GI Issues in Ultrarunning with Kyle Smith | Koopcast Episode 92

trail and ultra runners what is going on what's happening welcome to another episode of the KoopCast glad everybody is here with me today this is another episode that i've been recording out on the road for the last few weeks i recorded one from a hotel room because my hand broke down and that's a totally separate story this one i'm recording directly out of the adventure van on the heels of going out to the bigfoot 200 to pace one of my athletes which was a great experience a really hard race this year because it was extremely hot above 90 degrees for the first day and i gotta say these 200 mile races are becoming cooler and cooler and candace burt and her team over at destination trail has just done a fantastic job cultivating a really neat community there and they've got these races as problematic as they have been to run with covid and now there's a bunch of fires out in the tahoe area they've just done a good job operationally figuring things out so kudos to her and her staff long-time listeners of the podcast remember last week we talked with jamie pew about this recent research paper that came out that kind of overviewed how gastrointestinal distress really starts and really manifests itself in endurance athletes and the title of that paper is gastrointestinal pathophysiology during endurance exercise endocrine microbiome and nutritional influences

this week on the podcast is an extension of last week's podcast where we have the lead author of that paper and kyle smith who is uh in the research department at the university of arizona and i have to say that young kyle smith here he punches above his weight and experience i just learned this during the podcast this is the second paper that he's produced and he is with a lot of heavy hitters right out of the gate so kudos to you kyle and your young and in your young career that is on a very fast trajectory right now i expect great things coming out of kyle and the university of arizona what we really wanted to focus on on this podcast was first to try to set the table on how all of these different gastrointestinal distresses or stressors actually start when we begin to exercise and then we move down to the very practical and pragmatic ways that we can alleviate them both before during the actual training process and when they actually occur during the race and as always with this podcast if you get bored with simple solutions you're going to be a little bit bored with this podcast because the solutions are remarkably simple interesting but simple at the same time i had a lot of fun with it as i do with all my podcasts i hope you guys do too i hope there's a lot of practical things that everybody takes away from it so here we go i'm going to get out of the way here's my conversation with kyle smith all about gi distress and how to prevent it from happening in the first place which is the most

important part you were rocking a sweet mullet i want to say right out of the gate thank you thank you good choice my friend appreciate it well you are you're in arizona right i am yeah southern arizona yeah yeah well we used to have an office in tucson so um oh really yeah yeah the mullet goes a long way in southern arizona oh yeah definitely some say it's ergogenic i'm gonna leave that in the recording the mullet is ergogenic i love it perfect uh good well thanks for joining me man i appreciate it yeah thanks for having me i'm excited about this what uh what do you guys currently have cooking in your lab uh so i'm in actually a strict exercise immunology lab so uh we do a lot of um cancer immunotherapy we look at how exercise can maybe augment treatments for those with cancer or even the treatment itself um different kind of tumor models and animals and then we do a whole lot of stuff with astronauts as well looking at kind of exercise to mitigate uh psychological stress and then therefore hopefully maintain immune function in space so we've got we've got a lot of things cooking right now so i didn't i so so i didn't know that so then what's the connection between that type of research and the paper we're about to talk about yeah it's uh it's it's funny how it all works out so um i did my master's at florida state

uh under dr mike ormsby and so i the the gut stuff kind of just fell in my lap we were going to go to uh the ultraman uh ultra triathlon um and i was interested in looking at inflammatory markers uh and then with the collaborator you know might as well look at gut stuff too uh so that was kind of handed to me and then um we published that paper last year i'd already moved on my master's here to the PhD after we published that and the european journal of applied physiology they reached out and said hey like this paper uh would you guys want to write a review and so that's how that culminated so we linked up with jamie and graham clothes in the uk and got it done dude you you uh hooked up with some heavy hitters man right out of the gate there it's almost like i know i always tell these coaches you got to take the opportunities that like fall into your lap like that and for you like you know one probably one of your you know is this your first lead lead paper or one of the first lead papers that you've had yeah second the first one was it was a cut paper yeah so it was it was a big opportunity and not gonna lie i was a little intimidated when we we were working with those uk folks but well that's like it like i said you gotta take advantage of the opportunities in front of you man you get you get an opportunity to uh collaborate with particularly graham with no with all due respect to jamie who's great and he was he was on the podcast last week man you uh you jumped into the fire and it's a great paper um thank you yeah so it's really good it's been covered in a number of different news articles and the listeners will remember last week we talked to jamie about some aspects we've already kind of gone through this weird transition that you've had

personally working yeah it's uh it's kind of not specifically or exclusively in exercise immunology type of setting but then move it moving it over to gut function but what would with athletes in particular right it always seems like we learn from other disciplines from astronauts like like you're mentioning earlier to people in more of a disease setting we take those we take learnings from those and we start to apply them into an in an athletic realm so things that were originally intended for something else somehow get intended for an athletic realm do you see it like any of those parallels just in the early work that you've been doing yeah definitely from both sides so especially when it comes to the gut stuff there's a lot we can pull from the clinical side you know people suffering in fact that was kind of the justification for my first paper looking at inflammatory markers because let's add some markers no one's looked at before because we see them in situations like crohn's disease or ibd and maybe that's they're playing a role here in exercise especially ultra uh and maybe we can measure them that didn't pan out um but that that's one example just taking it from the clinical side and then from you know maybe the astronaut side they are indeed athletes so uh you know they exercise a lot up there and so you know we're interested in uh reducing the stress response so being in spaces inherently stressful um and so that leads to a bunch of negative consequences some of which are immune oriented and so we're trying to see if exercise can mitigate some of those things um and that kind of shares a link too because i think you've had patrick wilson on here before right yeah

