Carnival Belly, Running, and a Digestive Health Survey

Lately, William and I have been taking weekend adventure runs, meaning we’ve been getting out of town for a good part of the day to run somewhere new. Often this is followed by a picnic with a very runner-favorite spread: PB&J sandwiches, fruit, and tortilla chips. A couple weekends ago, the route I chose was based on being new and not far to drive, and as such it was on a course that’s designed more for mountain biking. After three miles of steady running upwards amidst the giant forest foxgloves and complete peace that is running away from civilization, we got to our summit and the single-track mountain biking descent. It started out as a really fun, fairly technical terrain with lots of creek rocks, tree roots, twisty trails and garden-gnome spotting. But there were also steady, heavy mountain biking moguls, making every bit of downhill come with nearly the same in little uphill rollers.

By about halfway through the downhill, I had this experiential memory of being on a carnival ride, and I was unsurprised to find my digestive system was feeling jostled in just the same way. By the end of the fourth and final mile of downhill, I realized I’d taken for granted that the norm for runners is to cruise and ‘wheee!’ downhill once the climbing is done. And I’d gladly take that steady climb over the tumbling in my lower GI and the muscle fatigue setting in from all those rollers.

My carnival belly largely went away for the day once I stopped running and had a meal, but it was mildly painful and upset for a day or two afterwards. Relatedly, this week our annual relay team has taken the very different challenge of racing the 2020 relay race virtually, and because this race coincides with the hottest stretches of heat year after year (and no different this year), I had that same mild carnival belly throughout the day yesterday after a hard race effort in the morning heat that was quickly becoming uncomfortable. Similarly to the week before, the discomfort was mostly gone again within a few hours.

So What’s With the Carnival Belly From Exercise, and in Running Particularly?

When we exercise, our body directs blood flow away from the gastrointestinal tract and to the working muscles. This reduction in blood flow, accompanied by an increased release of stress hormones during higher intensity or long exercise efforts, as well as the high impact of running (just visualize the internal organs being jostled up and down as we run), all combine to cause damage to the cheesecloth-thin lining to the gut, leading to all sorts of uncomfortable symptoms, as well as impaired digestion and absorption of food and drinks.

And yes, all of this is fairly normal in small amounts given the nature of doing long or hard exercise bouts. When we are dehydrated (a big topic in itself for another day) and/or exercise in the heat or to an extent that we have a high body temperature, we further reduce blood flow to the GI system, increasing stress hormone release, and develop a higher likelihood of digestive distress. But what might be a small amount of discomfort and upset sometimes should not lead to or be confused with frequently occurring and/or greater than mild GI symptoms.

Despite the serene views, this was taken at the point in the day when the sun was getting hot, the water bottle was running low, and my fun to need-to-be-done ratio was starting to tip directions.

What Can We Do For MILD GI upset?
Rather than grimace and bear it, there are many nutritional and training strategies we can do to minimize GI distress. Primary strategies include being properly hydrated in the 24 hours before / after exercising, especially in the summer heat, as well as training the gut. Just like other aspects of the body, we can train our gut to tolerate different types of foods, fuels, and amounts. Other helpful tactics include avoiding NSAIDS around exercise (as frequent use negatively impacts the gut), and eating and drinking smaller and more frequent amounts during exercise–this method alone helps alot with optimizing absorption and reducing upset.

But what about when that GI ‘offness’ or tummy upset isn’t just mild, and it continues long-term or occurs frequently?

That’s what I’d love to ask about today. Having chronic or frequent digestive symptoms including nausea, GI pain or cramping, reflux, lack of appetite (in general or after exercise), bloating, gas, diarrhea, constipation, loose stools with undigested food, or limited food choices due to reacting to many foods are all big warning signs, kind of like our body’s version of a flashing yellow or red light telling us to proceed with caution, or just plain stop and seek to understand what’s going on.

Rather than address any of those symptoms individually or all together, I’d actually first like to know how common those symptoms are–so I’ve created an anonymous survey for you to tell me about them.

If you’ve followed along here longer term, you’ll know I write about digestion a lot as it’s one of a few factors that finally pushed me into clinical nutrition, and it’s honestly my favorite nutrition topic to help others with–partly due to my own challenges over the years, but also because it can be complicated and I love a good challenge.

So if you’d please, fill out the quick survey for me and I’ll see if I can share about any of those flashing yellow or red symptoms that can cause us distress in or out of exercise in the coming weeks.

Best summer post-exercise treat / summer snacking — all the berries!

References:
Costa, R.J.S., Miall, A., Khoo, A., Rauch, C., Snipe, R.,…and Gibson, P. (2017). Gut Training: The Impact of two weeks repetitive gut-challenge during exercise on gastrointestinal status, glucose availability, fuel kinetics, and running performance.
Costa, R.J.S., Snipe, R., Kitic, C.M., and Gibson, P.R. (2017). Systematic Review: Exercise-induced gastrointestinal syndrome-implications for health and intestinal disease.
Snipe, R. (2018). Exertional heat stress-induced gastrointestinal perturbations: Prevention and management strategies.

