After college, Hayden, a pediatric medical resident in his thirties, had fallen in love with competing in triathlons. He had always found that exercise benefitted his physical, mental, and emotional health. Unfortunately, severe bloating, cramping, and diarrhea during intense training sessions was affecting his training and race performance. His GI distress was so severe that it kept him from adequately fueling his races. He could hardly stomach the goos, gels, and drinks athletes rely on to sustain their energy and electrolyte levels during races. As he was nearing the finish line, he sometimes experienced an intense urgency to use the bathroom—but that urgency would subside when he got to the restroom. He would typically endure GI distress, fatigue, and brain fog for up to three days after his races.
Hayden had struggled with these gut symptoms for years. Although he had seen doctors about his symptoms, he hadn’t gotten the answers he needed so he could start to feel better and train without discomfort. He decided to begin eating a mostly vegetarian diet with the hope that it would solve his stomach problems. His diet was rich in a variety of fruits, vegetables, healthy fats, and plant proteins. He also ate fish, eggs, cottage cheese, and yogurt throughout the week to support his protein intake. Even though he was eating well, he still wasn’t feeling well, especially after intense training or races.
Hayden was getting about six and a half hours of sleep each night and he rarely took a true rest day. Instead, he would push a training pace during his easy run days or go for a long hike. Because of his busy schedule, he rarely practiced mindfulness simply because he couldn’t squeeze it in. Also, due to masking in his work setting, he wasn’t getting enough water most days.
A few weeks before his first meeting with his Ixcela Registered Dietitian, Hayden completed a 15K race. He shared with his dietitian that he had had stomach issues for three days following that race. He wanted to learn which foods and beverages might be contributing to his digestive issues, and if a gut bacteria imbalance was to blame for his irregular digestion and discomfort. He was eager to make specific changes that would help him feel better during all aspects of his active life.
Hayden’s test results showed that his xanthine, a stress marker metabolite, was above optimal levels.
Intense exercise, poor sleep, and/or mental and emotional stress from work are common causes of GI distress.
Hayden’s Ixcela Registered Dietitian explained that if his xanthine remained elevated, it could disrupt his microbiome and lead to a gut imbalance. Therefore, it was important to pinpoint the source(s) of stress and begin to manage them.
They would review what Hayden ate throughout the day and before training sessions.
They would also take a look at the carbohydrate powders and gels he was including during training.
Hayden hadn’t realized the extent to which stress affected his digestion. He was aware that his athletic training and his profession were stressful, but he did not connect these stressors to his GI troubles. His Ixcela Registered Dietitian explained the connection between the gut and the brain and how mental and emotional stress increases inflammation just like physical stress can. He was excited to try targeted changes to see if he could finally get some results.
Because Hayden was participating in the 90-day Complete Package Program, he and his registered dietitian were able to come up with a week-by-week plan that would allow him to slowly build habits to support optimal xanthine levels and ease his stomach problems.
Identify certain foods that may be causing discomfort.
If doing a light run, reduce speed. Spend a few extra minutes stretching, foam rolling, or practicing yoga on recovery days.
Try low FODMAP, easier-to-digest fuel.
High FODMAP carbohydrates can pull water into the gut and increase the risk and/or severity of stomach issues during intense exercise.
These powerful antioxidant blends support elevated xanthine levels and help with athletic recovery.
Strive to get at least 8 hours of sleep daily.
GI distress during intense exercise is commonly related to dehydration.
Example pre-race eating plan
Breakfast: white rice with 3 eggs
Snack: ½ cup blueberries with pancakes and maple syrup
Lunch: 2 white tortilla wraps with tofu, soy sauce, green onion, and toasted sesame seeds
Snack: ½ cup blueberries with pancakes and maple syrup
Dinner: white rice with protein of choice; sea salt in 2 cups of tart cherry juice or beet juice
Examples: Add peanut butter powder to overnight oats, eat high-protein pasta (edamame, lentil, or chickpea), or add steamed edamame/edamame hummus to meals and snacks.
Include an antioxidant-rich juice like beet juice or tart cherry juice daily.
During their Zoom sessions, Hayden and his Ixcela Registered Dietitian discussed his progress. Weekly text check-ins with his dietitian kept Hayden motivated, accountable, and on track for success.
Keeping a food journal helped Hayden and his dietitian identify that, even with his well-balanced regular diet, certain foods were triggering some of his symptoms. He was able to gain clarity and confidence about his eating habits and strategically modify his diet leading up to long training sessions and races.
After just three weeks of focusing on adequate sleep, Hayden was consistently sleeping eight or more hours each night. He was starting to feel better and he reported no stomach problems during his longer runs, which had typically left him feeling sick for days afterward. Along with reducing intensity on recovery days, he added additional restorative activities like stretching, foam rolling, breath work, and light yoga. Getting more sleep was helping him feel better overall. He noticed that inadequate sleep alone greatly affected his GI symptoms.
After working with Ixcela for just six weeks, Hayden's athletic performance improved and his recovery time was much faster. Hayden shared that it had previously taken him seven days to recover from an Ironman race, but now it was only taking two days before he felt like he could move comfortably and start training for his next race.
Hayden’s training continued to increase during his first few weeks of working with Ixcela. Although the increased training would typically come with more bloating and irregular digestion, his symptoms had greatly decreased. Changing his training fuel helped Hayden alleviate bloating and cramping, which allowed him to tolerate the fluids and calories he needed during races. He went from being able to tolerate only about 150 calories during the run leg of his Half Ironman to consuming 450 calories during the run portion. The additional calories better fueled his body and he was able to shave eleven minutes off his half marathon time from his 2021 time to his most recent 2022 race time. (See chart below.)
Before working with Ixcela, Hayden experienced uncomfortable bloating and diarrhea daily. After working with an Ixcela dietitian, he reported that he experienced stomach issues only seven days per month. There was a 75% decrease in days with diarrhea and a 50% decrease in days he experienced bloating. Although he needed to focus on further reducing his stomach issues, he was more aware of what triggered his upset stomach and he was more mindful about avoiding anything that could cause an upset stomach. With his new habits and changes to his nutrition practices, Hayden went from experiencing GI distress during and after a race six days per month to experiencing no GI distress during or after races.
|BEFORE Ixcela||AFTER 6 Weeks with Ixcela||AFTER 10 Weeks with Ixcela|
|Swim:||37 minutes, 19 seconds||34 minutes, 57 seconds||37 minutes, 8 seconds|
|Bike:||2 hours, 39 minutes, 36 seconds||2 hours, 48 minutes, 18 seconds||2 hours, 45 minutes, 7 seconds|
|Run:||1 hour, 59 minutes, 49 seconds||1 hour, 50 minutes, 27 seconds||1 hour, 48 minutes, 43 seconds|
|Total:||5 hours, 31 minutes, 54 seconds||5 hours, 23 minutes, 12 seconds
8 minutes faster and a new personal record!
|5 hours, 21 minutes, 57 seconds|