Hosted by Brad Brown, join Coach Parry and resident dietician at the High Performance Centre at the University of Pretoria Nicki de Villiers as they discuss nausea. In this video training you’ll discover the most common causes of nausea, how to prevent nausea and what to do when you feel ill in the middle of the run. You will discover the dangers of overhydration and what you should do to avoid it.
Transcription
BRAD BROWN: Here we go, welcome everyone to the next Coach Parry online seminar. We’re coming to you live today, it is Wednesday and we’ve got folks from all over the show once again. Thanks for joining us from around the planet, wherever you are, if it’s morning, evening or afternoon, welcome, it’s good to have you with us. Just to run through a couple of formalities before we get into why you’re actually here and to find out how to beat nausea, let’s cover who is online and who we’ve got with us today.
I’m Brad Brown, I’m going to be hosting it and holding everything together and making sure that everything works. We’ve also got Nicki de Villiers who is the resident dietician at the High Performance Centre at the University of Pretoria, Tukkies, Nicki is with us as well and then we’ve got Lindsey Parry, the official Comrades Marathon coach, he joins us today as well, Coach Parry on the line. How this is all going to work, just to run through a couple of the things we’re going to cover today, so you can stick around and know what exactly is coming up. What you’re going to discover today, the common causes of nausea, as well as how to prevent nausea, that’s a pretty big one. How to cope when it strikes in the middle of a run and then we’ll also be chatting quite a bit about over hydration and why that is so dangerous and then we’ve got a couple of great running resources for you as well, which we’ll share with you later on in this webinar, you’re not going to want to miss out on that.
Then, if you would like to ask a question, you’re more than welcome to, at any stage during today’s seminar, all you need to do, in the question bar, just type your question in, we might not be able to get to it straight away, but we will definitely get to it at some stage through the seminar. All you need to do is type your question in there. If you’ve got any comments or if there’s anything else that you’d like to know, just pop it in there as well.
Before we get started, I just want find out for my own interest, obviously we’ve re-launched the seminars and I want to know, if you look in the little bar that you have on the right, where the questions are, where the chat is, I want to know how many of these online seminars have you attended with us here on Coach Parry. Is it your first? Have you been to one? Have you been to between 2-5 or more than 6 over the years that we’ve been doing this, I’d love to get your thoughts, so if you wouldn’t mind just taking a second and just popping it in the poll section, let us know how many of these you’ve attended.
Let’s get straight into today’s seminar and let me introduce and say howzit to our panelists on the line. We’ll start with Nicki de Villiers, Nicki welcome, it’s great to have you on, are you well today?
NICKI DE VILLIERS: Ja, very well, thanks for asking me to join.
BRAD BROWN: No prob, all the way from Pretoria, I’m sitting in the horrible city of Cape Town at the moment, looking at the mountain, it’s terrible J I hope your view is as nice as mine in Pretoria. Lindsey Parry joining us as well, Lindsey, howzit.
LINDSEY PARRY: Ja, very good thank you, also chilling at home, overlooking my beautiful garden, thanks, courtesy of the students at Pretoria University.
BRAD BROWN: All right, we’re all comfortable, we’re all sitting down, let’s get straight into it and obviously the first thing we want to look at is what are some of the common causes. Nicki, I’m going to ask you to jump in here, why do people suffer from nausea when they run?
NICKI DE VILLIERS: Brad, there’s quite a few speculations, I wish we had a clear cut answer. One of the things in our research is that there’s a change of blood flow, so we’ve got less blood going to the stomach and more to the muscles and the lungs and all the other supporting organ systems. If there’s less blood to the stomach, we obviously have to look at what we put into the stomach because there’s going to be a reaction to it. Then there’s obviously causes that’s just basically bound to your running, the impact with a stomach consistently moving up and down and then there’s definite nutrition aspects, stuff that we put in there that’s not necessarily due to the decrease in the blood flow, but just because those are nutrients that’s not really well coped with during running.
If I look at those nutrients, it’s basically the stuff that’s going to stay in the stomach for a long time, considering especially fibre foods, very high in fibre, stuff that’s very high in fat, especially heated fat that we eat prior to running, that’s going to stay there for a while. Very heavy protein meals and then more and more indication of the type of carbohydrate that you put into the stomach and that certain ones are not that easily clear, we look at specifically fructose as being quite a villain in all of this and then never disregarding the hydration issues. As soon as we high power hydrate, as soon as we’re dehydrate then, there’s even less blood going to the stomach area, which can obviously aggravate all of these.
BRAD BROWN: There’s lots, like you say, there’s no one cause, if it was that simple, no one would be suffering from nausea and unfortunately it’s one of those things, I’m sure that runners need to figure out along the way, what triggers it, what causes it and how they can prevent it. It’s almost like an experiment of one, essentially.
NICKI DE VILLIERS: Ja, and that is why it’s so important that whatever we’re going to do in a race, we have to do in training to figure out what is working, what is not working and then obviously also considering that all of these get worse the longer you run. Although we’re not always training on the same durations of our races, it can get worse towards the end of the race, just because of the pure duration of what we’re doing.
BRAD BROWN: Lindsey, you chat to a lot of runners as well, Nicki’s covered pretty much all the bases, what are some of the common things that you pick up why people struggle and get nauseous on a run?
LINDSEY PARRY: I think for me one of the main factors is the constant need to keep your nutrition up and then in a race like Comrades, that’s incessant taking of things which are easy to carry, so gels being probably one of the major culprits, just taking very sweet foods over and over and over again for such a long time. I know Nicki is going to talk to some of the ways to prevent it, but one of the things that she said as she was ending off speaking there was to talk about managing it on race day and one of the things that I found, particularly in races that last longer than 4 hours, is that if we look after our nutrition early in the race, while the blood is still flowing to the stomach, before we’re getting too fatigued, before the stomach is getting too bloated and too full, too irritated from the things that we’re putting into it, if we are then very good about getting our recommended amount, depending on who you’re working with, you’d be recommended between, somewhere in the region of 55 to as much as 70-80g of carbs an hour, that will become quite stressful on your gut.
If you do that early in the race, but then you back off a little bit, even for a couple of hours, 2-3 hours where you aren’t so good about your nutrition, you’re just sipping a little bit of water here and there, I then find that you actually start to get quite desperate for some nutrition and for the last couple of hours of the race you can put in what you need to get to the end. That’s just really a practical way of how I’ve dealt with it in any race and hopefully Nicki has got some good tips to give us on what to do and what not to do in the lead up to and during the run.
BRAD BROWN: Before we get into that, Lindsey, I just want to ask something and Nicki, you can jump in here too. Lindsey, you mentioned that it occurs for a lot of people on runs longer than 4 hours, if nausea exclusive just to long runs? I’m lucky – touch wood – I don’t suffer from it, but it can strike at any time? If you’re only running up to 10, could you suffer from nausea on a 10km run or perhaps a run that’s taking an hour or is it specifically something that people who run marathons and ultra-marathons struggle with?
LINDSEY PARRY: I’ve heard of it in half marathons. If you were getting nausea in a short event, something like a 10km, I would be a little concerned. There are probably some things that if you eat for breakfast could perhaps cause nausea during running, but I would be much more concerned that there’s some sort of cardiac or cardiovascular issue that’s causing nausea in the shorter runs. Of course you’re excluding when you’re absolutely racing flat out, eyes on stalks for a PB because then that’s an entirely different kind of nausea that you’re going to experience.
If you’re running a fairly standard 10km and you’re getting nauseous that early, I would certainly do some investigations. Nicki will be able to give us, I’m sure she does come across people who just suffer from nausea full stop.
BRAD BROWN: Before we get into that, there’s a poll up on the screen, I just want to find out exactly where you suffer nausea from, so pop that in there and let us know where it strikes for you on your run. Nicki, let’s chat about that now. How do you counter it, how do you deal with nausea?
NICKI DE VILLIERS: Ja Brad, I think especially in the shorter races, it’s sometimes easier to deal with it because it’s probably something that you ate or did not eat prior to going into that run. We have to then obviously look at exactly what was the pre event meal. So pre event I mean anything that you ate from waking up until you hit the road. Look at what is part of that meal, often as I say, people put a lot of fibre in there that can have a bit of a problem. Was there fluid intake, any kind of fluid, just to make sure the hydration is up to date. It’s very evident that once there’s fluid in the stomach when you start running, the clearance of fluid throughout your run would be much, much better, so it is enhanced. We have to look at the fluid intake there as well.
Then offending foods, so a lot of people will get nauseous with specific foods. They can tell me, I ate this or that, so there’s a lot of nausea complaints with, as I say, excessive fat intake, if I had bacon and eggs prior to, if I had excessive amounts of protein maybe prior to this, some people may be struggling with that and then specific herbs, specific spices, looking especially at fructose. Fructose is the sugar that we get in fruit, so if you’re not used to eating fruit all day long or regular fruit intake and you eat a lot of fruit right before you go for a run, that can cause a bit of nausea.
Some people struggle with caffeine. Being a drug that will enhance performance, but some people struggle with drinking caffeine prior to and that can cause a bit of damage in terms of nausea and then also milky products and some have to experiment with a little bit of milk or yoghurt or stuff that we use. It is so individual that it’s important that we do understand that what makes the one nauseous is not going to make the other nauseous and that’s why it’s so important to experiment with these things in the mornings when you go on training runs because if we’re going to have to listen to everybody telling you what they avoid, we’re going to end up with nothing left to eat except for maybe water, that’s quite important.
Then very, very important, look at the timing of the meal. Hey, we can’t eat a whole load of stuff, think we’re going to go into a race, especially if you’re going to have a quick start. That is important then to decrease the amount of food that you eat prior to it, if you’re going to have a very low start and the race is full and you’re going to walk a few K’s, then you can probably have a bit more food in the stomach as such.
BRAD BROWN: Let’s jump into a few questions and there are a few coming through. You can ask your questions in the chat box. I got one in from Lisa and she said: I’m fine when running Comrades and have a good, strong finish, half an hour after the race, however, I feel nauseous and vomit the whole night, why would that be the case? Nicki if you want to jump in there?
NICKI DE VILLIERS: Okay, there’s quite a few physiological things that’s happening after a race for the body to try and recover from this. Blood pressure can be one culprit, there’s a very quick change in blood pressure. The other one is that there’s quite a few things that the body must deal with in terms of getting waste products away from the area and handling with that. That can be one of the causes and then a quick blood distribution where the blood then suddenly, you’ve got an increased blood flow going through to the stomach in those areas.
Another thing that often happens is that all of that carbohydrate that you took throughout the race, it’s not that all of those are absorbed quickly, at the end of the race, so if you stop running, everything is out of the stomach and those things are [inaudible 0.13.53], in other words, they’re going to draw fluid into the stomach area and seeing that you stopped running, there’s a redistribution of fluids, so therefore there will be moving more fluid into the stomach and that can make you nauseous. It’s basically left over carbohydrates in the gut that often does this.
The ideal would be to start recovering and also start recovering hydration levels, so not only look at necessarily putting more carbohydrates into it, but look at fluid intake and electrolytes through that period to try and stabilize the distribution and the blood flow to the stomach, obviously staying away maybe from food for a while, not necessarily putting in solid food into your stomach that’s already aggravated by the very high carbohydrate content.
BRAD BROWN: Excellent stuff, Lindsey, I don’t know if there’s something you want to add onto that?
LINDSEY PARRY: That’s quite a difficult one to deal with and I think a lot of it has to do with the fact that you have just spent hours and hours with the blood being diverted away from your gut and obviously this athlete is not especially sensitive to those perhaps gels or Coke or whatever it is that’s lying in the stomach. Remember, as our blood is diverted away from our stomachs, less and less of that is absorbed because it’s just harder to do so with less blood coming past. That one probably has a lot to do with the sudden rushing back of the blood into the area and people respond to this differently.
Other people would then, suddenly the stomach would work, which means that the whole intestinal process would kick-start and they get what we call the Runners Trot. We also do respond to these things in different ways. A lot of people get nauseous without throwing up and other people, the throwing up does come and that I suppose will depend a little bit on what’s in the stomach contents and other people will get ‘jippo guts’. I think the suggestion there to sip, to slowly sip on some fluids so that you can slowly kick-start that process again, getting everything moving through and to keep moving.
You want to just lie down, but if you keep moving so that there’s a more gradual return of blood flow, of your blood pressure stabilizing and you kind of more gradually come back to ground zero and then to add some solids and some more savoury type of foods, probably 30-45 minutes post activity, that will probably help, just from a practical point of view.
BRAD BROWN: There’s a follow on question to that as well and it’s along similar lines, Nicki, I don’t know if there’s anything else to add to it. Greg was saying, the weird thing is, when he hit the grass at Comrades this year, he gets nauseous and it ruins his finish. He said this year’s Comrades he was fine, 100%, as soon as he got into the stadium he says he felt ill. Could it be a mental thing as his body then knows that the end is in sight and like Lindsey said, the blood flow then starts going back from the extremities to the stomach. Could it be a mental trigger?
NICKI DE VILLIERS: I’m sure it can be. I think especially if there was no nausea throughout the whole way, just the sheer emotion you have when you see this is the end, I think can cause you to experience nausea.
BRAD BROWN: Cool, we’re touching on prevention and this is a great question from Rikus. He says he gets nausea after 38km, all depending on his pace and I think that sort of ties into what you were saying Lindsey, obviously if you’re going for a PB over a short distance, you feel like you’re going to throw up, obviously the harder you’re running from a physical exertion perspective, the more chance you’ve got of it happening. He says he stopped running Comrades after 6 times, he says he’s completed 4, he wanted to know, is there a typical experimental plan, Nicki, you were saying you’ve got to figure out what works for you, can you talk through basics with regards to trying different things in your training runs ahead of your training runs that again, it’s a trial and error thing, but is there a sort of basic way to actually work around it?
NICKI DE VILLIERS: Ja, it’s a process of elimination, I guess. There’s just so many influences, obviously the intensity being a big role as we’ve mentioned, but on Comrades, I hardly think that would be one of the main problem areas. You know what sometimes happens Brad, we eating something prior to, we get nauseous and then our first reaction is to not eat at all and blood sugar dropping can also give you quite a bit of nausea. Related to what Lindsey said previously, the first part of the race, it’s quite important to be aggressive with fuel sources. Fuel sources I mean looking at what you had prior to the race and looking what you have in that first I would say quarter of the race, it’s quite important to really see that as a fuelling opportunity.
Then looking at the specific stuff that you included, looking at what you ate prior to, if the nausea only started at 30 or after 30km, it’s probably much more what you did during that period and there’s also quite a few things involved in terms of carbohydrate sources, but different types of carbohydrates that you can take and can play around with. I just mentioned fructose a few times, sometimes some of the gels contain a blend of certain carbohydrate sources and sometimes if you use those, sometimes we just buy a gel because that’s what there is or I got some at the expo or whatever, the sugars that they use in that gel is different from what you normally use or just more of what you normally use.
