General Discussion Triathlon Talk » Nauseous/vomiting during IM Bike leg Rss Feed  
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2009-09-18 7:32 AM

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Subject: Nauseous/vomiting during IM Bike leg
After my experience at IM Canada of getting sick on the bike and reading about similar experiences at IMWI for a few BTers, I thought it might be helpful to discuss what happened and see if we can learn anything from others experiences to hopefully avoid this in the future.

If this has happened to you maybe you could share what happened, thoughts on why you think you got sick and ideas you may have to avoid this in the future.

Some of the reasons I have heard that make folks get nauseous/vomit on the bike in an Ironman
  • ingesting water on swim
  • wrong amount of sodium
  • osmolality of nutrition
  • being ill
  • heat


2009-09-18 7:50 AM
in reply to: #2413236

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Subject: RE: Nauseous/vomiting during IM Bike leg
I thought I'd start and share what happened to me.

Day before race I felt dizzy which is something not normal for me. Swim went okay, did choke on water a couple times on back half of course. Start of bike I felt fine, nutrition was dead on first 3 hours, it started to get hot without any shade or cloud cover and it got up to about 95 and it was about mile 47 on bike, my legs started cramping on hills of certain steepness which would stop on down hills or flats. Soon after wards I started vomiting while riding. My stomach didn't feel horrible like it normally would if I was going to vomit if I was sick at home.

I tried to get down what I could for nutrition and water, but would repeatedly throw up.  Things were pretty bad from miles 60-95. I would stop periodically, cramping continued to get worse. I ended up walking some which seemed to help as didn't throw up while walking.

I had limited mental abilities that declined for a time due to lack of calories as our brains are fueled by blood sugar only. I only cared about getting water and getting out of the sun, didn't care about race, finishing, or much. I thought I saw an aid station that wasn't really there.

Once I got to the top of Yellow Lake after a bunch of walking, I sat in the shade for a short time, drank cold water, and felt slightly better and rode as it was mostly down hill to T2.

In time on run after maybe 1-1.5 hours I got calories and fluid in, cooled down with ice and temperatures went down, my mind came back and I felt better and cramping went away. Strange as it sound my run went pretty well and my first and second half splits were within 6 minutes.

What happened?
I don't know as I had trained in that temperature on long rides a few times with same nutrition.

I've never done well in the heat so that added to whatever else happened. Perhaps my nutrition was a little to concentrated. Add in I had something going on with the dizzy issue that has continued on still. My doctor thinks I have an inner ear issue with misfiring signals giving me vertigo.

Next IM I'm choosing one that odds are it won't be so hot.
2009-09-18 8:59 AM
in reply to: #2413236

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Subject: RE: Nauseous/vomiting during IM Bike leg
Kathy - thank you for sharing your experience. This is something that concerns me for IMFL. I did the Gulf Coast Tri HIM on the IMFL course and I swallowed quite a bit of water on the choppy swim. About 25 miles into the bike my stomach started to feel off. Thankfully, I didn't vomit but I talked to many people who did or who felt similar to me. I have used the same nutrition in training with zero issues, so the only thing that was different that time was the salt water intake. I read somewhere that delaying your nutrition for 30 minutes and just drinking water can help flush things out, but I am hoping someone else can validate that. Thanks again - great topic and congrats again on powering through such a difficult time.
2009-09-18 9:28 AM
in reply to: #2413434

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Subject: RE: Nauseous/vomiting during IM Bike leg
irondreams - 2009-09-18 9:59 AM Kathy - thank you for sharing your experience. This is something that concerns me for IMFL. I did the Gulf Coast Tri HIM on the IMFL course and I swallowed quite a bit of water on the choppy swim. About 25 miles into the bike my stomach started to feel off. Thankfully, I didn't vomit but I talked to many people who did or who felt similar to me. I have used the same nutrition in training with zero issues, so the only thing that was different that time was the salt water intake. I read somewhere that delaying your nutrition for 30 minutes and just drinking water can help flush things out, but I am hoping someone else can validate that. Thanks again - great topic and congrats again on powering through such a difficult time.


My coach had me not take any fluid or nutrition for 20' on the bike and that is what I did to allow my body to adjust to being on the bike. I've never heard of 30' wait.
2009-09-18 9:36 AM
in reply to: #2413236

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Subject: RE: Nauseous/vomiting during IM Bike leg
I really think the heat and the effort level plays into vomiting.

