Why Does A Guy Like Lance Armstrong Have Gastrointestinal Issues During A Triathlon?

Hey, folks, it's Ben Greenfield here. And if there's one subject that seems to baffle folks more than just about anything else, it's how to fuel your body during an endurance event like a marathon or triathlon or anything else, where stomach issues can tend to creep up on you, as well as knowing just how much you're supposed to eat, how much you're supposed to drink, those type of things. So I have a real expert on the call today. She has a PhD in environmental exercise physiologist. She is a nutrition scientist expert. She works with the Trek Professional cycling team and has worked with many other cycling teams in the past, as well as a lot of triathletes and endurance athletes. She herself has done half Ironman Ironman triathlons. And she's one of those people that knows both the science as well as what goes on in the trenches. So her name is Dr. Stacy Sims. And Stacy, thank you for coming on the call today.

Thanks, Ben. Thanks for having me.

So I guess we should probably just jump right into this, but in terms of GI problems among runners, among endurance athletes, I hear about it a lot from the folks that I coach. You read about it a lot in people's race reports, but do you have any figures in terms of how many people this happens to, in terms of kind of the rough percentages of athletes who experience some kind of GI distress while they're out there racing?

Yeah. So when you're thinking about shorter races, shorter duration, about 70% of runners and triathletes experience GI distress. And the longer the race distance and the time you're on your feet, the Greater people experience GI distress. So it can be up to 85% of endurance athletes who actually experience some kind of GI distress.

So it seems like you're pretty much guaranteed that at some point something's going to go on with your stomach.

Yeah. So a lot of people report it as simple bloating and the sloshing feeling. And then other people are severe as having to stop on the side of the road with diarrhea or IBS or something like that. So there's a variance in the what is GI distress? But it's a pretty high percentage of endurance athletes that actually do experience some sort of stomach and GI problem.

So you can pretty much assume when you're out there and your stomach is talking to you that it's more than likely that if you're in a group of 10 other athletes that a good seven or eight of them are kind of experiencing a lot of the same Things, huh?

Yeah. And it turns to conversation.

Yep. So let's delve into the science of this. When you get gut issues while you're out there exercising, what exactly is going on physiologically that makes it so something that maybe you did just fine in training and, you know, you didn't experience GI distress when you were doing swimming or cycling or running or anything like that leading up to your events. All of a sudden, what goes on when you get into a race, as far as physiologically in the gut that causes these issues to all of a sudden become a problem?

So I'm going to take just one step back and try to get people to understand the difference between illness dehydration and what happens in the gut versus exercise induced dehydration that happens in the gut. Because a lot of people will turn a Pedialyte or some other kind of GI rehydrator as a pre hydrator for a race or a rehydrator after a race. And it's not ideal because when you're sick and you have, you know, diarrhea and all those other kinds of issues from a virus or jet lag or something like that, you don't have the shunting of the blood from the gut. So you still have full blood flow to all the intestinal cells and there's no deviation to the working muscles. So it's okay to take things like Pedialyte because it will help. But when you start exercising, it's a different scope on the dehydration and what's happening in your intestines because the blood is diverted to the working muscles as well as to the skin to help offload heat. So blood flow to the gut is pre compromised. And so this is where it becomes the nuance of GI distress. During exercise, you have the impact of running that is really harsh and can cause some eccentric load on the intestinal muscle itself. And then what you're eating and drinking also impact it. One of the biggest things is when people are taking things with sodium chloride. So chloride is a really critical.

Which is in almost everything it seems like.

Yeah. But in the intestinal cells, it's part of the whole cell membrane potential that allows fluid and glucose and everything to cross from the intestines into the system. When you're taking in a lot of sodium chloride, the sodium will be taken up with water, not necessarily through, through the intestines, but it starts in your esophagus and on its way down. But when the chloride ion disassociates from the sodium, you change the Membrane potential at the level of the intestinal cells, and it causes them to kind of open up and release endotoxins. So when you have this endotoxin release and heat shock proteins that cause issues as well, then you are triggering that GI distress.

Now, is there a reason for that? Like, why would we have a mechanism that would cause when the intestinal cells open up to have an endotoxin release or heat shock protein release? Is it a protective mechanism to keep us from going too hard? Do you know why that would be?

