Addressing Endurance Athlete Gut Issues with Dr. Patrick Wilson

The author of The Athlete’s Gut talks with us about digestive issues like bloating, cramps, pain and inflammation, all of which can derail the best event preparation plans.

Young man running athlete during a workout in a hill

If you’re an endurance sports athlete, chances are you’ve had an event where you had to scale back your ambitions or even pull out due to GI issues. It’s happened to all of us. For me, it was at the Belgian waffle ride in San Diego.

But for Grand Tour riders like Brent Bookwalter, who had to pull out of the Giro d’Italia, it can be the only reason they’ve ever quit a grand tour. For those of us who suffer from these issues, we’re willing to try almost anything:

  • Get up at 4am to have breakfast well before an event.
  • Eat a low FODMAP diet for the week leading up to a race.
  • Pop antacids and experiment with raised food after race food until we find one that works with our stomachs.

But the important question is: what causes your digestive issues and what’s been proven to help?

That’s where this episode’s guest comes in.

Registered Dietitian and researcher Dr. Patrick Wilson literally wrote the book on. His book The Athlete’s Gut has helped numerous endurance sports athletes keep their digestion under control during their events.

At the core of the conversation is identifying what causes your digestive issues because it can be unique to every athlete, and the solution depends on the cause.

Along with Dr. Wilson, we talk with recently retired pro cyclist Brent Bookwalter, who now dedicates his time to the Pro Cyclist Foundation, an organization that provides mental support for athletes.

We also hear from exercise physiologist Jared Berg, and current pro Tom Skujins from Trek-Segafredo about how he addresses gut problems.

So grab your favorite easily digestible food, and let’s make you fast.

Episode Transcript

Rob Pickels 0:04
Hello and Welcome to Fast talk your source for the science of endurance performance. I’m your host Rob pickles here with my co host, Trevor Connor. If you’re an endurance sports athlete, chances are you’ve had an event where you had to scale back your ambitions or even pull out due to GI issues. It’s happened to all of us. For me, it was at the Belgian waffle ride in San Diego. But for Grand Tour riders like Brent Bookwalter, who had to pull out of the Giro d’Italia, it can be the only reason they’ve ever quit a grand tour. For those of us who suffer from these issues. Were willing to try almost anything. Get up at 4am to have breakfast well before an event. Eat a low FODMAP diet for the week leading up to a race, pop and acids and experiment with raised food after race food until we find one that works with our stomachs. But the important question is what causes your digestive issues and what’s been proven to help? That’s where our guest today comes in. Registered Dietitian and researcher Dr. Patrick Wilson wrote the book on it literally. The athlete’s gut has helped numerous endurance sports athletes keep their digestion under control during their events. At the core of the conversation is identifying what causes your digestive issues because it can be unique to every athlete, and the solution depends on the cause. Along with Dr. Wilson, we talk with recently retired pro cyclist Brent Bookwalter, who now dedicates his time to the pro cyclist Foundation, an organization that provides mental support for athletes. We also hear from exercise physiologist Jared Berg, and current pro Tom squinch. From trek Segafredo about how he addresses gut problems. So grab your favorite easily digestible food, and let’s make you fast.

Trevor Connor 1:57
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Rob Pickels 2:12
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Trevor Connor 2:32
your USA Cycling coach visit fast talk To get started today. Dr. Wilson, welcome to the show. So we are talking about a subject that seems to be near and dear to your heart. You even wrote the book The athletes guts. So this is something that you’ve really focused on? For

Unknown Speaker 2:54
sure. Yeah, I mean, it’s something I’ve been interested in a while enough. So as you mentioned that I decided to kind of write a whole book on it, you know, it’s it’s an issue GI issues, gut issues are problems that pretty much every endurance athlete at some point or another is going to encounter. Unfortunately, some it’s it’s almost every training session or every competition, you know, fortunately for most, it’s more of a relative occurrence or somewhat of a rarity that it’s bad enough to impact their performance. But like I said, at any point in time, I mean, it’s a chance that an athlete’s can experience a problem. And over long periods of time, you know, months training, it’s likely that, you know, at some point, there’s going to be an issue where it’s bad enough to interfere with either, you know, their ability to carry out the training or in competition, setting their ability to perform as well as they want or even sometimes finish a race. You know, it’s bad enough that they have to drop out.

Rob Pickels 3:46
So Dr. Wilson, I feel like a lot of people find their way into research because of issues that, you know, they’re interested personally, I know, that’s how I ended up in sports science. I also know that I have a lot of sort of gut things that go on when I’m out there riding. Was it the same for you? How did you end up in this field of gut health? Was it through personal experience or just sort of through education and schooling? How did you end up here?

Unknown Speaker 4:07
You know, it’s kind of a little bit more happenstance than me, I’ve certainly had my fair share of functional gut issues. I mean, I’ve had stuff that probably resembles IBS, dyspepsia that sort of thing. I’ve gotten to gastrin or inner ologists multiple times and that it’s not been bad enough to the point where it’s, I think, been a major impediment in my life really interfered with my training a whole lot. But in terms of how I got into it from a research perspective, it was largely when I was doing my PhD. I was researching kind of multiple transportable carbohydrates, you know, the idea that you mix glucose and fructose into supplement or beverage and it’s gonna help enhance performance, increase carbohydrate burning, and also reduce potentially gi side effects from supplementation. So I gotten into that area of research And I was carrying out a study with runners, because pretty much all the studies at that point have been done in cyclists. And it’s just a lot easier to feed cyclists a high rate of carbohydrate. And it had not really been shown to work in runners to use a mixture of glucose and fructose. And that’s kind of where it started, you know, GI symptoms, were something that I evaluated and just kind of got interested in that aspect of it from that project. And from there, it kind of just ended up showing up in other areas of my work. And it’s, you know, kind of hard to go back and track exactly what the through line was for all of it. But you know, I just progressively got more interested in it, because it’s so common for endurance athletes to experience problems, you know, it’s one of those things that sometimes people don’t like to mention, or they feel uncomfortable talking about, but it’s so problematic for so many endurance athletes.

Trevor Connor 5:54
So let’s go there. And you’re right, it is a problem that a lot of endurance athletes experience. So what are some of the causes? What are some of the reasons that this is so common in endurance athletes?

Unknown Speaker 6:05
Yeah, it really ranges a lot. And that’s, I think, what makes it interesting is that, you know, there’s a variety of different symptoms an athlete can experience. And for each of those symptoms, there can be similar causes, or they can be completely different causes. I mean, a good example is like bloating, you know, that’s really kind of a distension of the abdomen, or the gut from a buildup of gas. And that oftentimes is going to be triggered by, you know, eating certain types of foods, that result in fermentation of carbohydrate in the production of gas, that’s a very specific cause. Whereas, you know, something like nausea, or maybe something like reflux or going to have other causes, you know, eating too much fatty food, before you work out, could cause reflux, nausea could be caused by dehydration, it could be caused by just very high intensity of exercise. So that I think that’s what really makes it sometimes challenging to figure out is, all these different symptoms can have different causes. So I kind of advocate the approach of trying to document the specific symptoms that an athlete is experiencing, when they’re experiencing them, what the context is, and then from there trying to pin down what’s the most likely cause in that scenario, because, you know, ultimately, there can be a lot of different causes for the gut problems that athletes experience.

Rob Pickels 7:27
And that seems to be the crux of the situation, right, that it can be different for everyone, and maybe even for the same individual, they have different responses in a slightly different situation. I think that it’s interesting that you point out, trying to document exactly what’s going on and figure out what are the common threads that caused me to feel the way that I do? And I think that that’s maybe something athletes should be doing more of, but it seems difficult in the moment, what sort of thing should they be documenting? What are the factors that come into this environmental conditions? Intensity?