and so he's i think he's kind of driving a little bit of research in the area of kind of psychological stress and gi issues and athletes uh so it's kind of in the same kind of realm how can we reduce the the stress response and therefore it might actually translate to less gi issues and then increase performance so uh it's funny we pull from all these different fields to kind of generate these ideas it's always multidisciplinary um definitely so with gi distress we typically look at it as one of the bigger limiting factors in ultra in ultra running performance and there's this kind of classic paper that marty hoffman did several years ago that surveyed athletes at the end of the western states 100 and they asked them kind of what impacted your performance and gi issues rose to the kind of kind of to the top of the list and we've used that ever since as this this kind of very literal litmus test of okay this is the biggest thing that limits performance but we're starting to appreciate more and more that a there's a range of gi issues that are out there and there's also a range within each one of those gi issues in terms of severity and then there's also a range of how all of those actually impact performance which go from well you know as jamie put it last week i was just farting out on the course right and that's not going to impact my performance that much to i'm puking on the side of the road or the trail for three or four hours and i can't hold down food and i and i and i might even drop out and that's a huge range right from nothing to dropping out is is the biggest range you can

actually think of so can you kind of contextualize that picture of just a little bit better based on what you've learned from doing the research in the paper in terms of how impactful that range is and how athletes need to need to kind of like look at the potential performance impacts yeah definitely so it it definitely makes the research harder the variability and not only people's responses but then the severity so in terms of the the incidence of of these symptoms like we know in ultra like they're just going to happen right so we can just put that on on the table that's going to happen but for the athletes themselves it may be that the severity of whatever symptom it is kind of guides the intervention so you know most people deal with nausea as their biggest issue during these races but some people might have extreme lower gi issues and especially as iteration goes on and so that you know we can address try to at least the best of our ability with the research we have address those individual symptoms based on which are more severe because those are the most likely to impact performance and like you said it could be something that's just a minor annoyance to completely dropping out of the race and even in some cases hospitalization so it is a huge range so is it kind of an unfair umbrella to cast over all of these things i use the analogy of strength training all the time right we use strength training to encompass everything from like plyometric types of lifts to physical therapy activities and that's a huge you know maybe sometimes 100 or even maybe

500x in terms of the force production right is is it are you kind of viewing this gi distress is the same thing as it's a little bit of an overly broad umbrella because of all those different impacts in the severity yeah definitely definitely and you know that i think the research is starting to recognize that so you know you look maybe 10 years ago we're looking at just overall gi symptoms during exercise but as the papers develop um you know now they're starting to get split into upper gi issues lower gi issues maybe psychological influence and so i think that's a really good thing that's starting to happen in the literature is we're starting to tailor it and get a little more specific because everybody's different and you can't just kind of blanket statement all of gi issues so okay so let's let's take a note and then you're going to have to probably correct me more than i'm going to correct you because you're the expert i'm going to paint the overly broad brush and you can kind of drill it down to the down to down to the specific ones and this is this this is a good transition point to those specific ones there is a there is a range of all of these complaints in endurance sport and you know they've looked at triathletes and cyclists and marathoners and ultraman athletes you know like like you're uh involved in who have a lot of gi issues as well i think that's the one of the better parallels to ultramarathon running and the the overview of complaints is just like this like laundry list i feel like of of of of different of different gi systems which is the which is the broad umbrella um what are the like what are the more impactful ones in

terms of performance when we look at that whole laundry list of things i think probably the number one we got to focus on is the most common which is nausea um so some of the symptoms that we experience are more just uncomfortable um so like say like bloating or flatulence or something like that those are just uncomfortable i mean they can verge on on pain especially in the bloating situation but something like nausea not only is it extremely uncomfortable but actually is going to limit especially in ultra race and nutrition fluid intake everything so it actually has the the potential to really impact performance besides just how we feel and want to drop out or whatever the psychological feeling it's almost like a second order effect right or the the impact is on a second order effect yeah definitely and then uh you know that's the most common but then for the athletes that also get lower gi stuff where they you know they have to run off the trail or they have to find port-a-potty or something like that's that's a huge issue as well and so i tend to think of those two as the biggest so kind of diarrhea on the on the lower side or a nausea on the upper side but then there's this huge range of things in between um you know cramping bloating flatulence stuff that that influence both of them um and commonly occur but tend not to really detrimentally affect performance like like those two ends of the spectrum do and take the listeners through the severity component of nausea and how you determine it in the lab because we're going to talk a little bit about that but if you have no sense of how does how does somebody like you in the field who's trying to put this scale on things

and we're relaying that scale to people who might not have ever experienced that right they just think oh i'm puking on the side of the trail but in reality what you need to do is you need to say okay what like what is the actual severity of that how does that work in the field so we can calibrate that in everybody's minds right now yeah that's a little bit easier in the lab because you can really explain how you want it done and familiarize them with the scale i mean all we can really do is is provide the scale and you know it's usually one to ten or something and of course the response is completely subjective so someone's five might be someone else's eight right you know you never know but in the field itself you probably have limited time with the participants to you know educate them on what you want done on your scale uh and so it definitely complicates it and most of ultra research has to be a field study right so uh that's a struggle is explaining you know zero corresponds to this whereas 10 corresponds to the absolute worst nausea you have to quit the race uh sort of thing um that's that's a tricky question because it's so subjective uh and the best and it sucks that the best we can do is a scale right right we don't have like a biochemical marker or you know that's exactly what i was going to point out right i mean we we're used to seeing things like lactate and cpk as kind of surrogates of other types of activity that are going on and that are going on the body with gi distress while there are some bio biochemical markers that can that can indicate of uh that can be indicated of uh uh uh damage in terms of the actual nausea that people are experiencing

