Stomach cramping at IMLP - not enough salt or too much calories?

[Deleted User]

There is a related thread right now in the race execution section, but I did not want to hijack that with my question.

I did IM Lake Placid last weekend.  Had a great race, with the exception of severe stomach cramping at about mile three and lasting to some degree for the rest of the race.  I am wondering what my have caused it and how to prevent it in the future.

Here is the background.  My bike leg lasted about 6:15, during which time I took in a total of 2,440 calories and 2,460 mg of sodium, along with about 10 bottles of water (I lost track, but took one or two at every aid station).

[Specifics of what I took in on the bike: 1,650 cal worth of Infinate, containing 360 mg of sodium per serving, so about 2,160 mg total.  Also a GU gel every hour, adding about 100 calories and 40 mg of sodium, and a bag of powerbar energy blasts at special needs (190 cal and 60 mg sodium].

No GI issues on the bike and I felt great the entire time.

At T2 I ate another bag of energy blasts (190 calories and 60 mg sodium), and over the first three miles of the run I estimated I took in about 120 cal and 230 mg of soduim from my run infinate formula, for a total of about 310 calories in about the first 40 minutes of the run (a lot in retrospect!!)

I took not salt tablets during the race.  I've never needed them in training, even on the longest days.

At about mile three I noticed some sloshyness going on in the stomach.  Otherwise felt great and foolishly ignored it and continued to sip on my infinate every 15 min.  By mile 5 I had an extremely painful stomach cramp, and was forced to walk for half a mile.  I slowly recoverd over the next five mile or so, but was not 100 percent the rest of the race.  I could take in no calories the rest of the day, or the cramping would start again.  Only ice water is what I wanted, and lots of it at every aid station.  That alone was fine in my stomach.  I was afraid of bonking going so long without additonal calories, but never did.

So the question is what caused this?  To many calories too soon on the run? Or not enough salt?  Thanks for the feedback!

Jim

Keith Wick

I'm wondering if the stomach cramping was mostly too many calories. By my calculations (2440 cal/ 6.25 hrs= 390 cal per hr), 390 calories per hour is way too much. The guidance is definitely capped at around 300 cal per hour and you exceeded that, plus put in another 190 in less than 10 minutes during your transition. I'm not so sure this is related to sodium as to calories, but I would be willing to bet that your running close to the minimum allowance at 345.6 mg per hour on the bike.

[Deleted User]

Now that I add up all the calories, it does seem high. I guess I kind of evolved to that point. I started out training for long rides with Infinite only, 275 cal per hour. But during the first RR I bonked at about mile 70 - got very dizzy on the bike and did not feel right. So I added a GU on the hour, and that really seemed to help. I feel very good on the bike with the number of calories I've been doing. Perhaps I should just back off on the run? Hmmm. Thought I had dialed in the nutrition, but now the more I look at the numbers and cramping thing perhaps not.

Gordon Cherwoniak

Jim,

As Keith has mentioned the calories are pretty high and is looks like you can handle them on the bike at least at IM racing pace. You may find a different as the IF goes up especially in to 1/2 IM paces.

  The energy blast have a lot of calories in them and you took on a bunch of calories at the start of the run, this could have compounded the problem further.  Not to mention the energy blast are not a true gel causing the stomach to work a little more. 

I think your statement of " I was afraid of bonking going so long without additonal calories, but never did." shows that you had plenty of calories on the bike to make it thorugh the run.  Spread some of those calories on to the run and you should be fine.

Gordon

Norton

Another piece: how was your pacing on the bike? So often gastric issues on the run are a result of poor pacing on the bike; it's difficult to make the diagnosis so far downstream.

[Deleted User]

Makes sense. Thinking of modifying my Infinite formula to 200 cal per serving, and supplement with a 100 cal caffeinated gel on the hour. I seem to be fine with 300 cal per hour on the bike. I'm also thinking about boosting the sodium to 500 mg, but am concerned this may taste way too salty. But would be simpler than fooling with salt pills. Then on the run just go with gel and water.

[Deleted User]

I think my pacing on the bike and run were good - exactly where I wanted to be and at power/paces that worked well during the race rehearsals.

Steve West

Mike Folan of Infinit says it's a bad idea to mix different sugar sources. Not sure if that my have been a partial contributor to your GI issue. Never tested this - not sure I want to.