Yeah, for the most part, because the human body's temperature is very, very finite in how much it can move. You sit about 37 degrees C at rest, and then there's some argument of what is your dead endpoint, not dead in the water kind of thing, but fatigue endpoint being 40 to 41 degrees C. So that's a very narrow window. And your muscles, your working muscles and your intestinal muscle cells will get warmer and hotter than, say, other parts of your core. So it becomes a denaturing of proteins, it becomes a feedback mechanism. And your body's like, wait a second, we need to do something to protect this because we're getting to that endpoint of temperature where things start really fall apart. So this is where you have this release of endotoxins as a feedback. You have kind of gut shut down as a feedback that things are getting a little bit too hot for continuation.

And can that type of thing happen even if you're in maybe conditions that aren't so hot? I mean, can the gut heat up to that point?

Yeah.

Yeah, gotcha.

And then the other aspect that you have to remember when you're racing, you have a lot more epinephrine and adrenaline that's being released. And this is kind of a catabolic hormone as well for fueling. Because when you're training, you're a little bit more relaxed and you are in a more controlled environment. But when you get into a race situation, it's like everyone starts a little bit on edge and you can feel the caffeine and adrenaline buzz at the start of a race. And all these things contribute to a different environment from a training environment.

Now, does that kind of affect. I know that the nervous system and the gut are highly related, but as far as kind of like how those two aspects are related, is there any change in neural activity in the gut or anything like that that would cause it to be different in a race situation than a training situation? Or does the heat affect that neural activity or anything of that Nature?

Yeah, somewhat. And it also depends on kind of supplements that people are using on race day versus what they do in training. So a lot of people start shooting back caffeine and stuff a little bit too soon. And this alters some of the neural control. Just the way that caffeine receptors are in the brain as well as all systematically through the body, and then you have more of the parasympathetic response that's kind of the part of the flight or fight response, and that affects the neural activity that goes down into the intestines as well. So there's quite a few different scenarios that can trigger things to happen on race day that doesn't ordinarily happen in training. So it's beginning to realize what you can do to take to kind of stop or attenuate those things happening on race day. And along this is what kind of supplements you're taking or what you're actually ingesting, timing of food and all that kind of stuff.

Gotcha. What about actual absorption, like the way that foods absorb from your stomach into your intestines, through your intestinal cells into your bloodstream. Does that change during the race, or does it change as your body heats up when you reach higher intensities?

Yeah, because as you become dehydrated, like I said, you have reduced blood flow to the gut. That slows your gastric emptying rate. And then the other thing is what you're eating and the concentration as well. Anyone who's heard me give a talk will know that I absolutely abhor gels, because gels, goos, those kinds of things are concentrated carbohydrate that gets shoved into a dehydrated gut. And no one that I am aware of is actually consuming the 8 to 10 ounces of water that they say to have with every sachet. So you're taking this concentrated carbohydrate, putting it into a dehydrated gut, it changes the osmotic pressure. And body water has to come from within the system to dilute it in order for it to be absorbed. Meanwhile, it's sitting in the gut sloshing, and anything else that you ingest with it kind of gets held in the gut too, because nothing's passing through.

Interesting. So when you've got the gels sitting there in your gut metabolizing, what goes on from a standpoint of, you know, kind of the way that those oxidizes, they're in your stomach or the heat that's produced along with them.

So the gels are usually fructose and. Or maltodextrin oriented. And by the nature of them being a longer molecule and having to go to the liver as a final step for oxidation, they actually release a lot more heat than something that's glucose sucrose. So you end up with a greater heat storage. And then when you're thinking about what's happening actually in the stomach with slow gastric emptying, it's kind of like if you were to take a whole bunch of icing and put it in a sink and then try to run water down it, and the water just can't get through because it has to dissolve the icing first. And that's kind of.

You mean like sugar icing from a cake?

Yeah, like the Betty Crocker stuff. You get in the tub and you want to throw it out, and you try to wash it down the sink, and it doesn't really quite get through until it's dissolved enough. And that's kind of what's happening with the gel, except instead of running water, your body is having to throw that water in from somewhere else. So it's kind of an effective dehydrator.

