worth of liquid cal. This will allow me to have more plain water in my bta which I was really craving last time but just couldn't carry given my setup.
for the first few hrs I'm good w endurance only as my drink and gummy junk to fill out the rest of the cal but a feed bottle on the down tube would give me flexibility on the back 1/2 of the bike. I raced this way at Cozumel in 2014 and it worked fine.

Shaughn Simmons

@jimmy augustine
Be sure to take in sodium along with that extra water.......

jimmy augustine

@Shaughn Simmons always a concern but I think my problem is too much sodium. I'm washing down salty gu chomps with salty Gatorade endurance. By hour 5 of that my toungue feels pickled. And my weight balloons for a couple of days after. 

Jeff Horn

My full race report is forthcoming and haven't uploaded my devices yet, but suffice it to say, I wasn't laid out in a ditch at mile 80 wishing for death!  Used EFS Pro at 5 scoops / bottle (200 cal), and took in a couple chocolate chip cookies per hour until mile 56.  Also had one banana and one Cilf bar (downed with water of course).  Made it fine to special needs.  Had some pepsi and salty chips over about 7-8 minutes off my feet.  Got back on the EFS Pro until about mile 80, then was starting to feel full / sloshy but not dizzy or weak.  Threw away the EFS at next Aid station and traded out for some Gatorade endurance (much sweeter than EFS Pro).  This switch seemed to settle my stomach and was a nice change of flavor, got me home to the beach/T2.  Peed at mile 56, and then shortly into the run.  My stomach was very full for the majority of the run/walk until about mile 18 when the broth came out.  Was finally able to run more than walked. I think this is something I can build off of for future race nutrition.

Sheila Leard

@jeffhorn - I can't figure out how many calories you took in. That would be helpful for future races. Looks like you're making progress.

jimmy augustine

God &*#(&)& it I just buggered another race with the same stomach shut down. Couldn’t keep anything down after mile 10 of the run.
short version- swam fine. Same 1:15 it always is. Biked to heart rate of 136bpm like sims. Over 6hr bike took in 6 x 190 cal Gatorade endurance, 3 x 200 cal clif blocks, 2x100 cal sport beans, 1 x 100 clif gel 2x16oz water. Peed twice. Was really psyched getting off the bike because I thought that I had been conservative and consistent. By mile 10 my stomach was so sour and crampy up high that I couldn’t get anything down.
this happened last year identically and my Doc who is also an Ironman told me to get on pepsid a week before the race and it should fix the problem.
nope.
this stomach issue has gotten progressively worse for me over the years. It never shows up in race rehearsals though. The guess they aren’t long enough.

Jorge Duque

@jimmy augustine Same here. Stomach killed me during the race and couldn’t take any food or fluids. Had to walk run first half and walk second half. Really dehydrated by the end. I have posted the details on my race report JD IMAZ race report

Tom Glynn

I've had highs and lows with nutrition over the past 15 years.  This spring I decided to get serious about getting dialed in, understanding what worked and what didn't and fixing the issue once and for all.

I signed up with one of ENs sponsors, Core Diet and couldn't be happier.  I got a sweat test, race week plan and about 6 months of weekly consults to work through all the issues.  We worked on race weight, hydration needs (day to day, while training and race day) and overall nutrition. The ability to talk to a dietician that understood Ironman racing was invaluable.  I ended up having the best race of my career nutritionally and time-wise this year.