Unknown Speaker 7:58
Yeah, that’s a good question. You know, I think it’s going to be partly environmental, it’s going to be potentially what the athletes eating. Yes, environment plays a big role in terms of whether or not someone’s going to experience problems, you know, there’s good research to show that if you exercise in a hot environment, or human environment, that makes honestly most symptoms worse. So that’s one of those examples of something that can make a variety of symptoms more prevalent, or more severe. You know, you’ve got basically a redirection of blood flow away from the gut, to the skin, you know, you’re losing fluid through sweating. So you’ve got this kind of constellation of things going on, that makes it just more probable everything was the good is going to kind of shut down. So yeah, I mean, that’s definitely one to pay attention to, obviously be the environmental conditions. But in terms of what you might document otherwise, I think it depends on how often you’re experiencing symptoms. And if it’s relatively frequently, then maybe it’s time to start really considering, you know, what exactly are you eating before these training sessions or competitions where you’re having problems? And can you identify something as a causative agent in the foods that you’re eating? Another big one, I think sometimes is overlooked. And it’s been more of a focus in my research in the last couple of years is anxiety and stress. So how are you feeling in terms of your psychological state, particularly before competition? Are you feeling quite anxious? And does it seem like that anxiety is manifesting as gi problems we’ve done? You know, at least three or four studies now that show consistently that anxiety is correlated with GI symptoms in endurance athletes, in particular, if it’s the morning of competition, and those symptoms are pretty prevalent in someone’s experiencing anxiety, that could be one thing to take a look at as a target for intervention. So yeah, it could be diet. It could be your psychological state, environmental conditions, medications, are you taking NSAIDs is another example. Yeah, that’s what really makes it kind of a tough not to crack sometimes is there’s just a lot of potential causes. And I guess if you’re regularly experiencing symptoms, the more you can document the context around those problems, the better chances you have at identifying an underlying cause, if you just kind of take a oh, you know, I’ll think about it at the time. And then, you know, retrospectively, you go back and try and think of what you did, it’s a lot less likely, I think you’re going to come up with a, you know, a real concrete explanation for what’s going on.

Trevor Connor 10:28
Brett book, Walter suffered from gi problems throughout his professional career, he shares with us both some of the causes he found and how he addressed them. Have you ever had any sort of gut issues? And what have you done about it? If you have,

Brent Bookwalter 10:43
oh, we need a whole podcast for my gut history? Yeah, gut issues, for sure. I think you’d be hard pressed to find a pro cyclist who’s done Grand Tours, that has never had any gun issues. Yeah, but by nature of the beast, the stage races that we do the the feeling demands, and energy consumption and expenditures, just off the charts. And despite training for it definitely developed a greater appreciation of training for that energy consumption, and expenditure in terms of eating and fueling and training as well as racing throughout my career. But yeah, there’s only so much you can do, you know, you can ever totally train for predict that stress of the race physically, emotionally, mentally, logistically, everything. So yeah, it’s been definitely, like I said, I think every every grand tour I did, there’s definitely a period with just at the least, least least, you know, some acid reflux and some indigestion and some bloating and, and then yeah, more seriously, I had a had a really difficult period would have been 2019. Yeah, ultimately, it forced me to stop. The Giro was the first Evergrande tour that I didn’t finish. And I had some digestive gut issues, whenever totally got to the bottom of it. But the brief diagnosis was that I had a lot of inflammation, didn’t have stomach ulcers, but had a very irritated, irritated stomach. And yeah, it was, you know, it’s lights out, if you can’t process energy, and if you’re having huge amounts of acid reflux, and it starts and impairing your breathing as well,

Trevor Connor 12:19
do you think looking back on it? Do you feel like oh, boy, I wish I had done X or done y? And I think that would have fixed it? Or is it just, these things just happen? And sometimes there’s nothing you can do about it?

Brent Bookwalter 12:31
Yeah, I think, um, you know, just like the rest of our bodies, you know, we our bodies are miraculous. And we, we can dish a lot out to them, and they, they keep coming back, and they come back stronger, and the body we heal, but just like, just like our lungs can get sick, and just like our bones can get broken. You know, there’s viruses and there’s bacteria that gets in there. And there’s imbalances and some of that is just can be chalked up to sickness, and, you know, vulnerable immune systems and that dynamic where we’re more as being thrown out that system of the body than it can handle. So yeah, in some ways, I think there’s going to be times when it’s just unavoidable, but there are definitely, definitely things we can do. I think, I think in general, just stress plays on the gut stress in general emotional stress, mental stress, and then obviously the physical stress. So I think having a way to navigate that manage that plan for it anticipate it is really important. The other big thing I think that I learned throughout my career for sure is that when when those energy demands are so high and the consumption and expenditure demands are so high that you really have to sort of like dumb down the flavors and and all the extra stuff in our diet and just go for that the fuel just the carbohydrate, okay, I remember being being a young writer on BMC and complaining that the team chef was never making anything with any flavor you know, bring in like brand sauces from home even and chucking Tabasco and everything and looking over my Italian teammates just do an olive oil and cheese on this massive plates of pasta one after another after another and I was repulsed and revolted by that very disgusted and critical but yeah, fast forward 15 years later and I was there many a day when I was just yeah, the chef would make something maybe even the opposite something super delicious and my stomach’s you know maybe feeling a little unsettled and you know, I got to kind of turn down or just maybe eat a little bit of the the real flavorful item and then just go for the basic car bomb.

Trevor Connor 14:40
Keep it simple. Yeah. I mean that stress is a factor is a big one. You know, I certainly remember early in my cycling career when I used to not sleep well the night before my races because I’d be so stressed about them. I’d get up in the morning and even though I’d read about the you know, eat your typical breakfast, make sure You get enough food in your system, my gut would be doing such flips before the race that if I could get anything down, it would be nice. But I did a lot of races without eating beforehand, just because I couldn’t.

Unknown Speaker 15:13
Yeah, that’s a great point, you were actually trying to confirm your anecdote, there is something that happens more widespread across the board. I mean, we’ve we’ve shown now consistently, that anxiety correlates with symptoms. But now we’re doing we actually have collected data on about 150 endurance participants in races and asked them to report what they ate before and during the races. And then they also rated how anxious they were before the race. And we’re in the process of kind of analyzing the data now. And the hypothesis is essentially what you just said there that athletes who are more anxious going into races are going to fuel less beforehand. And potentially during I think it’s probably more probable that, you know, pre race, nutrition is going to be affected. And we’ll see if that is actually, you know, more consistently what we find across the board. But your anecdote, you know, of kind of having gut problems, because you’re anxious and stressed about the race impacts feeling. I mean, that obviously has implications for, you know, potentially how somebody is going to be able to perform, particularly if it’s obviously a really long event where a feeling is, you know, obviously very critical. If it’s a shorter race, you know, that’s not such a big deal. But if it’s getting into your, you know, two plus hour territory, then that becomes more problematic.

Trevor Connor 16:26
But I want to go back to something you brought up, because I do think this is an important factor this this whole question of blood perfusion, because, you know, first I’ll tell you, I’m very interested in evolutionary biology. And something I’ve said on the show a few times is, we weren’t designed for doing competitive sports, our bodies think when we’re going really hard that we’re probably running away from a lion or something really big. And that’s a point when your body says right now, I don’t really care about digestion, I don’t want to be digested myself. So blood gets shunted other places gets shut to to your muscles to your heart, basically, to help you do it you need to do and it says right now sending blood to my gut is not the top priority. And that seems to be a big factor in these endurance sports, where if you’re going hard, and for extended periods of time that you point out, particularly in the heat, where you also need to be able to sweat and get blood to the surface, you’re not getting that blood flow to the gut, it’s not going to function as well.

