• Fuel carefully Over longer distances when you need race fuel you might find that highly concentrated or caffeine-containing sports supplements upset your gut. Experiment with normal food such as home-made energy balls, fruit loaf and bagels.
• Calm down If pre-race nerves are high, then your adrenalin levels will be surging and this might affect your bowel. Try to relax with deep breathing, distraction by friends or listening to music.
• Be prepared Arrive in plenty of time for races so you have time to queue for the loo at least once! Sometimes, however, it just happens out of the blue and despite all your tricks and practice the sudden urge is overwhelming. A tissue in your race belt weighs little and helps a lot if you have an unexpected bush stop or there’s none left in the portaloo.
Q Is it OK to take an anti-diarrhoea tablet before a race?
A You’ll frequently see runners on online forums saying they take a medication to stop them having diarrhoea during a race. The most commonly used is loperamide, which slows down the movement of food though the bowel, allowing more time for water to be reabsorbed back into the bloodstream and thereby drying out the faeces. It also increases the tone of the anal sphincter (muscular ring keeping the anus closed) so it can help to reduce the urgency to pass a stool. Loperamide is used to control diarrhoea resulting from medical conditions. It isn’t licensed for preventing exercise-induced diarrhoea. It can be an effective way to control the runner’s trots if a dose is taken before running, but it’s important to know what the side-effects or dangers are so you can decide if it’s right for you.
Loperamide is designed to dry up faeces so you may end up constipated or with abdominal cramps. It can also make you feel sick, dizzy or give you a headache. All medications obviously have a risk of allergic reaction too. In 2017 there were reports of serious cardiac adverse reactions due to overdoses of loperamide, so never take more than the recommended dose. Although loperamide is available to buy over the counter, it may react badly with some prescribed medications so always check with the pharmacist. Don’t take it for the first time on race day. Try it out beforehand and be aware it doesn’t work for everyone. It’s far better to look at your triggers and find other ways to control your bowels if you can. Never forget to see a doctor if you have blood in your stool or a persistent change in your bowel habit.
Q Will running help my irritable bowel syndrome?
A Irritable bowel syndrome (IBS) is a very common condition affecting around one in five people. Its causes are not fully understood. Symptoms include diarrhoea, constipation, bloating and abdominal pains, but indigestion, fatigue and headaches can be a feature too. Sometimes IBS can cause muscle pains, bladder symptoms and, for women, pain during sex. IBS can’t be cured, but running is a great way to help manage it. It can keep constipation at bay, because it speeds up the passage of faeces through the bowel and it can help to reduce symptoms of bloating too.
The other way that running can help with IBS is by controlling mood and stress levels. We know that stress and tension in daily life can cause flare-ups of IBS. All runners know how much better they feel emotionally after a run so exercise can be used to stabilise mood, relieve stress and therefore manage IBS. There seems to be a close relationship between the brain and the gut. Certain antidepressant medications improve IBS symptoms even in people who aren’t depressed. This may be because they reduce pain or have a direct effect on the nerve endings in the gut. When you run, your body releases natural versions of some of the chemicals that are in antidepressants, such as serotonin, a well-known feel-good chemical. So although we don’t fully understand the mechanism, running can ease IBS through controlling stress, but it also seems to have a more direct action on the gut. However, it would be wrong not to mention that for some people with IBS running can trigger symptoms, especially if they suffer from excessive pre-race nerves or diarrhoea.
Real-life runners
I have IBS. I get a griping pain, a gurgling in my stomach and I have to go. It becomes all I can think about. For some reason it started affecting me 4km into runs. Thankfully a recent 10km race was a country route and I climbed over a gate and hid behind a hedge. Luckily I had tissues, but I pity the poor sheep! I was fine afterwards and could run again. I worked out the trigger was my breakfast and since swapping from Greek yoghurt and oats to a plain bagel it hasn’t happened since. It certainly wasn’t my finest hour and I was just glad it wasn’t a city centre race!
Louise, parkrun director and cockerpoo owner (find me on the last page of the race results)
Q I’ve got food poisoning and can’t get off the toilet today. I have a race at the weekend. Will I be OK to run?
A Bouts of food poisoning or other types of gastroenteritis can be as brief as 24 hours, but can last up to a week. Your digestive system is vigorously and efficiently ridding itself of its entire contents with vomiting or diarrhoea or, if you’re unlucky, both at once. The biggest risk is dehydration. You can lose large amounts of fluid in vomit and loose stools. It can be hard to get sufficient intake when you’re vomiting recurrently or liquids seem to be going straight through you. There’s no doubt you will feel weak and drained after this illness and without sufficient recovery time you aren’t going to be in good racing condition. Before you return to exercise you should have at least two full days of recovery when you can eat and drink normally without having diarrhoea or being sick. If you’ve had a short 24-hour bug and bounced back quickly then it may be reasonable to race following that recovery time, but don’t expect a PB. Longer illnesses are going to need more time and recuperation, particularly if you’re taking part in an endurance race. For now, concentrate on resting, sipping frequent, small amounts of fluid and make the call nearer the event.
Did you know?