I agree with Keith and Gordon on the too many calories. You went heavy during the bike, preloaded in T2 and continued to overload early on the run. I preloaded in T2 on about 180 cals of Infinit (normal concentration) but didnt take any other calories till after mile 5. I know that when running marathons, I need to give any calories a long time between each dose - lets me assess my GI stress before it turns bad. If there is any distress, even minor, I only do water and wait till my gut is better berore I Gu again.

[Deleted User]

Now that I add it all up it seems obvious I overdid the calories. Interesting how I gradually slipped into this during training, but got away with it so I thought I was good. The extra calories at T2 was something I never did before - so that was dumb in retrospect. As was hitting the infinite too hard early in the run.

My only question now is whether a lack of sodium could have contributed. I never take salt pills. Am I the only one not taking extra sodium?

[Deleted User]

Steve - do you use only GU after mile 5? Any additional sodium?

Scott Alexander

I agree, definitely too many calories for most people (I did know a guy that did surprisingly well at IMCDA a few years ago with 400+/hour, astonishing). But if you're okay on the bike with that amount of calories, I would have at least stopped taking in more calories at least 30mins before the run-but continue with water. That way you could process what was already in your pipeline and somewhat empty it before the run began.

Personally, I try to never take calories in T2, and wait at least 1/2 mile onto the run before I even contemplate it (course/length dependent).

Steve West

Yes, Gu only. At LP I did try Coke twice but only managed a few sips and only 1 sip of broth. Niether tasted right and I didn't want to risk GI issues. I did 2 waters at each aid station and Gu at 5, 9, 14, 18 and 22 (i think). In some marathons I might do 6. Once I did 8 and it was nasty stomach for 18 miles - not going to do that again. Less is better.

My approach is not to prevent a muscle bonk but to intercept the beginning of a brain (glycogen) bonk. As soon as I feel my attitude start to slip I know my blood sugar is dropping. If I Gu right away I can prevent the 'dark place' from taking over and I start to recover within about a half mile. If I wait till it gets bad, it will take 2 miles to recover.

The other side of the coin is managing GI distress. If it feels wonky or is sloshing, dont Gu. Easy off, manage the HR and drink water if you can (not sloshing and bloated).

Steve West

@ Scott - good advice. My T2 cals are optional and depend on realtime conditions in my gut, hydration and attitude (blood sugar).

Chris G

I never take any salt.  Have in the past but only because people told me I should rather than any need.  The science does not appear to support that lack of salt causes cramps or taking salt prevents them...but a lot of people swear that taking salt allows them to race without cramps.  There are a million ST threads on the subject that link the studies.  It is the one area where a lot of "science works" people take it based on n=1 stories.  Pretty interesting really.

GMAN 19030

Posted By Jim Daley on 29 Jul 2011 08:43 PM

Interesting how I gradually slipped into this during training, but got away with it so I thought I was good.  

I did that a couple of years ago.  I could iron gut anything in training.  Fast forward to a 70.3 race day and I took in some asinine amount of calories on the bike and paid a dear price.  I vomitted a couple of dozen times and walked the last 6 miles of the run.  Way more vomitting and debilitating cramps after the race lead to a 9 hour hospital stay, 6 IV bags, a heavy dose of some antiemetic, pain meds and a whole lot of hurt.

[Deleted User]

Thanks for the feedback everyone. @Chris - that is why I never bothered with salt. No good evidence that it has any effect on cramping, and I never took it and I never have muscle cramps. I did start to freak out a little when they were calling for very hot humid weather for race day. Had me worried about hyponatremia if I started drinking much more water than usual. During the actual race it is interesting that from about mile 5 of last weeks race on all I had was water (and maybe 5 pretzels and one sip of chicken soup), and lots of water. And I gradually felt better and better as the race went on.

Here is my current thinking:
1. Day before the race I sip NUUN all day, which has a good dose of sodium. So I'm preloading to some degree.
2. I'm going to change my Infinite formula to 200 cal and 400 mg sodium
3. On race day, plan is for Infinite plus one GU per hour, for a total of 300 calories and 460 mg sodium. I'm 195 and seem to better on the high end of the recommended calorie intake. A moderate increase in sodium mostly because it won't hurt, and may guard against hyponatremia. But not salt caps or anything. @Steve - I don't think the mixing of carbs bothered me. And I think this is what Patrick does. Nice to mix it up a little, plus I can use caffeinated GU if I want.
4. On the fence with the extra bike special needs snack. If I'm hungry, have it in the bag just in case? Will have plenty of time to process it.
5. For the run, no extra carbs at T2 or early in the run, then only a GU every 45 - 60 minutes, while carefully monitoring my condition, as per Steve W. And only water.