Normally you run a training run on one gel, we say be aggressive and fuelling and I have two gels in the first 30km and just more of that specific sugar, so I would advise to play around with the type of fuel that you’re taking, rather than just leaving it. Look at the back of the thing, what is in there and choose another product that doesn’t necessarily have that mix and as I said, be especially aware of fructose. It’s a good sugar for us to use, but it is one that is quite prominent in causing a bit of nausea in some people.
BRAD BROWN: Nicki, it’s quite a tough one, particularly in a case like this for Rikus where he says he gets nauseous after 38km, obviously with it being a trial and error process, you can’t get to that point in your training, every second training run. You really have to be sort of, you’ve got to plan this, it’s not something you can do by accident, particularly when it’s happening that long in a run.
NICKI DE VILLIERS: I would suggest that over fuel a little bit in some of the shorter trainings so that we can see if it is some of the sugars that’s influencing it. The other thing that obviously can cause the nausea, it’s too aggressive in fuelling, so that we just put too much carbs in the gut and also then not diluting those carbs. If it is a gel that he’s running with, we can experiment with maybe some other things and see if solid food wouldn’t work better and so forth. The aggressiveness of fuelling can also obviously cause it and especially with fluid intake.
What we’re going to do in the race, we have to try and obviously do something different, if this is what’s causing the nausea and the one thing I would definitely look at is looking at, the first question to answer is, is it too little or is it too much, that’s the one thing and then also look at the hydration, was it too much fluid or too little fluid. It would be interesting in the longer runs that he takes, the longer training runs, if nausea would appear there as well or is it only during the races.
BRAD BROWN: We’re going to get onto over hydration a little bit later on in this chat as well and there’s a couple of questions coming with regards to that, but this is an interesting one as well Nicki, like I said, I’m lucky that I haven’t experienced this, but if I think back to my dad’s running career, this is something that happened to him and Ryan is asking this question. He says he’s run 9 consecutive Comrades Marathons and he’s suffered with terrible nausea for the last 3 of them, usually around Drummond. That’s half way on both the up and the down, he says it didn’t happen in the first 6 years, since he’s started he says he hasn’t changed anything with regards to what he’s doing and that sort of thing.
My dad used to be exactly the same, he says he’s consulted a gastroenterologist, he suggested gastric emptying and prescribed some meds for him. The nausea persisted, he’s subsequently consulted Prof [Dermin?] in Cape Town and he suggested that it wasn’t gastric emptying, but told him to see a cardiologist. He did this with the cardiologist and he said everything was fine. He says he’s been nauseous in half marathons, actually vomiting on the side of the road, is it something that becomes more prevalent later on in your running career? I don’t mean later as you get older, but once you’ve done numerous, particularly Comrades Marathons, it has to have an effect on your body long term, could that be something that we need to be cognizant of as well?
LINDSEY PARRY: What I want to say is one of the things that Nicki alluded to in her causes was dehydration and one of the things that certainly has happened over the last couple of years of Comrades is that Comrades has gotten hotter and hotter. Our physiology doesn’t respond particularly well to heat. It forces us to run slower, it means it diverts more blood away from the stomach to the surface of the skin to help us cool down. One of the reasons why nausea could be so on the increase is just because of the increase in physiological stress that people are under and the other thing I wanted to add because I think then Nicki will be able to take the answer a bit further, is that often in, and I’m going to use the word ‘allergy’ very loosely now, but in allergies, typically if you’re allergic to dogs or bees or whatever it is, the more of that stimulus you receive, the worse that allergy becomes over time.
If you develop an intolerance to fructose or glucose for that matter, then it stands to reason that that intolerance will become worse and the onset of it will be earlier, will gradually become earlier as you become less and less tolerant to it. In that scenario, then I would start looking at alternate forms of energy altogether.
BRAD BROWN: Brilliant, go for it Nicki.
NICKI DE VILLIERS: I’ve seen two or three studies where it actually shows that people are doing better in the first few years after the onset of running and that here in the middle years stuff gets worse and I’ve read about it because that’s often what I find in practice as well, that everything is fine and then all of a sudden we struggle and then we struggle a lot.
Referring back to the motility and the gastric emptying and those kind of things, it seems that running doesn’t change, I mean it does change a bit of the oesophagus motility and it does change a bit of the stomach motility as such, but it’s not so severe if we don’t run hard, so in a Comrades, for instance, if it’s much more duration than what it is this very, very intensity, but most of the studies tell you that it doesn’t really increase the gastric emptying, it can decrease the gastric emptying, but not running as such, more the dehydration part of it and the motility as well.
What can happen because of this constant blood, that the stomach doesn’t get or the gut doesn’t get blood, there’s an increase in what we call permeability in the gut epithelial layer. It sounds very complicated, but it’s not really, it just means that your barrier in your gut that’s supposed to keep stuff in the gut instead of sending it to the blood, you easier then absorb stuff into the blood that’s not supposed to be there and this is just because there’s not enough oxygen going to the gut as such. This can also throughout the years have an influence, so that maybe we must look at feeding the gut, there’s a few supplements and stuff that you can use to make the gut barrier a little bit stronger in these cases. Maybe it’s the same sugar we’re working with, but the digestion is just not complete before it gets into the blood and that sometimes also can cause this nausea in late onset, later in your running life.
BRAD BROWN: All right, cool, there’s lots more questions coming through. Let’s touch on how to cope with it Nicki. If you’re in the middle of a run, the last thing you want is for it to strike, but it does, let’s be honest, that’s why we’re here today to talk about it. We’ve touched on how to prevent it and trial and error and what you need to figure out, but happens if you hit halfway in Comrades or you’re 6km out of a marathon and you start feeling ill, what’s the best way to deal with it?
NICKI DE VILLIERS: Brad, it’s a difficult one, but I would suggest that you stop the intake first, stop carbohydrate intake for the next few K’s. If we can get blood back to the gut just for a while so we can try and clear whatever is in there, it usually goes better, people usually feel better if they vomit, they can carry on. It’s those that can’t get to vomit that really struggle. That would be the one thing.
To look at dehydration versus fuel intake. I would stop necessarily the fuel, especially if you had an aggressive fuelling before you get nauseous, look at if dehydration is a possibility, to carry on with hydrating with small amounts, regularly throughout, but I think the best advice I can give is to just stop carbohydrates for a while so that we can just clear whatever is in the stomach before we carry on.
BRAD BROWN: Lindsey, do you want to jump in there as well for some practical strategies on how to deal with it on the run?
LINDSEY PARRY: I would increase the amount of walking you do, cause for a start, you want to try and get some of that gastric emptying improving a little bit. One of the ways we can do that is by dropping the intensity. Even though the intensity on Comrades is quite low anyway because we’re running quite slowly, we can drop that intensity slightly again by walking and then take note of how thirsty you are and I would move to mostly drinking water, particularly if you are extremely thirsty and it’s a particularly hot day and then in a way, to try and help to drive that thirst, I would try to take in slightly saltier foods. When you’re feeling nauseous, maybe it doesn’t sound like a great idea to eat anything, but if you have a few small nibbles of salted chips, for example, just something with a bit of salt to stimulate your thirst a little bit.
The one thing I left out which I would very definitely try first up and it doesn’t sound amazing, but I would actually physically try and throw up because if it is just a case of having a stomach that’s too full of sweets mixed up and your stomach lining is not doing its job, often if you just purge your body of whatever is in there, then you can go about just slowly sipping a bit of water and then perhaps in another hour or so you can stand the thought of having a little bit more food. Once that’s done or if you can’t do it or if you are continuously throwing up, that’s one of the hardest things, but if you are continuously throwing up and you do need to be aware that you may get yourself into a very dehydrated condition, you just need to sip small amounts of fluid.
If you take one sachet, you might take the entire duration between water tables to get that sachet, you literally just have a slow trickle or get ice, often sucking on ice and letting that water slowly trickle into the system, that’s not a bad way of doing it.
BRAD BROWN: All right, fantastic, keep those questions coming through. There’s lots of them coming through this afternoon. Let’s get into over hydration. This is something that I think a lot of people, I don’t want to say misunderstand, but obviously over many years there’s been a huge talk about dehydration and how dangerous it is, but it turns out that over hydration is way more dangerous than dehydration. Prof Noakes, if you’re interested in this and reading up on it, his book Waterlogged is probably a good starting point with regards to over hydration and why it’s so dangerous. Nicki, over hydration is a huge problem, particularly at a long race like Comrades or Old Mutual Two Oceans, it does become a serious issue.
NICKI DE VILLIERS: Yes it does, it’s maybe not that prevalent, but if it’s an issue, it’s serious, that’s one of the aspects and especially with regards to the weather. With Comrades I think we’re still lucky because of the extreme hot weather that’s usually prevalent there, I think we’re lucky that we probably don’t see that many cases, but I think as soon as it’s a cooler day and I’ve got this strategy of drinking that regularly, I think you’re definitely prone to over drinking or water intoxication or whatever you want to call it.
The best thing, I think, you have to drink according to thirst, that’s first of all quite important to not force stuff down when it becomes difficult for you to drink, not to keep on drinking just because you think dehydration is going to cause me to stop this race. The other thing again, looking at your training efforts. If you can work out a little pattern or schedule that you do in training and know that probably my sweat rate is around this or that and drink according to that schedule. We don’t want people to, for instance, if you weigh yourself prior to and after training, I don’t want you to pick up weight because that will give you an indication that you may be drinking way too much fluid whilst you’re out there.
There is a caution about it and I think the confusion is quite heavy in terms of should I drink or should I not drink, but I think in those longer races, that thirst mechanism is quite an important one and just be aware of it, I think that’s important. There are lots of water tables, so if you become thirsty, it’s not that long before you hit something to drink. I think that would be wise advice, to drink according to thirst whilst you’re out there.
BRAD BROWN: Nicki, let’s touch on what over hydration is. For someone who has heard the term, can you in layman’s terms explain to us what over hydration is?
NICKI DE VILLIERS: It’s about diluting the electrolytes, especially sodium in the body. Over hydration, if you drink too much fluid for amount of sodium that’s there, that sodium balance is quite important for basically controlling our water balance between membranes in the body. If we drink way too much, there’s a decrease of sodium in the blood, as such, then we’re very prone to [inaudible 0.35.11], if it’s happening in the brain, then that’s what we’re scared of because that can really lead to dire consequences.
It’s basically drinking too much fluid with too little electrolytes or especially then sodium in it. If we want to work on the other side of this, say okay, we’re going to drink a lot, let’s take a lot of sodium with it to try and balance this, you’re hardly going to achieve that because taking in that much sodium is really going to be horrid in a drink, you’re going to feel like you’re drinking sea water. That’s not really going to help. It works much better to work on the hydration side of the equation that we rather control it.
It’s basically just the dilution of electrolytes and especially then what we talk about is sodium in the blood that can cause this over hydration or water intoxication symptoms.
BRAD BROWN: Brilliant, I mean we talk about the dangers of it and people often think that dehydration is way more dangerous, but that’s not the case. Can you tell us why it’s dangerous? You could literally die from being over hydrated, can you not?
NICKI DE VILLIERS: Yes you can.
LINDSEY PARRY: Effectively what’s happening is that your chemical process has become completely disrupted because our body works on shunting things from high pressure to a low pressure across a membrane and if, that’s cause of osmotic potential, if your osmotic potential starts to reach zero, your body can’t move fluids around anymore and as Nicki pointed out, you then get a situation where you get pressure buildup in the brain. Your body can’t get rid of the water effectively because we continue to put more fluid in.
Then what happens is that we go into a coma and the reason we go into a coma is because our body is really just protecting us from ourselves so that we do not drink anymore and then we often mistaken that for heat stress or dehydration and [pop a drip in?] and that’s when people do die from hypernatremia and over intoxication and that’s why it’s so dangerous. Nicki said it, I think three or four times I counted it when she was talking, in a race of this nature, where the intensity has dropped and our sweat rates are dropping, if you use thirst as your guide, you’re very unlikely to get yourself into this situation. If you’re thirsty, drink, if you’re not thirsty, don’t just drink because you’re at a watering table.
BRAD BROWN: Lindsey, you make a very important point there, don’t just drink cause you’re at a water table. If you’ve never run Comrades, you’re in for an interesting experience because the latter half of Comrades, the water tables become so close together that you can almost see the next one from the one you’re at. If you think you need to drink at every single table, there’s a good chance you’re going to get yourself into a bit of trouble being over hydrated and being too much liquid, particularly in your gut. A great question in, Nicki, I don’t know if there’s anything else you want to add onto the over hydration before we get into a couple of other questions. We’ve got a few great questions in?
NICKI DE VILLIERS: No, shoot.
BRAD BROWN: I think this is fantastic, it’s from Damian and he wanted to know, how important is solid foods in an ultra. Is it not possible to run a race like the Comrades on fluids alone?
NICKI DE VILLIERS: It will be possible to run the race on fluids alone, it just makes much more sense, the body absorbs much better if I give a different type of carbohydrate mixes, so therefore if you’re used to only running on fluids and there’s no risk for having any gastrointestinal distress, in other words, your stomach is fine and you never battle with it, then you probably will be able to race on fluids, you’re probably get hungry, depending on the intensity of what you’re out there with, but it does seem that it helps to combine different carbohydrate sources. I would definitely ask somebody to, especially if they’re going to be out there for long, to experiment with solid food as well, but it’s not a must. As long as you get the fuel in and you’re comfortable with the way you get it in, there shouldn’t be an issue that you we have to force people to eat solid food at all for that matter.
BRAD BROWN: All right, let me get into another question, what about taking anti-nausea tablets before a run?
LINDSEY PARRY: I’m always very wary about taking any kind of medications, if a miracle cure, like anti cramping stuff, I would firstly have a look at their efficacy, what research was done and obviously try it in advance. If you’re talking specifically about taking medicines that are designed to take away nausea when you’re sick, I would not do that without getting medical advice and look, I know some doctors are happy to let people run on anti-inflammatories and pain killers, but those can have some extremely serious side effects and in fact, we’re busy talking about nausea and that’s the one thing we haven’t mentioned, but anti-inflammatories in particular can trigger extreme nausea during exercise.
Medicines in themselves can lead to irritation of the stomach lining and the intestinal tract, which then also leads to nausea, but I would firstly check with the doctor around nausea medication is, is it safe, what are the potential side effects and don’t ever take that sort of medication without the knowledge of your medical doctor and the people that are watching you in the race because if they don’t know what you’ve taken and something starts to go wrong, they don’t know where to start looking. If you know that there are certain side effects that can come from taking anti-nausea medication, for example, and something starts to happen to you, people can say very quickly once they get hold of your emergency contact, he was taking pain killers, anti-inflammatories, nausea medication or whatever the case may be.