So what you're saying is gels basically produce more heat in your gut than perhaps some other sources of sugar. Specifically gels that are made up of, like, a long chain fuel. Like maltodextrin.

No, maltodextrins kind of have the same issue, and it's the type of sugar, but also the osmolality. So it's better to do something like blocks or jelly beans. It's a small amount of carbohydrate that gets introduced because, you know, like a sleeve of Clif blocks is maybe 200 calories, whereas one gel is 100 to 110. So people will slug down one or two gels in a very short period of time in comparison to eating a whole sleeve of blocks. So it's a kind of a titration effect. If you're having a small amount of carbohydrate at a time, you don't get that gut reaction because your body's like, okay, well, I can actually deal with this little bit of carbohydrate. Get it into the system so your blood sugar stays a little bit more constant, and you don't have this big glug of stuff that's hanging out in your. In your GI tract.

So the type of sugars that make up things like blocks or chomps or jelly beans or these type of chewable sugar sources, while it may be the same type of sugar that's in a gel. What you're saying is that we tend to consume things like that in smaller amounts and kind of ration them throughout an hour versus kind of eating them all at once via a gel source.

So yes and no. So gels are primarily fructose and maltodextrin, which have the heat issue. And if you're thinking about jelly beans or blocks or other sharkies and those kind of gummy things, they're primarily sucrose based. So sucrose is readily absorbed. It gets broken down. People always like. But it gets broken down to glucose and fructose. What's going on? The glucose gets absorbed. The fructose works with the glucose to get out of the system a lot faster. So there are co factors involved. When you start just ingesting fructose or just ingesting maltodextrin with fructose, this is where you have the issue with the heat. And then you have to look at the concentration of it. So if you're eating small amounts, then the osmolality and aspects of what you're ingesting is lower than slugging back something that's concentrated.

So what you're saying is if we're kind of turning over the label and looking at something that we're planning on eating during an intense event or a hot event, we should be looking for basically something that contains fructose plus a combination of. A combination of fructose plus a simple sugar like a glucose or sucrose, or like just glucose or sucrose, but not like a fructose and a maltodextrin or a fructose by itself.

I'm gonna say no to fructose across the board.

Okay.

Glucose, sucrose are the two best sugar combinations. One, they encourage fluid absorption, and two, they're not as harsh on the body to actually digest, get through the system and get out to the working muscles. Fructose has that extra step where it actually has to go to the liver to be oxidized. And I know that there's a lot of research out there that's saying the combination of glucose and fructose, or glucose with another. I mean, fructose with another type of sugar is great for carbohydrate absorption.

Yeah, that's what I was going to ask you, actually.

Yeah, yeah. So this is where I kind of deviate where you're looking at what's most important in Hot race, Staying hydrated and keeping the gut working or ingesting a lot of carbohydrates and this is where people start to go kind of awry, where they're like, okay, well, I want a lot of carbohydrate. So I'm going to look for those that maximize carbohydrate availability and carbohydrate absorption. So this is where they turn to the things like Gatorade and the Cytos and all those other the Hammer products that all are liquid calories. But it's kind of a sofa bed analogy where it's not a good bed and it's not a good sofa. So those kinds of things, it's not a good fuel and it's not a good hydration solution. So if you're looking to maximize fluid absorption with some carbohydrates, you're looking for a glucose sucrose combination. And then you have real food or solid food in your pocket to top up the carbohydrate and macronutrients that you need.

So talk to me a second about practical aspects here. Glucose sucrose. And then you mentioned solid food. To top things off, what would a typical scenario look like? Let's say if you yourself were to go do Iron man, what would you be eating?

So I would start solid and work my way semi solid. So what I mean by that is I would have had a good lead in to the race through my taper week, so I wouldn't have changed my nutrition during taper week, so that as my volume intensity drops down, I'm effectively glyco, glyco loading and carbo loading throughout the week because my nutrition hasn't changed. Then the morning of making sure that I have good protein and carbohydrate combination, you know, oatmeal with a little bit of whey protein or, you know, some people are doing Ensure or something like that, that it depends on what your stomach can handle. Then when I get out of the swim in T1, I'm going to have a bar that I'm going to shove in my pocket. I'm going to eat within the first 10 miles of the race for that.