Unknown Speaker 17:26
Yeah, I mean, there’s definitely studies that show exercise intensity is correlated with the amount of or extent of reduction in gut blood flow, you know, the higher you get an intensity, the more impairment there is in that sort of flow to the visceral region of the body, to your intestines, to your visceral organs. And heat is gonna exacerbate that, like you said, you know, you’ve got only so much blood to go around. And if it’s a hot environment, your brain you know, knows that that’s a priority to cool yourself off. Because, honestly, overheating your brain is more of a threat to survival, then I think probably what’s going to happen if you reduce cut blood flow. I mean, there’s potentially some negative implications there. But they’re less dire than overheated brain. So yeah, your body’s kind of trying to figure out how to prioritize blood flow, and in particularly in prolonged strenuous races in a hot environment, you know, it certainly is a part of the body that maybe isn’t prioritized. Yeah. And, you know, historically, you know, humans may have been walking and jogging to track animals and hunting and things like that, where they obviously were giving sustained efforts for longer periods of time, but it’s not like modern day marathons, right? Nobody I can really think of, probably in our ancestral past was running at 80% of their view to max or higher for two hours straight. I mean, it doesn’t really seem plausible to me. So that’s more of a modern sort of thing with humans that, you know, our gut isn’t really built to handle probably very well, in a lot of cases, you get better with training these impairments and get blood flow and your ability to cool yourself more efficiently gets better with training and climatization. So those are a couple pieces, I think of the puzzle is just knowing that over time, some of these things get better as you train more. And then also making sure you climatized to the environment appropriately.

Trevor Connor 19:21
It really observant, because I’ve actually read the studies about hunter gatherers, observations of them and when they were hunting, as you said, they weren’t going hard. It was more kind of a walk jog. The only times they went hard were going in for that final kill, or generally when they were running away from something.

Unknown Speaker 19:37
Yeah, so it’s, you know, it’s a modern human invention endurance races. And yeah, it’s just such a physiological stressor that it’s very difficult for the body, I think, in some ways to balance all those demands, right in terms of what’s going on. So it’s pretty amazing that the body is able to really deal with that the way that it can. But, you know, I don’t think we really evolved for the purposes of high level competition, specifically why that’s obviously some people are more well suited for that than others. But the guide is certainly an Oregon system that is going to be affected by the blood flow that gets, or the lack thereof in situations where it’s not prioritized.

Trevor Connor 20:15
So what is the impact on the gut, when you have this decreased blood flow, when you have this increase in heat shock proteins, what happens?

Unknown Speaker 20:24
Yeah, that’s physiologically, you know, your gut, like any other organ system needs oxygen and energy. So it’s that necessarily the blood per se, that’s the problem or the lack of blood, that’s the problem. It’s the lack of oxygen, it’s the lack of nutrients being delivered, you get kind of a hypoxic environment, in the intestinal cells in the cells lining the guts, and they start to have, you know, dysfunction, they start to kind of loosen up, the tight junctions that normally characterize the gut start to open up in that allows the passage of larger molecules that generally you don’t want circulating in your bloodstream, for example, endotoxins are these kind of lipid polysaccharides substances that you find in bacteria, kind of a marker of infiltration of things into the bloodstream that normally aren’t present in high amounts. And the consequence of that, for example, would be if there’s a lot of that you can have an inflammatory response to systemic inflammatory response that maybe in a hot environment can actually contribute to or accelerates the rise in in core body temperature. And that could contribute to heat illness, in theory, at least. So that’s one example of a potential consequence of you know, having a reduction in blood flow is just letting stuff into the body that you generally don’t want, going into the body in large amounts. The other kind of obvious implication is if your intestinal cells are starved of oxygen, or they’re not getting as much as they need, the overall function of the gut is going to be impaired. So motility and absorptive capacity might be impaired. So it’s just not able to really do its job. And if it does, you’re not absorbing the stuff that you eat, it’s just sitting there in your gut causing kind of havoc. So the two main main consequences in my mind would be malabsorption, and GI symptoms associated with that. And then the other more systemic inflammatory response that might contribute to heat illness. And then also maybe GI symptoms like nausea, you know, the hotter you get, the more inflammation going on in your body, the more likely you are to experience nausea and vomiting.

Rob Pickels 22:31
So if we look at this at the high level, as you mentioned, a hot environment, increase exercise, intensity, stress, all of those things are going to lead to this decrease in oxygen, that can cause this increase in permeability in the gut. As you mentioned, inflammatory responses occur in malabsorption. Do these processes tend to happen equally in both genders in people of all ages? Can we make generalizations that there are some groups more naturally able to deal with these stressors,

Unknown Speaker 23:02
people who are trained who have customized themselves to, you know, regularly experiencing intense exercise are better able to avoid kind of exaggerated responses, for example, good blood flow in a given exercise intensity gets better with training, and the sort of permeabilities probably less severe, you know, as you train and then also, again, a climatization to environment can make those things better as well. Terms of a gender sex effects, I don’t know that that’s been really shown or an age effect. If there is one of an age effect, it probably has more to do with the fact that as people get older, they tend to exercise at lower intensities. And in general GI symptoms, gut distress tends to be negatively correlated with age, meaning the older you get, the less likely you are to experience symptoms during training and competition. It’s not a super strong correlation, but it’s a consistent correlation that’s been seen across multiple studies. So I think the biggest factors in my mind would be training experience, and then a climatization to the environment. Beyond that, nutritional choices are certainly going to have some sort of impacts, they will play a role, but climatization and training status are two big ones. From my perspective, as Dr. Wilson

Trevor Connor 24:21
pointed out, not everyone is affected equally. Another issue can be sensitivities to foods and that can impact even the best trained athletes, as Tom squinch is about to explain. So Tom’s I know this is something that is becoming increasingly important to athletes, at least they’re paying attention to as the research is expanding. And we’re realizing the importance of the gut, his gut health, your microbiome, something that you think about that you pay attention to and if so, what do you do?

Toms Skujins 24:53
Yeah, that is a really good question. I definitely have experienced both good my probiotics my gut and both bad the first time actually, I realized that it’s a thing was 2013. So almost 10 years ago now, when I realized that I have a pretty solid sensitivity to gluten, and my skin was just getting worse, and my body weight was just growing and there was a lot of water weight I was carrying around for no particular reason, until I found out that it was just gluten was not really something I could digest well, and once I cut that out, I slimmed down quite a bit, my skin got way better. And since then, pretty much I’ve been a big fan of using probiotics probably have used mostly sound probiotics for quite a while, and they make some really good product. And I have been known also to brew my own kombucha, here and there every once in a while. But right now the scoby is looking pretty weak, I gotta say.

Trevor Connor 25:56
So what I’m really interested in is you did bring up something that I’ve seen a lot in the research, even Dr. You can drip has done a couple studies on this, that when you have this decrease in blood perfusion to the gut, and you get some damage and opening of the tight junctions, you get what you talked about this endotoxemia so actually, when a doctor you can drip studies, he kind of compared it to sepsis, which is the same effect it’s an opening of the the gut and allowing gram negative bacterial these toxins into the systems and extreme sepsis can kill you. But in sports, you’re not obviously getting that extreme. But I’ve seen studies that point out when you get this endotoxemia that can actually lead to symptoms of illness when you actually don’t have a virus. So I’ve kind of as I was getting ready for this recording, I kind of found that interesting that there are some things you’re going to feel on the bike or when you’re in a race when you’re running such you brought up bloating brought up nausea, but there might also be some effects that you’re gonna have from too much training too much racing, where it can actually make you feel sick, when when it’s actually just this dysfunction in the gut.