BRAD BROWN: Fantastic, a question in from Barbara, Nicki, I think this one I can pass onto you cause you mentioned glucose and that earlier in the seminar. It’s from Barbara and she wants some advice, in the past she thinks that she hasn’t taken enough in terms of glucose on her runs. She’s now finding that nougat is a great source of that while she’s running, she just needs to be careful that she doesn’t eat too much. She said she felt a little sick at the Meiringspoort half marathon this past weekend and she thinks she ate too big a piece in the run. Do you think that not having enough glucose could be the cause of Barbara’s nausea?
NICKI DE VILLIERS: Very definitely. If blood sugar levels drop, it can be that people will feel nausea because of that and if those nougats work, it’s perfect. Again, eating too much of it is also going to make you nauseous, I would definitely, if the lack of fuel is what’s troubling her and she thinks she’s over eating on a nougat, experiment with different carbohydrate sources. Have whatever they have at the table and just lower the intake of the nougat, but it’s a perfectly fine source of carbohydrate, it shouldn’t be a problem at all, but if you’re going to eat too much of it, it’s definitely going to make you nauseous. I think she did a good thing, maybe just experimenting with it once more and maybe bring in a second carbohydrate source and decrease the amount of nougat that she eats.
Remember, it’s also a solid that goes into the stomach and another thing that can make people nauseous, some people are not good with running and eating, so if we walk whilst we’re eating, that we just swallow less air as well, this can sometimes also help a bit, so that we don’t have that much air in the stomach.
BRAD BROWN: Eating too much nougat, even when you’re not running, could make the best of us nauseous, so Barbara, I hope that helps. A quick question in from Janet, blood pressure was mentioned a little bit earlier, she wanted to know, is there a correlation between high blood pressure and nausea when running, Lindsey can I hand this one over to you?
LINDSEY PARRY: Look, low blood pressure is normally the one that’s associated with dizziness and nausea. Hypertension is normally more related to headaches than actual nausea and it’s normal for your blood pressure to go up during exercise, it’s quite normal for it to go up quite high, particularly in high intensity exercise, but if it’s going up excessively high and the only way we can track that is by actually doing a test with a cardiologist or someone who works in a cardiology practice, we don’t want abnormally high blood pressure and especially you don’t want to have abnormally high diastolic. When you get blood pressure, it gets given to you as two numbers, typically resting is somewhere between 110 and 130, being considered quite normal, over 60 to say 70, maybe 80, but that’s starting to get up a bit.
When that bottom number starts to push over 90 and heading towards 100 during exercise, that would be alarming, but it should be associated with headaches and when your head feels like you can feel the pulse in your head and you feel that pressure build up in your head, nausea would normally be associated with low blood pressure rather than high blood pressure.
BRAD BROWN: Right, I hope that helps. Another question in from Belinda, says I’ve recently returned to running on the road after a two year recovery period from back surgery. She says she has received the go-ahead from her surgeon. She spent the last 4 months preparing to get back into training and loving every minute. She’s using a run/walk strategy at the moment. She’s running 100m, walking 100m, she’s only covering 5km distances at a time now and working on improving her time over that distance. The problem is that she finds when she pushes herself harder, the more nauseous she feels, what’s the cause of this? She doesn’t eat before training and doesn’t consume copious amounts of water before training. She says: Please advise, this is an awful sensation and one that I’ve not experienced before. Lindsey, it ties into increasing your intensity.
LINDSEY PARRY: Ja, so there’s two parts to this answer. I’ll pass the ball to Nicki for the other part but yes, when you run at very high intensity, now, in this instance it may not feel like very high intensity because you haven’t run for a long time, so you might not feel like you’re running particularly hard, but if you’re pushing yourself very hard, then you will develop high amounts of blood lactate, so your muscles will product lactic acid because they cannot produce enough energy from using oxygen or pathways that involve oxygen, so they start making energy from pathways that do not use oxygen and that has lactic acid as a byproduct and while lactic acid in itself is not the bad guy that everyone makes it out to be, I don’t want to get this answer too complicated, but in terms of the extreme nausea that you feel, very high levels of blood lactate will make you feel nauseous.
The other part, she says she’s not eating or drinking, so that in itself is problematic and one of the things that Nicki has explained to my athletes a lot and it’s made a big difference to them, is that you either fuel before exercise or you fuel during exercise. If you are going into exercise and it’s been too long since you’ve given yourself fuel, and you perhaps had a busy day and you’re a little bit hypoglycaemic before the exercise, that can also lead to the nausea in exercise because of low blood sugar. I don’t need to pass the ball over, I think I answered the question but Nicki might have something more to add.
NICKI DE VILLIERS: Nothing more, just the hydration part as well, especially if it’s early morning where you’re usually dehydrated, so make sure you drink something as well.
BRAD BROWN: Perfect, Nicki, I’m going to ask you this question because I think you mentioned it, Robyn wanted to know, she said, when you spoke about, or was it Lindsey, I’m not sure, you spoke about gut permeability, you mentioned oxygen saturation, could your oxygen saturation level be related to nausea?
NICKI DE VILLIERS: A better question for Lindsey I think.
LINDSEY PARRY: Look, it can be, and I think it probably goes on a couple of, it speaks to a couple of points. Let’s take the extreme example of someone coming from Cape Town or Durban, or the UK, and going to do a race in Mexico City at 3 000m, there’s immediately going to be an oxygen deficit, again, not a great phrase, but it explains what I’m trying to get at. There’s not enough oxygen to go around, therefore you immediately are pushed into a scenario where you are having to produce a large amount of energy from pathways that don’t use oxygen and as soon as we do that, then there’s an increase in metabolite or byproducts of energy production and when that happens, there is an increased degree of nausea that would be associated with exercise.
I’m using a very extreme example, but that would probably lead to, someone coming from sea level straight to competing at 3 000m, even at low intensity exercise, they’d probably feel dizzy, light headed and nauseous quite early in the exercise. One of the things we haven’t touched on at all and it just came into my head while we were talking, and it’s not a common thing that happens to people, but it does happen to some people, this phenomenon of what we term rebound hypoglycaemia. So you do all the right things before you exercise, but in a small percentage of people, just the act of starting the exercise means there’s a sudden increase in blood sugar followed by an immediate drop in blood sugar, which leads to feeling dizzy and nauseous, but that typically doesn’t happen during exercise and Nicki can correct me if I’m making any mistakes in my explanation. That typically wouldn’t happen into exercise, that’s something that happens quite early and at the onset of exerciser or just before exercise.
NICKI DE VILLIERS: That’s correct, that’s basically just timing of your meal and then working a little bit, intensity can also make that better, to include a bit of high intensity warm up, a little bit of that. That is such a small percentage of people and it’s really right at the onset.
BRAD BROWN: Talking of intensity, this is also a fabulous question, we’ve spoken and mentioned that the intensity of the race makes a difference, does that mean that there’s a different approach as far as a different eating and drinking plan to nausea, if you’re trying to run a silver medal at Comrades as opposed to a 10 hour or 11 hour or 12 hour. Lindsey, intensity, it obviously depends on your ability. For someone like me to try and run a silver medal, I’m going to puke within the first kilometer, whereas someone who has trained for a silver, the intensity is probably the same, I’m guessing, if that’s the medal you’re going for. How would you approach that?
LINDSEY PARRY: There is a difference and there’s a difference for a couple of reasons. The first one is the most obvious and that is because if I’m going for a 6 hours, 6.5 or 7 hour, I’m going to be consuming far less calories over a far shorter period of time than somebody who is running 10-12 hours. One of the main differences is the duration. You are more likely to get away with nausea if you are running faster, although there are still a lot of people up at that speed that do suffer from nausea and then there’s also the relative intensity. There are similarities in terms of relative intensity. I would perhaps be running a 7:15 Comrades where someone else may be running a 8:15 Comrades and the intensities that we’re running at are fairly similar, but by the same token, there’s going to be loads of people that a 9 hour, it’s just out of the question.
They’re not going to run at that intensity so that they can get 9 hours and 15, they’re going to run much easier and get a 10 or a 10:50, so there are different nutrition strategies, fluid rates that need to be taken into account for someone that is really pushing the envelope to run 7:55 and someone who is running a very comfortable 9:45 because they know they’re not going to go under 9, so let’s rather just enjoy it.
BRAD BROWN: I love that, a very comfortable 9:45, in my wildest dreams! Nicki and Lindsey, before we wrap things up, we are running out of time, I just wanted to touch on those running resources and the first one is Nicki de Villiers. Nicki is superb, I mentioned at the start of the seminar that she works out of the High Performance Centre at the University of Pretoria. She’s worked with some of South Africa’s top athletes, not just runners, she’s worked across the board. There’s some great athletes that train out of there and if you want some one-on-one help from Nicki, if you’d like to book a consult or find out more about her rates and what she does, you can pop her an email. That’s the email address, it’s: nicki.devilliers@hpc.co.za. You can also call the office line, it’s 012-4841711, I’ll pop those details in an email to everyone as well when we’re done with this.
So Nicki, let me say thank you to you for joining us today, it’s much appreciated, your time and Lindsey, thank you to you as well.
LINDSEY PARRY: Absolutely pleasure.
BRAD BROWN: If you’ve got any questions about the Coach Parry membership community as well, you’re more than welcome to pop those into the question tabs as well, but it looks like we’ve done pretty well on the questions. Lisa just wanted to know, does chewing gum along the way help with nausea?
NICKI DE VILLIERS: It would be individual. I would think it would aggravate nausea, but if that is one of the things that you’ve tried and tested and it works for you, go for it.
BRAD BROWN: Fantastic, there you go, that’s pretty much it for the questions. That link once again if you want to join the Coach Parry online community, it is coachparry.com/membershipoptions, you can sign up there right now. From the three of us, myself, Brad Brown, Lindsey Parry and Nicki de Villiers, thank you so much for joining us. We look forward to having you along for the next one. Until next time, cheers.
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Hosted by Brad Brown, join Coach Parry and resident dietician at the High Performance Centre at the University of Pretoria Nicki de Villiers as they discuss nausea. In this video training you’ll discover the most common causes of nausea, how to prevent nausea and what to do when you feel ill in the middle of the run. You will discover the dangers of overhydration and what you should do to avoid it.
Transcription
BRAD BROWN: Here we go, welcome everyone to the next Coach Parry online seminar. We’re coming to you live today, it is Wednesday and we’ve got folks from all over the show once again. Thanks for joining us from around the planet, wherever you are, if it’s morning, evening or afternoon, welcome, it’s good to have you with us. Just to run through a couple of formalities before we get into why you’re actually here and to find out how to beat nausea, let’s cover who is online and who we’ve got with us today.
I’m Brad Brown, I’m going to be hosting it and holding everything together and making sure that everything works. We’ve also got Nicki de Villiers who is the resident dietician at the High Performance Centre at the University of Pretoria, Tukkies, Nicki is with us as well and then we’ve got Lindsey Parry, the official Comrades Marathon coach, he joins us today as well, Coach Parry on the line. How this is all going to work, just to run through a couple of the things we’re going to cover today, so you can stick around and know what exactly is coming up. What you’re going to discover today, the common causes of nausea, as well as how to prevent nausea, that’s a pretty big one. How to cope when it strikes in the middle of a run and then we’ll also be chatting quite a bit about over hydration and why that is so dangerous and then we’ve got a couple of great running resources for you as well, which we’ll share with you later on in this webinar, you’re not going to want to miss out on that.
Then, if you would like to ask a question, you’re more than welcome to, at any stage during today’s seminar, all you need to do, in the question bar, just type your question in, we might not be able to get to it straight away, but we will definitely get to it at some stage through the seminar. All you need to do is type your question in there. If you’ve got any comments or if there’s anything else that you’d like to know, just pop it in there as well.
Before we get started, I just want find out for my own interest, obviously we’ve re-launched the seminars and I want to know, if you look in the little bar that you have on the right, where the questions are, where the chat is, I want to know how many of these online seminars have you attended with us here on Coach Parry. Is it your first? Have you been to one? Have you been to between 2-5 or more than 6 over the years that we’ve been doing this, I’d love to get your thoughts, so if you wouldn’t mind just taking a second and just popping it in the poll section, let us know how many of these you’ve attended.
Let’s get straight into today’s seminar and let me introduce and say howzit to our panelists on the line. We’ll start with Nicki de Villiers, Nicki welcome, it’s great to have you on, are you well today?
NICKI DE VILLIERS: Ja, very well, thanks for asking me to join.
BRAD BROWN: No prob, all the way from Pretoria, I’m sitting in the horrible city of Cape Town at the moment, looking at the mountain, it’s terrible J I hope your view is as nice as mine in Pretoria. Lindsey Parry joining us as well, Lindsey, howzit.
LINDSEY PARRY: Ja, very good thank you, also chilling at home, overlooking my beautiful garden, thanks, courtesy of the students at Pretoria University.
BRAD BROWN: All right, we’re all comfortable, we’re all sitting down, let’s get straight into it and obviously the first thing we want to look at is what are some of the common causes. Nicki, I’m going to ask you to jump in here, why do people suffer from nausea when they run?
NICKI DE VILLIERS: Brad, there’s quite a few speculations, I wish we had a clear cut answer. One of the things in our research is that there’s a change of blood flow, so we’ve got less blood going to the stomach and more to the muscles and the lungs and all the other supporting organ systems. If there’s less blood to the stomach, we obviously have to look at what we put into the stomach because there’s going to be a reaction to it. Then there’s obviously causes that’s just basically bound to your running, the impact with a stomach consistently moving up and down and then there’s definite nutrition aspects, stuff that we put in there that’s not necessarily due to the decrease in the blood flow, but just because those are nutrients that’s not really well coped with during running.
If I look at those nutrients, it’s basically the stuff that’s going to stay in the stomach for a long time, considering especially fibre foods, very high in fibre, stuff that’s very high in fat, especially heated fat that we eat prior to running, that’s going to stay there for a while. Very heavy protein meals and then more and more indication of the type of carbohydrate that you put into the stomach and that certain ones are not that easily clear, we look at specifically fructose as being quite a villain in all of this and then never disregarding the hydration issues. As soon as we high power hydrate, as soon as we’re dehydrate then, there’s even less blood going to the stomach area, which can obviously aggravate all of these.
BRAD BROWN: There’s lots, like you say, there’s no one cause, if it was that simple, no one would be suffering from nausea and unfortunately it’s one of those things, I’m sure that runners need to figure out along the way, what triggers it, what causes it and how they can prevent it. It’s almost like an experiment of one, essentially.
NICKI DE VILLIERS: Ja, and that is why it’s so important that whatever we’re going to do in a race, we have to do in training to figure out what is working, what is not working and then obviously also considering that all of these get worse the longer you run. Although we’re not always training on the same durations of our races, it can get worse towards the end of the race, just because of the pure duration of what we’re doing.