which is the functional part of it you're right it is entirely subjective yeah and actually that's another really hard part of this research is you look at all these laboratory studies and yeah they might observe a marker that we associate with damage or increased permeability of the gut but yet that person had no symptoms and so we try we're trying to link these things as the causes but it doesn't always equal one-to-one and that's that's a really hard part of kind of interpreting the research okay so this is this kind of brings me to what i really wanted to talk to you about the most is like how does it happen right how does it how does an athlete go from standing on the start line i've got my nutrition plan dialed i've done it in training i know what the heck's going on to some handful of hours later everything starts to unravel and they can't take in food and they're you know kind of a mess on they're a mess on the side of the trail what things are potentially happening between that start line and that point from a physiological perspective that is that has that has caused this state that we're trying to avoid right yeah so totally linked but yeah if we just consider the physiology and then then the nutrition has a separate influence um you'll notice in a lot of these gut reviews we all tend to say the same thing over and over again when it comes to the cause because we really can't go past that yet uh but there's there's a few main causes that most people agree on right and so one of which is the simplest which i'll just uh put in here at the beginning because we can't talk about it that much is the mechanical damage to the lining of of the gut so uh most symptoms are observed in runners and so the thought is that

you know that repetitive foot strike is causing impact and and this jostling of the gut over time especially over hours and hours uh causes damage to the gut which is going to lead to you know you name it down the line that's obviously not a good thing that we don't we can't really observe that very well but that's thought to occur because running being the the prominent sport that produces gi symptoms and can we pause on that really quick like another one of the thought another one of the reasons that that is a thought is what we see when we do gut testing in like a cycling modality versus a running modality when the when the caloric intake is roughly equal right the cyclists can tolerate they have fewer you know they're they're lower on the incident scale they're lower on the severity scale kind of however you want to slice and dice it and they're also lower on the biochemical markers that you're that you're referring to as compared to the runners when you kind of look at an equivalent an equivalent trial so it's thought to be it's not necessary or in the intensity is a smaller component than the jostling from that perspective right yeah and again it's a very that's a very hard thing to quantify right it's it's a we observe these effects and say oh that's probably playing a role but there's not a really good lab way to test like you just completely jostle the gut does that cause a lot of damage right that's not an easy thing to test so that's why we can't talk about it that much but that that's a good point in cycling running which is a good segue to like the next major cause um that we observe regardless of cycling or running which is blood flow restriction so as soon as you start exercising um the gut is going to lose a portion of blood flow so at rest um the gut may receive around 30 percent

of your cardiac output i mean it's a substantial amount that's a lot yeah it's going to the gut yeah it's a lot uh and as soon as we start exercising that blood is needed elsewhere right so the working muscle the lungs the heart and then especially if it's in the heat uh the skin to cool us off so uh the gut serves as the major reservoir of blood uh in the body so that's where we pull from you get constriction of vessels in the gut it's going to reduce that blood flow part of the uh cause of that is going to be uh catecholamines so exercise essentially is a stressor it almost it's almost analogous to a fight-or-flight response so you're going to get a huge increase in epinephrine norepinephrine um both systemically and then locally within the gut to constrict blood flow which is not a good thing in the gut because just the way that parts of the gut operate um kind of the the way the enterocytes uh are designed blood kind of comes up from the bottom of them and then circulates back down and so that the tip of many of the cells in the gut are already low oxygen environment so if you further reduce blood flow you're causing kind of a local hypoxic response which is not good for cells uh and theorize that that causes a lot of damage that's not only going to cause inflammation it may cause kind of phosphorylation of these tight junctions that keep ourselves together and maintain that gut lining and that's going to lead to a whole host of other problems so that's i'd say that's the more universal thing is for sure there's restriction of blood flow and does this kind of like lead like circle us back to one of the ways to alleviate nausea and other types of gi distress you can see how i'm pausing there i'm trying to add some level

of detail to the to the gi distress umbrella um is to just slow down and cool off i mean that's what we've been saying to athletes for you know well over a decade right now this is my third decade coaching and i can remember saying this just add nauseam just slow down and cool off and we really didn't know that that was you know an efficacious intervention that we could that we could use as simplistic as it is but based on that based on the mechanistic happenings that you just described that tried and true saying slow down and cool off is kind of one of the big things right cool off you're you're redistributing the the blood flow that's gone to the skin hopefully back to the stomach and slow down you're redistributing the blood flow that's to the muscles back to the stomach as well right exactly and so it's funny that many of the recommendations specific recommendations we can make to avoid these issues are incredibly practical like that just you need to cool down slow down you know any way you can so unfortunately we can't get too specific with the recommendations that's that's one big one because by and large if you look at the research if you add heat as another component of what you're testing and looking at anything in the gut it almost always exacerbates symptoms so it's thought because of that blood flow uh issue not necessarily not necessarily the temperature inside the stomach but the blood flow redistribution that's caused from the heat or is it both it's both it's both yeah uh so just leaking it back to the whole universal blood flow restriction that definitely gonna exacerbate that because we've got to move more blood to the skin to cool um but as core temperature rises too it's correlated with many of these uh not only damage but side

