Slowtwitch: Please help me stop puking

Please please please. I will listen to any suggestions. Please, I need help. IMC last week was my 15th ironman race. I still feel like a rookie, although I guess that number qualifies me for veteran status. I’ve had bad races, mediocre races, and okay races, but never an actual good race, because I can’t make it through the run with any fluids or foods in my system. There have been slight differences from year to year, but IMC this year was pretty typical. It went like this:

Training all summer was fantastic. Best performances in the pool, on the bike, and on the run. Weekly nutrition tests went perfectly. Long bricks such as 100-6 were smooth, fast, and powerful, and I felt well fueled. I was very confident going into the race. Race day unfolded in a typical fashion. Swim was fine. 1:01 is a little slow for me, but it was pretty choppy (PB is 58). Bike started off great, legs were great, first four hours flew by, nutrition was spot on. It was hot but not as bad as predicted. I wore my standard road helmet to keep cool, and I was wearing arm coolers which I kept wet throughout the ride. My stomach started feeling a little wonky after the out-and-back, but my legs still felt great. I kept up with the water through the final headwind section, but didn’t manage to finish my last gel. I also didn’t finish my last three salt pills (salt stick, 215mg each). I still finished pretty well (the wind on the last stretch through town was a bitch) and hit T2 with a 5:34 ride time. A little disappointing, I’ve had basically the same split the past three years. Two pee stops during the ride (after descending Richter and then at special needs), and I had to really hold it to not stop again near the end.

Not as quick as I would like through T2, loaded up my pockets with gels (I don’t like powergel, so I carry Carboom and Honey Stinger). I had a bag with a few salted almonds that I ate out of T2, a new thing I’ve been doing this year (but not new for this race) to try to settle my stomach a bit after the bike and before starting in on run nutrition. Started running pretty nicely, 8-8:30 pace. Legs felt good but I knew that there were going to be stomach problems. My plan was coke and water at the aid stations, with a gel every three miles. I got down the gel at miles three and six, and little cups of coke at 1,2,4, and 5. Legs still felt good. Got to the mile seven aid station and had not had any salt in over an hour, so I threw a couple pills down with water. And that was the end. I immediately emptied the entire contents of my stomach on the side of the road. Rinsed my mouth out and started running again, actually feeling better than I did at mile six. Ran a few more miles just taking water at the aid stations, trying to build my fluids back up. Started feeling pretty low on the energy scale, so I took a few cokes before hitting the turn around in just under two hours. And that was the start of the death march. At this point everything was making my nauseous, including water. I completely emptied myself out again at mile 14 or 15. A mouthful of water would completely set me off. I kept running between the aid stations and then trying to get some fluids in (I was worried about being out in the heat for so long with no liquids). I would feel a little better after two or three miles, then take a gulp of water and then lose it again. At one aid station one of the volunteers suggested I try some food, so I managed to get four or five pretzels down. That seemed to be okay, so at the next station I took a few orange slices. Bad idea, empty once again. For the last eight miles all I could do was run between aid stations, get a cup of the coldest possible water with ice, and then walk and sip it until I finished (3-5 minutes, any bigger drink spelled doom), and then run to the next station. At mile 22 even this was making my nauseous, so I just said screw it and shuffled to the finish. Crossed the line in 11:20 with a 4:35 run split. Hard to take since even at the finish my legs felt good. I was very dehydrated at the finish. My parents came to the race and were staying at the host hotel. I went straight upstairs and crawled into bed with a 500ml bottle of water on the bedside table. Then every five minutes of so my wife made me sit up and take a sip. It took me an hour and a half to finish that bottle. Then I was able to eat a couple of peaches and a bowl of cereal and another small water bottle before falling asleep several hours later.

So that’s pretty much a standard run for me these days. The same thing has happened to me after taking in low, medium, and high sodium during the bike. Same result with 250, 300, 350, and 400 cals per hour on the bike. Same thing with bottle after bottle of water as with just one bottle per hour. Cool temps (IMC 2010, IMAC 2010), you guessed it, same deal. Hot temps? Yup, the same. I can always tell how much effort I put into my race by how hungry I am the next day. This time, nothing. Felt almost normal. A little sore for a couple of days, but then felt normal by Wednesday. Only thing was that I didn’t really pee again until Tuesday morning. I mean I peed a little bit on the drive home, you know, wife wants to stop at a rest area, I go pee just in case, but I didn’t REALLY pee until Tuesday. Ugh.

