Tuesday, February 21, 2017

A possible solution to gastrointestinal distress in ultrarunning

I have recently immersed myself in Jason Koop’s Training Essentials for Ultrarunning and am quite thrilled. I’m not usually one for training manuals – then again, I wasn’t one for coaching for 16 years :-) – rather more partial to race reviews and personal experiences, but last summer bought Bryan Powell’s Relentless Forward Progress and The Sage Running Secret by Sage Canaday. I didn’t find anything actually groundbreaking nor, ultimately, very useful, apart form Powell’s chart on different hydration ailments – extremely helpful in determining where you are at with sodium/water in-take and balance based on body reactions) – but Koop’s book almost makes them irrelevant. He debunks several training notions (implicitly poking fun at Powell's pizza analogy for layered training) and takes the confusion out of apparent conundrums like “drink early” vs “drink when thirsty” and “speed work” vs “no speed work” and “what kind of speedwork”. He does so because he explains the mechanics, backing everything up with research and convincing illustrative arguments.

I particularly like how he makes fitness the key training factor, with everything else coming after (an extreme illustration would be: you can’t compensate lack of training by buying the best gear). He really just makes it sound like plain commonsense, and drives this home very effectively by highlighting how the major reasons invoked for DNFs – hydration, , gastrointestinal distress, blisters, muscle pain – can all be linked back to lack of training (which means lack of adequate fitness), even though that is rarely the reason highlighted by the person  him/herself. (I would add the time barriers, which highlights a lack of speed – but that might just be my personal experience!)


He addresses these ‘failures’ really well, again drawing on scientific evidence, and providing solutions. There is one instance, however, where that solution is unsatisfactory since it boils down exclusively to: “train more, be in better shape” – and yet I think there is a possible solution out there that is founded on the very scientific evidence that Koop provides. And that is gastrointestinal distress.

Let me first quote him at length:

In addition to competition for blood flow, damage to the gut occurs during any endurance running activity as a by-product of digestion, blood flow reduction, and constant jostling up and down. Recently, researchers at Monash University studied the naturally present bacteria (endotoxins) that leak into the bloodstream as a result of this damage. They found that most individuals participating in an ultramarathon had markers in their bloodstream equivalent to those found in hospital patients with sepsis.


Although the researchers concluded that the damage was significant and that the gut was impaired, little evidence was presented as to how to alleviate or avoid the condition. The one correlating factor suggested by the research team was that the individuals who had simply trained more exhibited less damage.

Ok, so there are two reasons for GI distress, the first being “competition for blood flow” and here I have nothing to add to all of Koop’s recommendations (read the book for those).

However, regarding the endotoxins damaging the gut (sepsis?! ow!), there is definitely something I would suggest all endurance athletes try (in addition to better training) – it has certainly worked for me, and the solution is based on the cause. For seven years now I have had almost no GI issues while ultrarunning; so much so that I’ve almost forgotten that I used to be plagued by them. I thought it went with the territory, until a friend of mine who is a pharmacist and naturopath said exactly what Jason Koop said: running for extensive periods of time damages the stomach lining – and this includes training! Basically, not only are you damaging the gut during an ultramarathon but even the training required to compete in one exposes the stomach to bad bacteria.

So what’s the solution? Pro-biotics and L-Glutamine: Give the stomach good bacteria and strengthen the stomach lining.

Here’s what my health practioner friend prescribed and what worked for me:

  • A 2-3 month cure
  • Probiotics: must take one with a high concentration of active ingredients (CFU) – at least 10 billion, in the morning on an empty stomach.
  • L-Glutamine: google it for more info, but it is definitely indicated to fix the stomach lining (which, when it wears down, is the primary cause of ulcers); 1g, again every morning on an empty stomach.
  • (I took the L-Glutamine first ,about 30mn before eating, and the probiotics about 10mn later – and have a green tea in the mean time…)

I do this every spring. Try it: I bet your race this summer will go a lot better. I used to be a heavy drinker, and even alcohol consumption did not get the way of its efficiency.

Of course, no-one can guarantee anything when it comes to ultrarunning. But if you’ve been plagued with GI issues, it’s worth the try. Of course ask your doctor/pharmacist first, usual disclaimer, but I really see no down-side and a lot of potential upside.

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