effects as well okay so we've got jostling right which we can we can we can realist i mean i don't know this is one of those things where i think it's a logical a logical guess that the jostling is part of it blood flow restriction this low oxygen environment what what else can potentially cause or i'll also say exacerbate any of these types of issues either during the event itself or going into an event with you know we talk about going into an event under train and things like that going into it going into an event where we know we're going to stress this whole gastrointestinal system to a certain extent yeah so the the two ones that come to mind immediately are one that's completely under researched which is the psychological component um you know i think there's been a correlation at this point that those that increase more uh experience more anxiety or stress and have more gi issues during the race and those would probably pre-race anxiety as well so that's one thing leading up to the race and the other huge one in this whole component is nutrition so uh in the days leading up to the event there's a number of things that you could be ingesting ingesting that you know may already put you in a situation that's going to make it rough during the event and that that requires a lot more detail we can get into that but uh but i'd say those are those are two of the big ones um the other the other thing is just on the practical side again like the the saying you know don't try anything new on race day right like that that's that's a good good advice because if if all of a sudden you're trying something new that may affect either blood flow or or nutrition uh it may lead to gi issues so those are those are kind of the big three things leading up to the event you know

what i also extend that don't try anything new on race day too because most people think about it as like a type of food right i'm right i'm eating gels and i'm going to try a pretzel or something like that which is probably a pretty benign you know change at the end of the day but i also extended to rate right because there's a lot of athletes that'll train at let's just say 200 calories an hour and then they try to race at 300 calories an hour i view that extra 100 calories an hour as as quote-unquote new they're trying that new on race day that rate component and and you know race day is not like a training day like you're going to be a little more amped up you're going to have a little more anxiety too so it's already you're throwing that into the mix and then if you're adding extra calories uh it's just uh all these things have to be practiced i'm sure we'll get into like the practical recommendations towards the end here but uh all these things have to be practiced before you you know actually take it to the course well if anything it should be less than right because if everything else is amped up all that blood you're going harder during the race than you are during training yeah you from your body's systems capabilities or from your gi systems capabilities in theory it actually should be less than what you're actually experiencing on training which is an interesting component because nobody does it that way right everybody wants to supersede what they've done in training and racing well yeah and it's it's hard you know to you know actually just take a step back and you know maintain your pace you're going to be excited i mean an ultra eventually you're going to have to settle into a pace right but especially for shorter events maybe marathon you can imagine you know like i'm just going to push a little bit harder um push my pace a

little bit harder and that's uh fun but you know when it comes to gi issues it's it's really like what are what are you used to what is the gut used to uh and that's one of the best ways to avoid symptoms i think one i think an interesting way to look at this kind of circling back to the complaints component is where those complaints occur and you looked at a lot of research from let's just say like the 10k and running and 40k and cycling duration all the way up to ultra distance and that's a big huge range there seems to be almost kind of like a bell curve that exists in terms of what athletes are having the the kind of the the most problems and it's not at either ends of the spectrum i mean it's kind of like in in the middle of it can you go through that and theorize to a certain extent why you think that is yeah so uh you know i'd say the general rule of thumb with any gi symptoms so regardless if it's upper or lower seems that as duration or workload increases the likelihood increases um and that's why we you know assume basically all ultra athletes are going to experience something just duration is that the maximum yeah it's just through the roof yeah exactly but in the shorter races um again depending on intensity but it doesn't really based on our understanding of what we think the mechanism physiological mechanism is uh it doesn't really seem like they provide enough time for some of those symptoms to occur um and a lot of this can be on nutrition so if you're doing a 10k you really need to be you know really focusing on nutrition

and adjusting something during the race you don't so you kind of eliminate that aspect and that's probably upper gi because it's just a short duration uh you probably don't need to be taking in carbohydrate during the 10k um but as you increase the duration maybe get up to marathon then it becomes you know more of an issue especially for people who aren't running it super fast there you know it goes on to four or five hours you know you're going to have some most likely uh during the race nutrition that's going to increase the severity of upper gi issues but then the duration is sufficient at that point that we may start to see more lower gi issues and it's hard to really be specific about that because some people will experience lower gi issues just from anxiety so uh you know that could happen anyway but in terms of the mechanism of what we're thinking about blood flow restriction uh and then you know sufficient time maybe with that jostling effect like as you go on and distance the more symptoms you're going to experience so i have this experience out in the ultramarathon world where i go and i attend a lot of events and i see by far the most gi issues at the 100k and 100 mile distance i see far fewer at 50k almost none at the marathon not that they don't exist but almost none at the marathon and just this past weekend i was at a 200 mile race and i heard i hardly saw any of it you see little but not a whole lot of it it's 200 mile yeah 200 mile race um it but the but i kind of i kind of it kind of speaks to this duality of duration and intensity i guess it could be and and or intensity because of the 200

mile distance the intensity is just so low right that you have the opportunity to eat a whole bunch of stuff and your blood flow isn't redistributed so much due to the exactly output exactly exactly so yeah if it's a super long duration and it's just the requirement is your pace has to be very slow you know are you pushing the physiological threshold for causing you know severe reductions in blood flow that would lead to symptoms maybe not and maybe that's why you're not seeing symptoms of course we haven't done that research it's it's incredibly hard to do but that that would be the logical conclusion there whereas you know if you go half that distance it's still an extremely long race right but people can push a little harder and then perhaps we're crossing that threshold into reduction in blood flow uh enough to cause symptoms and the blood flow reduction really could cause symptoms across the whole the whole length of the gi track so again that's very individual based person to person if you want uh subjects for studying 200 milers and gi distress i can i can hook you up with some we'll we can arrange that we can arrange that okay so let's drill down to the really nitty-gritty practical stuff right we're going to take the simple scenario of a runner and i'll pick the 100 mile distance because that's the one that we see the most of they get through 50 or 60 miles and they start getting nauseous right they might throw up they might just not be able to take in calories let's take a before and then during approach of what they could have done in advance to potentially alleviate that and then if they just you know didn't do any of that stuff beforehand which