Bar you're wanting to eat a type of bar that doesn't have fructose and maltodextrin in it.

Right. So preferably an uncoated one that doesn't have fruit nuts in it.

Okay.

So go to. For a lot of people I work with are like the toasted, the toasted, uncoated Luna bars or Mojo bars. That Clif Bar puts out.

Gotcha.

Okay, so then you're getting something solid in your stomach before you start getting into any kind of low body water. And then I aim for 45 to 50 grams of carbohydrate plus about 10 grams of protein per hour, which is a little bit, or I shouldn't say a little bit. It's usually a lot lower than what comes out in a lot of other people's research saying you can go up to 90 grams of carbohydrate per hour.

Right.

It's a bit too much when you get up there because most of that research has been done on elite College aged 18 to 20 year old white men that are in a lab situation and they don't take into account gender differences or sex differences, I should say menstrual cycle status, intensity of the race, environmental conditions or any of that. So you can always come back from a low sugar, but you can't come back from dehydration. So this is where I always tell people to go on the lower side of carbohydrate intake. And then if they start to get hungry, you can top up that. But for the fluid intake, making sure that it is low osmolality, glucose, sucrose, with some good sodium, magnesium and calcium. So I'm eating, I'm drinking that kind of drink throughout the race and then starting solid, working my way, semi solid, trying to stay solid as much on the bike as possible. So I mean, it could be anywhere from the engineer nutrition of mojo bars to a peanut butter sandwich or a turkey and cheese sandwich that's shoved in my pocket, or salt and new potatoes or some other kind of real food that I've put in my pocket or my special needs bag.

So basically something solid that again isn't a bunch of fructose and maltodextrin.

Exactly.

And that's just kind of like to top things off at the end of each hour.

Yep. Okay, gotcha. And you're eating bits along the way. So you're, you know, a lot of people set their watch and go, ooh, 15 minutes, gotta eat something. And they tend to kind of overeat whenever their alarm goes off. So if you're kind of eating small bites along the way and you make sure that you finish, you know, your designated carbohydrate intake per hour, you end up with a little bit more steady stream and it takes a little bit of practice. And this is what you do in training.

Gotcha. And I've always come from the standpoint of looking at total carbohydrate absorption, meaning usually looking at fructose and maltodextrin based liquid or gel sources. Looking at this from a heat production standpoint and kind of an energy of digestion standpoint, that being kind of an. A new process in terms of like brands. And this isn't a commercial for any brands, just so listeners know. I have no clue what Stacey uses, but glucose, sucrose, are there like specific brands of drinks or specific choices that you make in terms of your actual things that people, you know, let's say somebody's listening in now. They've got an Ironman in eight weeks. They would go buy some stuff and experiment with it. What would they use?

So there's a lot of things on the market. The big ones out there that are on the race courses for the most part are things you want to avoid. The Ironman perform drink that's out there is okay, but you want to have it diluted. The goo brew is okay, but again, you kind of want to have it diluted.

Diluted by how much?

So it's one third dilution factor. So you're making it one third as strong as what they say. And then I think we'll get to a point of what about electrolytes and stuff in a second. But if you're eating real food, then you're topping up the carbohydrate and the sodium potassium intake. So you can afford to have the diluted sports drink because the idea is to maximize hydration. So Kai nutrition is another one that's coming on board.

Kai?

Yeah, K A I Nutrition. So they have an active recovery drink or active drink and a recovery drink. And they're both low in osmolality.

And those are like the sucrose and glucose that you talked about.

Yep, yep. All of these are. The PowerBar perform one, I think has a little bit of maltodextrin and dextrose, which is better than a fructose.

You mean the power bar perform drink or the power bar gels?

The drink. The drink, yeah.

Okay.

Yeah.

All right, well, cool. I think folks have some ammo, at least some knowledge so they can start turning over the label on stuff and looking at it. I want to backpedal because before I started bugging you about what you actually eat when you're out there, we had gone through what's actually going on physiologically during intense exercise or dehydration that causes gut issues. You described about the endotoxins getting released by the cells and decreased absorption through the intestinal cells. And you mentioned caffeine as being one thing that can aggravate this issue you mentioned starting to take that too early is that, I mean obviously caffeine is an ergogenic aid and can help. But do you have kind of a best practices that you recommend for caffeine in a situation like this?