BRAD BROWN: Lindsey, you chat to a lot of runners as well, Nicki’s covered pretty much all the bases, what are some of the common things that you pick up why people struggle and get nauseous on a run?
LINDSEY PARRY: I think for me one of the main factors is the constant need to keep your nutrition up and then in a race like Comrades, that’s incessant taking of things which are easy to carry, so gels being probably one of the major culprits, just taking very sweet foods over and over and over again for such a long time. I know Nicki is going to talk to some of the ways to prevent it, but one of the things that she said as she was ending off speaking there was to talk about managing it on race day and one of the things that I found, particularly in races that last longer than 4 hours, is that if we look after our nutrition early in the race, while the blood is still flowing to the stomach, before we’re getting too fatigued, before the stomach is getting too bloated and too full, too irritated from the things that we’re putting into it, if we are then very good about getting our recommended amount, depending on who you’re working with, you’d be recommended between, somewhere in the region of 55 to as much as 70-80g of carbs an hour, that will become quite stressful on your gut.
If you do that early in the race, but then you back off a little bit, even for a couple of hours, 2-3 hours where you aren’t so good about your nutrition, you’re just sipping a little bit of water here and there, I then find that you actually start to get quite desperate for some nutrition and for the last couple of hours of the race you can put in what you need to get to the end. That’s just really a practical way of how I’ve dealt with it in any race and hopefully Nicki has got some good tips to give us on what to do and what not to do in the lead up to and during the run.
BRAD BROWN: Before we get into that, Lindsey, I just want to ask something and Nicki, you can jump in here too. Lindsey, you mentioned that it occurs for a lot of people on runs longer than 4 hours, if nausea exclusive just to long runs? I’m lucky – touch wood – I don’t suffer from it, but it can strike at any time? If you’re only running up to 10, could you suffer from nausea on a 10km run or perhaps a run that’s taking an hour or is it specifically something that people who run marathons and ultra-marathons struggle with?
LINDSEY PARRY: I’ve heard of it in half marathons. If you were getting nausea in a short event, something like a 10km, I would be a little concerned. There are probably some things that if you eat for breakfast could perhaps cause nausea during running, but I would be much more concerned that there’s some sort of cardiac or cardiovascular issue that’s causing nausea in the shorter runs. Of course you’re excluding when you’re absolutely racing flat out, eyes on stalks for a PB because then that’s an entirely different kind of nausea that you’re going to experience.
If you’re running a fairly standard 10km and you’re getting nauseous that early, I would certainly do some investigations. Nicki will be able to give us, I’m sure she does come across people who just suffer from nausea full stop.
BRAD BROWN: Before we get into that, there’s a poll up on the screen, I just want to find out exactly where you suffer nausea from, so pop that in there and let us know where it strikes for you on your run. Nicki, let’s chat about that now. How do you counter it, how do you deal with nausea?
NICKI DE VILLIERS: Ja Brad, I think especially in the shorter races, it’s sometimes easier to deal with it because it’s probably something that you ate or did not eat prior to going into that run. We have to then obviously look at exactly what was the pre event meal. So pre event I mean anything that you ate from waking up until you hit the road. Look at what is part of that meal, often as I say, people put a lot of fibre in there that can have a bit of a problem. Was there fluid intake, any kind of fluid, just to make sure the hydration is up to date. It’s very evident that once there’s fluid in the stomach when you start running, the clearance of fluid throughout your run would be much, much better, so it is enhanced. We have to look at the fluid intake there as well.
Then offending foods, so a lot of people will get nauseous with specific foods. They can tell me, I ate this or that, so there’s a lot of nausea complaints with, as I say, excessive fat intake, if I had bacon and eggs prior to, if I had excessive amounts of protein maybe prior to this, some people may be struggling with that and then specific herbs, specific spices, looking especially at fructose. Fructose is the sugar that we get in fruit, so if you’re not used to eating fruit all day long or regular fruit intake and you eat a lot of fruit right before you go for a run, that can cause a bit of nausea.
Some people struggle with caffeine. Being a drug that will enhance performance, but some people struggle with drinking caffeine prior to and that can cause a bit of damage in terms of nausea and then also milky products and some have to experiment with a little bit of milk or yoghurt or stuff that we use. It is so individual that it’s important that we do understand that what makes the one nauseous is not going to make the other nauseous and that’s why it’s so important to experiment with these things in the mornings when you go on training runs because if we’re going to have to listen to everybody telling you what they avoid, we’re going to end up with nothing left to eat except for maybe water, that’s quite important.
Then very, very important, look at the timing of the meal. Hey, we can’t eat a whole load of stuff, think we’re going to go into a race, especially if you’re going to have a quick start. That is important then to decrease the amount of food that you eat prior to it, if you’re going to have a very low start and the race is full and you’re going to walk a few K’s, then you can probably have a bit more food in the stomach as such.
BRAD BROWN: Let’s jump into a few questions and there are a few coming through. You can ask your questions in the chat box. I got one in from Lisa and she said: I’m fine when running Comrades and have a good, strong finish, half an hour after the race, however, I feel nauseous and vomit the whole night, why would that be the case? Nicki if you want to jump in there?
NICKI DE VILLIERS: Okay, there’s quite a few physiological things that’s happening after a race for the body to try and recover from this. Blood pressure can be one culprit, there’s a very quick change in blood pressure. The other one is that there’s quite a few things that the body must deal with in terms of getting waste products away from the area and handling with that. That can be one of the causes and then a quick blood distribution where the blood then suddenly, you’ve got an increased blood flow going through to the stomach in those areas.
Another thing that often happens is that all of that carbohydrate that you took throughout the race, it’s not that all of those are absorbed quickly, at the end of the race, so if you stop running, everything is out of the stomach and those things are [inaudible 0.13.53], in other words, they’re going to draw fluid into the stomach area and seeing that you stopped running, there’s a redistribution of fluids, so therefore there will be moving more fluid into the stomach and that can make you nauseous. It’s basically left over carbohydrates in the gut that often does this.
The ideal would be to start recovering and also start recovering hydration levels, so not only look at necessarily putting more carbohydrates into it, but look at fluid intake and electrolytes through that period to try and stabilize the distribution and the blood flow to the stomach, obviously staying away maybe from food for a while, not necessarily putting in solid food into your stomach that’s already aggravated by the very high carbohydrate content.
BRAD BROWN: Excellent stuff, Lindsey, I don’t know if there’s something you want to add onto that?
LINDSEY PARRY: That’s quite a difficult one to deal with and I think a lot of it has to do with the fact that you have just spent hours and hours with the blood being diverted away from your gut and obviously this athlete is not especially sensitive to those perhaps gels or Coke or whatever it is that’s lying in the stomach. Remember, as our blood is diverted away from our stomachs, less and less of that is absorbed because it’s just harder to do so with less blood coming past. That one probably has a lot to do with the sudden rushing back of the blood into the area and people respond to this differently.
Other people would then, suddenly the stomach would work, which means that the whole intestinal process would kick-start and they get what we call the Runners Trot. We also do respond to these things in different ways. A lot of people get nauseous without throwing up and other people, the throwing up does come and that I suppose will depend a little bit on what’s in the stomach contents and other people will get ‘jippo guts’. I think the suggestion there to sip, to slowly sip on some fluids so that you can slowly kick-start that process again, getting everything moving through and to keep moving.
You want to just lie down, but if you keep moving so that there’s a more gradual return of blood flow, of your blood pressure stabilizing and you kind of more gradually come back to ground zero and then to add some solids and some more savoury type of foods, probably 30-45 minutes post activity, that will probably help, just from a practical point of view.
BRAD BROWN: There’s a follow on question to that as well and it’s along similar lines, Nicki, I don’t know if there’s anything else to add to it. Greg was saying, the weird thing is, when he hit the grass at Comrades this year, he gets nauseous and it ruins his finish. He said this year’s Comrades he was fine, 100%, as soon as he got into the stadium he says he felt ill. Could it be a mental thing as his body then knows that the end is in sight and like Lindsey said, the blood flow then starts going back from the extremities to the stomach. Could it be a mental trigger?
NICKI DE VILLIERS: I’m sure it can be. I think especially if there was no nausea throughout the whole way, just the sheer emotion you have when you see this is the end, I think can cause you to experience nausea.
BRAD BROWN: Cool, we’re touching on prevention and this is a great question from Rikus. He says he gets nausea after 38km, all depending on his pace and I think that sort of ties into what you were saying Lindsey, obviously if you’re going for a PB over a short distance, you feel like you’re going to throw up, obviously the harder you’re running from a physical exertion perspective, the more chance you’ve got of it happening. He says he stopped running Comrades after 6 times, he says he’s completed 4, he wanted to know, is there a typical experimental plan, Nicki, you were saying you’ve got to figure out what works for you, can you talk through basics with regards to trying different things in your training runs ahead of your training runs that again, it’s a trial and error thing, but is there a sort of basic way to actually work around it?
NICKI DE VILLIERS: Ja, it’s a process of elimination, I guess. There’s just so many influences, obviously the intensity being a big role as we’ve mentioned, but on Comrades, I hardly think that would be one of the main problem areas. You know what sometimes happens Brad, we eating something prior to, we get nauseous and then our first reaction is to not eat at all and blood sugar dropping can also give you quite a bit of nausea. Related to what Lindsey said previously, the first part of the race, it’s quite important to be aggressive with fuel sources. Fuel sources I mean looking at what you had prior to the race and looking what you have in that first I would say quarter of the race, it’s quite important to really see that as a fuelling opportunity.
Then looking at the specific stuff that you included, looking at what you ate prior to, if the nausea only started at 30 or after 30km, it’s probably much more what you did during that period and there’s also quite a few things involved in terms of carbohydrate sources, but different types of carbohydrates that you can take and can play around with. I just mentioned fructose a few times, sometimes some of the gels contain a blend of certain carbohydrate sources and sometimes if you use those, sometimes we just buy a gel because that’s what there is or I got some at the expo or whatever, the sugars that they use in that gel is different from what you normally use or just more of what you normally use.
Normally you run a training run on one gel, we say be aggressive and fuelling and I have two gels in the first 30km and just more of that specific sugar, so I would advise to play around with the type of fuel that you’re taking, rather than just leaving it. Look at the back of the thing, what is in there and choose another product that doesn’t necessarily have that mix and as I said, be especially aware of fructose. It’s a good sugar for us to use, but it is one that is quite prominent in causing a bit of nausea in some people.
BRAD BROWN: Nicki, it’s quite a tough one, particularly in a case like this for Rikus where he says he gets nauseous after 38km, obviously with it being a trial and error process, you can’t get to that point in your training, every second training run. You really have to be sort of, you’ve got to plan this, it’s not something you can do by accident, particularly when it’s happening that long in a run.
NICKI DE VILLIERS: I would suggest that over fuel a little bit in some of the shorter trainings so that we can see if it is some of the sugars that’s influencing it. The other thing that obviously can cause the nausea, it’s too aggressive in fuelling, so that we just put too much carbs in the gut and also then not diluting those carbs. If it is a gel that he’s running with, we can experiment with maybe some other things and see if solid food wouldn’t work better and so forth. The aggressiveness of fuelling can also obviously cause it and especially with fluid intake.
What we’re going to do in the race, we have to try and obviously do something different, if this is what’s causing the nausea and the one thing I would definitely look at is looking at, the first question to answer is, is it too little or is it too much, that’s the one thing and then also look at the hydration, was it too much fluid or too little fluid. It would be interesting in the longer runs that he takes, the longer training runs, if nausea would appear there as well or is it only during the races.
BRAD BROWN: We’re going to get onto over hydration a little bit later on in this chat as well and there’s a couple of questions coming with regards to that, but this is an interesting one as well Nicki, like I said, I’m lucky that I haven’t experienced this, but if I think back to my dad’s running career, this is something that happened to him and Ryan is asking this question. He says he’s run 9 consecutive Comrades Marathons and he’s suffered with terrible nausea for the last 3 of them, usually around Drummond. That’s half way on both the up and the down, he says it didn’t happen in the first 6 years, since he’s started he says he hasn’t changed anything with regards to what he’s doing and that sort of thing.
My dad used to be exactly the same, he says he’s consulted a gastroenterologist, he suggested gastric emptying and prescribed some meds for him. The nausea persisted, he’s subsequently consulted Prof [Dermin?] in Cape Town and he suggested that it wasn’t gastric emptying, but told him to see a cardiologist. He did this with the cardiologist and he said everything was fine. He says he’s been nauseous in half marathons, actually vomiting on the side of the road, is it something that becomes more prevalent later on in your running career? I don’t mean later as you get older, but once you’ve done numerous, particularly Comrades Marathons, it has to have an effect on your body long term, could that be something that we need to be cognizant of as well?
LINDSEY PARRY: What I want to say is one of the things that Nicki alluded to in her causes was dehydration and one of the things that certainly has happened over the last couple of years of Comrades is that Comrades has gotten hotter and hotter. Our physiology doesn’t respond particularly well to heat. It forces us to run slower, it means it diverts more blood away from the stomach to the surface of the skin to help us cool down. One of the reasons why nausea could be so on the increase is just because of the increase in physiological stress that people are under and the other thing I wanted to add because I think then Nicki will be able to take the answer a bit further, is that often in, and I’m going to use the word ‘allergy’ very loosely now, but in allergies, typically if you’re allergic to dogs or bees or whatever it is, the more of that stimulus you receive, the worse that allergy becomes over time.
If you develop an intolerance to fructose or glucose for that matter, then it stands to reason that that intolerance will become worse and the onset of it will be earlier, will gradually become earlier as you become less and less tolerant to it. In that scenario, then I would start looking at alternate forms of energy altogether.
BRAD BROWN: Brilliant, go for it Nicki.
NICKI DE VILLIERS: I’ve seen two or three studies where it actually shows that people are doing better in the first few years after the onset of running and that here in the middle years stuff gets worse and I’ve read about it because that’s often what I find in practice as well, that everything is fine and then all of a sudden we struggle and then we struggle a lot.
Referring back to the motility and the gastric emptying and those kind of things, it seems that running doesn’t change, I mean it does change a bit of the oesophagus motility and it does change a bit of the stomach motility as such, but it’s not so severe if we don’t run hard, so in a Comrades, for instance, if it’s much more duration than what it is this very, very intensity, but most of the studies tell you that it doesn’t really increase the gastric emptying, it can decrease the gastric emptying, but not running as such, more the dehydration part of it and the motility as well.