Unknown Speaker 27:05
Yeah, that’s that’s an interesting point. I mean, it’s the actual symptoms of like nausea that accompany you know, this endotoxemia is probably driven to a large extent by the inflammatory response, you know, there’s studies outside of the context of exercise where you can mimic, you know, the symptoms of infection by injecting inflammatory compounds into people and just isolating that outside of actually then being infected. And you can get sort of those fever symptoms that they experience with large doses of these inflammatory like cytokines, but we call them so yeah, I think if someone is overtraining or training a lot, or if they’ve recently been sick, and they haven’t really allowed themselves enough time to really heal from that, and they jump back into training too aggressively. I think that is potentially a recipe for, in certain situations, leading to more gi problems, especially if it’s, you know, you’ve been sick, you haven’t recovered well, and then you decide to go into do a really long training effort in a hot environment, you know, that’s a recipe for problems, not only probably increasing your risk of having some sort of heat illness problem, but also maybe having exacerbation or worse gi problems. So yeah, it’s it’s certainly some other things you can look at contextually, like the training load, you know, whether someone’s been ill recently, and those sorts of things. And, you know, that could be in some cases contributing to GI symptoms, that’s a hard one to, you know, a hard one to figure out, you know, why, why somebody would actually be experiencing the symptoms, but you’d have to look at the broader context, look at multiple variables at the same time and do some investigative work. But that’s a tricky one, I think, because it’s, you’re not going to evaluate those cytokines in somebody’s blood just day to day. So you don’t really know what’s going on behind the scenes. And it largely comes down to looking at self reported symptoms and other things you can document and that makes it challenging to figure out if that’s contributing to the problem in a in the real world outside of the context of research.

Trevor Connor 29:06
That’s really interesting. Great that you brought that up, because certainly that’s what I was seeing in multiple these studies is they did look at the cytokine levels and saw elevated TNF alpha elevated inflammatory aisle six, he says these are two of the key cytokines that you see when people are in an inflammatory state.

Unknown Speaker 29:24
Yeah, I think it’s interesting that studies do there have been some studies have shown a correlation between those cytokines and development of GI symptoms, particularly Nausea is the one that I think most consistently see a correlation. So this is, you know, these are observational correlations, you know, the increase in those during a race correlate with the development of symptoms. Interestingly, the shorter studies, the experimental studies haven’t found that as clearly I think, in part because they just use shorter exercise protocols, potentially. I mean, it’s the studies where there’s been a correlation a lot of times it’s been something like, you know, a half Ironman race or an Ironman race or something. like that, that’s a whole different level of stress than, you know, exercising for an hour or two in the lab. And in those shorter studies that there hasn’t been this really clear, consistent systemic inflammation, and cytokine levels correlate with GI symptoms in those more controlled context. So it’s an interesting puzzle to try and figure out exactly what role they play, and I think probably becomes more of an issue. Again, when you’re getting into really long, prolonged stuff, particularly in hot environments.

Rob Pickels 30:30
I think, Patrick, the last thing that you mentioned, when we’re talking about prolonged where my mind goes, is not just a prolonged event. And I definitely understand how the observational studies that use these really grueling and arduous endurance events can maybe elicit a different response than a researcher trying to exercise somebody in a lab in just a very different situation. But what I’m wondering is, when we talk about cytokines, when we talk about inflammation, when we talk about these changes that we’re seeing in the gut, is this related just to the event itself, and then tomorrow, when you’re sitting on the couch, with your legs up, everything goes back to normal? Or do we see this increase in potentially these changes the increased permeability that we discussed before, does that continue for 135 days, months after

Unknown Speaker 31:20
in healthy, trained individuals who are exercising a lot, who, you know, don’t have metabolic diseases who don’t have diagnosis, guess intestinal conditions. Generally, these are pretty transient changes, I mean, the extent of how long they last is going to depend, you know, on the extreme nature or the nature of the event in terms of its intensity, and duration. But for the most part, these are pretty transient changes that within a day, or to largely, you know, those cytokine levels are going to come back down to, you know, relative normal, there, I guess, could be some circumstances where maybe you’re doing like a multi day event, or you are going through a very heavy training period, and you’re maybe getting into the overtraining territory, where I guess theoretically, you can see some see some more persistent elevations in these cytokines in systemic inflammation, but for the most part, they’re relatively transient. So your body does recover pretty quickly from these types of exposures. And I think that’s an important thing to remember is that for the most part, the body’s pretty resilient, does recover fairly quickly. And increases in GI permeability are typically transient with the exception of again, maybe people who have a diagnosed gi condition, maybe they have uncontrolled celiac disease, or Crohn’s disease or something of that nature.

Rob Pickels 32:44
Yeah, I think that that’s a really interesting point. And it led to my next question here, which is, in those people who have the diagnosed issues, it’s important previously that you pointed out everything we’re talking about is in an otherwise healthy person. But for people that have a known gi issue, are they more likely to experience nausea, bloating, all of these negative symptoms that we’re talking about?

Unknown Speaker 33:05
With exercise? We don’t know, there are just few few few studies on GI symptoms in the context of exercise in individuals who have diagnosed conditions like celiac or Crohn’s disease or ulcerative colitis, I mean, even IBS, which is incredibly common, there’s really not a lot of research on the interactions of exercise underlying systemic inflammation and GI symptoms. So scientifically, I don’t really have a good answer for you there because there just aren’t studies to pull from. In theory, there could be more concern that because of, you know, the possible, you know, micro damage that is consistently happening in that person’s gut, because of a disease process, they are more susceptible to, you know, things like systemic inflammation with exercise or heat illness or something like that. But that’s just kind of a speculative guess.

Trevor Connor 33:57
So I’m going to throw in a bit of a roundabout way. But this goes back to some of my master’s research. There is a lot of evidence that athletes tend to have a more healthy micro flora, they have a greater diversity. And there’s certainly been plenty of research showing that greater diversity seems to help with a lot of these gi problems, such as Crohn’s, such as IBS, and there’s been actually a fair amount of research on supplementing with probiotics to help with those conditions. So, as you said, I haven’t seen any direct research, but there is a potential pathway here.

Unknown Speaker 34:29
Yeah, the gut microbiota, or microbiome, depending on how you define it. You’ve got on average, I think the calculations projections are roughly you know, 35 to 40 trillion bacteria residing in your, you know, your large intestine. So it’s this huge community of microbes that are impacting your house. So we know that if you completely remove the microbiota from an animal, you raise a mouse. A mouse is born in a germ free environment that it definitely causes no physiological and physical changes. to impact health. Now, how do we study that in human, obviously, we can’t raise people in germ free environments in an ethical manner. So we end up doing a couple of things. We will, you know, observationally test their microbiome, usually through stool analysis, and correlate that with what they’re eating, how much they exercise, that sort of approach. There’s the probiotic approach, which you mentioned, trying to kind of manipulate the gut microbiota. You know, there’s also these studies that have actually done like fecal transplants, but that’s been more in clinical populations. It’s a difficult thing to study. But you are right, that there’s disturbances in the microbiome. And a lot of individuals who have issues with GI illnesses. So whether they have Crohn’s or IBS or ulcerative colitis, those types of things, you tend to see sort of disturbances or changes in the patterns of their microbiome, that would suggest that potentially, if you’re able to favorably manipulate their gut microbiota, to more match somebody who’s quote, unquote, healthy that that could contribute to some improvements in their symptoms, you know, an athlete specifically probiotics are a mixed bag, I would say that there’s been a handful of studies that have shown improvements in symptoms, others that have shown known known provement, one or two that I’ve suggested even an increase in the frequency or severity of kind of mild GI symptoms like flatulence and gas, and that sort of thing. So you know, it’s kind of a, it’s a mixed bag with probiotics in terms of whether or not they are helpful for improving symptoms. So you know, bloating, fullness, reflux, nausea, that sort of thing. I think the reason is, is because there’s just so many choices in terms of how you can study it, you know, what species and strain, what dosage, what’s the delivery mechanism, there’s just an infinite number of variables that makes it really challenging to generalize about probiotics. And I think that makes it hard to apply them in kind of the real world in an evidence based way.