So yeah, if you're a habitual caffeine user, you just keep using caffeine, you wake up, you have your espressos or whatever. If you're not a habitual caffeine user, then you want to wait till the second half of the bike ride. And you're not taking caffeine pills because the anhydrous caffeine that's in no go's and stuff is notorious for giving you shakes and the runs. So you want to look for something like green tea extract or. And I get bombarded when I say this five hour energy. Because if you look at the label of five hour energy, it's just a big shot of B vitamins with some caffeine. So those are kind of two things that I would say. If you're a habitual caffeine user and need that extra boost of caffeine, then you're going with something like five hour. If you're not a habitual caffeine user but you need that extra boost of caffeine, then you're going with something like green tea extract at this in pill forms or you know, you can get some food and stuff that's fortified or supplemented with green tea extract. And it's the caffeine aspect that you want. If you're out on a training ride and you know that you have a big brick, then people often stop for low fat or non fat mocha. So you get a little bit of sugar and some protein and some caffeine ready to go. So it's kind of fueling, fueling by fire.

Okay, gotcha. People are out there taking a lot of other supplements or possibly medications. Which ones would you highlight as having potential aside from, you know, just like straight up caffeine pills which you mentioned, potential to aggravate the gut issue even more.

Sodium bicarbonate. So people will take or follow the sodium bicarb loading for lactic acid buffering or for preloading.

So we're talking about stuff like, like sport legs or hammer fatigue caps or those type of things.

Yeah, so when you're looking at those kinds of things, you want to see what the concentration is. If you're going to go with something like that, then you want it to be a bicarb and a citrate combination. You don't want any kind of chloride because I know that there are different variations like sports legs and salt tabs and those kinds of things. They use potassium chloride with sodium chloride.

For the reason that those cause the intestinal cells to open up. And the endotoxin issue.

Right. And sometimes like mototabs are high in sodium bicarb, but they also are linked with potassium citrate. So the citrate and the bicarb kind of work together to reduce the GI distress issues that you would have with bicarb. The other thing that is notorious for causing kidney and GI distress are non steroidals. So people are taking Advil or Aleve or something like that.

Ibuprofen.

Yep. And it interferes with some of the receptor sites and function of the kidney, which changes fluid balance and can also contribute to GI distress.

Gotcha. Okay. Okay. So those would be some of the major ones to essentially avoid if you don't want to experience this type of, of GI distress.

Yep.

You're looking for caffeine pills or regular kind of caffeine sources, aside from like green tea or five hour energy. You're looking at things like ibuprofen and then also if you're checking the label, anything that kind of says chloride.

Right.

Okay. So does exercise actually cause changes in your gut muscles or the way that your intestines actually kind of operate as far as like the way they bounce around, the way they move, what exactly is going on from that standpoint?

So it's not the exercise per se, it's the heat and the. Well, I guess it could be mode of exercise because a lot of people are just kind of experiencing bloating on the bike, but then when they get off to run. I've yet to meet an ironman athlete that doesn't have some kind of stomach pain disorder. GI problem the first five miles. And it's because you get off from the bike that's non impacting to start starting to run. And then all of a sudden you have this bouncing of the intestines and the impact and that will cause some GI problems. And the hotter you are, the more susceptible you are to the gi. So staying on top of your fluid and then doing things like Tums or magnesium or something like that before you get off the bike. So you have some kind of coating in the stomach before you actually start running helps with the attenuation of any kind of GI problem.

Interesting. It's an interesting tip. So is stuff actually moving around? Are your intestines actually when you start running kind of changing position, does that cause stuff to move through more quickly? I mean, what is it about running from kind of a mechanical standpoint?

It's the actual bouncing of everything that's in your thoracic area. So you have the intestines that start bouncing from the impact of running that hit other organs. And it's just kind of like a big paint shaker that all of a sudden you go from pretty stable to a big paint shaker. And yeah, some people it causes IBS or quicker gut transit. Other people just kind of sits there and, you know, kind of get a backlog in the stomach. So you have all this sloshing. So it's a little bit independent. But again, it's like going from pretty stable to putting everything into a paint shaker and moving it up and down.