What can happen because of this constant blood, that the stomach doesn’t get or the gut doesn’t get blood, there’s an increase in what we call permeability in the gut epithelial layer. It sounds very complicated, but it’s not really, it just means that your barrier in your gut that’s supposed to keep stuff in the gut instead of sending it to the blood, you easier then absorb stuff into the blood that’s not supposed to be there and this is just because there’s not enough oxygen going to the gut as such. This can also throughout the years have an influence, so that maybe we must look at feeding the gut, there’s a few supplements and stuff that you can use to make the gut barrier a little bit stronger in these cases. Maybe it’s the same sugar we’re working with, but the digestion is just not complete before it gets into the blood and that sometimes also can cause this nausea in late onset, later in your running life.
BRAD BROWN: All right, cool, there’s lots more questions coming through. Let’s touch on how to cope with it Nicki. If you’re in the middle of a run, the last thing you want is for it to strike, but it does, let’s be honest, that’s why we’re here today to talk about it. We’ve touched on how to prevent it and trial and error and what you need to figure out, but happens if you hit halfway in Comrades or you’re 6km out of a marathon and you start feeling ill, what’s the best way to deal with it?
NICKI DE VILLIERS: Brad, it’s a difficult one, but I would suggest that you stop the intake first, stop carbohydrate intake for the next few K’s. If we can get blood back to the gut just for a while so we can try and clear whatever is in there, it usually goes better, people usually feel better if they vomit, they can carry on. It’s those that can’t get to vomit that really struggle. That would be the one thing.
To look at dehydration versus fuel intake. I would stop necessarily the fuel, especially if you had an aggressive fuelling before you get nauseous, look at if dehydration is a possibility, to carry on with hydrating with small amounts, regularly throughout, but I think the best advice I can give is to just stop carbohydrates for a while so that we can just clear whatever is in the stomach before we carry on.
BRAD BROWN: Lindsey, do you want to jump in there as well for some practical strategies on how to deal with it on the run?
LINDSEY PARRY: I would increase the amount of walking you do, cause for a start, you want to try and get some of that gastric emptying improving a little bit. One of the ways we can do that is by dropping the intensity. Even though the intensity on Comrades is quite low anyway because we’re running quite slowly, we can drop that intensity slightly again by walking and then take note of how thirsty you are and I would move to mostly drinking water, particularly if you are extremely thirsty and it’s a particularly hot day and then in a way, to try and help to drive that thirst, I would try to take in slightly saltier foods. When you’re feeling nauseous, maybe it doesn’t sound like a great idea to eat anything, but if you have a few small nibbles of salted chips, for example, just something with a bit of salt to stimulate your thirst a little bit.
The one thing I left out which I would very definitely try first up and it doesn’t sound amazing, but I would actually physically try and throw up because if it is just a case of having a stomach that’s too full of sweets mixed up and your stomach lining is not doing its job, often if you just purge your body of whatever is in there, then you can go about just slowly sipping a bit of water and then perhaps in another hour or so you can stand the thought of having a little bit more food. Once that’s done or if you can’t do it or if you are continuously throwing up, that’s one of the hardest things, but if you are continuously throwing up and you do need to be aware that you may get yourself into a very dehydrated condition, you just need to sip small amounts of fluid.
If you take one sachet, you might take the entire duration between water tables to get that sachet, you literally just have a slow trickle or get ice, often sucking on ice and letting that water slowly trickle into the system, that’s not a bad way of doing it.
BRAD BROWN: All right, fantastic, keep those questions coming through. There’s lots of them coming through this afternoon. Let’s get into over hydration. This is something that I think a lot of people, I don’t want to say misunderstand, but obviously over many years there’s been a huge talk about dehydration and how dangerous it is, but it turns out that over hydration is way more dangerous than dehydration. Prof Noakes, if you’re interested in this and reading up on it, his book Waterlogged is probably a good starting point with regards to over hydration and why it’s so dangerous. Nicki, over hydration is a huge problem, particularly at a long race like Comrades or Old Mutual Two Oceans, it does become a serious issue.
NICKI DE VILLIERS: Yes it does, it’s maybe not that prevalent, but if it’s an issue, it’s serious, that’s one of the aspects and especially with regards to the weather. With Comrades I think we’re still lucky because of the extreme hot weather that’s usually prevalent there, I think we’re lucky that we probably don’t see that many cases, but I think as soon as it’s a cooler day and I’ve got this strategy of drinking that regularly, I think you’re definitely prone to over drinking or water intoxication or whatever you want to call it.
The best thing, I think, you have to drink according to thirst, that’s first of all quite important to not force stuff down when it becomes difficult for you to drink, not to keep on drinking just because you think dehydration is going to cause me to stop this race. The other thing again, looking at your training efforts. If you can work out a little pattern or schedule that you do in training and know that probably my sweat rate is around this or that and drink according to that schedule. We don’t want people to, for instance, if you weigh yourself prior to and after training, I don’t want you to pick up weight because that will give you an indication that you may be drinking way too much fluid whilst you’re out there.
There is a caution about it and I think the confusion is quite heavy in terms of should I drink or should I not drink, but I think in those longer races, that thirst mechanism is quite an important one and just be aware of it, I think that’s important. There are lots of water tables, so if you become thirsty, it’s not that long before you hit something to drink. I think that would be wise advice, to drink according to thirst whilst you’re out there.
BRAD BROWN: Nicki, let’s touch on what over hydration is. For someone who has heard the term, can you in layman’s terms explain to us what over hydration is?
NICKI DE VILLIERS: It’s about diluting the electrolytes, especially sodium in the body. Over hydration, if you drink too much fluid for amount of sodium that’s there, that sodium balance is quite important for basically controlling our water balance between membranes in the body. If we drink way too much, there’s a decrease of sodium in the blood, as such, then we’re very prone to [inaudible 0.35.11], if it’s happening in the brain, then that’s what we’re scared of because that can really lead to dire consequences.
It’s basically drinking too much fluid with too little electrolytes or especially then sodium in it. If we want to work on the other side of this, say okay, we’re going to drink a lot, let’s take a lot of sodium with it to try and balance this, you’re hardly going to achieve that because taking in that much sodium is really going to be horrid in a drink, you’re going to feel like you’re drinking sea water. That’s not really going to help. It works much better to work on the hydration side of the equation that we rather control it.
It’s basically just the dilution of electrolytes and especially then what we talk about is sodium in the blood that can cause this over hydration or water intoxication symptoms.
BRAD BROWN: Brilliant, I mean we talk about the dangers of it and people often think that dehydration is way more dangerous, but that’s not the case. Can you tell us why it’s dangerous? You could literally die from being over hydrated, can you not?
NICKI DE VILLIERS: Yes you can.
LINDSEY PARRY: Effectively what’s happening is that your chemical process has become completely disrupted because our body works on shunting things from high pressure to a low pressure across a membrane and if, that’s cause of osmotic potential, if your osmotic potential starts to reach zero, your body can’t move fluids around anymore and as Nicki pointed out, you then get a situation where you get pressure buildup in the brain. Your body can’t get rid of the water effectively because we continue to put more fluid in.
Then what happens is that we go into a coma and the reason we go into a coma is because our body is really just protecting us from ourselves so that we do not drink anymore and then we often mistaken that for heat stress or dehydration and [pop a drip in?] and that’s when people do die from hypernatremia and over intoxication and that’s why it’s so dangerous. Nicki said it, I think three or four times I counted it when she was talking, in a race of this nature, where the intensity has dropped and our sweat rates are dropping, if you use thirst as your guide, you’re very unlikely to get yourself into this situation. If you’re thirsty, drink, if you’re not thirsty, don’t just drink because you’re at a watering table.
BRAD BROWN: Lindsey, you make a very important point there, don’t just drink cause you’re at a water table. If you’ve never run Comrades, you’re in for an interesting experience because the latter half of Comrades, the water tables become so close together that you can almost see the next one from the one you’re at. If you think you need to drink at every single table, there’s a good chance you’re going to get yourself into a bit of trouble being over hydrated and being too much liquid, particularly in your gut. A great question in, Nicki, I don’t know if there’s anything else you want to add onto the over hydration before we get into a couple of other questions. We’ve got a few great questions in?
NICKI DE VILLIERS: No, shoot.
BRAD BROWN: I think this is fantastic, it’s from Damian and he wanted to know, how important is solid foods in an ultra. Is it not possible to run a race like the Comrades on fluids alone?
NICKI DE VILLIERS: It will be possible to run the race on fluids alone, it just makes much more sense, the body absorbs much better if I give a different type of carbohydrate mixes, so therefore if you’re used to only running on fluids and there’s no risk for having any gastrointestinal distress, in other words, your stomach is fine and you never battle with it, then you probably will be able to race on fluids, you’re probably get hungry, depending on the intensity of what you’re out there with, but it does seem that it helps to combine different carbohydrate sources. I would definitely ask somebody to, especially if they’re going to be out there for long, to experiment with solid food as well, but it’s not a must. As long as you get the fuel in and you’re comfortable with the way you get it in, there shouldn’t be an issue that you we have to force people to eat solid food at all for that matter.
BRAD BROWN: All right, let me get into another question, what about taking anti-nausea tablets before a run?
LINDSEY PARRY: I’m always very wary about taking any kind of medications, if a miracle cure, like anti cramping stuff, I would firstly have a look at their efficacy, what research was done and obviously try it in advance. If you’re talking specifically about taking medicines that are designed to take away nausea when you’re sick, I would not do that without getting medical advice and look, I know some doctors are happy to let people run on anti-inflammatories and pain killers, but those can have some extremely serious side effects and in fact, we’re busy talking about nausea and that’s the one thing we haven’t mentioned, but anti-inflammatories in particular can trigger extreme nausea during exercise.
Medicines in themselves can lead to irritation of the stomach lining and the intestinal tract, which then also leads to nausea, but I would firstly check with the doctor around nausea medication is, is it safe, what are the potential side effects and don’t ever take that sort of medication without the knowledge of your medical doctor and the people that are watching you in the race because if they don’t know what you’ve taken and something starts to go wrong, they don’t know where to start looking. If you know that there are certain side effects that can come from taking anti-nausea medication, for example, and something starts to happen to you, people can say very quickly once they get hold of your emergency contact, he was taking pain killers, anti-inflammatories, nausea medication or whatever the case may be.
BRAD BROWN: Fantastic, a question in from Barbara, Nicki, I think this one I can pass onto you cause you mentioned glucose and that earlier in the seminar. It’s from Barbara and she wants some advice, in the past she thinks that she hasn’t taken enough in terms of glucose on her runs. She’s now finding that nougat is a great source of that while she’s running, she just needs to be careful that she doesn’t eat too much. She said she felt a little sick at the Meiringspoort half marathon this past weekend and she thinks she ate too big a piece in the run. Do you think that not having enough glucose could be the cause of Barbara’s nausea?
NICKI DE VILLIERS: Very definitely. If blood sugar levels drop, it can be that people will feel nausea because of that and if those nougats work, it’s perfect. Again, eating too much of it is also going to make you nauseous, I would definitely, if the lack of fuel is what’s troubling her and she thinks she’s over eating on a nougat, experiment with different carbohydrate sources. Have whatever they have at the table and just lower the intake of the nougat, but it’s a perfectly fine source of carbohydrate, it shouldn’t be a problem at all, but if you’re going to eat too much of it, it’s definitely going to make you nauseous. I think she did a good thing, maybe just experimenting with it once more and maybe bring in a second carbohydrate source and decrease the amount of nougat that she eats.
Remember, it’s also a solid that goes into the stomach and another thing that can make people nauseous, some people are not good with running and eating, so if we walk whilst we’re eating, that we just swallow less air as well, this can sometimes also help a bit, so that we don’t have that much air in the stomach.
BRAD BROWN: Eating too much nougat, even when you’re not running, could make the best of us nauseous, so Barbara, I hope that helps. A quick question in from Janet, blood pressure was mentioned a little bit earlier, she wanted to know, is there a correlation between high blood pressure and nausea when running, Lindsey can I hand this one over to you?
LINDSEY PARRY: Look, low blood pressure is normally the one that’s associated with dizziness and nausea. Hypertension is normally more related to headaches than actual nausea and it’s normal for your blood pressure to go up during exercise, it’s quite normal for it to go up quite high, particularly in high intensity exercise, but if it’s going up excessively high and the only way we can track that is by actually doing a test with a cardiologist or someone who works in a cardiology practice, we don’t want abnormally high blood pressure and especially you don’t want to have abnormally high diastolic. When you get blood pressure, it gets given to you as two numbers, typically resting is somewhere between 110 and 130, being considered quite normal, over 60 to say 70, maybe 80, but that’s starting to get up a bit.
When that bottom number starts to push over 90 and heading towards 100 during exercise, that would be alarming, but it should be associated with headaches and when your head feels like you can feel the pulse in your head and you feel that pressure build up in your head, nausea would normally be associated with low blood pressure rather than high blood pressure.
BRAD BROWN: Right, I hope that helps. Another question in from Belinda, says I’ve recently returned to running on the road after a two year recovery period from back surgery. She says she has received the go-ahead from her surgeon. She spent the last 4 months preparing to get back into training and loving every minute. She’s using a run/walk strategy at the moment. She’s running 100m, walking 100m, she’s only covering 5km distances at a time now and working on improving her time over that distance. The problem is that she finds when she pushes herself harder, the more nauseous she feels, what’s the cause of this? She doesn’t eat before training and doesn’t consume copious amounts of water before training. She says: Please advise, this is an awful sensation and one that I’ve not experienced before. Lindsey, it ties into increasing your intensity.
LINDSEY PARRY: Ja, so there’s two parts to this answer. I’ll pass the ball to Nicki for the other part but yes, when you run at very high intensity, now, in this instance it may not feel like very high intensity because you haven’t run for a long time, so you might not feel like you’re running particularly hard, but if you’re pushing yourself very hard, then you will develop high amounts of blood lactate, so your muscles will product lactic acid because they cannot produce enough energy from using oxygen or pathways that involve oxygen, so they start making energy from pathways that do not use oxygen and that has lactic acid as a byproduct and while lactic acid in itself is not the bad guy that everyone makes it out to be, I don’t want to get this answer too complicated, but in terms of the extreme nausea that you feel, very high levels of blood lactate will make you feel nauseous.
The other part, she says she’s not eating or drinking, so that in itself is problematic and one of the things that Nicki has explained to my athletes a lot and it’s made a big difference to them, is that you either fuel before exercise or you fuel during exercise. If you are going into exercise and it’s been too long since you’ve given yourself fuel, and you perhaps had a busy day and you’re a little bit hypoglycaemic before the exercise, that can also lead to the nausea in exercise because of low blood sugar. I don’t need to pass the ball over, I think I answered the question but Nicki might have something more to add.
NICKI DE VILLIERS: Nothing more, just the hydration part as well, especially if it’s early morning where you’re usually dehydrated, so make sure you drink something as well.
BRAD BROWN: Perfect, Nicki, I’m going to ask you this question because I think you mentioned it, Robyn wanted to know, she said, when you spoke about, or was it Lindsey, I’m not sure, you spoke about gut permeability, you mentioned oxygen saturation, could your oxygen saturation level be related to nausea?