Trevor Connor 36:57
It’s a really hard thing to study. That’s actually my one of my thesis advisors, she studied the microbiome. And I remember sitting in on her research meetings, and she was always just putting up these giant heat maps, because there’s so many different varieties of bacteria that, as you said, you have to look at the whole picture, you just can’t look at one.

Unknown Speaker 37:17
You’re right, that you know that people who are trained in exercise, they do have tend to have more diversity in their in their microbiome. So that is a point that you brought up that is actually fairly consistent in the literature that I’ve seen. So on the opposite end of the spectrum, people who are sedentary, maybe who have obesity, tend to have less diversity in terms of the number of species that inhabit their their gut. So that’s an interesting observation that there tends to be kind of a correlation between training or exercise, metabolic health, and then just the diversity, the number of species that you can basically identify within somebody’s microbiota.

Rob Pickels 38:00
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Trevor Connor 38:57
Interestingly, Rob, going back to your question of can some of these effects be long lasting? While we’re on the topic of the bacteria? There is some research showing that when athletes are overtrained, it actually will cause a change in their their microbiome, promote certain inflammatory bacteria? And here I’ll list them just because you can laugh at my horrible pronunciation. But there’s so an increase in phyla, tenor cutes and Proteobacteria, which I’m sure I just butchered both even that second one should be pretty easy. But those are both inflammatory and do seem to increase permeability.

Unknown Speaker 39:33
Yeah, that’s a it’s definitely going to be an area of growing research in the next five to 10 years. I mean, there’s already a probably a couple of dozen studies that have in some way or another assessed the microbiome of athletes, and, you know, looked at correlations with diets, how it might change with training, how it might change with overtraining. There was an interesting study a couple years ago that came out where they actually manipulated the microbiome. of mice, they essentially introduced species of bacteria VNL into these mice, and then had an exercise on this, you know, basically treadmill, and found that manipulating their microbiome like that actually led to longer running times in the mice. And to pair that with human data. They show that after completion of the endurance events, like marathons, the sort of presence of the VNL, bacteria increased after the marathon so that there was kind of a change that reflected, potentially, you know, what’s going on with the gut during exercise like a marathon, the theory might be that it’s involved in processing and metabolizing, lactate and short chain fatty acids that might be related to performance. Now, I’ve actually seen a study that is transferred that to humans to show that it directly improves performance. But it got a lot of press a couple of years ago, kind of suggesting that there are strains or species of bacteria that might have direct performance implications, it’s yet to really be shown in actual athletes that manipulating bacteria that way can improve performance. But I think that’s where the next probably three to five years, you’re going to see some research coming out, trying to, you know, manipulate the microbiome through supplementation or other means, as a way to directly improve performance.

Trevor Connor 41:20
Totally interesting, good to look forward to seeing some of that research,

Unknown Speaker 41:24
blood doping. And it’s, you know, stool doping is kind of probably

Rob Pickels 41:29
one of the self limiting over the other one, perhaps, but I do think that we see that oftentimes right in, in supplements, kind of, as you’re saying here, on paper, it works. And maybe even a very controlled study, when you’re looking at one part of the pathway, it makes a difference. But when you take that to the entire human organism, and you look for performance changes, it’s not necessarily there. And I think that people need to understand that there’s not necessarily a panacea that might work well on a petri dish, but you put it in a person, and it’s a different situation.

Unknown Speaker 41:57
Yeah, that’s a great point. And that relates back to that study is that, you know, they should saw this and proven performance in these mice by introducing this VNL bacteria. But the athletes in the study that they looked at the human athletes already had a high abundance of that particular bacteria. So it’s seems dubious, to me that finding people who already really fit were really well trained, and adding in more of this particular bacteria, that they probably already have a relatively large amount of, it seems unlikely to me that that’s going to confer a very large improvement performance. But we’ll see. You know, I’m sure there’ll be much more studies coming out in the next couple of years.

Trevor Connor 42:32
Yeah. And I’m also going to point out, I read a study last night that scared me a little bit that talked about designer probiotics, where they genetically manipulate the bacteria to either make a more effective or more resistance to the the toxic environment in your gut. And all that just sounded a little scary to me, not something we should be experimenting with

Rob Pickels 42:50
takes GMO to the next level. Yes. Ironically, you guys are kind of making me feel a little bad about myself, because I’m actively negatively manipulating my gut microbiome, because I actually have to take oral vancomycin three times a day for an autoimmune issue I have. And so this topic, when we begin talking about probiotics and the microbiome, it’s just so funny to me, because I’m literally taking antibiotics constantly, every single day of my life. So I’m just in a totally different situation.

Unknown Speaker 43:22
Yeah, this Yeah, of course, you know, there’s situations where, you know, you do have to take antibiotics, and even though there might be concerns about what it might do to your microbiome, I mean, you know, the alternative is not really an option either. So that’s an interesting point in reminder that there’s situations where, you know, looking at the microbiome isn’t the end all be all, because we’re still just really in the infancy of understanding it. And I think the marketing to a large degree is well ahead of where the science probably is, in most cases.

Rob Pickels 43:52
Dr. Wilson, we’ve gone through the different environmental conditions, we’ve talked about all these negative consequences that people have, but is there actionable information that people can use in their daily training in their events? How do we prevent all of these things from happening? So that people have the best performance they can, and they’re as comfortable as possible when they do it?

Unknown Speaker 44:14
Yeah, I mean, I think there’s multiple approaches or avenues you can take to kind of dealing with these issues and ranges from nutritional to medication to supplementation to psychological interventions. So again, it goes back to what do you think are the underlying origins of your problems? And that’s step one, you want to try your best to figure out what you think is actually an underlying cause. Because if you don’t really understand what the root is of the problem, you know, just throwing the kitchen sink at it isn’t necessarily going to be an effective way to deal with it or prevent the problem in the first place. So is an example if you’re dealing with feeling issues and whenever you try and feel during your, you know, your ultra or your iron man or something like that and just You’re trying to hit a high target of carbohydrate intake, and it’s just not working for you, you know, you can potentially take a look at either training the gut, or you can look at the actual foods or supplements you’re using. Maybe you made a mistake, and you’re picking something that has all glucose in it, and you’re not using a mix of sugars is an example. Or maybe you’re just overdoing it in general. And maybe you just you’re not the person who can tolerate a high rates, and you need to tailor it back for you as an individual. Because you’re just the person who doesn’t handle you know, 90 grams an hour. So yeah, I think there’s, there’s lots of actionable information you can utilize and implement, it just depends on what the source of the problem is. I think, again, that is the major point, I think that athletes and understand is you want to try and figure out what’s going on underneath

Trevor Connor 45:46
exercise physiologist, Jared Berg has been studying carbohydrate absorption and briefly talked with us about the impact carbohydrates have on our gut, and how we can train our tolerance, let’s hear what he has to say.