My cousin (Jkron) experienced the same thing in Arizona, May 2008. It was really bad for him too. That was an extremely hot day and he hadn't been training in that kind of heat.

I also speculate that when people start to feel nauseous they don't notice it and stay on top of their nutrition, versus backing off ensuring they don't vomit.

At mile 80 on the bike at my IM, my stomach had a small rumbling of feeling questionable. It was a hot day, and my effort level was decent. I decided to back off my nutrition and in fact, changed my nutrition plan on the fly. I then moved to only liquid nutrition and less of it. My focus was NOT to vomit, period. I knew if I started to vomit, I wouldn't stop. Luckily I had put extra Infinit in my special needs bag and had extra liquid nutrition prepared and ready to go.

Anyways... that's my experience and my thoughts on it. It sucks when it happens to someone, and the fact that you were able to finish in that kind of shape is amazing. I was in awe of my cousin finishing his IM as bad off as he was!

2009-09-18 10:03 AM
in reply to: #2413535

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Subject: RE: Nauseous/vomiting during IM Bike leg

I only got nauseous on the bike during one race, and that was a HIM. I didn't puke, but was close to it. It stemmed from getting seasick during the swim (the lake grew rather choppy). In any case, after trying to stay on top of my nutrition plan for about an hour, I decided to just bag it and actually didn't consume anything for quite a while...maybe 45 mins or so. I also found that sitting up REALLY helped. I was on a road bike with clip-on aerobars at the time, so sitting up was a little easier than on a tri bike. But 10 or 15 mins of being mostly upright was a huge help...that might be similar to why you felt better when walking than when riding. But, I think the cause of the nausea varies from person to person and day to day, and therefore the cure will too.

Great job toughing it out!!



2009-09-18 11:21 AM
in reply to: #2413236

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Subject: RE: Nauseous/vomiting during IM Bike leg
I didn't see anybody throw-up on the bike, but I couldn't believe how many folks I saw on the run giving it all up.  Yeah, it got up to about 91, but last year in Louisville, it got up to 93, and I didn't see as many as I did this year.  I counted 6 guys off on the side of the road, bent over at the waist, in full dry heave mode.  I couldn't believe it! ! !

So, it wasn't only on the bike, that's for sure.  But, I think the cause surely must be up to the individual.  One person takes in too much water on the swim, while another has nearves.  One might be drinking too much, while another might have a stomoch bug.  Who knows? ? ?

At the point I got off the bike, I had drunk 132 ounces of INFINIT, plus another 60 to 80 ounces of water.  When I Peeed in T2 (and not during the bike), I realized I was probly a bit dehydrated.  So what did I do, I started over drinking on the run.  At 4 miles I was so doggone full of liquid I thought people could hear me sloshing as I run up to them.  Anyway, at that point, if I hadn't cut back some on my water/Infinit intake, I probly would have thrown-up just because I had too much liquid in me. 

I think it is a problem determined by the individual during the race. . . . .
2009-09-18 12:41 PM
in reply to: #2413236

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Subject: RE: Nauseous/vomiting during IM Bike leg
Good topic. I also think it is very much individualistic but it is still good to share stories...someone might read something that helps them.

About the same thing happened to me in both my IM's. IMKY 07 it happened later in the bike and affected my run more than the bike and I didn't throw up but was very bloated and just couldn't put any more in me. Nothing seemed to be digesting...almost like it just layed in my stomach and filled me up but never digested. I got very weak and cramped. I thought it must have been the heat. I used Hammer Perpetuem and Hammer gels, water and endurolytes. I ended up taking some other stuff on the run just trying to get something to work. I had trained with Perp, gels, water and endurolytes...so I figured it was the heat.

This year at IMWI it happened about mile 40 of the bike. I could not keep calories in me. Again I felt very bloated and like nothing was digesting. I got sick and ended up dry heaving and cramping. At that point I didn't take much of anything else in on the bike...a little water and a little concentrated Hammer Heed. I barely finished the bike...9 minutes to the cutoff. I didn't think it was too hot.

Surprisingly I made somewhat of a recovery on the run. I made it to the first aid station and someone said "chicken broth?" and I said hey that might work. So I sipped chicken broth and chewed on ice for the first couple aid stations. Then I started alternating between broth and coke with ice. Then I'd take a little water, then a couple grapes or oranges. Never too much but just little bits. I walked up hills and in aid stations and then when it got dark and I would have trouble seeing the path I would walk so I didn't fall but other than that I jogged. I was able to run the last 2 miles...mostly up hill...and finish with the best feeling ever!