most people don't what what potential things could they do in the race let's start with the before though like before the race actually unfolds what does the research say about the things that could that could be preventative against having a lot of these issues okay yeah let's roll with the assumption that they're not doing any of these interventions right they just go out and run and that's what they do that's how they train exactly uh so the simplest and i think actually the most promising is gut training right so both fluid and carbohydrate really just nutrients in general but fluid and carbohydrates especially you need to practice ingesting those during your training much like you would during the event so practice how you're going to race so and this isn't like uh you know you go out for your hour two hour run and you know you can take in 30 grams of carbs so you assume you'll be fine for the entire ultra marathon you know 30 grams carbs per hour uh this is like you know on your longer runs go ahead and try and take that fluid in while you're running uh what you think you'd need for your event so that your gut gets used to it and the same with the carbohydrate find out where your limit is because uh one of the disconnects between the research and the practical side and i hear it all the time like everyone knows what the carbohydrate recommendations per hour are right like oh yeah you need 90 grams per hour and that'll improve your performance but it's just completely impractical especially for someone who does not practice that if you take like that's nothing new on race day right if you took someone who not used to taking carb at all and they tried 90 an hour uh during the ultra marathon i don't think they're finishing the race to be honest with you so that 90 grams per hour recommendation

all pun intended it drives me bananas because people take it as such a dogmatic number and i appreciate all of asker juke and jube's research that has gone into that and it's absolutely efficacious in a lot of practical situations but a if you don't practice it be in an ultra marathon setting it's not even necessary because your output for almost everybody except for the elite athletes is not high enough to really require that much that's that's another that's another thing so let's stay on gut training for a little bit because you know i'm a coach and i wouldn't let somebody say oh well you just have to train for an ultra marathon right because it's not specific enough right you just have to go run like you said go through your race day pro your race day routine does it need to be more than that and how frequently and for how long do you think that that and i'm saying think intentionally because it's not something that we've kind of quite pinned down how for how long in advance does that training need to occur so for example somebody i get this question all the time on instagram how long do i need to train for an ultra marathon right in general like all training oh trust me it's yeah and i can't even answer that right so i'm gonna ask you the impossible question as well but let's try to get a little bit of a fix on it like realistically how like what what's the dose response in order to create something adaptive to actually happen and for that to have an impact on race day yeah so we don't we don't

have a ton of research on this but we do have some really solid studies uh both asker you've been groups and ricardo costa's groups have done some really good work in this area and so i'd say in terms of how long is it going to take to cause some adaptations in your gut if you're doing the right thing in terms of gut training uh weeks okay i think i think weeks yeah i mean you might some of the research is like one to two weeks and that works um but then you run the risk of you know if you're doing everything perfect and maybe you have some issues during your training uh you don't want to do that just just start that one to two weeks before your event right so i would say weeks you know start thinking about this weeks out and then the recommendations are you know practice what you're going to need but like you said more might actually be better so part of it is determining what you can tolerate to begin with because um if you're doing more than you can tolerate you're not even going to complete your training sessions so um you know you kind of do that threshold so like we're saying with the 90 grams per hour don't jump to that start with one gel an hour you know or one gatorade or something um and see if you can tolerate that and then work your way up uh that's one really practical thing is that you don't take like the max you know to the max uh estimate of carbohydrate needs or fluid needs and then just start with that start small make sure you can tolerate stuff and work your way up and that takes time that's why i'm saying weeks rather than just one to two weeks um because these adaptations can occur rather rapidly if you're if you're doing it frequently and much of this research is doing like five days a week so that it is pretty frequent um but i would say weeks out start um decide how much fluid based on the temperature of your race also but how much fluid you think you'll need and try to take that and at least that much

during you know maybe spread it out over an hour decide how much you're going to drink uh and then you can add the carbohydrate in as well and i would start with i think it's simplest just to do a gel right like just one gel an hour see if you can tolerate it um and another practical recommendation there is not to just like okay this is hour one i'm gonna chug all the water and take all gel all at once like it's it's probably better to spread it out over that that amount of time um so i think that's how people could start this process and then you start to tailor it so i know i can tolerate this uh for three hours let me try a little bit more fluid a little bit more carbohydrate because if you if you do practice more i would say and again there's a little research here but i would say that it's less likely that you're going to have issues on race day if you're doing a little bit less than what you're used to so it's almost like endurance training right it takes weeks yeah endurance training is probably a little bit longer but it takes it takes weeks not days and you want to use some type of progressive overload structure yeah it almost has to be periodized which is strange but yeah no i mean i i think that that's really salient that the fact that you don't want to start out at okay i just i guess my maximum is going to be 400 calories an hour or however you want to slice and dice it i'm going to start low and then kind of titrate up from there and let the adaptive process kind of coincide with the training process that's actually that's actually going on right yeah so it's it's going to take time and that's why it's not easy to do these things but from from the before the race perspective in the training training days i'd say those are two of

