Run Well

by Juliet McGrattan

  Did you know?

  The urge to breathe is mainly driven by rising carbon dioxide levels in the blood rather than by low oxygen levels. Sensors in the brain, and in the aorta and carotid arteries (major blood vessels), monitor levels and adjust breathing rate accordingly.

  Top tips for healthy runner’s lungs

  • Don’t smoke and avoid passive smoking too.

  • Maintain a normal weight.

  • Exercise regularly at a variety of paces.

  • Eat a healthy, varied diet.

  • Practise diaphragmatic breathing (see here).

  • Avoid rush hour running to minimise exposure to air pollutants if you experience symptoms or have lung problems.

  • Maintain a good running posture (see here) to allow your lungs to expand freely.

  • Consider Pilates to help control breathing, strengthen muscles and improve posture.

  FURTHER HELP AND ADVICE

  Pollen counts and the Air Quality Index – Met Office: www.metoffice.gov.uk

  British Lung Foundation: www.blf.org.uk

  Asthma UK: www.asthma.org.uk

  Allergy UK: www.allergyuk.org

  British Thoracic Society guidelines: www.brit-thoracic.org.uk/quality-improvement/guidelines/

  NICE guidelines: www.nice.org.uk

  Chapter 4

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  The Gastrointestinal System

  Of all the body’s systems, it’s the gastrointestinal system that seems to cause the most frequent (and embarrassing) problems for runners. From vomiting to diarrhoea, stitches to piles, there are lots of issues that can crop up and stop you in your running tracks. But regular running has many important benefits for the gastrointestinal system, for example, helping prevent constipation and lowering your risk of bowel cancer by up to 50 per cent, so it’s important to know how to overcome problems and keep going. This chapter features lots of tips and advice to make sure you’re not always running towards the toilet!

  The gastrointestinal system allows us to extract energy from food and get rid of waste products through digestion and excretion. Digestion begins in the mouth where food is chewed, mashed up and mixed with digestive enzymes in saliva. It’s parcelled up into small packages called food boluses, which are propelled down the oesophagus (gullet) by a process called peristalsis, a series of involuntary muscular contractions. The sphincter (muscular ring) at the top of the stomach relaxes, allowing food into the stomach, where further enzymes continue to break it down and stomach acids destroy any harmful bacteria. There is a further sphincter at the bottom of the stomach which relaxes intermittently to allow small amounts of the stomach’s contents to pass into the small intestine (small bowel).

  Most of the digestion and absorption of nutrients occurs in the small intestine. Food meets enzymes from the pancreas and fats are digested by bile squirted in from the gall bladder. The lining of the small intestine is specially designed to absorb nutrients into the bloodstream. It is lined with small finger like projections called villi which each have microvilli covering them. This creates a huge surface area over which nutrients can be absorbed. What’s left of the food then travels on to the large intestine (large bowel), where our healthy gut bacteria break it down further and water is reabsorbed to make a formed stool. The stool is held in the rectum until the time is right for it to be expelled through the anus.

  Having knowledge of our basic gut anatomy and physiology helps us to understand why things can sometimes go wrong and what we can do about them. Let’s move on to answer the questions most frequently asked by runners. We’ll start at the top and work our way down from mouth to anus.

  Q Why do I always need to spit when I run?

  A Saliva is designed to lubricate our mouth and throat, and helps to keep germs out. The amount and consistency of our saliva, which is controlled by our nervous system, changes frequently. Exercise increases the flow of saliva, but also the thickness of it. Thick, sticky saliva is harder to swallow and many runners find they need to spit it out. The increase in thickness is thought to be due to a higher concentration of protein in the saliva, with moderate and vigorous exercise triggering protein production and release in the salivary glands. Cold air seems to stimulate mucous secretion too. It’s also likely that water evaporates from saliva when we mouth-breathe during running and that our body produces less watery saliva if we are a bit dehydrated. All of these factors mean that we can end up with a mouthful of sticky spit and a bit of a dry mouth. There’s no easy answer, but if you’re particularly troubled by it then sipping small amounts of water frequently can help. Whether you think spitting is socially acceptable or not is a personal preference and you’ll spark fierce debate amongst the running community if you ask that question!

  Did you know?

  Our intestines are approximately 8 metres long in total. The small intestine is about 6.5 metres and the large intestine about 1.5 metres.

  Q I often get heartburn and an acid taste in my mouth when I run. Why is this and what can I do about it?

  A If food and acid from your stomach travels back up your oesophagus they can give you an unpleasant tang or discomfort, usually a burning sensation, behind your breast bone. Getting a bit of acid reflux from time to time is normal, especially if you’ve eaten a large meal. The oesophageal sphincter sits between your oesophagus and your stomach. Its role is to prevent stomach contents from travelling back upwards, but occasionally they leak through and the acid irritates the delicate lining of the oesophagus. It’s easy to see why the repetitive jiggling up and down of running might cause reflux. Eating too much, eating too close to running and not leaving enough time for digestion are obvious causes of reflux, but it’s also worth seeing if there are any specific triggering foods – caffeine, fruit juices, tomatoes and spicy foods are common causes. If you’re still struggling, then speak to your pharmacist about trying an antacid medication. This will neutralise the acid in your stomach and relieve the symptoms, but won’t stop you getting heartburn again.