The liver is the biggest solid organ in the body. It weighs approximately 1.5kg and it’s the only organ that can regenerate itself.
Q Will drinking alcohol affect my running?
A The liver is part of the gastrointestinal system and has a huge number of roles in the body, including the breaking down and removal of alcohol from the bloodstream. As a rough guide, the body breaks down alcohol at a rate of one unit per hour. This means that it takes about two hours to break down a pint of beer and three hours for a large (250ml) glass of wine. How much alcohol affects you depends on a number of variables, including your gender (women break down alcohol more slowly than men), weight, metabolism and race (some Asians have an inherited deficiency in one of the enzymes which breaks down alcohol). A moderate alcohol intake is unlikely to have a significant negative influence on your general running, but you’d be hard pushed to claim it could have a positive one, apart from perhaps a glass of something to help you relax the night before a race. If you’re looking for optimal performance, then these negative effects of alcohol might be enough to convince you to abstain:
• Alcohol affects sleep Even small amounts of alcohol can affect sleep quality. You may fall asleep more quickly, but you’ll experience less restorative (REM) sleep and that will have a knock-on effect to your performance.
• Alcohol can impair recovery A few pints after a race is a nice way to celebrate, but a single, large amount of alcohol can affect skeletal muscle repair, impede hydration and affect glycogen synthesis as the body attempts to replenish its stores. How much is too much post-race has many variables, but 0.5g/kg of bodyweight is unlikely to have a significant effect on recovery. One unit contains 8g of alcohol so this works out at around two pints of beer (four units of alcohol) for a man weighing 70kg.
• Alcohol contains empty calories Alcohol is highly calorific (a 175ml glass of wine contains around 160 calories – equivalent to three ginger nut biscuits) but of no nutritional value. High-performance running requires nutrient-dense, high-quality food. Alcohol doesn’t offer this and an excess can lead to weight gain.
• Alcohol reduces immune function Excessive long-term use and binge drinking can affect the body’s ability to fight infection and hea
l injuries.
• Alcohol causes dehydration Alcohol is a diuretic, which means it increases the amount of urine produced and water is therefore lost from the body. Hydration is also important in temperature regulation so this may be disrupted too, further affecting performance.
• Alcohol lowers blood sugar Although blood sugar may rise initially, soon after a drink, once the liver gets busy removing the alcohol from the body, it neglects its role of regulating glucose. Insulin secretion is increased causing low glucose levels, which are not compatible with good sports performance.
Q Is it safe to run with a hangover?
A Obviously, the more alcohol you consumed and the later into the night you drank it, then the bigger the effect on your ability to exercise the next day. Whether you ate or not can also determine how good you feel. It’s worth calculating how many units of alcohol you drank, because that will give you some idea as to whether it’s likely to be out of your system. It takes approximately one hour for one unit of alcohol to be removed from the body. The negative effects of alcohol mean that there are a number of reasons why exercising with a hangover isn’t a good idea. With poor sleep you’ll be lacking in energy but may also find your co-ordination and balance are affected, which can increase your injury risk. You will be dehydrated from the alcohol and further dehydration from sweating through running will only add to this. When you’re dehydrated you also have a faster pulse rate. Running will raise this further and put you at increased risk of developing abnormal heart rhythms such as atrial fibrillation. Your metabolism may not be in the best shape to endure a run either, especially if it’s still trying to clear alcohol from your system and you need plenty of available glucose for running.
Whether a run is safe and whether it will make you feel better or worse really depends on how you feel. If you just have a bit of a thick head then your risks are low, but if you’re dizzy, nauseated or have a racing heart then it makes sense to opt out or at least delay your run. Rehydrate as much as possible, make sure you’re passing plenty of pale, yellow urine and take a drink with you when you run. Wait until your pulse rate has calmed down and also make sure you have eaten before you run to counteract the alcohol-induced low blood sugar levels. Just be sensible! Don’t go if you don’t feel up to it and if you do go take it very easy and see how you feel. Go home if you need to. There’s always tomorrow.
Did you know?
The UK Chief Medical Officers recommend a weekly alcohol intake of no more than 14 units of alcohol for both men and women. This is equivalent to six pints of beer and six (175ml) glasses of wine. Avoiding binging, spreading alcohol intake over at least three days and having alcohol-free days each week are advised to minimise the health risks associated with alcohol.
Q I’ve just been diagnosed with coeliac disease. Will I have enough energy to run?
A If you have coeliac disease, your immune system attacks the healthy tissues of the gut when you eat gluten. In order for the tests for it to give an accurate answer, you need to have consumed some gluten in at least one meal a day for a minimum of six weeks before the test. Once you have the official diagnosis of coeliac disease you can begin a full gluten-free diet and you should find that your symptoms disappear quite quickly. Diarrhoea, abdominal pains and bloating will resolve and your energy levels will increase. There is no reason why you shouldn’t run. In fact, you may notice an improvement in your performance as you begin to feel generally better in yourself. It’s important to attend scheduled reviews with your doctor to check for any complications of coeliac disease and to see if you need any dietary supplements, such as iron, calcium or vitamin D. It’s very helpful to see a dietician when you are diagnosed and at any point if you are struggling with symptoms again. Coeliac disease is not the same as gluten or wheat intolerance, allergy or sensitivity. It is an auto-immune condition where the lining of the small intestine becomes damaged, leading to abdominal symptoms and inadequate absorption of essential nutrients. It is a life-long condition which requires treatment and monitoring. When it is well-controlled – and the majority of people control it simply by following a gluten-free diet – then it shouldn’t have any effect on your energy levels and ability to run.
