with Coach Kelsey McGill

Whether you’re new to the sport or a seasoned veteran, just about every one of us has been in the throes of some stomach-revolting nightmare.

On the nausea rollercoaster and guzzling down another gel sound like a good idea? YOU’RE KIDDING, RIGHT?!

Got the endless squirts and you’re only a third of the way through the race? Been there!

Curled up into a ball on the side of the trail to squeeze out some flatulence but also trying to maintain a podium position? YUP!

Can a mid-race fart be trusted? Never.

It’s no surprise that GI issues are actually the most common reason runners drop from races! Tummy problems are a real thing out there, and hopefully this article can break down some strategies for preventing your next DNF. 

Some common issues that can lead to gastrointestinal problems:

• Too little electrolytes (hyponatremia)
• Too many electrolytes (hypernatremia)
• Too much water
• Not enough water
• Too many carbohydrates (or food for that matter)
• Not enough food
• Altitude
• Heat

Good gravy… How do I decide which course of action to take when these all can lead to the same discomfort?!

Let’s start here!

• Your long runs are critical not only for mechanical loading (i.e. adapting to the running volume), but it’s also essential for metabolic adaptation. Basically, how we train the gut during these long runs is excellent information for how our stomachs can withstand nutrition, electrolytes, and hydration on race day. However, there is a difference between a 3 hour run and an 8, 12, 24, 72 hour run (aka racing!). Sometimes we can get away without much issue during a 3 hour run, but those same mistakes or issues you’re overlooking can be costly during a much longer event. In a nutshell, DO your long runs, and hydrate and fuel like you would on race day so you can limit any unwanted surprises!
• Sodium sweat test. This can really be a game-changer for many! Precision Hydration and Fuel has partners all over the world that do these tests, and it’s worth every penny, in my opinion, if that means it can rule out race DNFs due to electrolyte issues. Some people need as little as 200mg of sodium per liter whereas others need up to 2500mg! That’s a massive range. If you tend to have lots of unpleasant symptoms during races or long runs such as cramping or GI issues, I highly encourage you to get this test. 
• Different from the sodium sweat test, this is the sweat rate test. This is when you weigh yourself pre-run without clothing on (since clothing absorbs sweat) and then you’ll weigh yourself again post-run without clothing on. (side note: if you prefer to not know your body weight, you can stuff a backpack full of items and put that on you when you weigh yourself pre and post run). Take note of different temperatures and humidity as these can fluctuate how much we need to drink! We also get more heat adapted throughout summer so retake the sweat test again.

Troubleshooting dehydration & electrolyte imbalances

Dehydration	Hyponatremia (low electrolytes)	Hypernatremia (too high of electrolytes) – this one is less common but can still occur
Nausea	Nausea	Nausea
Thirsty (especially when it’s hot)	Not thirsty	GI upset: bloating, diarrhea, vomiting, stomach cramps
Haven’t peed in 2-3 hours	Pee excessively	Confusion, headache
Pee is dark/gatorade orange	Clear pee	Muscle weakness
Muscle cramps	Muscle cramps	Extreme fatigue
Not sweating anymore (bad)	Swollen hands/feet can lead to pitting edema (bad)	Irritability
	Confusion/sleepiness/disoriented (bad)	Pee excessively
Solutions:	Solutions:	Puffy hands/feet can lead to pitting edema (bad)
-cool them off/put in shade	-Cut hourly fluids in half for a while	Heart irregularities (bad)
-have them drink whatever fluid they are able to tolerate	-Increase sodium intake by 250-500mg/hr. Electrolyte capsules are very helpful for this!	Solution:
-start them on a drink timer (i.e. 10-12oz every 15min)	-If bad headache and nonstop vomiting, seek medical attention ASAP	-Switch to plain water for a while and start them on a drink timer

*Please note this is not medical advice! Troubleshoot with caution since many of these symptoms overlap with each other!

*Also note that you can be experiencing more than 1 of these things at the same time! It’s possible to be dehydrated and low/high on electrolytes. When in doubt, seek out a medic at the race.

Other strategies to implement:

• Lower your effort! This will help expedite gastric emptying (aka digestion) rather than sending all the blood mainly to your extremities which is what happens when running at high intensities. This can be particularly important for those racing at altitude who aren’t used to the elevation. 
• The higher the intensity, the more you’ll want to consume carb-specific food sources (i.e. carb drink mix, gels, chews, etc.) as these digest the fastest out of any of the micro food sources. Some athletes perform extremely well at 70 grams of carbs/hr whereas other athletes need more such as 120+ grams of carbs/hr. Avoid new surprises on race day, do what you’ve practiced. 
• The slower the intensity, you can integrate more fat-based foods since these are digested more slowly. 
• If it’s a particularly hot and/or humid race day, be careful not to overconsume carb drink mix because you’ll be consuming more fluids. Essentially, avoid consuming way more carbs than your gut is trained for. Overconsuming carbs can definitely cause GI distress
• Keep your electrolyte to water ratio the same! For example, if you need to consume 800mg of sodium per liter, be sure to keep that ratio consistent regardless of how much fluid you are taking in. 
• Have a variety of options to consume electrolytes (i.e. electrolyte drink mix, electrolytes in carb drink mix, electrolyte capsules, gels with electrolytes, real food, etc.). Again, if your stomach starts to revolt, you want to be sure you can get electrolytes somehow.
• Be sure to drink lots of fluid when you take an electrolyte capsule! My personal favorite are the Relyte 200mg capsules (they also have 400mg capsules if you’re an super salt sweater)
• Ginger chews – you need to have them on you! I prefer the Ginger People softchews. If any stomach upset is starting up, take one of these right away and there’s a good chance this can settle things. If that doesn’t work, try a mint tum. If you’re struggling to get in anything (liquids, electrolytes, food), talk with a race medic especially if you’re having other concerning symptoms. It also might be worth talking with your primary care provider and consider carrying some anti-nausea medication during races. Ginger ale at aid stations can really help too!
• The importance of cooling cannot be stressed enough! Use the ice bandana, stuff the ice in your vest, arm sleeves, and/or sports bra – the earlier you start cooling, the better off you’ll be. Not only will evaporative cooling keep your core temperature more regulated, you’ll also be able to digest food much more easily as your body won’t be working quite as hard to thermoregulate. 
• Have a variety of food options to choose from on race day that you know will work! Whether it’s GI distress or palate fatigue, you’ll want an array of options. 
• DO keep eating, even if it’s very tiny portions. More times than not, simply not eating will make the stomach revolt harder. Small portions often. 
• If you’re really in a pinch and can’t get a darn thing down, try the “swishing” method where you put some carb drink mix or soda in your mouth, swish it around, and spit it back out. Sometimes we can trick the brain this way and it can help as a reset. 
• Do practice good hydration, fueling, and electrolyte consumption the entire week leading up to the race, don’t just prioritize this on race day. If you’re in a deficit in any one of these things, you’ll likely pay the price for it during your race.
• Some common magic elixirs to help settle the stomach: broth; broth with rice, broth with mashed potatoes, soup, coca-cola, ginger ale, etc. 

Disclaimer: This information is based upon my personal background as an athlete, certified UESCA Ultrarunning Coach, and having been a certified Wilderness First Responder for the past 15 years. I am not a medical professional nor a registered dietician so I’d recommend reaching out to either of these resources to provide more clarity to your situation.

Kelsey is a coach with Team RunRun, to learn more about her or to work with her, check out her coach profile.