  When heartburn and acid reflux are severe, happening frequently and at times when you aren’t running, then you may have GORD (Gastro Oesophageal Reflux Disease). We know that being overweight, smoking and drinking alcohol can trigger GORD, so lifestyle changes to address these can help reduce symptoms, as can lowering stress levels. It’s worth knowing that anti-inflammatories like ibuprofen or aspirin, commonly used by runners, can cause GORD, so you should stop these and speak to your GP. If lifestyle changes aren’t controlling your symptoms, then your doctor might suggest trying medications to give you relief. These can be short or long term and are usually very effective. They might also arrange some investigations to check for underlying causes of GORD, such as a hiatus hernia, which is when part of your stomach moves up into your chest. Long term, untreated GORD can cause problems such as ulcers and in rare cases, over many years, cancer, so take action.

  Q Why do I vomit when I run? It’s usually after I’ve really pushed myself in a 10km race or during the second half of a marathon.

  A ‘Training till you puke’ is often seen as a badge of honour, a celebration that you’ve pushed yourself to your limits. In all honesty, it isn’t to be recommended. In short, high intensity workouts, vomiting is usually due to blood being diverted away from your gastrointestinal system and towards your skeletal muscles. Reduced blood flow to the gut slows digestion and your stomach contents then seek an alternative route out during strenuous exercise. What you’ve eaten and drunk before running can determine whether you vomit. Allow a couple of hours for digestion and avoid trigger foods such as citrus fruits and juices, spicy or fatty foods. If you suffer from heartburn or acid reflux, then you may be more likely to vomit during running.

  Over longer distances there are more possible causes of vomiting that need to be considered. Eating on the run can make you sick, especially if you haven’t practised it in training. High sugar loads from sports supplements can upset some runner’s stomachs, especially if t
he supplements are concentrated and taken with insufficient water. Dehydration is a common cause of vomiting, but it’s important to know that over-hydration can cause it too. There’s a condition called hyponatraemia when the body’s salt levels become dangerously low (see here). Don’t forget that heat stroke can cause vomiting too. The dangers of heat exhaustion and heat stroke not only come from dehydration as a result of the sweat lost while running, but also from a rising core temperature (see here). Warming up and cooling down to avoid abrupt changes in exertion can help to prevent vomiting during and after running, so don’t skimp on these if you’re someone who tends to get sick!

  Q After my long run I completely lose my appetite. I know I should eat, but I really don’t feel like it.

  A Many runners feel like this. It’s thought that exercise influences the release of appetite hormones such as ghrelin, which increases appetite, and leptin, which suppresses it. This effect may vary between individuals, between men and women, and possibly between people with differing amounts of body fat. For some, a long run can reduce ghrelin and increase leptin, so you don’t feel hungry at all. The ‘runger’ (running hunger) may not strike for several hours or even days later.

  It’s a good idea to ingest something after a long or hard run, but there is some doubt as to whether that magic 30-minute window to replace your glycogen stores that people talk about really exists. The ideal timing of post-exercise nutrition is debatable. Try liquids rather than solid foods if you have no appetite or feel slightly nauseated – for example, fruit smoothies, ice cold chocolate milk or a sports drink. A couple of hours later you should be ready for a more substantial feed and if you’re still struggling at that point then soup is a good option. If you are listening to your body and getting the general balance between your fuelling and your running right, then you don’t need to worry (see here).

  Q What is a stitch and how can I stop it happening?

  A There’s a simple answer to this – we don’t know! A stitch can be a dull ache, but more often it’s a stabbing pain, usually in the side. It’s hard to advise how to prevent it, but there are theories about what triggers it and things you can try to stop one spoiling your run. Stitches are more common in runners than they are in cyclists, which adds weight to the theory that they could be caused by the internal organs tugging on ligaments and tissues as they get jolted up and down, or by friction irritating the lining of the abdominal cavity. They’re more common in beginners, runners training harder than usual and those who have eaten prior to running, so these situations suggest that a lack of blood supply to the gut or to the diaphragm muscle, resulting in cramping, may be the answer. There’s also a theory that the pain isn’t from the abdomen itself and originates from the spine and radiates around to the side and front. It may well be a combination of things and different for each individual. What is certain, however, is that stitches hurt and make you want to stop running!