Okay, gotcha. So how about men versus women? I personally hear about this more in women. Is that just just sheer perception or are issues like GI issues more prevalent in women than men?

So it's very much more prevalent in women who are in the high hormone phase of the menstrual cycle. So estrogen, progesterone, even if you're on the pill, you have similar, similar responses. It's the estrogen and progesterone that changes the woman's body, makes her have a higher core temperature, so she has less room to that end point, so she's running hotter. She also has a decrease in her plasma volume by about 8%. So these are already contributing to triggers for GI distress. And then the estrogen affects prostaglandins. And the prostaglandins can also affect intestinal cells and allow them to be a little bit more relaxed and open up. So this is why a lot of women get diarrhea right before their period starts. So yeah, a lot of the times when you hear women are having GI distress, you talk to them and you find out that they're in the high hormone phase of their menstrual cycle. So it's not a misnomer. It actually is a true sex difference.

So is there any kind of quick tips you have for women that they can use during that high hormonal phase of their menstrual cycle?

Yeah. So one of the best things to do about two weeks before their period starts is to start taking about 250 milligrams of magnesium and some omega 3 fatty acids, because that helps with that prostaglandin interaction that you have with estrogen. But you can't really do much about the plasma volume and the heat change or the body temperature change, because that's just a physiological thing. So it's staying on top of hydration and actually making sure that what you're drinking is hydrating instead of being a carbohydrate source.

Okay, gotcha. I want to kind of move on real quick to that race day meal that you mentioned and kind of what to eat, or more specifically, what not to eat for your race day meal. When you're waking up in the morning and you're having something to eat, or I guess even in the days leading up to the race, if that comes into play here, what are the most common mistakes that you see athletes making when it comes to race day meal planning? And kind of the second part of that question, are there specific things, specific compounds, specific ingredients that they should be just avoiding like the plague?

A lot of it starts the night before. You know, the big pasta loading, carbo loading, dinner. And a lot of people have the night before a race. It kind of sets you up in a bad start. And the fact that you end up with a lot of extra insulin and ghrelin and leptin and all these things that are involved in sugar metabolism. And you also end up with extra bloat because of the carbohydrate and water combination. For every gram of carbohydrate, you have four grams of water. And this water will be used eventually during the race. But you wake up feeling really lethargic and bloated and your metabolism is a little bit off and with the vagal response of nerves. So it's race day, you've gotten short sleep or poor sleep. You have a lot of adrenaline going. You're running all these scenarios through your head. So you're already having a little bit of blood compromise to the gut. So getting up and having something that's really heavy and just sitting there is a lot of times not the right thing to do. So if you're going to do something like oatmeal, make sure that it's kind of runny oatmeal, not a big bowl of heavy, thick oatmeal. And you want to have some kind of light protein. So this is where like pea and hemp flour protein powder comes into play. If you can handle dairy, then using whey isolate protein with some almond milk. So it's a little bit coating to the stomach, gives you a little bit of protein. You have the carbohydrate from the oatmeal. But then some people can't handle that either. So then they turn to things like Ensure or complain or some other kind of liquid breakfast. And I always try to steer people the other way to making their own with their own whey protein powder and almond milk. Because if you look at the ingredients and things like Ensure, they're chock full of fructose fiber. They have a lot of chloride molecules in them as well as the fortification. So you're kind of setting yourself up for a little bit of GI distress before you even get started. One of the better things to do is to kind of play around and see how your stomach does on short sleep and nerves. Some people have go to breakfasts, but the biggest concern is to top up carbohydrates and to get some protein on board. So you're not trying to actually load for the race, you're just trying to top up.

What kind of thing would you eat before, like an Ironman triathlon?

Probably what I have most mornings before training, it's some berries, some Berscher muesli. So it's the oatmeal with almond milk that's been put in the fridge the night before, so it's not cooked. So it's already pretty easy to digest. And then I top it up with a little bit of whey protein powder and then about an hour later I'll have some toast with some almond butter and salt.

Gotcha. So you're basically having like a soaked, easy to digest carbohydrate with some protein added and then a little bit later kind of topping that off with a little bit more carbohydrate and a little bit of fat.