NICKI DE VILLIERS: A better question for Lindsey I think.
LINDSEY PARRY: Look, it can be, and I think it probably goes on a couple of, it speaks to a couple of points. Let’s take the extreme example of someone coming from Cape Town or Durban, or the UK, and going to do a race in Mexico City at 3 000m, there’s immediately going to be an oxygen deficit, again, not a great phrase, but it explains what I’m trying to get at. There’s not enough oxygen to go around, therefore you immediately are pushed into a scenario where you are having to produce a large amount of energy from pathways that don’t use oxygen and as soon as we do that, then there’s an increase in metabolite or byproducts of energy production and when that happens, there is an increased degree of nausea that would be associated with exercise.
I’m using a very extreme example, but that would probably lead to, someone coming from sea level straight to competing at 3 000m, even at low intensity exercise, they’d probably feel dizzy, light headed and nauseous quite early in the exercise. One of the things we haven’t touched on at all and it just came into my head while we were talking, and it’s not a common thing that happens to people, but it does happen to some people, this phenomenon of what we term rebound hypoglycaemia. So you do all the right things before you exercise, but in a small percentage of people, just the act of starting the exercise means there’s a sudden increase in blood sugar followed by an immediate drop in blood sugar, which leads to feeling dizzy and nauseous, but that typically doesn’t happen during exercise and Nicki can correct me if I’m making any mistakes in my explanation. That typically wouldn’t happen into exercise, that’s something that happens quite early and at the onset of exerciser or just before exercise.
NICKI DE VILLIERS: That’s correct, that’s basically just timing of your meal and then working a little bit, intensity can also make that better, to include a bit of high intensity warm up, a little bit of that. That is such a small percentage of people and it’s really right at the onset.
BRAD BROWN: Talking of intensity, this is also a fabulous question, we’ve spoken and mentioned that the intensity of the race makes a difference, does that mean that there’s a different approach as far as a different eating and drinking plan to nausea, if you’re trying to run a silver medal at Comrades as opposed to a 10 hour or 11 hour or 12 hour. Lindsey, intensity, it obviously depends on your ability. For someone like me to try and run a silver medal, I’m going to puke within the first kilometer, whereas someone who has trained for a silver, the intensity is probably the same, I’m guessing, if that’s the medal you’re going for. How would you approach that?
LINDSEY PARRY: There is a difference and there’s a difference for a couple of reasons. The first one is the most obvious and that is because if I’m going for a 6 hours, 6.5 or 7 hour, I’m going to be consuming far less calories over a far shorter period of time than somebody who is running 10-12 hours. One of the main differences is the duration. You are more likely to get away with nausea if you are running faster, although there are still a lot of people up at that speed that do suffer from nausea and then there’s also the relative intensity. There are similarities in terms of relative intensity. I would perhaps be running a 7:15 Comrades where someone else may be running a 8:15 Comrades and the intensities that we’re running at are fairly similar, but by the same token, there’s going to be loads of people that a 9 hour, it’s just out of the question.
They’re not going to run at that intensity so that they can get 9 hours and 15, they’re going to run much easier and get a 10 or a 10:50, so there are different nutrition strategies, fluid rates that need to be taken into account for someone that is really pushing the envelope to run 7:55 and someone who is running a very comfortable 9:45 because they know they’re not going to go under 9, so let’s rather just enjoy it.
BRAD BROWN: I love that, a very comfortable 9:45, in my wildest dreams! Nicki and Lindsey, before we wrap things up, we are running out of time, I just wanted to touch on those running resources and the first one is Nicki de Villiers. Nicki is superb, I mentioned at the start of the seminar that she works out of the High Performance Centre at the University of Pretoria. She’s worked with some of South Africa’s top athletes, not just runners, she’s worked across the board. There’s some great athletes that train out of there and if you want some one-on-one help from Nicki, if you’d like to book a consult or find out more about her rates and what she does, you can pop her an email. That’s the email address, it’s: nicki.devilliers@hpc.co.za. You can also call the office line, it’s 012-4841711, I’ll pop those details in an email to everyone as well when we’re done with this.
So Nicki, let me say thank you to you for joining us today, it’s much appreciated, your time and Lindsey, thank you to you as well.
LINDSEY PARRY: Absolutely pleasure.
BRAD BROWN: If you’ve got any questions about the Coach Parry membership community as well, you’re more than welcome to pop those into the question tabs as well, but it looks like we’ve done pretty well on the questions. Lisa just wanted to know, does chewing gum along the way help with nausea?
NICKI DE VILLIERS: It would be individual. I would think it would aggravate nausea, but if that is one of the things that you’ve tried and tested and it works for you, go for it.
BRAD BROWN: Fantastic, there you go, that’s pretty much it for the questions. That link once again if you want to join the Coach Parry online community, it is coachparry.com/membershipoptions, you can sign up there right now. From the three of us, myself, Brad Brown, Lindsey Parry and Nicki de Villiers, thank you so much for joining us. We look forward to having you along for the next one. Until next time, cheers.
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Hosted by Brad Brown, join Coach Parry and resident dietician at the High Performance Centre at the University of Pretoria Nicki de Villiers as they discuss nausea. In this video training you’ll discover the most common causes of nausea, how to prevent nausea and what to do when you feel ill in the middle of the run. You will discover the dangers of overhydration and what you should do to avoid it.
Transcription
BRAD BROWN: Here we go, welcome everyone to the next Coach Parry online seminar. We’re coming to you live today, it is Wednesday and we’ve got folks from all over the show once again. Thanks for joining us from around the planet, wherever you are, if it’s morning, evening or afternoon, welcome, it’s good to have you with us. Just to run through a couple of formalities before we get into why you’re actually here and to find out how to beat nausea, let’s cover who is online and who we’ve got with us today.
I’m Brad Brown, I’m going to be hosting it and holding everything together and making sure that everything works. We’ve also got Nicki de Villiers who is the resident dietician at the High Performance Centre at the University of Pretoria, Tukkies, Nicki is with us as well and then we’ve got Lindsey Parry, the official Comrades Marathon coach, he joins us today as well, Coach Parry on the line. How this is all going to work, just to run through a couple of the things we’re going to cover today, so you can stick around and know what exactly is coming up. What you’re going to discover today, the common causes of nausea, as well as how to prevent nausea, that’s a pretty big one. How to cope when it strikes in the middle of a run and then we’ll also be chatting quite a bit about over hydration and why that is so dangerous and then we’ve got a couple of great running resources for you as well, which we’ll share with you later on in this webinar, you’re not going to want to miss out on that.
Then, if you would like to ask a question, you’re more than welcome to, at any stage during today’s seminar, all you need to do, in the question bar, just type your question in, we might not be able to get to it straight away, but we will definitely get to it at some stage through the seminar. All you need to do is type your question in there. If you’ve got any comments or if there’s anything else that you’d like to know, just pop it in there as well.
Before we get started, I just want find out for my own interest, obviously we’ve re-launched the seminars and I want to know, if you look in the little bar that you have on the right, where the questions are, where the chat is, I want to know how many of these online seminars have you attended with us here on Coach Parry. Is it your first? Have you been to one? Have you been to between 2-5 or more than 6 over the years that we’ve been doing this, I’d love to get your thoughts, so if you wouldn’t mind just taking a second and just popping it in the poll section, let us know how many of these you’ve attended.
Let’s get straight into today’s seminar and let me introduce and say howzit to our panelists on the line. We’ll start with Nicki de Villiers, Nicki welcome, it’s great to have you on, are you well today?
NICKI DE VILLIERS: Ja, very well, thanks for asking me to join.
BRAD BROWN: No prob, all the way from Pretoria, I’m sitting in the horrible city of Cape Town at the moment, looking at the mountain, it’s terrible J I hope your view is as nice as mine in Pretoria. Lindsey Parry joining us as well, Lindsey, howzit.
LINDSEY PARRY: Ja, very good thank you, also chilling at home, overlooking my beautiful garden, thanks, courtesy of the students at Pretoria University.
BRAD BROWN: All right, we’re all comfortable, we’re all sitting down, let’s get straight into it and obviously the first thing we want to look at is what are some of the common causes. Nicki, I’m going to ask you to jump in here, why do people suffer from nausea when they run?
NICKI DE VILLIERS: Brad, there’s quite a few speculations, I wish we had a clear cut answer. One of the things in our research is that there’s a change of blood flow, so we’ve got less blood going to the stomach and more to the muscles and the lungs and all the other supporting organ systems. If there’s less blood to the stomach, we obviously have to look at what we put into the stomach because there’s going to be a reaction to it. Then there’s obviously causes that’s just basically bound to your running, the impact with a stomach consistently moving up and down and then there’s definite nutrition aspects, stuff that we put in there that’s not necessarily due to the decrease in the blood flow, but just because those are nutrients that’s not really well coped with during running.
If I look at those nutrients, it’s basically the stuff that’s going to stay in the stomach for a long time, considering especially fibre foods, very high in fibre, stuff that’s very high in fat, especially heated fat that we eat prior to running, that’s going to stay there for a while. Very heavy protein meals and then more and more indication of the type of carbohydrate that you put into the stomach and that certain ones are not that easily clear, we look at specifically fructose as being quite a villain in all of this and then never disregarding the hydration issues. As soon as we high power hydrate, as soon as we’re dehydrate then, there’s even less blood going to the stomach area, which can obviously aggravate all of these.
BRAD BROWN: There’s lots, like you say, there’s no one cause, if it was that simple, no one would be suffering from nausea and unfortunately it’s one of those things, I’m sure that runners need to figure out along the way, what triggers it, what causes it and how they can prevent it. It’s almost like an experiment of one, essentially.
NICKI DE VILLIERS: Ja, and that is why it’s so important that whatever we’re going to do in a race, we have to do in training to figure out what is working, what is not working and then obviously also considering that all of these get worse the longer you run. Although we’re not always training on the same durations of our races, it can get worse towards the end of the race, just because of the pure duration of what we’re doing.
BRAD BROWN: Lindsey, you chat to a lot of runners as well, Nicki’s covered pretty much all the bases, what are some of the common things that you pick up why people struggle and get nauseous on a run?
LINDSEY PARRY: I think for me one of the main factors is the constant need to keep your nutrition up and then in a race like Comrades, that’s incessant taking of things which are easy to carry, so gels being probably one of the major culprits, just taking very sweet foods over and over and over again for such a long time. I know Nicki is going to talk to some of the ways to prevent it, but one of the things that she said as she was ending off speaking there was to talk about managing it on race day and one of the things that I found, particularly in races that last longer than 4 hours, is that if we look after our nutrition early in the race, while the blood is still flowing to the stomach, before we’re getting too fatigued, before the stomach is getting too bloated and too full, too irritated from the things that we’re putting into it, if we are then very good about getting our recommended amount, depending on who you’re working with, you’d be recommended between, somewhere in the region of 55 to as much as 70-80g of carbs an hour, that will become quite stressful on your gut.
If you do that early in the race, but then you back off a little bit, even for a couple of hours, 2-3 hours where you aren’t so good about your nutrition, you’re just sipping a little bit of water here and there, I then find that you actually start to get quite desperate for some nutrition and for the last couple of hours of the race you can put in what you need to get to the end. That’s just really a practical way of how I’ve dealt with it in any race and hopefully Nicki has got some good tips to give us on what to do and what not to do in the lead up to and during the run.
BRAD BROWN: Before we get into that, Lindsey, I just want to ask something and Nicki, you can jump in here too. Lindsey, you mentioned that it occurs for a lot of people on runs longer than 4 hours, if nausea exclusive just to long runs? I’m lucky – touch wood – I don’t suffer from it, but it can strike at any time? If you’re only running up to 10, could you suffer from nausea on a 10km run or perhaps a run that’s taking an hour or is it specifically something that people who run marathons and ultra-marathons struggle with?
LINDSEY PARRY: I’ve heard of it in half marathons. If you were getting nausea in a short event, something like a 10km, I would be a little concerned. There are probably some things that if you eat for breakfast could perhaps cause nausea during running, but I would be much more concerned that there’s some sort of cardiac or cardiovascular issue that’s causing nausea in the shorter runs. Of course you’re excluding when you’re absolutely racing flat out, eyes on stalks for a PB because then that’s an entirely different kind of nausea that you’re going to experience.
If you’re running a fairly standard 10km and you’re getting nauseous that early, I would certainly do some investigations. Nicki will be able to give us, I’m sure she does come across people who just suffer from nausea full stop.
BRAD BROWN: Before we get into that, there’s a poll up on the screen, I just want to find out exactly where you suffer nausea from, so pop that in there and let us know where it strikes for you on your run. Nicki, let’s chat about that now. How do you counter it, how do you deal with nausea?
NICKI DE VILLIERS: Ja Brad, I think especially in the shorter races, it’s sometimes easier to deal with it because it’s probably something that you ate or did not eat prior to going into that run. We have to then obviously look at exactly what was the pre event meal. So pre event I mean anything that you ate from waking up until you hit the road. Look at what is part of that meal, often as I say, people put a lot of fibre in there that can have a bit of a problem. Was there fluid intake, any kind of fluid, just to make sure the hydration is up to date. It’s very evident that once there’s fluid in the stomach when you start running, the clearance of fluid throughout your run would be much, much better, so it is enhanced. We have to look at the fluid intake there as well.
Then offending foods, so a lot of people will get nauseous with specific foods. They can tell me, I ate this or that, so there’s a lot of nausea complaints with, as I say, excessive fat intake, if I had bacon and eggs prior to, if I had excessive amounts of protein maybe prior to this, some people may be struggling with that and then specific herbs, specific spices, looking especially at fructose. Fructose is the sugar that we get in fruit, so if you’re not used to eating fruit all day long or regular fruit intake and you eat a lot of fruit right before you go for a run, that can cause a bit of nausea.
Some people struggle with caffeine. Being a drug that will enhance performance, but some people struggle with drinking caffeine prior to and that can cause a bit of damage in terms of nausea and then also milky products and some have to experiment with a little bit of milk or yoghurt or stuff that we use. It is so individual that it’s important that we do understand that what makes the one nauseous is not going to make the other nauseous and that’s why it’s so important to experiment with these things in the mornings when you go on training runs because if we’re going to have to listen to everybody telling you what they avoid, we’re going to end up with nothing left to eat except for maybe water, that’s quite important.
Then very, very important, look at the timing of the meal. Hey, we can’t eat a whole load of stuff, think we’re going to go into a race, especially if you’re going to have a quick start. That is important then to decrease the amount of food that you eat prior to it, if you’re going to have a very low start and the race is full and you’re going to walk a few K’s, then you can probably have a bit more food in the stomach as such.
BRAD BROWN: Let’s jump into a few questions and there are a few coming through. You can ask your questions in the chat box. I got one in from Lisa and she said: I’m fine when running Comrades and have a good, strong finish, half an hour after the race, however, I feel nauseous and vomit the whole night, why would that be the case? Nicki if you want to jump in there?