the biggest version it becomes an absolute must in ultra right so you can probably get away with short you know half marathon or something you're not doing anything but as the distance increases nutrition is a given so you need to practice that and and you want to take in as much as you can to increase performance so okay so all the experts have kind of like come down to the same thing gut training is first before all before all of the other interventions that can kind of happen not that they're not mutually exclusive because they can definitely benefit from each other but before you start down the path of any of these other interventions that we're going to talk about gut training kind of has to happen first that's like the almost like the foundation of of what you're trying to figure out fortunately it helps training as well right i mean you take in some calories during training your training is better your training is better your fitness is better and things like that but right making it a deliberate part of training i think is a different context okay so we're still in the before gut trainings your heavy hitter what else before the event can the athletes do to help mitigate some of this gi distress uh two things come to mind so one is more on the nutrition side as well so you know everybody practices different diets um so it gets really individualized here but one of the aspects that's receiving a lot of attention right now is low fodmap diets right so uh these are diets that kind of exclude the uh short carbohydrates that may cause gut issues so a bunch of different types foods that if you ingest um not only draw fluid into your gut which you probably don't want during

this time but also um are fermented by bacteria in the gut produce a bunch of gas and therefore potentially symptoms uh so without getting into the nitty-gritty on that uh not that people are advocating for low fodmap all the time but just that maybe in the day before the event you're not taking in a ton of fiber uh or anything like that that that could still be around during your event that could be fermented and cause some issues so i'd say that's probably one of the last very practical nutrition recommendations um it's a little harder to do i'd say the gut training is uh definitely prioritized there and then the last last practical thing is just plan right um um these things you know know what you're going to do at each aid station or this mile marker i'll have this ready so you can kind of actually plan out how you're going to do your fluid nutrition cooling even um throughout the race i think that's that's huge because if you just go in head first i think it's more likely that you'll experience it so you're you're going to have to get into a little bit more detail about what a low fodmap diet is because i got some comments on based on the last podcast that i did with jamie it was like what is this so okay when we're talking you kind of you kind of described it very very briefly as a diet that avoids some of these short chain carbohydrates practically what does that mean like what are the foodstuffs that could be potential that that people that people can try to avoid in order to potentially these are all the caveats can try to avoid to potentially reduce some gi uh issues yeah it gets really tricky i'd say i'll

dive into that but i would say just the very practical take-home for athletes is like don't max out on fiber in the 24 hours before so that that's a very like one-liner practical so fodmaps are fermentable oligo uh dye monosaccharide and polyols so these are just different names for carbohydrates some of the examples of different things that fit in that category are like wheat rye barley beans um lactose or dairy especially for someone who's sensitive to dairy maybe in the 24 hours before uh avoid some of that and then the polyol side of things is artificial sweeteners which i feel like actually people don't really talk about that often um but maybe good to avoid those in the 24 hours before and this applies during the race as well so 24 hours before and into the race don't don't be loading up uh and actually this is an important topic because um although i i guess i would have expected there was a recent review out of um university illinois i think that that found that they surveyed like a bunch of endurance athletes in the hundreds uh and found that not only were endurance athletes eating what they would consider a high fodmap diet because athletes tend to eat healthy anyway i think a lot of fibers through vegetables um but they were also doing so habitually around and during exercise without without knowing so uh that you know it's some evidence that maybe that's a very practical approach so again this is a harder one to tailor than than the other things and that's why i said maybe the one-liner is you know what if you just reduce your fiber intake in the 24 hours before but it's so interesting because we talked about this with jamie right and i've had athletes on both sides of the

fence with this is they've i've had athletes that have perpetual gi issues no matter how much gut training we do no matter what we do in training and things like that it's just always an issue and one of the kind of advanced interventions that i've put into place with those athletes is is going on a low fodmap diet and with some of those athletes it's almost miraculous like to be honest with you like it's such a night and day difference that i just kind of shrug my shoulders and go okay like let's just keep doing this but other but with other athletes it's kind of a big nothing burger you know like nothing yeah like really nothing's different and so i don't know quite how to put a pin on it other than to say that if you do it if you're taking the approach that you want to do it um as a as more of a lifestyle intervention versus the last few weeks of training intervention you really have to make sure that you're getting with a registered diet registered dietitian or nutritionist because it's so it it's so disruptive in your normal dietary pattern to the to this to this recent uh study that came out of the university of illinois kind of pointed out that you might be at risk of not having enough energy availability because you're switching around all these foodstuffs and trying to train at the same time yeah exactly it it gets really tough and that's why i we actually put i think a line in the in our most recent review um that you know this is receiving a lot of attention for some athletes it definitely seems to work although we you know from the nutrition side of thing and i'm a dietitian

as well you know i wouldn't necessarily recommend low fodmap all the time um because saying that is really this gets in the microbiome stuff i'm sure you and jamie covered a lot of the microbiome stuff but um these are the kind of the things that promote diversity and health of the microbiome and unfortunately a side effect of that could be gas production and drawing water into the gut so um i'm more of a fan of you know try the gut training first the fluid training and carbohydrate make sure you're you're running training after all is adequate as well and if that doesn't work for you like you said you have some athletes that doesn't matter like they just still get the issue that they got trained then move on to trying maybe low fodmap in the in the days before the event and during the event see if that helps and so i think that's that's the bulk of the pre uh before the race kind of thing that we can do practically uh at this point i mean we're constantly you know expanding the research and hopefully we'll find more and more interventions but those are the big ones okay so we've got these two big ones training the guts definitely the heavier hitter there so let's assume we have a prototypical athlete that says i'm not going to train my gut beforehand i'm just gonna deal with it during race day which is what a lot of people do and they're listening to this podcast now i'm going that is me that is me i did that i neglected to do this during training and i tried everything new on race day they get themselves into a pinch and there's a significant amount of time left in the race they still need to take down calories but they just feel their stomach is in knots or whatever you know whatever term we want to use for having uh having all these myriad of gi distress