This is very long and I apologize for that. Two of the best coaches on Slowtwitch are vexed by this. The top nutrition guru hasn’t been able to figure this out. If anyone has any idea, please speak up. Please.

Thanks,
-Colin

Colin,

I can’t wait to see what others have to say.

I have had the same experience over my last four Ironman attempts and your story below is eerily similar to my last race. All is fine until mile 8 or so and then it becomes a puke fest. Incapable of keeping any fluids down and staying hydrated, the run slows to a crawl, especially in warm weather.

I’ve tried all sorts of nutritional combinations, all to no avail. It is almost as if my body gets to a certain point of exhaustion and simply shuts down.

Sorry to hear of your fate.

tip

Glad to hear that I’m not alone here. Same as you, I’ve tried many different nutrition strategies. Brands, amounts, solid, liquid, I’ve done it all. And it still sucks.

Two thoughts worth trying;

  1. Immodium

  2. Glucose tubes (available in diabetics section of local pharmacies) instead of mixed-sugar gels.

They’re $4 per package, versus $1-2 for regular gels, but virtually no digestion is required. The Immodium may prevent the stomach upset in the first place. I hope this helps…

Have you been tested for fructose malabsoprtion?

For some reason, gas-x has been relieving my nausea, but I also get it in training as well as racing. When you have excess gas in your system, it can often cause nausea, and in a race situation it may lead to puking.

Two thoughts worth trying;

  1. Immodium

  2. Glucose tubes (available in diabetics section of local pharmacies) instead of mixed-sugar gels.

They’re $4 per package, versus $1-2 for regular gels, but virtually no digestion is required. The Immodium may prevent the stomach upset in the first place. I hope this helps…

Interesting idea, but uhhhh… isn’t Immodium for uhhhh…the other end?

I’m not sure I like the idea of introducing a drug into my system in T2 when my body has already been working hard for 6+ hours, but it might be worth a shot.

Look at LongBoarder’s posts about this (sorry, but I think it’s in the thread about not looking like IMFL guy-cringe)

My experience is that GI distress can manifest itself in either end, depending on the person. Like I said before, it’s just a thought worth exploring on a hard training day before a big race and NOT as an experiment on race day. I hope this helps you.

I used to puke during nearly every race I did, long or short, but never in training. I met a crazy old drunk track coach one night in a bar and told him my problem. His response was “you have the heart of a champion but the body of a loser”. Basically I was willing to push harder and longer than I was physically capable of going. It made sense, although he could have phrased it better IMO. I learned how to preemptively “hit the reset button” with the old finger down the throat trick, race with a small baggie of tums in my pocket, and stopped using nutrition for shorter distances. Obviously that last one won’t work for an IM though. The first marathon I ran I used zofran to combat the nausea, but it left me feeling like a zombie. I know a lot of ultra runners who use ginger products for nausea. Look on zombierunner.com.

Good luck man.

Can’t digest salt capsules…have to just eat the contents.

Unlikely, but possible. Swallowing saltsticks makes me puke every time…

Do you always put down that much salt when your racing? Seems like a lot at a glance. Personally I’ve gotten by in races without any more sodium than I get from gatorade and I sweat quite a bit.

I’ve puked from ingesting too much salt at once before (in the form of ocean water, swim teammate caught me by surprise and dunked me in the ocean).

Yeah, this race was definitely high salt. I started experimenting with high sodium over the winter (~1500 mg/hr) when I was getting light headed near the end of long trainer rides (4+ hours). That seemed to work well. But I have had these same problems (puking) with a fairly wide range of sodium intake, down to around 6-700 mg/hr. Salt is definitely something I will look at in the 11 weeks between now and IMAZ.

Thanks,
Colin

Do you have acid reflux issues?