NICKI DE VILLIERS: Okay, there’s quite a few physiological things that’s happening after a race for the body to try and recover from this. Blood pressure can be one culprit, there’s a very quick change in blood pressure. The other one is that there’s quite a few things that the body must deal with in terms of getting waste products away from the area and handling with that. That can be one of the causes and then a quick blood distribution where the blood then suddenly, you’ve got an increased blood flow going through to the stomach in those areas.
Another thing that often happens is that all of that carbohydrate that you took throughout the race, it’s not that all of those are absorbed quickly, at the end of the race, so if you stop running, everything is out of the stomach and those things are [inaudible 0.13.53], in other words, they’re going to draw fluid into the stomach area and seeing that you stopped running, there’s a redistribution of fluids, so therefore there will be moving more fluid into the stomach and that can make you nauseous. It’s basically left over carbohydrates in the gut that often does this.
The ideal would be to start recovering and also start recovering hydration levels, so not only look at necessarily putting more carbohydrates into it, but look at fluid intake and electrolytes through that period to try and stabilize the distribution and the blood flow to the stomach, obviously staying away maybe from food for a while, not necessarily putting in solid food into your stomach that’s already aggravated by the very high carbohydrate content.
BRAD BROWN: Excellent stuff, Lindsey, I don’t know if there’s something you want to add onto that?
LINDSEY PARRY: That’s quite a difficult one to deal with and I think a lot of it has to do with the fact that you have just spent hours and hours with the blood being diverted away from your gut and obviously this athlete is not especially sensitive to those perhaps gels or Coke or whatever it is that’s lying in the stomach. Remember, as our blood is diverted away from our stomachs, less and less of that is absorbed because it’s just harder to do so with less blood coming past. That one probably has a lot to do with the sudden rushing back of the blood into the area and people respond to this differently.
Other people would then, suddenly the stomach would work, which means that the whole intestinal process would kick-start and they get what we call the Runners Trot. We also do respond to these things in different ways. A lot of people get nauseous without throwing up and other people, the throwing up does come and that I suppose will depend a little bit on what’s in the stomach contents and other people will get ‘jippo guts’. I think the suggestion there to sip, to slowly sip on some fluids so that you can slowly kick-start that process again, getting everything moving through and to keep moving.
You want to just lie down, but if you keep moving so that there’s a more gradual return of blood flow, of your blood pressure stabilizing and you kind of more gradually come back to ground zero and then to add some solids and some more savoury type of foods, probably 30-45 minutes post activity, that will probably help, just from a practical point of view.
BRAD BROWN: There’s a follow on question to that as well and it’s along similar lines, Nicki, I don’t know if there’s anything else to add to it. Greg was saying, the weird thing is, when he hit the grass at Comrades this year, he gets nauseous and it ruins his finish. He said this year’s Comrades he was fine, 100%, as soon as he got into the stadium he says he felt ill. Could it be a mental thing as his body then knows that the end is in sight and like Lindsey said, the blood flow then starts going back from the extremities to the stomach. Could it be a mental trigger?
NICKI DE VILLIERS: I’m sure it can be. I think especially if there was no nausea throughout the whole way, just the sheer emotion you have when you see this is the end, I think can cause you to experience nausea.
BRAD BROWN: Cool, we’re touching on prevention and this is a great question from Rikus. He says he gets nausea after 38km, all depending on his pace and I think that sort of ties into what you were saying Lindsey, obviously if you’re going for a PB over a short distance, you feel like you’re going to throw up, obviously the harder you’re running from a physical exertion perspective, the more chance you’ve got of it happening. He says he stopped running Comrades after 6 times, he says he’s completed 4, he wanted to know, is there a typical experimental plan, Nicki, you were saying you’ve got to figure out what works for you, can you talk through basics with regards to trying different things in your training runs ahead of your training runs that again, it’s a trial and error thing, but is there a sort of basic way to actually work around it?
NICKI DE VILLIERS: Ja, it’s a process of elimination, I guess. There’s just so many influences, obviously the intensity being a big role as we’ve mentioned, but on Comrades, I hardly think that would be one of the main problem areas. You know what sometimes happens Brad, we eating something prior to, we get nauseous and then our first reaction is to not eat at all and blood sugar dropping can also give you quite a bit of nausea. Related to what Lindsey said previously, the first part of the race, it’s quite important to be aggressive with fuel sources. Fuel sources I mean looking at what you had prior to the race and looking what you have in that first I would say quarter of the race, it’s quite important to really see that as a fuelling opportunity.
Then looking at the specific stuff that you included, looking at what you ate prior to, if the nausea only started at 30 or after 30km, it’s probably much more what you did during that period and there’s also quite a few things involved in terms of carbohydrate sources, but different types of carbohydrates that you can take and can play around with. I just mentioned fructose a few times, sometimes some of the gels contain a blend of certain carbohydrate sources and sometimes if you use those, sometimes we just buy a gel because that’s what there is or I got some at the expo or whatever, the sugars that they use in that gel is different from what you normally use or just more of what you normally use.
Normally you run a training run on one gel, we say be aggressive and fuelling and I have two gels in the first 30km and just more of that specific sugar, so I would advise to play around with the type of fuel that you’re taking, rather than just leaving it. Look at the back of the thing, what is in there and choose another product that doesn’t necessarily have that mix and as I said, be especially aware of fructose. It’s a good sugar for us to use, but it is one that is quite prominent in causing a bit of nausea in some people.
BRAD BROWN: Nicki, it’s quite a tough one, particularly in a case like this for Rikus where he says he gets nauseous after 38km, obviously with it being a trial and error process, you can’t get to that point in your training, every second training run. You really have to be sort of, you’ve got to plan this, it’s not something you can do by accident, particularly when it’s happening that long in a run.
NICKI DE VILLIERS: I would suggest that over fuel a little bit in some of the shorter trainings so that we can see if it is some of the sugars that’s influencing it. The other thing that obviously can cause the nausea, it’s too aggressive in fuelling, so that we just put too much carbs in the gut and also then not diluting those carbs. If it is a gel that he’s running with, we can experiment with maybe some other things and see if solid food wouldn’t work better and so forth. The aggressiveness of fuelling can also obviously cause it and especially with fluid intake.
What we’re going to do in the race, we have to try and obviously do something different, if this is what’s causing the nausea and the one thing I would definitely look at is looking at, the first question to answer is, is it too little or is it too much, that’s the one thing and then also look at the hydration, was it too much fluid or too little fluid. It would be interesting in the longer runs that he takes, the longer training runs, if nausea would appear there as well or is it only during the races.
BRAD BROWN: We’re going to get onto over hydration a little bit later on in this chat as well and there’s a couple of questions coming with regards to that, but this is an interesting one as well Nicki, like I said, I’m lucky that I haven’t experienced this, but if I think back to my dad’s running career, this is something that happened to him and Ryan is asking this question. He says he’s run 9 consecutive Comrades Marathons and he’s suffered with terrible nausea for the last 3 of them, usually around Drummond. That’s half way on both the up and the down, he says it didn’t happen in the first 6 years, since he’s started he says he hasn’t changed anything with regards to what he’s doing and that sort of thing.
My dad used to be exactly the same, he says he’s consulted a gastroenterologist, he suggested gastric emptying and prescribed some meds for him. The nausea persisted, he’s subsequently consulted Prof [Dermin?] in Cape Town and he suggested that it wasn’t gastric emptying, but told him to see a cardiologist. He did this with the cardiologist and he said everything was fine. He says he’s been nauseous in half marathons, actually vomiting on the side of the road, is it something that becomes more prevalent later on in your running career? I don’t mean later as you get older, but once you’ve done numerous, particularly Comrades Marathons, it has to have an effect on your body long term, could that be something that we need to be cognizant of as well?
LINDSEY PARRY: What I want to say is one of the things that Nicki alluded to in her causes was dehydration and one of the things that certainly has happened over the last couple of years of Comrades is that Comrades has gotten hotter and hotter. Our physiology doesn’t respond particularly well to heat. It forces us to run slower, it means it diverts more blood away from the stomach to the surface of the skin to help us cool down. One of the reasons why nausea could be so on the increase is just because of the increase in physiological stress that people are under and the other thing I wanted to add because I think then Nicki will be able to take the answer a bit further, is that often in, and I’m going to use the word ‘allergy’ very loosely now, but in allergies, typically if you’re allergic to dogs or bees or whatever it is, the more of that stimulus you receive, the worse that allergy becomes over time.
If you develop an intolerance to fructose or glucose for that matter, then it stands to reason that that intolerance will become worse and the onset of it will be earlier, will gradually become earlier as you become less and less tolerant to it. In that scenario, then I would start looking at alternate forms of energy altogether.
BRAD BROWN: Brilliant, go for it Nicki.
NICKI DE VILLIERS: I’ve seen two or three studies where it actually shows that people are doing better in the first few years after the onset of running and that here in the middle years stuff gets worse and I’ve read about it because that’s often what I find in practice as well, that everything is fine and then all of a sudden we struggle and then we struggle a lot.
Referring back to the motility and the gastric emptying and those kind of things, it seems that running doesn’t change, I mean it does change a bit of the oesophagus motility and it does change a bit of the stomach motility as such, but it’s not so severe if we don’t run hard, so in a Comrades, for instance, if it’s much more duration than what it is this very, very intensity, but most of the studies tell you that it doesn’t really increase the gastric emptying, it can decrease the gastric emptying, but not running as such, more the dehydration part of it and the motility as well.
What can happen because of this constant blood, that the stomach doesn’t get or the gut doesn’t get blood, there’s an increase in what we call permeability in the gut epithelial layer. It sounds very complicated, but it’s not really, it just means that your barrier in your gut that’s supposed to keep stuff in the gut instead of sending it to the blood, you easier then absorb stuff into the blood that’s not supposed to be there and this is just because there’s not enough oxygen going to the gut as such. This can also throughout the years have an influence, so that maybe we must look at feeding the gut, there’s a few supplements and stuff that you can use to make the gut barrier a little bit stronger in these cases. Maybe it’s the same sugar we’re working with, but the digestion is just not complete before it gets into the blood and that sometimes also can cause this nausea in late onset, later in your running life.
BRAD BROWN: All right, cool, there’s lots more questions coming through. Let’s touch on how to cope with it Nicki. If you’re in the middle of a run, the last thing you want is for it to strike, but it does, let’s be honest, that’s why we’re here today to talk about it. We’ve touched on how to prevent it and trial and error and what you need to figure out, but happens if you hit halfway in Comrades or you’re 6km out of a marathon and you start feeling ill, what’s the best way to deal with it?
NICKI DE VILLIERS: Brad, it’s a difficult one, but I would suggest that you stop the intake first, stop carbohydrate intake for the next few K’s. If we can get blood back to the gut just for a while so we can try and clear whatever is in there, it usually goes better, people usually feel better if they vomit, they can carry on. It’s those that can’t get to vomit that really struggle. That would be the one thing.
To look at dehydration versus fuel intake. I would stop necessarily the fuel, especially if you had an aggressive fuelling before you get nauseous, look at if dehydration is a possibility, to carry on with hydrating with small amounts, regularly throughout, but I think the best advice I can give is to just stop carbohydrates for a while so that we can just clear whatever is in the stomach before we carry on.
BRAD BROWN: Lindsey, do you want to jump in there as well for some practical strategies on how to deal with it on the run?
LINDSEY PARRY: I would increase the amount of walking you do, cause for a start, you want to try and get some of that gastric emptying improving a little bit. One of the ways we can do that is by dropping the intensity. Even though the intensity on Comrades is quite low anyway because we’re running quite slowly, we can drop that intensity slightly again by walking and then take note of how thirsty you are and I would move to mostly drinking water, particularly if you are extremely thirsty and it’s a particularly hot day and then in a way, to try and help to drive that thirst, I would try to take in slightly saltier foods. When you’re feeling nauseous, maybe it doesn’t sound like a great idea to eat anything, but if you have a few small nibbles of salted chips, for example, just something with a bit of salt to stimulate your thirst a little bit.
The one thing I left out which I would very definitely try first up and it doesn’t sound amazing, but I would actually physically try and throw up because if it is just a case of having a stomach that’s too full of sweets mixed up and your stomach lining is not doing its job, often if you just purge your body of whatever is in there, then you can go about just slowly sipping a bit of water and then perhaps in another hour or so you can stand the thought of having a little bit more food. Once that’s done or if you can’t do it or if you are continuously throwing up, that’s one of the hardest things, but if you are continuously throwing up and you do need to be aware that you may get yourself into a very dehydrated condition, you just need to sip small amounts of fluid.
If you take one sachet, you might take the entire duration between water tables to get that sachet, you literally just have a slow trickle or get ice, often sucking on ice and letting that water slowly trickle into the system, that’s not a bad way of doing it.
BRAD BROWN: All right, fantastic, keep those questions coming through. There’s lots of them coming through this afternoon. Let’s get into over hydration. This is something that I think a lot of people, I don’t want to say misunderstand, but obviously over many years there’s been a huge talk about dehydration and how dangerous it is, but it turns out that over hydration is way more dangerous than dehydration. Prof Noakes, if you’re interested in this and reading up on it, his book Waterlogged is probably a good starting point with regards to over hydration and why it’s so dangerous. Nicki, over hydration is a huge problem, particularly at a long race like Comrades or Old Mutual Two Oceans, it does become a serious issue.
NICKI DE VILLIERS: Yes it does, it’s maybe not that prevalent, but if it’s an issue, it’s serious, that’s one of the aspects and especially with regards to the weather. With Comrades I think we’re still lucky because of the extreme hot weather that’s usually prevalent there, I think we’re lucky that we probably don’t see that many cases, but I think as soon as it’s a cooler day and I’ve got this strategy of drinking that regularly, I think you’re definitely prone to over drinking or water intoxication or whatever you want to call it.
The best thing, I think, you have to drink according to thirst, that’s first of all quite important to not force stuff down when it becomes difficult for you to drink, not to keep on drinking just because you think dehydration is going to cause me to stop this race. The other thing again, looking at your training efforts. If you can work out a little pattern or schedule that you do in training and know that probably my sweat rate is around this or that and drink according to that schedule. We don’t want people to, for instance, if you weigh yourself prior to and after training, I don’t want you to pick up weight because that will give you an indication that you may be drinking way too much fluid whilst you’re out there.
There is a caution about it and I think the confusion is quite heavy in terms of should I drink or should I not drink, but I think in those longer races, that thirst mechanism is quite an important one and just be aware of it, I think that’s important. There are lots of water tables, so if you become thirsty, it’s not that long before you hit something to drink. I think that would be wise advice, to drink according to thirst whilst you’re out there.