Jared Berg 45:59
It’s hard to pinpoint exactly what can be causing that for certain athletes, a lot goes into basically, how we move the foodstuff that we eat, you know, through our stomach and into our, into our small intestines, and eventually our large intestines and such, but the role of kind of like, simple things that can cause the bloating and such would be, you know, foods that sort of slow down, absorption can certainly cause that. So if like, you know, obviously, if you’re eating like a, you know, beaten rice burrito within an hour of a workout, right, those those foods can take on, you know, horrible, you know, a lot of water, and then those carbohydrates can really expand in the gut, and you know, cause some, some discomfort and you’re going to have a situation where, you know, you’re not able to, you’re basically like your your gut is holding on to that food. And then when you’re working out, you’re sort of pulling blood away from the gut. And so in trying to get to the working muscles, and so this is kind of sitting there and getting some discomfort. And so, you know, same thing, it’s like, if somebody were to have a real heavy start to start to, you know, kind of like, you know, maybe it’s even like powerlessness like that, and they just don’t, they don’t metabolize sort of, you know, gluten as well, or something like that, that back in, you know, even though they’re, they’re not gluten intolerant, or is or celiacs, they’re still just that kind of thing could slow down absorption, too. And so, I would say the biggest thing, I mean, this is some everyone’s heard forever, we have to practice and understand what our, what our guts can tolerate. And then also understand that our guts are somewhat trainable, we can introduce foods and try to try to challenge our gods a little bit and see if we can get them to get our get, you know, get our GI tract to pull in carbohydrates a little bit a little bit better, and from a variety of sources, but I would say, you know, I talked about variety of sources and trying to pull you know, we have different different transporters that pull in different glucose for basically carbohydrate molecules glucose or fructose for us around. And so they’re different craft cores that pull in. So if we could, you know, with our, with our meals, try to try to engage, you know, all the transporter, you know, transporters and try to pull in, so pulling a little bit of fructose and then but focusing more on the complex carbohydrates that are more glucose based, so that way, we get sort of multiple channels to pull in there, the carbohydrates that we’ll have that we’ll need to use for in our workout. And that’s a good a good target. So yeah, it might be something like how if we have oatmeal, have oatmeal, plus some a little bit of berries with that, you know, just to kind of like just to really, you know, top off of the liver glycogen storage, and also that to pull in to get the muscle glycogen topped off through the more complex and because these carbohydrates, I mean, then we can obviously go into training of nutrition nutrition while you’re while you’re working out. And I mean, the same thing goes with that is like want to keep a pretty balanced Do you want it you want to, you know, have that glucose, and then that fructose base carbohydrate source, more heavier on that glucose sides, which also can be maltodextrin on it, that’s fine. That’s just some a little different source of getting glucose and different sort of phase and the metabolism. But those different sources can allow us to pull in that during training nutrition load more efficiently to

Rob Pickels 49:47
if we talk about training the gut because you mentioned that, is there a specific protocol? Is it just involving eating as much as you can during training, so you’re used to it in the competition? What do you recommend?

Unknown Speaker 49:58
The few studies that have done On this and who’ve shown some improvements with it, generally, what they’ve done is they’ve kind of had individuals during their training sessions for a couple of weeks, just practice ingesting a large amount of carbohydrates, you know, maybe for an hour at a time. And you know that that would be, you know, 60 to 90 grams an hour is kind of a typical range. Whether you’d start out there depends on you know, where you’re currently feeling, I wouldn’t necessarily advocate for immediately starting that high if you’re not accustomed to it, but maybe gradually upping the intake until you get to that 60 to 990 gram per hour range, if that’s if that’s what you’re trying to target in competition. Now, how long does it take for these adaptations to occur? I think at a minimum, you’re looking at a few training sessions as the bare minimum, I would probably suggest, you know, at least something on the order of five to 10, within, you know, a month before your major competition just to really be sure or feel comfortable that you’re able to handle what you’re planning to do in the actual event.

Trevor Connor 51:00
A quick side point here, we did a actual whole episode with Dr. You can group who’s really known for this idea of training the gut, and that was episode 83. For anybody who wants to, to really dive into that, because obviously, we won’t be able to go as deep on on that subject in this episode.

Unknown Speaker 51:15
Yeah. And he’s he’s definitely written a lot about that particular topic. He’s written a lot about the multiple transportable carbohydrates. Obviously, he’s a, you know, world known expert in sport nutrition. So definitely, you know, the stuff that he says about God training is something you can certainly depend on her and find to be credible.

Rob Pickels 51:32
So knowing that we have that sort of in depth guide that people can look at, if we do switch over to the multiple transportable carbohydrates. You mentioned a mix, is there a mix that seems to work for everyone is this individual, or should somebody be having a certain ratio of glucose and fructose,

Unknown Speaker 51:50
usually, the ratio is anywhere from 5050 to maybe two to one. So 5050 glucose fructose, or two to one would be, you know, glucose to fructose, you know, the studies that have looked at it that I guess the higher you go, maybe the closer to a 5050 mix you want. Because you know, each of those, you know, the doors, the transporters in the intestines that are responsible for absorbing both of those sugars kind of have a max limit, they can handle and it’s probably, you know, 50 to 60 grams an hour for each of them in that sort of range. So if you’re pushing 90 to 100 grams an hour, you probably want roughly an equal mix of glucose and fructose, if you’re pushing 60 or 70 grams an hour, you’re probably fine with a, you know, a two to one ratio or something like that. But it is individual products, you know, vary in terms of their content of glucose and fructose. And fortunately, it’s not like it’s listed on the label. You know, it’s not on the nutrition facts panel. So it’s sometimes a little bit difficult to figure out actually what the ratio is. There’s this study did a part of my dissertation where we actually measured the glucose fructose ratio of maybe like 80 foods or something like that, that were used during a half Ironman. And we did publish those results. So some of those products, you could look up in that particular paper. But that is sometimes a little bit challenging is that companies don’t have to disclose that information, if they don’t want to, some of them choose to do it, because they incorporate that into their marketing, but others may or may not give you that information, or it’s not readily available.

Rob Pickels 53:21
So if you look at the newer high calorie, sort of drink powders that are that are coming out there, right, that are really trying to get at that 100 grams an hour or more. I do think that they are leaning, you know, these are companies that are putting out a little bit more information about what’s in there as opposed to maybe your normal athletic product. And I have definitely seen a movement toward that one to one ratio. I’m interested, though, that you brought up a two to one or a one to one, both of them could work, sort of depending on the event that you’re doing. Why would someone want say more glucose and a mix as opposed to treating them equally?

Unknown Speaker 53:57
I don’t know that you necessarily want more glucose, I mean, if you if you’re eating a lower amount of carbohydrate, though, let’s say 45 grams an hour. If you had to choose between glucose and fructose, generally speaking, glucose is going to be more readily quickly usable for skeletal muscle. I mean, fructose does go undergo some processing. In the gastrointestinal tract, a lot of it actually ends up as lactate, some of it ends up as glucose before it’s actually metabolized in the muscle. So I think if you’re eating a lower amount of carbohydrates, the priorities generally glucose, but as you get again, higher amounts, you are supplementing that with fructose and as you get into, you know, like the 100 gram territory, then you really want that equal mix because the the max limit for each of them is about you know, 50 grams, maybe a little bit higher, depending on the person, but at lower amounts. I would say generally, it’s more well accepted that glucose would be the priority because of its, you know, just ability be quickly used in skeletal muscle.

Trevor Connor 54:58
Some of the research that I’ve done So and this might be outdated at this point, but they looked at the so glucose and glucose have different transporters. And it some of the research I read showed that, you know, our max rate of transporting glucose is about 60, maybe 70 grams per hour where fructose is less, you’re you’re talking more around 3025 30, as you were just implying the transports also different glucose can go directly into the bloodstream and go to the muscles where fructose actually has to go to the liver where it’s processed by the liver, as you said, you have a lot of it, it gets converted to lactate.

Unknown Speaker 55:33
Yeah. And then if you have too much fructose, let’s say you went all fructose, anywhere, you’re going to lower amount, let’s say it’s 45 grams an hour, and you just decided ingest something with fructose, it’s more problematic without the presence of glucose, because there’s something called fructose malabsorption, that occurs in a significant number of people. It’s very variable in terms of what level of fructose that occurs at, but some people are really sensitive, some people are not, but when fructose is all on its own, everybody, at some point, if you give them enough fructose, they’re gonna have fructose malabsorption. But when you give it with glucose, it’s absorbed better, it’s absorbed more efficiently. So that’s why think, again, when you’re just lower amounts, the priorities glucose, because of the reasons we kind of went through. And then also, you don’t want too much fructose, because in the absence of glucose, it can actually cause problems, gastrointestinal problems.

