The runs: Aerobic exercise can cause GI woes

Pathetic– a good term to describe my my aerobic endurance. I can’t tell you the number of times I’ve vomited or almost vomited from intense workouts. Once while playing tennis I lobbed the ball really high to allow myself time to vomit by the fence and then continue the rally. (Then I won the point!)

I can’t run in the morning because I always vomit. It has taken me three years to be able to run three miles without stopping because I run like a geisha. Konnichiwa!

Can aerobic exercise be a blow to the gut?

Athletes are vulnerable to gastrointestinal (GI) issues such as diarrhea, nausea, vomiting, and abdominal pain. Approximately 80 percent of endurance competitors (i.e. long distance runners, triathletes) experience GI problems during or immediately after a competition.

A high school friend of mine who was a cross-country runner told me he carried toilet paper in his running shorts. I thought that was rather strange and asked him if he was going to TP the golf course as he ran around. He responded he usually had to take a dump during his run. (I wonder if he pooped in the sand trap like a cat in kitty litter?)

“Runner’s trots” is diarrhea or the urge to have a bowel movement while running, so my friend wasn’t a weirdo after all. In runners who run long distances, 14-38 percent experience diarrhea issues, 24-54 percent have an urge to poop, and maybe even 4 percent will experience fecal incontinence.

Nausea and vomiting occur in 6-26 percent of runners– probably because the stomach clears out slowly. So eating fatty, high-caloric meals within three hours of running is a bad idea. (Though I do better with a little food in my tummy.) In general, avoiding such meals is recommended for all the GI problems with high-endurance sports because the GI system doesn’t work as well during aerobic activities.

A stitch in time saves nine, but the “stitch” in aerobic activities is exercise-related transient abdominal pain (ETAP). Every athlete from swimmers to equestrians can experience an ache, cramp, or sharp pain– often in the right upper part of the abdomen. It might be due to lack of blood flow to the diaphragm. So bending forward while tightening the abdominal muscles can relieve the pain, or taking deep breaths and exhaling with pursed lips can help.

GERD (Gastroesophageal Reflux Disease) doesn’t occur more often in aerobic folks, but it can be a painful issue while exercising. Acid reflux can mimic angina due to the chest pain (and vice versa), so a trip to the doctor is warranted for athletes who experience such pain.

Even worse is an ulcer or gastritis from long-distance running. In 8-28 percent of marathon runners, the stools test positive for trace amount of blood that’s invisible to the naked eye. This is a sign of a GI bleed, likely from the stomach.

Hi-Yaw! Karate chops have been shown to break open red blood cells and cause anemia. Some runners can have the same thing happen when their heel strikes hard ground, so they should also be checked for anemia.

Women are more at risk than men to have exercise-induced GI problems. Younger folks as well are more vulnerable. Dehydration is definitely a risk factor for GI problems, as well as kidney failure, muscle breakdown, and heat exhaustion. Losing 4 percent of body weight after a workout means way too much dehydration.

I don’t think I’ll ever run a marathon– or even a 10K! It’s ok. I don’t want a photo of me puking at the finish line.
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Dr. Hook cracks a joke or two, but he’s a respected physician with an interesting website, drjohnhong.com. Email him with your questions!