Yep, gotcha.

Okay, cool. Good suggestions. How about artificial sweeteners, things like sucralose and anything else that we might tend to find in a pre race meal or even in something that we might have out there with us on the course. You talked about avoiding fructose and maltodextrin as far as your carbohydrate fuel sources and some of the issues with gels. But what about artificial sweeteners?

Yeah, so sugar alcohols like xylitol are becoming more and more popular in some of the products. Ends up being 40% less calories than sugar with the same sweetness. So this is kind of in your low carb sports supplements, also found in chewing gum. And sucralose is the other notorious one that's in like camelback elixir and noon tablets and things. And they both cause bloating and GI distress. So staying away from artificial sweeteners is a really good idea. And the fact that even at rest, they cause bloating by the nature of their compound and the fact that they're primarily derivatives of corn as a sugar alcohol. So doing something like a newin or a camelback elixir is fine if it's like an hour or two. But when you start ingesting a lot over the course of time, then you get this buildup of sucralose that can cause a lot of the intestinal issues that we talked about earlier. Separation, endotoxins and stomach bloating. And xylitol does the same thing. So small amounts, okay. But continuous use in one day of a race, it's not a good idea.

So while most of us aren't like chomping sugar free gum during the race or eating a lot of sugar free foods, you should even be careful with things like these effervescent electrolyte tablets that have sucralose in them.

Yeah. And some of the hammer products are also full of xylitol and amaltodextrin, just because they're trying to keep the osmolality low so it has better absorption, but they still include the xylitol, and then that gives you issues.

All right, so folks are taking notes furiously right now. So far, we've got the list of things to look for would be fructose, maltodextrin, chloride, xylitol, sucralose. Yeah, sucralose, caffeine, depending on the source of the caffeine. Okay, cool. Now let's go ahead. And we mentioned about sports drinks and how you'd say that things like power bar performance or the goo brew would be okay if we kind of cut these down by about one third. Now, those are obviously for a lot of people, the electrolyte source, you know, that's what they were designed for, is the optimum hydration along with calories. Now, do you think that we need to be using electrolytes? I've had Tim Noakes on the show before, and he says the body does a pretty good job maintaining plasma sodium levels if you're not taking in electrolytes. And if you think we should use electrolytes, do you recommend certain forms over others? Because there are a ton of different forms of salt tabs out there on the market.

Right. So I know Tim, he's a good guy. And I often get asked this question because you have Gatorade, that's on one end of the spectrum. You have 10 Nokes, that's on the other end of the spectrum. And it's actually somewhere in the middle. So if you're well fueled and you're eating real food or food with salt in it, then you're going to be okay. For sodium, you don't need to take salt tablets. This is another kind of misnomer that Ironman triathletes have where, oh, I'm going to cramp, I need to take salt tablets. But it's not. Cramping is such a nuance. It could be neuromuscular. From the jackknife position you have on your bike, it could be low potassium. Most people are low in magnesium. So it's not what you do on race day, but paying attention to how you get into the race. So the week or two weeks leading up, making sure that you're topping up with magnesium, making sure that you're eating, you're salting your food so you have all this already in your system. Again, as you're saying, there are different compounds. There's carbonates, there's chlorides, there's citrates. If you're looking to coat the stomach a little bit on rice day and you're starting to cramp, then going for a magnesium carbonate or calcium carbonate, which is what Tums is, is great. If you're looking to kind of top up during the week, then going for a citrate based compound is good because then you have an increase of your citrate storage, which helps with your Krebs cycle and your aerobic metabolism.

Why are you recommending specifically? You said carbonate and I know a lot of people just look at something and they're just like, oh, sodium. Okay, I'll take it. You talked about the issues with chloride. As far as citrate goes, using magnesium carbonate versus magnesium citrate. Why are we avoiding citrate in something like a race type of condition?

