Techniques to Prevent Nausea and Vomiting Before, During, and After Racing

For those who witnessed it live, the 1996 Men’s Olympic Marathon Trials is a race they’ll never forget.

Yes, race winner Bob Kempainen won in a course record time of 2:12:45, but that isn’t what made the race so memorable. At 22 miles, just as Kempainen began to drop his two nearest rivals, he began to vomit. And he kept vomiting for another two miles. Luckily for Kempainen, the vomiting didn’t slow him down and he held on for the victory.

While Kempainen’s unfortunate situation made for incredible TV drama, experiencing symptoms of nausea and vomiting while racing isn’t uncommon.

A 1992 study in the International Journal of Sports Nutrition found that 93 percent of  endurance athletes experienced some type of GI symptom (e.g., acid reflux, nausea, and vomiting) during their races. Unfortunately, most runners who struggle with throwing up before, during, or after races aren’t as lucky as Kempainen.

Normally, vomiting during a race is devastating to a runner’s performance. In the same study mentioned above, 45 percent of athletes reported that their symptoms were severe and 7 percent were forced to abandon the race due to their symptoms.

Given the prevalence of nausea-related symptoms before, during and after hard races and workouts, what are the main causes? More importantly, if you’re a runner who struggles with this issue, what steps can you take to prevent it from happening again?

Nausea and vomiting before races

During a scene in the running classic Without Limits, Steve Prefontaine stands under the Hayward Field bleachers before the 1972 Olympic Trials and vomits as the crowd roars his name. While most runners may never experience the fear of trying to make an Olympic team, many have dealt with the same nerves and queasy pre-race stomach Prefontaine felt that day.

Taryn Sheehan, assistant cross country coach at the University of Louisville is familiar with helping athletes overcome pre-race nerves.

“Nerves are a stressor that almost every athlete encounters that can spike and affect an individuals adrenal system. Very rare and special is the athlete that does not get nervous prior to competition. Even prior to some of our signature or key workouts, I’ll find some athletes get a little anxious or excited.”

Pre-race nausea is most commonly caused by the nerves and anxiety that big races and high pressure situations put on a runner. Anxiety is a physiological and psychological state that is typically related to situations perceived as uncontrollable or unavoidable.

“The most common reasons runners get nervous are because they put internal and external pressures on themselves that can’t be controlled, like time goals, weather, and trying to fulfill what others expect them to achieve” says Sheehan.

Physically, the nausea-like symptoms of anxiety are the result of the release of adrenaline.

Adrenaline disrupts the stomach because it pulls blood away from the  intestine and sends it to the heart, brain and skeletal muscle. Without proper blood flow, the body can’t move food through the digestive system. Moreover, anxiety and stress can also cause muscle tension in the abdomen, leading to tension that may squeeze the stomach and result in vomiting.

Prevention techniques

Focus on what you can control

Since anxiety is typically caused by fear of the uncontrollable and the unknown, Sheehan works with her athletes to “shift their pre-race mindset from the outcome and external pressures, such as opponents and the weather, to specific elements they can control like the warm-up, pre-race meal, and race mantras.”

In the months and weeks leading up to a big goal race practice the exact same warm-up routine before every workout. On race day, repeat the exact routine you used for every workout and focus on each of the steps rather than the race. Implementing this tactic before a race wraps your mind in a comfort zone with a familiar routine that has worked many times in training and keeps you calm, cool and collected on the starting line.

Pay attention to your pre-race diet

Because adrenaline and anxiety disrupt the digestive process, runners who struggle with vomiting before races should take extra care with their pre-race meal.

  • Switch to a low-fiber diet two to three days prior to race day; reduce fruit and vegetable intake and have more juices and processed low-fiber foods.
  • Runners who struggle with throwing up before races should test themselves for food allergies or general food intolerances. What sits well in the stomach of your running partner might not work for you. For example, runners with mild peanut allergies, who might not otherwise notice nausea symptoms,  can experience significant stomach distress if they put peanut butter on a bagel when nervous or before running hard.
  • Runners who suffer from pre-race nausea should consider a liquid pre-race breakfast, which is digested quickly and doesn’t sit in the stomach, as opposed to more solid foods like a bagel and a banana.
  • Avoid the use of anti-inflammatory drugs like Advil and Ibuprofen. Recent research points to a strong correlation to NSAID use and vomiting during endurance events.

Nausea and vomiting during races and hard workouts

The most common cause of vomiting and nausea during hard workouts and races is due to the shutting down of the digestive system as exercise intensity increases.