Trevor Connor 56:21
So I have a question for you. Because I’ve had this experience a few times. And unfortunately, I always think back to 2012, when I was focusing on tour, the healer was on one of the best fitnesses in my life. And unfortunately, I think I got a stomach bug. So I barely survived the first day. The second day, I’m like, Oh, I’m doing better. I think I’m gonna get through this race and was feeling really positive until 20 miles before the finish, at which point I forgot about the race pulled over the side of the road, ran into a field and pretty sure I traumatize the cactus. You know, basically, my I just started feeling really bloated, got really nauseous. And that’s something as you said, Everybody’s going to experience at some point or another when they’re in an event when they’re in a race. So if you’re feeling as if this starts happening, is there anything you can do? Or is it just what I experience you forget about the race and move on to the next event?

Unknown Speaker 57:12
Yeah, I mean, if it’s that bad at that point, I mean, it’s, it’s hard to some extent to come back from that. I mean, it shows up in, you know, in studies, for example, like the Western States endurance run, it says very significant amount that have, it’s severe enough that it impacts our performance, I think if there was like an easy, you know, fix to the problem to prevent those issues, you would be readily apparent, either through research or through practical application that the athletes are trying themselves. But once you get to that point where you’re ready to basically sort of up or you get a pull over to the side of the road, because, you know, things are about to come out here. I mean, it’s almost a little bit too late at that point. So again, that goes back to the idea that identifying the underlying causes beforehand and trying to solve them before it becomes an issue. But even despite your best best efforts, there’s probably going to be some days where it just happens. And you don’t know why. I think that’s part of the frustrating thing about gut problems is that sometimes you just you don’t know why, and it just does happen. I mean, ultra race directors will kind of say, you know, if we had an easy solution for nausea and vomiting, you know, we would have probably figured it out by now, there’s a reason still why they keep those anti nausea medications on hand at every race, and why so many athletes still drop out, even though we’re trying to educate them on it, it’s just sometimes it does happen.

Trevor Connor 58:34
So it sounds like prevention is really your your best approach. And so I’m going to bring up something I see a lot whenever I travel with racers and stay in a hotel with them or stay in host housing, we always have one person who has to get up four hours before the race and eat their food because they say they can’t eat within three hours of the race. Is there evidence of that? Is that something that can help athletes if they just get it all in and digest it beforehand? Or are they setting themselves up for any sort of failure doing that?

Unknown Speaker 59:04
I think if it’s an athlete who knows that if they eat any closer to exercise, they might have kind of that brick in the stomach feeling maybe because they’re anxious, for example, then yeah, it could be beneficial to them to get up earlier, to get that food and give them more time to digest it. And to some extent, what might be going on is if they’re overly anxious, that can slow emptying from the stomach. And you know, if you’re eating two hours beforehand, and it’s a relatively sizable meal, and then you’re also going to feel during the race, you’re kind of experiencing maybe a backlog of things in part because of that anxiety that the athlete is experiencing before the race. So I think in some cases, sure, it can be helpful to get up earlier and eat for hours beforehand. I don’t think that’s necessary for every athlete by any means. There’s also recommendations sometimes you see like to completely avoid fiber, fat and protein, you know, before a race in the meal, I think I think that also depends a lot on the person and depends on the timing. I mean, to me, there’s no reason to go overboard with restricting things like protein and fiber and fat necessarily, if you’re eating three or four hours before, I mean, that’s a pretty long time for things to empty from your stomach. And if you go completely absent with those things, sometimes you can feel you know, more hungry than you want to by the time the race starts. So I think it comes down to the situation and the athlete in terms of you know, what they’re experiencing, especially with, you know, pre race nerves in terms of what might be the appropriate timing for them to eat.

Trevor Connor 1:00:33
Also, remember, in your presentation, I believe you talked about hypertonic beverages and avoiding FODMAPs.

Unknown Speaker 1:00:39
Yeah, hypertonic beverages are actually fantastic sort of pre and post exercise because they are retained better in the body than just like drinking plain water. So hypertonic beverages, we mean things that have a high concentration of carbohydrate or electrolytes like sodium. And because of those high concentrations of solutes, they actually stay in the stomach a little bit longer. And it’s more like a drip drip drip from the stomach into the small intestine. And it means it’s a more gradual absorption of fluid into the bloodstream. And that’s potentially beneficial after exercise, because it doesn’t drop, or doesn’t change your serum sodium in electrolyte levels as much. If you drink plain water, what that’ll do is it’ll dilute the sodium and other electrolytes in your blood to a larger degree, your body senses that and says we get to make urine because we’re getting, you know, low blood sodium. So before, well before exercise, maybe a couple hours beforehand, if yours beforehand, post exercise hypertonic fluids are perfectly fine choice during exercise, you know, they’re staying in the stomach longer. So that’s obviously problematic, if you’re trying to hit a certain target rate of fluid replacements, and you’re being relatively aggressive about it, you know, you don’t want stuff just sitting in your stomach for obvious reasons. So I think hypertonic beverages, you know, they have their place, it’s just you need to be careful about when you’re consuming them. And then in what volume, if you’re taking a couple ounces of hypertonic beverage during a race, not a big deal. But if you’re relying on them as your primary fuel source or your fluid source that’s potentially more problematic. And what about FODMAPs? Yeah, so those are fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols. It just just just kind of jargon for short chain carbohydrates that some people don’t absorb is efficiently. And because of that, when you don’t absorb carbohydrate, the end fate tends to be fermentation by bacteria, you also have water being pulled out into the guts, because water is kind of attracted to solutes, like carbohydrate molecules. So that can equal you know, loose stools, bloating, gas, cramping. And some athletes have a very high intake of FODMAPs, because a couple of the most common FODMAPs are lactose and fructose. And those are found in obviously, dairy products. And then not only fruits and vegetables for like the fructose, but in sports supplements. So if you have an athlete who has a really high intake of FODMAPs, and they’re the type of person that’s kind of sensitive to those sugars, then going on a, you know, low FODMAP diets, particularly maybe before, like an important race is something they they might consider, you know, there’s evidence that you know, 24 hours, 48 hours is probably enough time for you to see some positive changes in in GI symptoms. So it doesn’t necessarily even have to be something you do all the time. Because FODMAPs are found in a lot of foods. And a true low FODMAP diet is actually pretty kind of difficult to follow. Because it’s FODMAPs are found in so many different foods. It’s not very intuitive in terms of where you would find them.

Trevor Connor 1:03:46
Yeah, and I would say go in on a permanent low FODMAP diet, you’re you’re eliminating a lot of foods that are actually quite healthy for you. But it sounds like if you’re having digestive issues with it wouldn’t be a bad thing to try before an event or before Saturday morning training race to see if it helps you.

Unknown Speaker 1:04:03
Yeah, it fits in the same box is like maybe limiting fiber intake potentially for some people for a couple of days beforehand. Or, you know, carbohydrate loading is obviously kind of an acute intervention that you apply for a few days, as you mentioned, restricting fruit and vegetables from your diet, reducing these fermentable carbohydrates might actually not be very good for your long term health in some ways, particularly your gut health, the micro biome, so I wouldn’t necessarily advocate for doing it all the time unless you’re under the supervision of some sort of medical provider.

Rob Pickels 1:04:32
So we’re having this conversation about real food outside of an event or competition. How do you feel about introducing real food and this was a big thing in the cycling world a few years back that you know, your drink should be your hydration and that your fuel should be from real food that you’re eating out of your pocket. Do you have an opinion on on this specifically as it comes to? A GI distress in individuals is a banana no better than an energy gel?