I have until 2013 to refine this!!

jburbatt

Unless you are going to do a couple of training bricks with the "special snack" at special needs, I would leave it out. Way too many stories of "Oh I'll just have XXX and it will be fine" turning into mile X onward being awful. Does your infinit mix have protein in it? This should be preventing any hunger issues. If it doesn't already I'd consider trying that out before I tossed a snack in my SN bag.

[Deleted User]

I'm thinking the same thing Jennifer. But it's funny that right after I saw your post I read TJ Tollakson's race report from IMLP. Turns out he takes in 300 cal per hour on the bike, with a bag of powerbar energy blasts along the way! Of course I'm no TJ...

He also seemed to heavy on the gu on the run - 300 cal/hour. And had salt sticks to ward of impending hyponatremia.

Here is a question - what are the symptoms of hyponatremia on the run? Perhaps recognizing this and having some emergency salt just in case would be the way to go.

TJ race report: http://blog.trainingpeaks.com/posts/2011/7/29/tj-tollaksons-ironman-lake-placid-winning-race-report-and-po.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed:+trainingpeaks/XAlX+(TrainingPeaks+Blog)

GMAN 19030

Posted By Jim Daley on 30 Jul 2011 08:40 AM

I'm thinking the same thing Jennifer. But it's funny that right after I saw your post I read TJ Tollakson's race report from IMLP. Turns out he takes in 300 cal per hour on the bike, with a bag of powerbar energy blasts along the way! Of course I'm no TJ...



He also seemed to heavy on the gu on the run - 300 cal/hour. And had salt sticks to ward of impending hyponatremia.



Here is a question - what are the symptoms of hyponatremia on the run? Perhaps recognizing this and having some emergency salt just in case would be the way to go.



TJ race report: http://blog.trainingpeaks.com/posts/2011/7/29/tj-tollaksons-ironman-lake-placid-winning-race-report-and-po.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed:+trainingpeaks/XAlX+(TrainingPeaks+Blog)

And that's where the genetic freak arguments come back to play.

Read some of Brian Shea's (Personal Best Nutrition) race reports he posts on his sponsored athletes like Jordan Rapp, Andrew Yoder, James Cunnama, etc.  Those guys take in 500-600 cals per hour on the bike (even for an IM for Rapp or Cunnama) and nearly 400 cals per hour on the run.  Sodium levels off the charts.

I tried to emulate that once (not necessarily on purpose) and spent 10 hours at the hospital for my efforts.  

penlynwilson

Posted By Steve West on 29 Jul 2011 08:37 PM

Mike Folan of Infinit says it's a bad idea to mix different sugar sources. Not sure if that my have been a partial contributor to your GI issue. Never tested this - not sure I want to.

Not sure what Mike is thinking. Current research is showing you can absor more with a 2:1 glucose:fructose mixture. Some people do have to be careful with fructose.

Nate Parady

Not sure I would compare anything I do to what TJ did...I have also heard Chrissy Wellington talk about her 3-400 calory/hour race day diet. Suspect there is a huge difference between being on the course for under 9 hours versus over 12 hours in terms of how your GI system starts to behave.

the mixing sugars discussion is interesting. people seem to have such a different reaction to this. I have tried to cause a problem on purpose during training by taking different sources but no issues.

I did start to get an upset stomach at about mile 6 or 7 from warm Perform. had to switch to coke and chicken broth.

I also took 3 Sodium pills throughout the day (two on the bike course, one on the run course) as some insurance I was getting enough sodium.

ironmtngrl

I know that Infinit has a good amount of electrolytes. How about Ironman Perform? If you use Perform do you need to supplement with Endurolytes or something similar?

penlynwilson

Just an FYI - the recommendation for sodium (not sodium chloride, just sodium) is 500 - 1000 mg per liter (about 4 cups of sweat lost). I don't make blanket recommendations about sodium needs. You need to do a sweat trial, figure out how much fluid you are using, determine if you are a salty sweater and if so how bad, then use that to get a starting point for your sodium. I believe there is a good discussion on sweat trials in the Wiki.