Radish + Hazelnut Grain Salad

This is the type of meal situation that’s my bread and butter. It’s the sort of thing I’ll bring to a potluck or picnic-style situation, and it makes a routine visit in our regular meals much the same way tacos do – i.e. same concept, different ingredients depending on what’s on hand and seasonal. Over the years, I’ve also found that William usually takes some of the leftovers for his work lunch the next day – which only happens if it meets his slightly different than mine taste-bud standards. It also helps when I add raisins, which in our house grace many a main dish. We are both lifelong raisin affectionados. :)

While everything is fairly interchangeable here, you’ll note I only list gluten-free grains as options. I don’t tend to be outright against gluten-containing grains for those that can tolerate them, but many individuals tend to be at least slightly sensitive – especially those with pre-existing autoimmune conditions (since inflammation in the gut significantly contributes and/or is part of the cause, and gluten is inflammatory to everyone to a certain degree). I also find that many individuals running long miles, particularly in the summer heat, suffer from more achy tummy – not hungry – can’t tolerate lots of foods symptoms. That’s because these kind of long or hard workouts in stressful physical conditions contribute to damage of the endothelial tissue in the gut, which by design is very thin (one cell thick!) to allow for absorption. If you eat gluten and wheat products regularly, purchase a few non-gluten grains next time you’re out shopping. And if you do avoid wheat and gluten, try to find one or two new to you or haven’t tried in a while gf grains next time. Dietary diversity is also imperative for good long-term gut health.

One last note I’ll make here is that I left out a protein-rich ingredient to this. If you tend to follow a vegan or vegetarian way of eating, and especially if you’re active, please add one to your meal. You can read more here about the importance of protein, particularly for plant-based, active folks. Often I’ll add cooked beans such as garbanzos to make this type of salad a one-dish situation, but a side of seasoned/baked/grilled tempeh or tofu, grilled salmon or similar, a couple fried eggs, or whatever else is your protein of choice will round this out nicely into a true meal. Enjoy!

Radish + Hazelnut Grain Salad, serves 4
1 cup mixed grains (like millet, quinoa, buckwheat or any combination of these)
1 onion, thinly sliced
a large handful of baby spinach or kale leaves
1 cup radishes, thinly sliced
1/4 cup raisins
1/4 cup dried apricots, sliced into small pieces
1 cup parsley leaves, minced
1 cup mint and / or basil, minced
2 Tbs. olive oil
2 Tbs. white wine or raw apple cider vinegar
1/4 cup hazelnuts, toasted
salt and pepper to taste

  1. Place the grains in a medium saucepan and add 2 cups water. Bring to a boil, reduce the heat to low, and then cover. Cook for 20-25 minutes until the water is absorbed, and then set aside to cool slightly.
  2. While the grains are cooking, saute the thinly sliced onions in a skillet with a little of the olive oil. Cook them until they are soft and translucent, bordering on being caramelized. Pull off the heat and transfer them to a large serving bowl.
  3. Tear or slice the spinach or kale leaves into small pieces and then pile them on top of the the onions.
  4. Add the slightly still warm cooked grains to the mixing bowl on top of the greens. Stir through to wilt them slightly. Then mix in the radishes, dried fruit, and herbs.
  5. Add in the olive oil and vinegar, 1 Tablespoon of each at a time, and stir through. Add additional as needed to make it the right consistency for you, i.e. add more oil and vinegar if you like a wetter mixture. Also taste as you go, since you might need more vinegar to bring a little more acid flavor for balance. Salt and pepper to taste at this time as well. You might need up to 3/4-1 tsp of salt and 1/8-1/4 tsp. black pepper.
  6. Serve slightly warm or at room temperature.

Are you eating enough for your activity level?

Today’s topic is one that’s been on my mind a whole lot lately. A nutrition question that is frequently asked is:  Should I be eating intuitively when I’m hungry or tracking what I eat and going off the numbers?

Before I tell you my answer, I’d like you to think about this question for a moment. No really, take a moment and think about what you’d say if someone asked you. (Humor me please, this is the educator in me.)

From my instagram a couple weeks ago: as mileage and/or time on feet goes up, eating becomes almost another part-time job. the last few days I felt like I wasn’t quite eating enough, and not surprisingly, today’s long run felt a little extra challenging.
low energy availability is extremely common in athletes, and long term, it can cause widespread physiological and psychological imbalances.
so the short story is if you’re moving a lot, you need to be eating a lot.

Now, my answer:  YES, eat intuitively!! Tracking numbers often leads to becoming reliant on the numbers rather than recognizing your own body’s needs. Your body is incredibly wise and those tracking websites and apps are all using estimates. They’re estimating your energy needs and using nutrition data done in a lab on a random sample item of the food tested. And that’s not to mention that your estimates of portion size, etc. are usually not entirely accurate either.
So random sample food that may not reflect the actual nutrition of the food you ate, formula estimating your energy needs, and, unless you’re a super type-A person that weighs every morsel ingested to the nearest gram (also please don’t do this), inaccurate food measurement. Yes, they can give you an idea if you might be in the ballpark with your nutrition needs, but as above, it can vary so much. And yes, some individuals can go into a lab and get their metabolic rate measured to determine a more accurate picture of energy needs, but most of us don’t have access to or need that data.