Real-life runners
Being coeliac doesn’t negatively impact my running. From ultramarathons to parkrun, the only difference for me is that I need to be prepared with gluten-free goodies. This means I usually end up supplying post-race nutrition to the entire club!
Dr Oliver Newell, runner and self-confessed science geek
Q I have Crohn’s disease. I need surgery and will have a stoma and a bag. Will I be able to return to running?
A Absolutely yes! You’ll need adequate time to recover from your surgery and a gradual return to core strengthening exercises and running, but a stoma needn’t stop you. Search online for lots of inspiring stories and blogs from people running with stomas and ostomy bags (a stoma is an opening surgically created in the abdomen so that waste can leave the body and an ostomy bag is what the waste is collected in). It might take some trial and error to find the right bag for you to run with and similarly the best way to secure your bag. There are belts and specially designed wraps, as well as high-waisted running leggings to ensure your bag is snug and you feel confident. Other runners probably won’t be able to tell you have a bag, but you can choose loose-fitting tops if you’re self-conscious. Getting your hydration and fuelling right can take a bit of practice. It’s extremely unlikely your bag will burst, but reducing gas and wind (see here) will minimise this risk if you are concerned.
Q I have a family history of bowel cancer. Will running reduce my risk?
A In fact, 95 per cent of bowel cancers are not due to an inherited gene. If your affected relative is first degree (mother, father or sibling) and had their cancer diagnosed before they were 50, there might be a genetic cause. Similarly, if your first degree relative was older, but had a first degree relative who was affected, then this may be significant. If you’re concerned about the likelihood of inherited cancer, then speak to your GP. There is strong evidence that regular exercise can reduce the risk of developing bowel cancer by 25 to 50 per cent. This is a striking figure. Exercise speeds up the passage of faeces through the gut and reduces the amount of contact time that any carcinogens (cancer forming substances) have with the bowel wall. Exercise also causes the release of natural killer cells and lowers inflammation levels in the body, both of which help to reduce cancer risk (see here). So making a commitment to running regularly is a powerful way to lower your risk of this common condition, whether you have a family history of it or not.
Q I’ve got piles which hurt and bleed. Has running caused this and what can I do?
A Running may have caused or worsened your piles (haemorrhoids) if you’ve been spending many hours running long distances. Both vigorous activity and being on your feet for a long time increase pressure on the blood vessels in the rectum. Piles are essentially swollen veins and fleshy tissue which form small lumps, either inside or just outside your anus. There are many causes of piles, other than endurance running. Child birth, straining on the toilet and sitting for long periods of time are frequently to blame. You may also have a genetic tendency to develop them. It’s crucial to make sure you are well-hydrated and avoid constipation. Exercise prevents constipation, but be sure to drink plenty of fluids after a run to fully rehydrate. A diet rich in fibre will help smooth the transit of stools through your gut. Piles usually shrink and disappear on their own, but speak to your pharmacist about creams you can use to soothe them and reduce any itching in the meantime. Apply a product like Sudocrem to help protect the delicate piles from sweat and chafing while you run, and make sure you clean and dry the area thoroughly after running. Blood from the back passage can be due to other more serious causes so don’t rely on self-diagnosis and see your GP. Don’t feel embarrassed to get it checked out – they’ve seen it all before.
Did you know?
The time it takes food t
o go from entering your mouth to passing out of your anus as waste is called ‘transit time’. Transit time varies hugely between individuals and is influenced by what foods and fluids have been consumed, but is approximately 24 to 72 hours. Most of this time is spent in the large bowel. Women have a longer bowel transit time than men and children have a shorter one than adults.
Top tips for a healthy runner’s guts
• Keep a food diary and use trial and error to help solve gut issues.
• Drink plenty of fluid and rehydrate properly after runs to avoid constipation.
• Assist your digestion by avoiding over eating or eating in a rush. Chew your food properly and allow enough time between eating and running.
• See your doctor if you have a persistent change in your bowel habit or any blood loss from your back passage.
• Eat a healthy varied diet with plenty of whole grain fibre (unless you have IBS and find whole grains aggravate it).
• Look after your gut microbiome. Keep the good bacteria in your gut happy by eating plenty of plant-based foods and live yoghurts, and avoiding excess alcohol.
• Manage your stress levels.
• Don’t smoke. It increases your risk of acid reflux and stomach cancer.
FURTHER HELP AND ADVICE
Coeliac UK: www.coeliac.org.uk
Crohn’s and Colitis UK: www.crohnsandcolitis.org.uk
The IBS Network: www.theibsnetwork.org
Run Well Page 8