what do they do when they're in the moment what can't what can they do we already went over slow down and cool off and you can back and stack that based on what you see in the research but what can those athletes do yeah that's that's the most practical stuff is just slow down cool off this is a really hard one because once it starts and it gets severe uh it's almost like a weighted out sort of thing that's really going to drain you so i guess one would be reduce your pace um if it is occurring you know it could be just due to the nutrition but these things all play in so if it's a blood flow related issue you're going to have to reduce your pace because the the greater the drive the more constriction to blood flow in that gut um and you know another hard thing about this is if you start to experience this and you're only halfway through the race you might get stressed out over that which is only going to exacerbate things so that's hard too um in terms of what can you do other than slow down um is if you were maintaining a nutrition intra-race and nutrition regimen you know you had a goal of having two gels an hour and it's much fluid uh maybe it's time to just you know step back on that a little bit um it's kind of paradoxical because if you feed the gut it should increase motility but um if you're having severe symptoms and i'm thinking particularly of nausea um and and bloating uh you may have to just basically it's take a step back on everything keep going right but uh slow the pace slow the pace of ingestion as well um at least to a safe extent like don't halt fluid intake especially if you're in the heat or something but um beyond that it's i wish we had more research on the intra race stuff because it everyone's so different and the

recommendations are gonna have to be extremely individualized beyond just the practical you know slow the pace try to cool off uh you know calm yourself down uh sort of thing do any of the old wives tales actually work because you see them all ginger i'm gonna suck on a butterscotch candy i mean even even taking an antacid that's probably not an old wives tale but those first two definitely are like any of those other things i mean in all these things i kind of view is just throwing shit against the wall and seeing what sticks yeah whether or not they stick or not i i think is the big question mark but i mean based on on your review do any of those have any promise of actually working from a physiological perspective and certainly they can from a psychological perspective if they heard oh this worked for so and so so it might work for me but from a physiological perspective do any of those things actually have any merit yeah so i think you kind of hit the nail on the head there it's the research is few and far between and usually if we do see an effect it's quite small um so then how do you determine if that's not just psychological like you know if some if someone tells you that i mean ginger actually does seem to work for some athletes some people swear by it right so um this is the thing if you think it works it might actually work yeah so um i i don't know it's hard there's no really concrete research at least not a substantial message from the studies to say like ginger butter scotch some of these other small things that people swear by uh will work um

what's the what's the bio plausible mechanism that's what i always kind of come back to like if it's going to work tell me the bio plausible mechanism so i can believe right not just this is me like with my physiology brain on and not my belief brain like tell me the biological the bio plausible mechanism for any of those actions or for any of those interventions and then i might believe it yeah so to be honest with you i cannot provide one at least at least not for especially not for butterscotch i have no idea um but i tend to focus on the big things because you know people find those little things that they swear by and if it helps them it helps them keep doing it but uh in my eyes you gotta you gotta do the big things like we were just talking about first it doesn't have the largest impact and then try these little so-called live tails um but no yeah it's much harder to provide like a physiological mechanism for those those little small sorts of things maybe on the antacid side and a medication side that there's a much more concrete mechanistic pathway that could contribute you know i probably wouldn't recommend um if it really helps someone then absolutely but medication is is last resort i think especially uh and and i haven't mentioned it yet but nsets are almost a complete avoid in this uh situational you want to avoid nsets usage especially during the just another reason to avoid nsets the long-term listeners podcast will long long list oh gosh well yeah they'll they'll remember my many rants on on nsets and in my my issues with those but that's a

that's a another story for another day so i think the learning lesson with the gingers and the candies that you can suck on and any of the other kind of things is don't look for the bio plausible mechanism just believe whoever's giving it to you yeah believe no seriously i mean i think that that like just believe it works just trust and believe it works and then maybe maybe maybe maybe it actually will you brought you just brought something up that i think we might have neglected in the before and this has popped up in a couple of research papers which is using a course of proton pump inhibitors in the days leading up to a race to potentially uh reduce specifically the damage that is occurring in the gut what what does the what does the research say about that because i i've actually used this intervention myself personally and so we'll have to describe it a little bit for the listeners that aren't that aren't uh familiar with the protocol but and i've also used it with athletes with kind of mixed you know it's n of five or whatever mixed kind of kind of mixed success there so what does the research say say about uh that type of intervention and first off what is it what is the intervention specifically so that we so that everybody's on the same page gotcha yeah so using proton pump inhibitors are just a method of reducing acid secretion in the stomach and one of the symptoms that we really haven't touched on um but classified in the upper gi symptom list is reflux right so uh that is something that some people experience of course even outside of exercise the common treatment for that is an acid or yeah proton pump there's many but proton pump uh inhibitors

specifically so again i i think you kind of hit it there mixed results it's kind of very person to person there's probably you know a place for them uh in some athletes especially that already have underlying issues but i think you run the risk of again let's go back to the planning but you run the risk of what if you're used to taking antacids uh specifically i'm thinking of proton pump inhibitors um up into the week for the race and then for whatever reason you forgot and it's not your bag on race day like again it takes it in planning but because chronic use of proton pump inhibitors once you come off them actually will jump start acid secretion until the body kind of finds its homeostasis again there's a fine line that you're kind of walking there with the removal of the intervention right so i imagine that you you know on race day all of a sudden you're doing this intervention to try to reduce acid secretion which might help with some of your symptoms um and then all of a sudden uh you don't have that intervention and you have even more symptoms uh so again it's just a planning thing there but again this is one of those things that comes far down the line for me in terms of interventions you might try like i think you've got to try the big things first before you get into medications and things like that and what we're talking about just to back this up for the listeners again is you take a course like a seven to ten day course of something like prilosec or nexium or what are some of the other brand names that people are going to recommend uh those are the two big ones but you're taking that in advance of the race and then probably up to race day in an effort to reduce the amount of acid that's you know fluxing up in the upper gi track essentially