It's not so much you're avoiding it, it's trying not to take supplements on race day. Specific for cramping. Like all the electrolyte tablets, people kind of put them in their pocket and becomes a placebo, nocebo. I need my salt pills, I need my magnesium pills and that kind of stuff. If you're doing something on race day, then if it's specific for cramping and it's kind of the go to, then citrate or carbonate is fine because the citrate works with your aerobic metabolism. But leading up to the race is when you should really be paying attention to your trace elements and making sure that you're hitting what you need to. So it's already in the system, it's already being absorbed, it's being extra. You know, there's extra storage and that kind of stuff of the citrate, of the magnesium, of the sodium, all those kinds of things. But if you're starting to have GI distress and you aren't using Tums, then you want to make sure that your electrolyte tablet is a carbonate based. If you're having the GI distress and cramping, does that make sense?

It does. What's an example of a brand out there that uses carbonate versus citrate as an electrolyte source?

So this is where you kind of have to go to like Pharmaca, or you can even go on Amazon and get something like magnesium Calm because they use a carbonate and then there's a couple of others. So it'll list the ingredients. And getting a magnesium or potassium or a sodium or not sodium, sorry, or calcium carbonate is pretty easy if you look at the label. Most of the sports supplements that you buy in specialty shops are chloride, because you have potassium chloride, you have magnesium chloride, you have sodium chloride. So just paying attention to what's on the label.

Okay, that makes sense. In a nutshell, though, with electrolytes, what you're saying is, say I'm going to Ironman Hawaii and I'm going to be competing down there. Smartest thing for me to do is to get my hands on like a good, like a, like a liquid mineral source or like a full trace mineral source. And be sure to just keep myself really taken care of from an electrolyte standpoint so that I'm not going into the race depleted. And then if I am going to use electrolytes, use, use an electrolyte source that, that doesn't have chloride or citrate in it, but is preferably like a carbonate source.

Right, right, exactly.

Makes sense. You had mentioned Tums, and that's fine if you want to elaborate on that. I am kind of curious about that. But as far as, like, your final tips that we can use if we find ourselves out there, and maybe we've followed all your rules or maybe we haven't, but we find that we've got GI issues, what are some final tips you can give folks who just need to, to pull out the emergency stoppage to get things to settle down?

So a lot of people who have this GI problem starts on the bike and they start getting the bloated feeling. So this is not the time to stop drinking. But making sure that what you're drinking is that low Carbohydrate, you know, it's sucrose, glucose. So you're still pulling in fluid and then letting your body settle. So part of the issue is when you're eating and drinking and it's kind of mixing and you're having all these problems that we talked about with heat and oxidation and all that kind of stuff. So lowering the food intake, staying on top of the fluid, that'll help get rid of some of the bloating. And then when you get to T2 of any race, having some real food, so not a bar, not some blocks, anything like that, it could be as simple as white bread with some blueberry jam and salt. So you're having a quick hit of carbohydrate from the jam and the white bread and topping up a little bit of sodium to help fluid get out of the gut. And this is also the point where I tell people to take peppermint Tums because peppermint is a natural anti nausea soothing agent, just like ginger. And then you have the calcium carbonate from the Tums that actually helps coat the stomach.

Okay, cool. And as far as folks who maybe are gluten intolerant or avoiding bread, I'm one of those people. Let's say potato with a little bit of jam on it. Would it also be okay?

Yep. Sweet potato and salt's my go to.

Cool. I love that meal. Man, this is a ton of really fantastic information. You know, I was actually just at a triathlon where I was watching Lance Armstrong compete and he was complaining about having GI issues and hydration issues during the race. So hopefully he listens in and maybe he can pick up some tips because you're full of great information and it was fantastic to be able to pick your brain today. I think this is really going to help folks out. So Stacy, any final words?

No, not really. Other than really pay attention of what you're drinking hydrates you and what you're eating actually fuels you because a lot of people neglect the idea of nutrition and leave it to the sport nutrition companies. And a lot of that's been based on marketing. So pulling it back a notch and paying attention to what you're eating is really going to go a long way in how you're racing and feeling.

Fantastic. Well, folks, I will be putting any notes that I was taking during Stacy's interview over on the show notes@bengreenfieldfitness.com if you've got follow ups, leave them as a comment or question or feedback right there in the show notes. If you yourself have some advice. If you know of some brands that kind of stay true to what Stacy has recommended, feel free to leave them there in the comments so we can all help each other out. And Stacy, thank you so much for coming on the call today.

Yeah, thanks for having me. It's been fun.