BRAD BROWN: Nicki, let’s touch on what over hydration is. For someone who has heard the term, can you in layman’s terms explain to us what over hydration is?
NICKI DE VILLIERS: It’s about diluting the electrolytes, especially sodium in the body. Over hydration, if you drink too much fluid for amount of sodium that’s there, that sodium balance is quite important for basically controlling our water balance between membranes in the body. If we drink way too much, there’s a decrease of sodium in the blood, as such, then we’re very prone to [inaudible 0.35.11], if it’s happening in the brain, then that’s what we’re scared of because that can really lead to dire consequences.
It’s basically drinking too much fluid with too little electrolytes or especially then sodium in it. If we want to work on the other side of this, say okay, we’re going to drink a lot, let’s take a lot of sodium with it to try and balance this, you’re hardly going to achieve that because taking in that much sodium is really going to be horrid in a drink, you’re going to feel like you’re drinking sea water. That’s not really going to help. It works much better to work on the hydration side of the equation that we rather control it.
It’s basically just the dilution of electrolytes and especially then what we talk about is sodium in the blood that can cause this over hydration or water intoxication symptoms.
BRAD BROWN: Brilliant, I mean we talk about the dangers of it and people often think that dehydration is way more dangerous, but that’s not the case. Can you tell us why it’s dangerous? You could literally die from being over hydrated, can you not?
NICKI DE VILLIERS: Yes you can.
LINDSEY PARRY: Effectively what’s happening is that your chemical process has become completely disrupted because our body works on shunting things from high pressure to a low pressure across a membrane and if, that’s cause of osmotic potential, if your osmotic potential starts to reach zero, your body can’t move fluids around anymore and as Nicki pointed out, you then get a situation where you get pressure buildup in the brain. Your body can’t get rid of the water effectively because we continue to put more fluid in.
Then what happens is that we go into a coma and the reason we go into a coma is because our body is really just protecting us from ourselves so that we do not drink anymore and then we often mistaken that for heat stress or dehydration and [pop a drip in?] and that’s when people do die from hypernatremia and over intoxication and that’s why it’s so dangerous. Nicki said it, I think three or four times I counted it when she was talking, in a race of this nature, where the intensity has dropped and our sweat rates are dropping, if you use thirst as your guide, you’re very unlikely to get yourself into this situation. If you’re thirsty, drink, if you’re not thirsty, don’t just drink because you’re at a watering table.
BRAD BROWN: Lindsey, you make a very important point there, don’t just drink cause you’re at a water table. If you’ve never run Comrades, you’re in for an interesting experience because the latter half of Comrades, the water tables become so close together that you can almost see the next one from the one you’re at. If you think you need to drink at every single table, there’s a good chance you’re going to get yourself into a bit of trouble being over hydrated and being too much liquid, particularly in your gut. A great question in, Nicki, I don’t know if there’s anything else you want to add onto the over hydration before we get into a couple of other questions. We’ve got a few great questions in?
NICKI DE VILLIERS: No, shoot.
BRAD BROWN: I think this is fantastic, it’s from Damian and he wanted to know, how important is solid foods in an ultra. Is it not possible to run a race like the Comrades on fluids alone?
NICKI DE VILLIERS: It will be possible to run the race on fluids alone, it just makes much more sense, the body absorbs much better if I give a different type of carbohydrate mixes, so therefore if you’re used to only running on fluids and there’s no risk for having any gastrointestinal distress, in other words, your stomach is fine and you never battle with it, then you probably will be able to race on fluids, you’re probably get hungry, depending on the intensity of what you’re out there with, but it does seem that it helps to combine different carbohydrate sources. I would definitely ask somebody to, especially if they’re going to be out there for long, to experiment with solid food as well, but it’s not a must. As long as you get the fuel in and you’re comfortable with the way you get it in, there shouldn’t be an issue that you we have to force people to eat solid food at all for that matter.
BRAD BROWN: All right, let me get into another question, what about taking anti-nausea tablets before a run?
LINDSEY PARRY: I’m always very wary about taking any kind of medications, if a miracle cure, like anti cramping stuff, I would firstly have a look at their efficacy, what research was done and obviously try it in advance. If you’re talking specifically about taking medicines that are designed to take away nausea when you’re sick, I would not do that without getting medical advice and look, I know some doctors are happy to let people run on anti-inflammatories and pain killers, but those can have some extremely serious side effects and in fact, we’re busy talking about nausea and that’s the one thing we haven’t mentioned, but anti-inflammatories in particular can trigger extreme nausea during exercise.
Medicines in themselves can lead to irritation of the stomach lining and the intestinal tract, which then also leads to nausea, but I would firstly check with the doctor around nausea medication is, is it safe, what are the potential side effects and don’t ever take that sort of medication without the knowledge of your medical doctor and the people that are watching you in the race because if they don’t know what you’ve taken and something starts to go wrong, they don’t know where to start looking. If you know that there are certain side effects that can come from taking anti-nausea medication, for example, and something starts to happen to you, people can say very quickly once they get hold of your emergency contact, he was taking pain killers, anti-inflammatories, nausea medication or whatever the case may be.
BRAD BROWN: Fantastic, a question in from Barbara, Nicki, I think this one I can pass onto you cause you mentioned glucose and that earlier in the seminar. It’s from Barbara and she wants some advice, in the past she thinks that she hasn’t taken enough in terms of glucose on her runs. She’s now finding that nougat is a great source of that while she’s running, she just needs to be careful that she doesn’t eat too much. She said she felt a little sick at the Meiringspoort half marathon this past weekend and she thinks she ate too big a piece in the run. Do you think that not having enough glucose could be the cause of Barbara’s nausea?
NICKI DE VILLIERS: Very definitely. If blood sugar levels drop, it can be that people will feel nausea because of that and if those nougats work, it’s perfect. Again, eating too much of it is also going to make you nauseous, I would definitely, if the lack of fuel is what’s troubling her and she thinks she’s over eating on a nougat, experiment with different carbohydrate sources. Have whatever they have at the table and just lower the intake of the nougat, but it’s a perfectly fine source of carbohydrate, it shouldn’t be a problem at all, but if you’re going to eat too much of it, it’s definitely going to make you nauseous. I think she did a good thing, maybe just experimenting with it once more and maybe bring in a second carbohydrate source and decrease the amount of nougat that she eats.
Remember, it’s also a solid that goes into the stomach and another thing that can make people nauseous, some people are not good with running and eating, so if we walk whilst we’re eating, that we just swallow less air as well, this can sometimes also help a bit, so that we don’t have that much air in the stomach.
BRAD BROWN: Eating too much nougat, even when you’re not running, could make the best of us nauseous, so Barbara, I hope that helps. A quick question in from Janet, blood pressure was mentioned a little bit earlier, she wanted to know, is there a correlation between high blood pressure and nausea when running, Lindsey can I hand this one over to you?
LINDSEY PARRY: Look, low blood pressure is normally the one that’s associated with dizziness and nausea. Hypertension is normally more related to headaches than actual nausea and it’s normal for your blood pressure to go up during exercise, it’s quite normal for it to go up quite high, particularly in high intensity exercise, but if it’s going up excessively high and the only way we can track that is by actually doing a test with a cardiologist or someone who works in a cardiology practice, we don’t want abnormally high blood pressure and especially you don’t want to have abnormally high diastolic. When you get blood pressure, it gets given to you as two numbers, typically resting is somewhere between 110 and 130, being considered quite normal, over 60 to say 70, maybe 80, but that’s starting to get up a bit.
When that bottom number starts to push over 90 and heading towards 100 during exercise, that would be alarming, but it should be associated with headaches and when your head feels like you can feel the pulse in your head and you feel that pressure build up in your head, nausea would normally be associated with low blood pressure rather than high blood pressure.
BRAD BROWN: Right, I hope that helps. Another question in from Belinda, says I’ve recently returned to running on the road after a two year recovery period from back surgery. She says she has received the go-ahead from her surgeon. She spent the last 4 months preparing to get back into training and loving every minute. She’s using a run/walk strategy at the moment. She’s running 100m, walking 100m, she’s only covering 5km distances at a time now and working on improving her time over that distance. The problem is that she finds when she pushes herself harder, the more nauseous she feels, what’s the cause of this? She doesn’t eat before training and doesn’t consume copious amounts of water before training. She says: Please advise, this is an awful sensation and one that I’ve not experienced before. Lindsey, it ties into increasing your intensity.
LINDSEY PARRY: Ja, so there’s two parts to this answer. I’ll pass the ball to Nicki for the other part but yes, when you run at very high intensity, now, in this instance it may not feel like very high intensity because you haven’t run for a long time, so you might not feel like you’re running particularly hard, but if you’re pushing yourself very hard, then you will develop high amounts of blood lactate, so your muscles will product lactic acid because they cannot produce enough energy from using oxygen or pathways that involve oxygen, so they start making energy from pathways that do not use oxygen and that has lactic acid as a byproduct and while lactic acid in itself is not the bad guy that everyone makes it out to be, I don’t want to get this answer too complicated, but in terms of the extreme nausea that you feel, very high levels of blood lactate will make you feel nauseous.
The other part, she says she’s not eating or drinking, so that in itself is problematic and one of the things that Nicki has explained to my athletes a lot and it’s made a big difference to them, is that you either fuel before exercise or you fuel during exercise. If you are going into exercise and it’s been too long since you’ve given yourself fuel, and you perhaps had a busy day and you’re a little bit hypoglycaemic before the exercise, that can also lead to the nausea in exercise because of low blood sugar. I don’t need to pass the ball over, I think I answered the question but Nicki might have something more to add.
NICKI DE VILLIERS: Nothing more, just the hydration part as well, especially if it’s early morning where you’re usually dehydrated, so make sure you drink something as well.
BRAD BROWN: Perfect, Nicki, I’m going to ask you this question because I think you mentioned it, Robyn wanted to know, she said, when you spoke about, or was it Lindsey, I’m not sure, you spoke about gut permeability, you mentioned oxygen saturation, could your oxygen saturation level be related to nausea?
NICKI DE VILLIERS: A better question for Lindsey I think.
LINDSEY PARRY: Look, it can be, and I think it probably goes on a couple of, it speaks to a couple of points. Let’s take the extreme example of someone coming from Cape Town or Durban, or the UK, and going to do a race in Mexico City at 3 000m, there’s immediately going to be an oxygen deficit, again, not a great phrase, but it explains what I’m trying to get at. There’s not enough oxygen to go around, therefore you immediately are pushed into a scenario where you are having to produce a large amount of energy from pathways that don’t use oxygen and as soon as we do that, then there’s an increase in metabolite or byproducts of energy production and when that happens, there is an increased degree of nausea that would be associated with exercise.
I’m using a very extreme example, but that would probably lead to, someone coming from sea level straight to competing at 3 000m, even at low intensity exercise, they’d probably feel dizzy, light headed and nauseous quite early in the exercise. One of the things we haven’t touched on at all and it just came into my head while we were talking, and it’s not a common thing that happens to people, but it does happen to some people, this phenomenon of what we term rebound hypoglycaemia. So you do all the right things before you exercise, but in a small percentage of people, just the act of starting the exercise means there’s a sudden increase in blood sugar followed by an immediate drop in blood sugar, which leads to feeling dizzy and nauseous, but that typically doesn’t happen during exercise and Nicki can correct me if I’m making any mistakes in my explanation. That typically wouldn’t happen into exercise, that’s something that happens quite early and at the onset of exerciser or just before exercise.
NICKI DE VILLIERS: That’s correct, that’s basically just timing of your meal and then working a little bit, intensity can also make that better, to include a bit of high intensity warm up, a little bit of that. That is such a small percentage of people and it’s really right at the onset.
BRAD BROWN: Talking of intensity, this is also a fabulous question, we’ve spoken and mentioned that the intensity of the race makes a difference, does that mean that there’s a different approach as far as a different eating and drinking plan to nausea, if you’re trying to run a silver medal at Comrades as opposed to a 10 hour or 11 hour or 12 hour. Lindsey, intensity, it obviously depends on your ability. For someone like me to try and run a silver medal, I’m going to puke within the first kilometer, whereas someone who has trained for a silver, the intensity is probably the same, I’m guessing, if that’s the medal you’re going for. How would you approach that?
LINDSEY PARRY: There is a difference and there’s a difference for a couple of reasons. The first one is the most obvious and that is because if I’m going for a 6 hours, 6.5 or 7 hour, I’m going to be consuming far less calories over a far shorter period of time than somebody who is running 10-12 hours. One of the main differences is the duration. You are more likely to get away with nausea if you are running faster, although there are still a lot of people up at that speed that do suffer from nausea and then there’s also the relative intensity. There are similarities in terms of relative intensity. I would perhaps be running a 7:15 Comrades where someone else may be running a 8:15 Comrades and the intensities that we’re running at are fairly similar, but by the same token, there’s going to be loads of people that a 9 hour, it’s just out of the question.
They’re not going to run at that intensity so that they can get 9 hours and 15, they’re going to run much easier and get a 10 or a 10:50, so there are different nutrition strategies, fluid rates that need to be taken into account for someone that is really pushing the envelope to run 7:55 and someone who is running a very comfortable 9:45 because they know they’re not going to go under 9, so let’s rather just enjoy it.
BRAD BROWN: I love that, a very comfortable 9:45, in my wildest dreams! Nicki and Lindsey, before we wrap things up, we are running out of time, I just wanted to touch on those running resources and the first one is Nicki de Villiers. Nicki is superb, I mentioned at the start of the seminar that she works out of the High Performance Centre at the University of Pretoria. She’s worked with some of South Africa’s top athletes, not just runners, she’s worked across the board. There’s some great athletes that train out of there and if you want some one-on-one help from Nicki, if you’d like to book a consult or find out more about her rates and what she does, you can pop her an email. That’s the email address, it’s: nicki.devilliers@hpc.co.za. You can also call the office line, it’s 012-4841711, I’ll pop those details in an email to everyone as well when we’re done with this.
So Nicki, let me say thank you to you for joining us today, it’s much appreciated, your time and Lindsey, thank you to you as well.
LINDSEY PARRY: Absolutely pleasure.
BRAD BROWN: If you’ve got any questions about the Coach Parry membership community as well, you’re more than welcome to pop those into the question tabs as well, but it looks like we’ve done pretty well on the questions. Lisa just wanted to know, does chewing gum along the way help with nausea?
NICKI DE VILLIERS: It would be individual. I would think it would aggravate nausea, but if that is one of the things that you’ve tried and tested and it works for you, go for it.
BRAD BROWN: Fantastic, there you go, that’s pretty much it for the questions. That link once again if you want to join the Coach Parry online community, it is coachparry.com/membershipoptions, you can sign up there right now. From the three of us, myself, Brad Brown, Lindsey Parry and Nicki de Villiers, thank you so much for joining us. We look forward to having you along for the next one. Until next time, cheers.