“As the need for oxygen-rich blood in the running muscles increases, the body begins to shunt blood away from non-critical resources, such as digestion, to help feed the muscles,” says former All-American runner Dr. Melanie Schorr. Research has demonstrated blood flow in the splanchnic system (which is responsible for the signals sent and received by the abdominal digestive organs) declines from 1.56 L/min at rest to 0.3 L/min during intense running.

In addition, overheating and running in hot conditions decreases blood flow to the digestive system. However, it doesn’t need to be hot to experience heat-related vomiting and nausea.

“Exercising, even in cold temperatures, naturally raises the core body temperature. At first, this rise in temperature aids performance by increasing blood flow to the working muscles. However, as the intensity and distance of a run increases, the body reaches a critical temperature threshold, usually around 101 degrees, and begins to divert blood from the digestive system to the skin in an effort to cool itself down” states Dr. Schorr.

Keeping symptoms at bay

The most effective way to avoid nausea-related systems during a race is to pay close attention to what and when you eat before and during your run. We’ve already covered some pre-race dietary tips, but if you plan on consuming fluids or fuels during a run, make sure you have a carefully orchestrated strategy that you’ve practiced in training.

  • When taking gels or other simple sugars during a race, make sure to take them with water and not another carbohydrate drink. In the absence of water, the digestive system will have to work harder to break down the gel into usable energy
  • If you take an energy gel with a sports drink, you run the risk of ingesting too much simple sugar at once. Taken together, a gel and sports drink could be delivering close to 60 grams of pure sugar. Even when fully functioning, the digestive system can have hard time processing that much simple sugar.
  • Likewise, don’t consume gels too quickly. Simple sugars are absorbed into your blood stream as glucose. The sugar will stay in the blood stream until absorbed by the working muscles or other organs. Too much sugar in the blood stream will make you sick, the same as it would if you ate too much candy.
  • In addition, dehydration can lead to overheating and can also slow stomach emptying. However, excessive intake of sodium, potassium, or other electrolytes can lead to bloating, nausea, and vomiting. Therefore, you need to develop a detailed hydration strategy that you implement and experiment with in training while running hard.
  • If normal dietary precautions don’t seem to help, you can try antacids or pepto bismol. If that doesn’t help, research on ultramarathoners has shown that 800mg of Cimetidine alleviated nausea and vomiting symptoms when taken one hour prior to the race.

Vomiting and nausea after running

While many runners might not be as concerned about vomiting after races since it doesn’t impact performance – and some hardcore runners feel that a workout isn’t hard enough unless it leaves them retching – throwing up after running can be harmful to  your body.

Dr. Schorr cautions runners that “vomiting brings up stomach acid that can damage your esophageal lining, which causes pain and affects your digestion.” You should not accept throwing up after an intense workout or race as something typical.

In addition to the normal digestive issues mentioned previously, vomiting after hard workouts and races can be caused by the sudden change in effort as you stop running hard. As for cross the finish line or finish off that final interval, your brain, lungs and heart may not be ready for the rapid change in exertion, and your stomach may continue contracting, which can make you feel ill – similar to the feeling of being sea sick.

Make sure you have a thorough cool down and avoid sitting immediately after a race or hard workout. At the very least, continue to walk around or jog lightly to give your body a chance to adjust to stasis level and prevent stomach cramping.

Hopefully, these tips and strategies can help you avoid pre, post and during race nausea and vomiting. Do you have any strategies that work for you? Share them in the comments section below so we can add as many potential solutions as possible.

References

1. Peters HP, Bosy M, Seebregts L, et al. Gastrointestinal symptoms in long-distance runners, cyclists, and triathletes: prevalence, medication, and etiology.Am J Gastroenterol. 1999;Jun;94(6):1570-81.
2. Rehrer NJ, van Kemenade M, Meester W, Brouns F, Saris WH. Gastrointestinal complaints in relation to dietary intake in triathletes. Int J Sport Nutr. 1992 Mar;2(1):48-59.
3. Simons, S M. (2004) Gastrointestinal problems in runners. Current sports medicine reports. Volume: 3, Issue: 2 Page:112

For fun viewing, here is a video of Bob Kempainen’s amazing victory in 1996 as he ran while puking.

A version of this article originally appeared in RunningTimes Magazine.

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3 Responses on “Techniques to Prevent Nausea and Vomiting Before, During, and After Racing

  1. My brother ran this trial and finished 14th! I remember watching the replay at the awards ceremony and Bob yakking those last two miles! Amazing what these elite runners can do. I can run a half in twice the time (or more) than my brother. But if I even tried to run at this pace, I’d hurl the whole time. So more power to them!

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