I was going your IMAZ '09 race report and basically the same issues. At that race it seemed the caffeine you took at the halfway point triggered the vomiting.

well, since you asked… and this may be very obvious, but have you tried:

a. Not eating or taking in anything except water on the last 15 min of the bike
b. Not eating anything solid on the run, and making sure you dilute any gels with water
b. And cruising on a very easy pace for the first 3-5 miles of the run, then ramping it up to your marathon pace?

I’d also recommend that you talk to Brian Shea of PBN, who posts here often and is the nutrition “coach” for Rappstar… if he can’t help you, you probably have a medical problem that only a MD can help with.

Yep, Brian is the “nutrition guru” that I mentioned in the original post! I have indeed tried those other things to no avail. Such fun, such fun.

Do you have acid reflux issues?

I was going your IMAZ '09 race report and basically the same issues. At that race it seemed the caffeine you took at the halfway point triggered the vomiting.

Nope, nothing like acid reflux for me. I generally have a very solid stomach. A stomach ache, constipation, excess gas, bloating, anything like that is very very rare for me. I’ve always thought that these race problems are absorption/dehydration problems, rather than nausea problems. But I wonder if I took some tums/ginger/immodium to clear up the puking, if that might turn out to help with the absorption.

At IMC 2009 I tried 4000 cals/hour (after training and racing on it all summer). That was the first big time puke fest. I attributed that to too many calories on the bike, and I believe you did as well. So I went the other direction and took only 250 cals/hour on the bike at IMAZ (I can’t remember my exact Na intakes at those races, but I believe it was the 6-700 mg/hr range). I felt better on the run in Arizona (still my PR run at 3:54), but I also felt fairly empty, as if I was under fueled from the bike. I was able to suppress my urge to puke for most of the race until I finally lost it at mile 18. I think holding it in for that long enabled me to have a relatively good run. I had the caffeine at the half way point, but the big mistake I made there was that it was PreRace mixed with EFS liquid shot. I HATE the taste of both of those, getting them down on a good day is a challenge, and at mile 13 of the run after sitting in the sun all day, it did not taste good. Who knew, mixing two terrible tastes makes it even more terrible! I only took a couple of sips of that, again suppressed my urge to upchuck, and then tossed it. I don’t think the caffeine can wholly be blamed on that day. Regardless, I haven’t had anything like that on the run since then. I’ve had good success with coke in shorter races, but then I have good success with EVERYTHING in shorter races. :frowning: The big change this time on the bike was the introduction of some solids, deviating from my normal all liquid diet. I had two stinger waffles (top of Richter and SN), and then the almonds out of T2. The goal was to try to settle my stomach a bit. I guess that didn’t work.

Any thoughts?

Thanks,
-Colin

At IMC 2009 I tried 4000 cals/hour (after training and racing on it all summer).

Stop everything, I know what’s your problem! :wink:

Any thoughts?

Yes. Go back to the plan you used at IMAZ '09, but this time no special stuff from special needs. Just keep doing what you were doing.

As a general rule, when you can’t figure out something in your nutritional plan, go for a simpler, not more complicated approach. Only if you limit the number of variables, you’ll be able to figure out what’s going on. I think you’re a great candidate for doing water+malto+salt ONLY for your next race.

I went straight upstairs and crawled into bed with a 500ml bottle of water on the bedside table.

Poor CCF :frowning:
I hope you get this all figured out.

Thanks for the input. I always tell me students that solutions are generally pretty simple, I guess I need to learn that for myself.

One question: when you say malto only, do you really mean just carbopro and water, or can I throw in some gatorade powder for flavor? My current standard is 700 cals in a bottle, 600 from carbopro, 100 from gatordade. I stopped eating all the brown rice syrup products a while ago.

Thanks,
-Colin

Water+malto+salt ONLY. I’m pretty sure that when you’re bent over throwing up you don’t care much about flavor :wink:

“Started running pretty nicely, 8-8:30 pace.” Have you tried slowing down? I know its a race but maybe throttling back and running 8:45-9:00, meaning lower intensity, would save you from a few minutes hurling on the side of the road.

Puking sucks. Sorry dude.