No one wants to see all their hard work go… down the toilet on race day. Here are my tips as a gastroenterologist to minimise that risk:
Avoid meals two to three hours before exercise. Especially avoid high-fat or high-fibre meals, as these can take longer to digest and can potentially aggravate nausea and acid-reflux symptoms. Some people load up on carbs the night before their sporting event. This is fine in healthy people because the carbs will have been emptied from their stomachs well before morning.
During long workouts, skip energy drinks, coffee and fruit juice. Take small, frequent sips of hypotonic fluids instead. Hypotonic fluids, such as many sports drinks, can help quickly replace fluid and electrolyte losses from sweat. But hypertonic fluids – such as sugary carbonated beverages, energy drinks and high-fructose juices – should be avoided. These draw fluid into your gut from your bloodstream and can worsen your chances of dehydration and ischemia.
Practice hydration during training – not just on race day. One study of more than 1000 long-distance runners found that gastrointestinal symptoms were worse among those who did not practice hydration during their training.
Avoid coffee right before the race. Coffee is a potent trigger of colonic contractions. (Not the best thing when you only have access to portable toilets.)
Don’t take NSAIDs for aching joints and muscles. Nonsteroidal anti-inflammatory drugs such as ibuprofen taken before exercise can increase damage to the lining of the gut, which is implicated in blood loss, at a time when your GI tract is already under stress. Instead, try paracetamol, ice packs or topical creams.
Experts recommend practicing your hydration during training, not just on race day.Credit: Getty Images
Get a good night’s sleep, and relax the morning of the race. Sleep disturbances and anxiety, especially the morning of a race, are associated with increased gastrointestinal symptoms.
The stress of travel and sorting out race logistics can trigger diarrhoea. Waking up before the crack of dawn, panicking that your ride won’t make it, hunting down the booth with the race T-shirt: none of that is fun. If you can, get in early to sort out these details calmly and to take some time to yourself before the big moment.
Use data smartly. If you have a smartwatch or other device that measures your heart rate, check whether you tend to feel nausea, cramping or other gastrointestinal symptoms when your heart rate goes over a certain threshold. With higher-intensity exercise, your gut may not be getting enough blood flow. Use that data to recalibrate your training goals to a safer range.
Lastly, there’s often discussion about the best form of carbohydrate intake to improve performance during a race: solids, gels or liquids. There isn’t enough data about which form may be the most beneficial to the gut, but some limited studies suggest that liquid forms may be the most gentle for people who frequently experience bowel symptoms during exercise.
What I want my patients to know
Physical activity helps us stay regular and is associated with a 7 per cent reduced risk of colorectal cancer. Still, I don’t advise pushing your body past its limits to reach a goal that may not be healthy for you. When you feel nauseated during exercise, that’s your body sending you a message. Pause and see whether you’re up to continuing. When you have fecal incontinence or bleeding, that’s your body asking you to stop what you’re doing. Please heed that call.
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