  You can try to prevent a stitch by allowing enough time for your food to be digested before you run. You’ll probably need at least two hours after a meal. Don’t drink excessively just before you run either. Small sips over a longer period are preferable and it might help to avoid high sugar drinks too. Warming up gradually and easing yourself into your run could avoid triggering stitches, as could keeping your breathing relaxed and comfortable. If posture plays a role, then ensuring you have a strong core to maintain a good posture over a long distance might be the key for you. If you’ve recently started running and are plagued by stitches, then do persevere because they tend to become less frequent as you get fitter and your body adjusts to running.

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  Getting rid of a stitch

  Although side stitches can be incredibly painful, they aren’t harmful and it’s fine to keep running. There’s little evidence to base a recommendation on, but here are some anecdotal things you can try to ease stitches while you’re on the move:

  • Slow down Taking your foot off the gas for a short time can be enough to help a stitch settle.

  • Deep breathing Focus on filling your lungs properly (see here). Try counting and finding a regular breathing pattern.

  • Apply pressure Pushing on the area where the stitch is can minimise movement and ease pain.

  • Stretch Try stretching the affected side, so if your pain is under your ribs on the right-hand side, put your right hand on your head and bend to the left.

  • Touch your toes Obviously you’ll have to stop briefly to do this, but bending over forwards for a few breaths is a trick that works for many.

  • Time your foot strike Some runners say that they can get rid of a stitch by exhaling as the foot on the opposite side to the stitch hits the ground. So for a right-sided stitch you need to breathe out as your left foot strikes the pavement.

  Q I’m really windy when I run, burping and farting all over the place. Why is this?

  A How much gas we each produce varies greatly and, whether it goes up or down, excess air needs to be expelled from the body somehow. It’s normal to swallow some air when you run, especially if you’re pushing yourself and gasping for breath, but particularly if you’re trying to combine running and drinking. It’s worth practising your ‘on the move’ fuelling and finding the bottle, cup or hydration pack mouthpiece that allows you to drink without gulping large quantities of air at the same time. Running itself may cause gas due to the jarring of the stomach and the faster transit of food through the gut. What you eat makes a difference too – some foods are more gaseous than others. Beans, lentils and cabbage are well known for making you trump, but so are other high-fibre foods such as fruit, bran and peas, as well as starchy foods and wholegrains. If windy runs are causing you problems, then it might be worth keeping a food diary to identify the culprits. Allow enough time for your food to digest before you run and eat slowly too, chewing food well to aid digestion and avoid swallowing air. Generally, there’s no better time to let one loose than out in the fresh air, but spare a thought for those running close to you and, as a running friend of mine (with tricky bowels) says, ‘Never trust a fart after 20 miles.’

  Did you know?

  The average person produces between 0.5 and 1.5 litres of flatus (gas) every 24 hours, and breaks wind between 10 and 20 times a day.

  Q Running makes me need to poo. I have to plan my route around the local toilets.

  A The dreaded runner’s trots! You can be assured you are most definitely not alone. There are a few theories as to why vigorous exercise makes you need to poo, but there’s no clear answer and it may be a combination of factors. It could be that jiggling your bowels around when you run irritates them or that, when you exercise, blood is diverted away from the bowel to the running muscles and the bowel doesn’t appreciate this. We know that running helps ease constipation and the adrenalin released during exercise speeds up the time it takes for food to travel through the gut. If you have pre-race nerves, then there’s even more adrenalin circulating and this effect can be heightened. It certainly explains why the motions are often loose and explosive, because a rapid transit time means there’s less time for water reabsorption in the large intestine. There are numerous things you can try to prevent diarrhoea. It’s usually a case of trial and error and being prepared. If you’re new to running then don’t be disheartened. Many runners find that as they get more experienced this issue bothers them less.

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  Resolving the runner’s trots

  If urgent trips to the toilet while you’re running are ruining your fun, then try these tips to reduce the likelihood of you needing to divert to the nearest bush:

  • Help your digestion Take your time when you eat. Sit down and chew your food properly. Smaller chunks will allow it to digest more easily. Allow enough time between eating and running. Everyone is different and digestion time also varies with what you eat, but an hour after a snack and two hours after a meal is a rough guide.

  • C
hoose your foods If you struggle with the trots then keep a note of what you’ve eaten prior to running and the day before too. Food diaries can be really helpful to work out whether there’s one food in particular which is causing problems. Spicy, rich or very fibrous foods are potential triggers.

  • Watch your drinks Drinks can trigger the urgent need to do a poo too. Alcohol the night before running won’t help your bowel, fruit juices can upset it and we know that caffeine is a stimulant, so while a quick pre-race espresso might help your performance, it might also speed up your guts.

  • Train your gut You might notice that if you suddenly increase the frequency, intensity or distance of your running that your bowels object. This is often why those new to running have more problems than experienced runners. Making changes gradually allows your gut to adjust to the new levels of exertion.

  • Warm up Wake your bowel up slowly with a good warm-up rather than suddenly diving straight into vigorous exercise. A slow walk speeding up to a brisk walk and then a jog might be sufficient to prevent suddenly needing the loo.