It is frustrating because these things worked for me training...but not on race day. I need to try something else I guess...but what...and how do you know what will work race day? (I know there is no way of answering that.)

2009-09-18 1:45 PM
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Subject: RE: Nauseous/vomiting during IM Bike leg
As a completely neeb person I'm wondering if on especially hot days if it's better to intake on the lower spectrum of calories right from the get-go? I remember reading something at EN about most people taking in too many calories. I suppose that all goes out the window though if you can't keep anything down.
2009-09-18 2:26 PM
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Subject: RE: Nauseous/vomiting during IM Bike leg
A couple of you bring up the idea of intensity on the bike.

I train and race with power meter so I have range of 10 watts that I keep my power levels at and can go up 10 additional watts on hills. My watts were in the middle of my goal range for first 3.5 hours and my power was dead on to what it should have been once I got sick watts fell way off.

I remember someone training for IM shared he did a long ride with his coach and shared that his coach had him go really hard for a while and had him try to keep same nutrition plan but he couldn't. I do think going to hard can give you stomach issues.

My nutrition plan was all liquid.

I have noticed when I race long when it is hot I end up burping a lot. It has been worse when I have done the bike portion of relays of 2 HIMS and 1 IM maybe because I was going higher intensity than I would have it I had been doing the whole event. Clearly from the relays the burping was not related to swallowing air swimming since I didn't swim. Vomiting in Ironman Canada seemed to be a progressive from the burping that has occurred in the past in other races as that occured first. Only a few times in Canada was it the gut wrenching vomiting that makes your stomach hurt, most of times stuff sort of came out like a burp with liquid (sorry it's kind of gross).

2009-09-18 5:01 PM
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Subject: RE: Nauseous/vomiting during IM Bike leg

I'm not sure what happened to me but I believe it was a combination of a hot day and a lake with a recent algae bloom.  I have battled GI problems all summer so that probably didn't help either.  I always take in more water thasn I should when I swim and would guess by the end of a satisfactory swim I probably drank 4-10 ounces of the lake.  Still I felt good after the swim.  As I started the bike I felt bloated for awhile but not bad.  I had a really good first 70 miles on the bike.  Probably did not hydrate as well as I should have and definetly did not eat as much as I should have.  About mile 72 I started feeling pretty bad.  By mile 73 I had started vomitting everything up.  By the time I made it to the aid station at mile 82 I was weak, nauseaus and so dizzy I could barely stand.  I was pulled from the race by medical at this point and that was the end of my day.  My guess is the lake water had a lot to do with the suddeness of my problems.  Other than that, not much to add other than I will be back with a new plan in hand.



2009-09-18 5:32 PM
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Subject: RE: Nauseous/vomiting during IM Bike leg
Kathy,
 My mother was recently diagnosed with a condition similar to Menieres, I can't for the life of me remember what it is called. Her sodium intake might be the root of it for her, only time will tell for certain. They sent her to a PT and they were able to get her vertigo symptoms under control with one session. The PT also showed her how to do the therapy to herself. It might be worth your time to check and see if you might be suffering from a similar condition. If you are interested let me know and I'll ask her for specifics on treatment. I'm pretty sure it is something you could do for yourself during a race.... of course you're gonna have to dismount first!
2009-09-20 12:00 AM
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Subject: RE: Nauseous/vomiting during IM Bike leg
  The only time I've felt nauseous on the bike happened in similar circumstances.  It was a long ride (100 mile) and quite hot (close to 100).  It was also a situation where it grew hotter over the duration of the ride.  I believe for me, it was that I was getting a little behind in hydration. Not to the point of being dehydrated, but enough to where the distance/time on the bike and high temp coupled with a need to consistantly ingest calories was starting to affect me. 
  It was mile 70 and I felt awful. Here's what fixed it. I changed from 5 gulps of liquid every 9 minutes to 7 gulps every 7 minutes. Within 20 minutes I was back to completely 100 percent.  Having trained alot in very hot temps, I can tell you that heat is very unforgiving even for being off the tiniest bit on hydration. Of course there are many things that could cause nausea, but this was my experience.

Jake
 
2009-09-20 6:10 AM
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Subject: RE: Nauseous/vomiting during IM Bike leg

KathyG - 2009-09-18 3:26 PM
I remember someone training for IM shared he did a long ride with his coach and shared that his coach had him go really hard for a while and had him try to keep same nutrition plan but he couldn't.

That is a really interesting idea.  I might try that during the offseason.

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