Nailing the basics - a physician's guide to preventing Runner's Trots

There isn’t a runner who hasn’t experienced GI distress.

Dr. Stephanie Flippin, a professional North American ultra-runner, coach and physician (left), is only too familiar with the threat this poses during summer months. 

One of the leading causes of 'DNF', gastric stress is caused by exercising in the heat, which affects 90% of runners - and particularly ultra-runners - or those who put in hard efforts over shorter distances. 

Here, Dr. Flippin shares her nine tips for avoiding GI stress.

To listen to the Dr Flippin interview, head over to Trail Runner Nation – click here.

1. Before race day, if you’re unable access heat acclimation training before a race, use blackcurrant extract. "Runners often take antacids in a bid to stave off these issues, but they have limited efficacy. Until now, there hasn’t been a supplement that could provide direct, scientifically-validated protection to those running just 7 days prior to an event.
   
   “CurraNZ is an incredible product, with exciting research that demonstrates that taking 2 capsules a day in the week ahead of exercising in hot conditions can decrease gut permeability.
   
   "With current strategies limited to heat training itself, any type of mitigation and protective measure is highly beneficial. This is an exciting new option for runners – there aren’t any other interventions like it available.”

2. Don’t introduce any new sources of carb-heavy foods on race day. They will pull more fluid into the gut, which can lead to GI stress. "Practice everything in training, including your nutrition and don’t introduce anything new - including carbs - on race day."

3. Implement skin-cooling strategies before you start to feel hot. Symptoms of exertional heat stress are triggered when blood is shunted from the gut to the skin, in order to regulate temperature. “Don’t wait until you feel hot before you start using ice – introduce while you’re still feeling cool. If you realise you’re overheating and haven’t deployed a cooling strategy, it’s usually too late.”

4. Stay on top of your electrolyte and salt intake – often if your gut is rebelling, it’s often due to a sodium imbalance.
   “Get a sweat test from a registered dietician so you have a clear picture of your needs. The average amount of sodium lost per hour is 400-500mg/hour but some people lose up to 800mg-1200mg/hour. This can be a huge reason for cramping and GI distress if you’re in sodium deficit and not replacing what you’re losing.”

5. Make sure you’re hitting the correct amount of carbs and sodium per hour. “More and more research is showing that the previously-recommendation of 60gm/carbs per hour is actually a bit low. We’re seeing steadier performance and energy levels, lower rate of perceived exertion with higher intake of carbs – 90-120gm/hour.
   
   “But you have to be careful, because many products don’t have any sodium, so you’ll need to use with salt tabs, or an energy drink mix that helps satisfy your sodium replacement needs.”

6. Aid station drink mixes that haven’t been correctly prepared – “We love our Aid Station volunteers, but be wary of the drink mixes as they may not have been made according to the brand’s recommended ratio. If they haven’t been mixed exactly according to the instructions, you won’t receive the absorptive properties. It is easy to get caught out, so I tend to have things pre-mixed and carry packets as well, but it can become cumbersome.”

7. Remedies on the trail if GI symptoms strike
   a) salty carbohydrate food, like pretzels will help break up sweeter sources of carbs, such as gels. Often the savoury food can help calm the stomach.
   b) Ginger chews, ginger beer or fermented ginger also have anti-nausea properties. c) Antacids with high calcium content can help combat acidic stomach. “sometimes I take these before the run too.”
   d) Sniff an alcohol wipe. “The strong smell can help with combating nausea.”
   e) Chicken soup – “sodium content is usually quite high and the combination of the noodles, rice, protein and salt provides a balanced meal with an ideal combination of protein to carbs, with addition of sodium. Being warm and broth-based can sooth the GI tract.”

8. Heat acclimation – the best way to train your gut and body. “This is your biggest key to success, but it can be challenging if you don’t live in a hot climate or have access to a heat chamber. Create a heat tent over a bike with a space heater, trying to get to 89F at least - and guide your training by heart rate.
   "Expose the body to exercising in the kind of conditions you’ll experience in the race. If you don’t have access to this, then sauna is the next-best step. Remember, this type of training isn’t meant to be paired with intensity.”

9. A ferritin word of warning for women: Women beware of an aggressive heat training program if you’re not on top of your ferritin levels. This is a blood protein that contains iron and indicates the body’s levels of iron stores. "We lose iron through sweat, so heat training can deplete iron stores, particularly in women. Have a total iron panel run from your primary care specialist, an accredited lab or sports medicine specialist to see where you’re sitting."