Running Your Guts Out
by Fatima Ahmad
Recently I heard from a reader about a problem she has: She vomits, either during or immediately after a race, and sometimes in workouts. I recalled the 1996 U.S. Men’s Olympic Marathon Trials, when Bob Kempainen upchucked repeatedly during the 24th mile, but still won in 2:12. At least our regurgitating friend was in fast company.
It turns out that speedy—or at least hard-effort—running can provide fertile ground for gastric upset. This is due to the jarring effect of running and the diversion of blood to working muscles, which leaves the gut in a state of hypoxia (low oxygen). Unable to perform its function (digestion), the gut responds by emptying its contents. “Vomiting is a reflex that’s designed to be protective,” says David E. Martin, Ph.D. “It’s how the tissues deliver the message that they are severely hypoxic.”
You’re most likely to vomit as a result of intense competitive efforts. A friend recalls vomiting only twice during his 23-year running career: Once immediately after setting a half-marathon PR, and again following a 25K in which he “felt great in the final miles, passing people I usually don’t, and pushed up the final hill to the finish,” where he retched in the chutes.
According to Martin, such occasional upchucking is usually nothing to worry about. “Assuming you are otherwise healthy, it’s not a sign of trouble,” he says. If medical personnel are on hand you may be held for observation, especially on a warm day, because the dehydrating effect of vomiting could be hazardous. This means you should replace those fluids ASAP, regardless of whether you end up in the medical tent. The one time I tossed my cookies at the end of a race I followed up by collapsing. I had to be packed in ice, and received two liters of IV fluid.
What if mid-race or post-race vomiting happens regularly? “If you are routinely barfing in races you might want to take another look at the situation,” suggests Martin. Eliminate the obvious culprits, such as eating too recently before the race or not taking needed time in the bathroom. “Look at it as the body asking you, ‘Why are you working so hard?’” If the answer is that you’re trying to make the Olympics, the effort is probably justified, but you might want to scale back your effort slightly in a local 5K. Of particular concern are those runners who push so hard that they vomit during workouts. Martin gives this practice a thumbs-down, and I agree—you shouldn’t be working that hard in training, never mind what expectations you or a coach may place upon yourself.
What of racing, though, when all-out effort generally is justified? Should we, when it matters most, be aspiring to push ’til we puke? Are we wimps if we merely pant, gasp or cough violently? Martin pooh-poohs that notion, pointing out that every runner is different, and some won’t throw up no matter how hard they drive themselves. “It’s certainly a sign that you’ve worked very, very hard—that you have guts, as they say. But if you don’t barf, it’s not an indicator that you didn’t try hard enough!”