yeah which i also i actually haven't really looked into this aspect of it but may may reduce the speed which you digest the nutrients you're taking in during race to fuel you um so again i'm not as familiar on that side of things and the antacids because i personally just ignore usually the very specific interventions like that because i want to focus on the big things but um but yeah they definitely work for some people so it's it's something that those you know at the end of the rope can can try so so is that's the end of the end of the rope that's after that's that's for me for you that's the end of the i mean if someone has a condition like gird or you know they have reflux all the time then absolutely you're already using it to manage those symptoms but if you're just an athlete wants to avoid gut issues i don't i don't think that's the first thing you turn towards why does it always come down to the simple stuff man yeah i don't know because the simple stuff sometimes it's hard to do that's true that's true okay so what's next i mean you mentioned a lot of research that you want to do what what if you and we can do the 200 mile research trust me i can find those people everybody people raise their ultra marathon athletes always raise their hand to be involved in research because there's a dearth of research in the ultra marathon world like specifically what would you like to get a better fix on or or or find out if you can wave a magic wand and say okay i want to do this and i want to find the answers to this next week what would those things what would those things be yeah so for me um i'm i'm biased towards a couple

things one is personally when i run i get lower jelly issues so i'm biased towards researching that a little bit more just personally um but also in line with that is i'm in exercise immunology lab that's my favorite topic uh and so the immune system seems to play a larger role on the lower gut side of things so i'm really interested in what is the gut immune interface because you know we we didn't really talk about it but a consequence of reduced blood flow for a long time is potentially the loss of integrity of the gut barrier which job is to keep bacteria out right and we can observe in some athletes that bacteria are actually getting in by you know certain markers in the blood uh that would suggest that the gut is now leaky um so i'm interested in you know what what is leading up to that we're still trying to figure out what is leading up to that but then at that that point when you start to get a large inflammatory response and you have bacterial components leaking into the blood because your gut's been damaged um what what can we do at that point to reduce kind of the overall inflammatory effect um that i think i'd say that's where i want to go and then if you remember from the review we had a whole section on like the endocrine side of things um which is kind of funny because we brought in um our expert on that side dr frank duca he's here at the university of arizona he's actually a microbiologist and kind of a nutrient sensing gut hormone expert um it happens to be an athlete himself but uh when we brought him in he brought these novel ideas in terms of all these hormones that no one has ever looked at and so we look at you know when we talk about hormones in this context you think about epinephrine norepinephrine cortisol maybe insulin glucagon things like that but no one ever looks at the the stuff that the gut secretes um so like these they're usually

involved in nutrient sensing that's i think that's why they've been ignored but there's a lot of evidence there that just linking little pieces together that maybe the hormones that the gut secretes could be playing a role uh in contributing to symptoms especially upper dysent so um those are the two aspects the immune side i want to see more of and then the uh hormonal side well you're gonna get you you you're just early in your academic and research career so i'm sure you'll get a chance to do a lot of that research if people want to find out more about you and about the research that you're doing where can they go uh so i don't have a whole lot on social media i think you've got a twitter i'm not gonna remember the handle off my head i'll link it in the show notes good for you i can send it to you but you know like you said i'm just i'm still the student so i don't really have anything going in terms of getting in touch but feel free to share my email or uh i'll give you my twitter handle as well all right we'll link it all up in the show notes as well as i'll link this i'll link the uh paper specifically to the show notes thank you for the work i think it was a really cool paper i got everybody thinking and if anything if we always come back to try the simple and effective solutions first before we go to the complicated and maybe less effective solutions with this stuff i think everybody's gonna if we're reminded of that consistently even through the academic research it's a good process yeah thanks for having me jason and yeah unfortunately we can only make very broad practical recommendations at this point but uh there's a lot of research to be done i don't think unfortunately you know if it works just gotta do it you just gotta do it right i mean when everybody wants the magic you know the magic button the magic pill but good old training gets you a long

get you a long long way i'm gonna run out of ideas for this podcast because that tends to be one of the recurring things no matter who i bring on that's the theme just train more yeah exactly train properly exactly exactly all right kyle thanks man i appreciate it thanks jason all right folks there you have it there you go much thanks to kyle for coming on the podcast today i cannot believe how early in his career kyle is and how what he's already brought to the table i expect great things out of you and wherever you go kyle no pressure there this is not the last time that kyle will be on the podcast i can guarantee you that because if he's starting out of the gate with stuff like this who who knows what's going to happen next so appreciate you coming on the podcast and sharing your wisdom appreciate the heck out of all the listeners out there i had this really neat experience out at bigfoot uh this weekend as i mentioned uh i was out there or as i mentioned during the intro i was out there pacing one of my athletes where i had a number of people just hear my voice and turn around and recognize me through this podcast before they even saw me and that means that the information contained within all these podcasts that i've been doing for the past year and a half is getting out there and getting in the community and that really warms my heart because that is the ultimate goal that i want to have happen from producing these is i want the information to get out there and i want ultra runners to be successful you can help that out by sharing this

content with your friends and with your training partners send them a note send them a text send something out on social media it means a lot to me when i when i see that and ultimately i'm doing this for you guys as always this podcast is not monetized i intentionally have not monetized it i never will monetize it i simply do it to get the information out there and to hopefully have an informative and entertaining product that finds your ears every single week i appreciate you guys for uh listening so that's it for today you guys and as always we will see you out on the trails you you