Unknown Speaker 1:05:02
No, I don’t think inherently there’s necessarily a difference between real food and supplements, I think both kind of camps, the real food, people in the supplement people will kind of articulate the advantages of each. I think there are scenarios where one or the other maybe makes more sense, I think shorter endurance events probably makes more sense to go with something that’s almost like pre digested, you know, that’s a gel or something of that nature, a beverage, because a shorter event just inherently is higher intensity. And thus, you may have more gut dysfunction, or a harder time digesting or absorbing some of those things. So the more simplified or homogenized, it is probably the better for some people, the longer you go, you know, into Ultras and things like that, you’re exercising inherently at a lower percentage of your view to max and you’re probably better able to maybe handle some of those things, you also have the time to chew them, and you know, get them down. Whereas in a marathon, you know, you see people just throwing the JLN, swallowing, throwing the beverage in and swallowing and you don’t necessarily want to take the time to thoroughly chew, you know, a Kind bars, something like that. So I think they both have their place, I think it’s more solid foods can be appropriate for longer events, particularly if someone’s kind of just sick and tired of the gels and the supplements, and they just want something you know, that tastes like real food, that that’s not necessarily a problem. My only caution would be there are studies that do suggest if you do not to whole foods, like take nuts, or granola or even cereal or something like that, if you don’t chew and break it down enough, and you swallow it, it takes longer for those things to empty from the stomach, because one of the things that regulates stomach emptying is the size of the food particle and how kind of broken down it is. So if you’re eating bar after bar of something that’s more closely resembling real food, and you’re not chewing it thoroughly, you know, at least in theory that could cause more problems.

Rob Pickels 1:07:05
So that gastric emptying concept his or topic is really interesting to me. Despite my background as a sprinter, the thing that I actually like to do are really long adventure mountain bike rides. And it seems like no matter what, I know what I should be doing, I know what I should be eating. I know all of those things. But no matter what, when a multiple hours into this event, at some point, it seems like my gastric emptying, it just slows down. And anything I put in, it just seems like it’s piling up in that moment in that situation. Am I too far gone? Is there anything that I can do at that point? Do I switch products? Do I slow down? Do I have more sodium, you get so many different recommendations from so many different people?

Unknown Speaker 1:07:45
You know, that’s a really common observation. And it’s clear from other studies, you know, like, again, the Western States endurance run, or their 100 mile runs or triathlons that the symptoms become more more and more prevalent, the longer you get in the event. So clearly, it’s it’s something physiologically going on where the gut is just having a harder time processing stuff, it’s probably the cumulative kind of stress that over hours and hours and hours of maybe partial reductions in blood flow, the physical stress, especially running where you’re impacting the ground is causing maybe some micro trauma. To some extent, there’s not a whole lot you can do about it, besides adjust your feeling either taking in less, or changing of what it is to make it maybe again, more simpler stuff that’s easy to digest. If you had prior to that been consuming more, you know, quote, unquote, real foods, that could be a switch that you make, but by the point, you know, where you get where things are just sitting in your stomach, like a brick, it’s, you know, it’s hard to at that point, kind of reverse things. So if it’s possible to delay that, or extend it through prevention efforts, that would be optimal. But just to be completely honest, I think inevitably, some people are gonna have GI symptoms, during really long events. It’s just it’s, you know, it’s such a prevalent observation consistently across different sports that, I think inherently there’s some of that that’s gonna go on. And you might want to just kind of anticipate that that’s probably going to happen in adjust your feeling accordingly.

Trevor Connor 1:09:14
I always tell my athletes if they’re doing a long event, particular long heart event in the heat, if you’re going to eat more solid foods, do that towards the beginning. And as you get further and further into the race, that’s where you, as I said, want to consume things that are already pre digested, that’s where you want to get into your gels or even just your drink mixes.

Unknown Speaker 1:09:33
Yeah, I think that’s a reasonable, reasonable recommendation, you know, it makes some good logical sense. And I don’t see a lot of harm in that. So even if it’s not like something that’s been verified and controlled experiments, I think it’s a logical, you know, reasonable recommendation that you made.

Trevor Connor 1:09:49
So Dr. Wilson, this has been a really fascinating conversation and thanks for all you’ve shared with us. So you’re new to the show. We finish out every show with our take home. So You have one minute to summarize what you think is the most important point that you want the listeners to take from this episode. So with that, what is your main message?

Unknown Speaker 1:10:12
Yeah, the main message would be if you’re consistently experiencing gut problems with training and exercise and competition, you want to try and figure out what the root problem is. So starting to document what’s happening before, during, and after, you know, these experiences, particularly the ones that are, you know, most significant for you. So that can include you know, what you did nutritionally, what medications you might have taken beforehand, what the environmental conditions are, how you’re feeling, psychologically, those would be some of the main ones to kind of kind of focus on and then take that information and use some of the resources available, whether it’s a podcast like this, or the scientific literature, or the book that I wrote the athlete’s gut and trying to, you know, pinpoint what you think might be those causes in your particular case. And then you got to try and do a little bit of trial and error to see what works best for you. There’s no single solution to gut problems, it tends to be you try one thing at a time and see if it helps, and then move on to the next thing if you don’t get any relief, and it oftentimes takes multiple tries, and multiple attempts to really figure out what the problem might be. And just realize, to some extent that this is an extremely common problem. And many athletes deal with it. And, you know, the hope is to get some improvement in some relief, but realize that you may never get complete relief from some of these things during exercise.

Trevor Connor 1:11:38
Rob, what’s your one minute?

Rob Pickels 1:11:40
Yeah, I think that we, and by we that I think that means everyone right off our listeners, everyone within this field. Oftentimes, when we talk about performance, we tie it to things like threshold like vo to max like economy, these hard numbers that we can really measure and improve upon. Maybe we talk about things like sports psychology, and how that affects performance. But something that perhaps we need to be talking and doing more study of are things like gut health, and then the symptoms that occur because all of these things that we talked about today, they can undo a performance, or they can at the very least make it a heck of a lot less enjoyable. And so I think that the points of trying to understand exactly what it is that’s causing your issues, I love journaling, writing that stuff down looking for the common thread between them. Understanding is this a pre event or a during event thing, and then trying to figure out what works for you so that you can have the best performance and experience that you can is super important.

Trevor Connor 1:12:41
So my take home is actually a bit of a tangent. Dr. Wilson, I think you’ve covered the main point of the episode. And that was great. But I was really fascinated by as I said, almost a tangent as I was doing my research for this, which was looking at some of that, what happens to the epithelium of the gut that opening of the tight junctions. It was fascinating to me, because that’s something I studied during my master’s. And I was studying looking at in terms of disease states, its impact on auto immune disease. So it was really surprising to read these studies about athletes and you always think of endurance sports, as you know, this is great for your health to see similar mechanisms and go wait a minute, this this is stuff I read in a disease state. So it’s important to recognize that not everything that happens when we’re doing the sports that we love is good for us that there are negative consequences as well. And this goes back to an episode that we just released recently about the importance of recovery. We need recovery not just to let our bodies adaptive because sometimes the sports that we love also do some damage, and we need to let our bodies recover from that damage. Well, Dr. Wilson, thank you so much for coming on the show it was an absolute joy.

Unknown Speaker 1:13:56
Thank you again for the invite for let me Come on fast talk absolute

Trevor Connor 1:13:59
pleasure having you.

Rob Pickels 1:14:01
That was another episode of fast talk subscribe to fast talk wherever you prefer to find your favorite podcast. Be sure to leave us a rating and a review. The thoughts and opinions expressed on fast dock are those of the individual. As always, we love your feedback. Join the conversation at forums dot fast talk to discuss each and every episode. Become a member of fast talk laboratories at fast talk and become a part of our education and coaching community. For Dr. Patrick Wilson. Friend book, Walter Tom’s winch, Jared Berg and Trevor Connor. I’m Rob pickles. Thanks for listening

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