AND also my answer: It depends. Many active individuals are actually not eating enough for their on-the-move lifestyles – and the body, because it is wise, makes decisions about where it is going to prioritize its precious calories. So if you’re going to go for a trail run in the forest for the day followed by an evening bike ride or weight session, and then follow with something similar tomorrow and the next day, and throw in a weekend long couple workouts, AND you’re routinely not eating enough to meet your caloric needs, the body is going to choose where to spend those nutrients because when this precious energy is used for one function, it is not available for another one. Essentially, you are putting your system into survival mode.

And it plays out along these lines as your body says,  “Well, if you’re going to make me go do these workouts, I’ll put my energy here, though maybe with a little less pep, energy, and high-end ability, but I’ve got to rob Peter to pay Paul, so I’ll compromise over here with bone metabolism, or over here with female reproductive hormones or thyroid health, or immune function, or over here with the GI system and the ability to break down nutrients in food (because digestive enzymes are made of proteins which may be lacking in the diet), or muscle and tissue repair or”…. and the list goes on.

Why am I bringing all this up? Because it’s actually common for active individuals to be eating to hunger levels and still not be eating enough.

While intuitive eating means we should honor our hunger, many athletes have a suppressed appetite after long or intense workouts, and we still need to replace nutrients quickly after exercise, and learn to recognize that symptoms of hunger go beyond simply an empty stomach.

While intuitive eating means we should respect our fullness, if you get to the point of overeating by having excessively large meals, it is often because of low energy intake throughout the day or because you did some seriously strenuous exercise. With more even or adequate energy intake before and during a long workout, you can avoid that ravenous feeling of needing to eat quickly and impulsively, which means you’re paying more attention to fullness.

A SELF-ASSESSMENT TO HELP YOU NAVIGATE YOUR ENERGY NEEDS

So what to do if tracking all your meals isn’t very accurate (and not to mention time-consuming and takes the joy out of eating and deciding what to eat), and eating intuitively might be a little faulty, especially at the beginning?

My suggestion is to start with a self-assessment. Ask yourself these questions:
– Am I sick more than I should be?
– Do I struggle with fatigue more than I think I should?
– Am I improving in my performance?
– Have I had a lot of injuries?
– How’s my overall health?
Basic bloodwork results holds a plethora of data on how the body is ‘performing’ internally.
– How is my menstrual cycle and/or sex drive? Women have a little advantage here in that any menstrual symptoms or irregularities* are symptoms telling you to heed warning because there’s a larger health story.
– Do I have a lot of gut upset / discomfort?
– Am I more irritable, depressed, anxious, or have decreased concentration?
– Am I sleeping well?
– and if you have teammates or friends/family that you work out with regularly: Do I eat less than my teammates but have a higher body fat? This is subjective of course because every body is different, but yep, higher body fat and eating less is also a tell-tale sign, since lower metabolic rate occurs with lower energy availability, meaning you might be eating less but weighing more or having more cushion than previously.
– and one more because it can become prevalent with long term low energy availability: Am I thinking about food ALL THE TIME? We know from eating disorder and starvation studies that chronically deprived individuals become obsessed with food, far beyond just being interested in food.

So where to go from here?
Above all, food and exercise should make you feel good. The goal is to be aware and in tune with yourself and your body’s ability to show you signs that something may not feel right or as great as it should.

And you may benefit from professional guidance. If you’re confused or concerned about your needs, or would like a professional opinion, I invite you to reach out to me for more personalized support.

*Women on hormonal birth control will not have the same ability to use their menstrual cycle to gauge abnormalities, since it is designed to eliminate ovulation and the normal hormonal fluctuation that occurs. If symptoms or irregularities occur without birth control, that is vital sign that your body has an imbalance somewhere.
This information does not intend to treat, diagnose, cure, or prevent any disease. 

References:
2018 UPDATE: Relative Energy Deficiency in Sport (RED-S)
Bronwen, L., Rowe, G., and Girdlestone, C. (2020). Low Energy Availability – an imbalance that impacts more than performance. CompeatCon Nutrition Conference.
Fahrenholtz, IL., Sjodin, A., Benardot, D., Tornberg, AB., Skouby, S.,…and Melin, AK. (2018). Within-day energy deficiency and reproductive function in female endurance athletes.
Torstveit, MK., Fahrenholtz, IL., stenqvist, TB., Svlta, O., Melin, A. (2018). Within-day energy deficiency and metabolic perturbation in male endurance athletes.
Tribole, E. and Resch, E. (2003). Intuitive Eating: A revolutionary program that works. (2nd ed.). St. Martin’s Griffin.