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by Chanelle Retief (Registered Dietician)
18 April 2018

Nausea while running seems to have become a common problem amongst many endurance runners, especially those tackling ultra distances. On top of this many have no idea what the causes of their sudden nausea could be. Chanelle Retief, Registered Dietician, explains.
Nausea can strike anytime: before, during or after a running event. One thing is for sure; it is definitely more common on marathons and ultra-marathons compared to shorter distances and even half marathons. There are many general reasons for this, including the following:
1.    Many runners stress more about a marathon or longer distance race compared to a 10km or even a half marathon.
2.    South African long distance runners, many taking on the gruelling 90km Comrades Marathon, are exposed to the hot South African weather for longer – thus they are much more prone for dehydration.
3.    Whilst running your body is moving a lot more. Runners generally have a higher incidence of nausea compared to cyclists – as our upper bodies move a lot more compared to the upper body of a cyclist.
4.    Runners use all of their glycogen stores and need to consume extra carbohydrates, which could cause nausea. On a marathon, (generally) all athletes consume some or other form of “food” or supplements compared to a 21km race where many runners will just run on Coke and water.
Some are more prone than others
In saying all this, keep in mind there are some individuals who are more prone to developing nausea while running. These individuals include:
1.    Those who start the race in a dehydrated state (thus not drinking enough fluids on a normal day-to-day basis).
2.    Those taking certain medications (not only the morning of the race, also on a normal day).
3.    Those eating too many complex carbohydrates or fat 24-48 hours prior to the race.
4.    Those athletes with IBS symptoms.
5.    Lastly, those individuals who are highly stressed about the race.
More specific causes
There are many different causes of nausea while running. Some of these causes are easy to correct, but unfortunately some of these causes are variables that cannot always be accounted for.
1.    Your gut
When you are running, most of the oxygen-rich blood is transported away from your gut and other non-essential organs. This oxygen-rich blood is transported to the lungs, heart and hardworking muscles. Your gut needs this oxygen-rich blood to absorb the food and water in the stomach. If food and fluids aren’t absorbed, it can cause nausea and/or vomiting. 
2.    Weather conditions
If you are running in a hot and humid environment, the oxygen-rich blood is also transported to the skin, to help you cool down. This could increase the risk of nausea even more.
3.    Dehydration
Dehydration is the most common cause of nausea while running, but luckily it is also easy to avoid. When you are dehydrated it slows down the digestion process in your stomach, which then cause a decrease in absorption and an increase in nausea.
4.    Increased pressure on stomach
Taking heavier breaths while running increases pressure on your stomach, and this could cause discomfort and nausea.
5.    Clothing
Wearing tight clothing could also be a culprit. Many long distance runners wear a fuel belt with supplements and gels. These belts can be too tight and make athletes feel uncomfortable and nauseous.
6.    Water and electrolyte balance in your body
Your body doesn’t only need water to keep it from dehydrating; it also needs electrolytes. Our bodies need an electrolyte gradient to actually absorb the water that we consume. If the electrolytes in the body are too little, the water will just sit in your stomach and make you feel sick.
7.    Eating
Eating too much or too little can play a big role in having stomach issues on race-day.
8.    New foods on race day
The number one rule of endurance running is to never try anything new on race day… Especially new food products!
9.    Having a picnic
Slower runners take more walk breaks and some stop at each feeding station. In a race such as Comrades where the feeding stations are much closer to each other compared to other races, this could be problematic as some runners eat too much, drink too much, try new foods etc.… All in one race!

Lack of electrolytes
Many runners complain that they continue to feel thirsty, even after drinking water. If they then consume more water to quench the thirst, they feel even more nauseous. This can be explained by the fact that the water you consumed are just staying in your gut, instead of going where the body needs it (into different areas and cells) and this is due to a lack of electrolytes. You need electrolytes in order for your body to absorb the water that you consume. Thus, you have to consume electrolytes while running; try to combine Coke and water in one cup (the Coke contains electrolytes), eat the potatoes with salt, eat some salt (provided on many races) and make sure you drink enough Rehidrate.
How to avoid it
Fortunately there are many things a runner can try to avoid nausea while running. There are also some strategies that runners can try to alleviate the feeling once it occurs:
1.    Take a sports drink with you to the start of the race. It will keep you hydrated, it contains some carbohydrates and it has electrolytes.
2.    Start hydrating early in the race; do not wait until you are thirsty.
3.    Take some electrolyte supplements with you during the race.
4.    Take a short walk to make sure the blood-flow returns to the gut.
5.    When you take your gels and other sugary foods drink it with water and not a sports drink or Coke.
6.    Although caffeine does pose some very promising performance enhancing properties for the endurance runner, it can be a risk factor for nausea. If you are prone to nausea while running, do not use caffeine supplements.
7.    Do not consume more than 60g of carbohydrates per hour while running.
8.    Try all your nutrition and race strategies before, on less important races. Do not try anything new on race day.
9.    Even if you feel like you do not want to eat or drink anything – try and eat some crackers, potatoes, and biscuits or drink some soup.
10. Do not wear clothes that are too warm or dark in colour.
11. The food that you eat before your race is very important. Even the food that you eat the evening before could play a role. These meals should be high in carbohydrates, low in fat, low in fibre, low in spices and moderate in protein.
12. Going out too fast in the beginning of the race due to the race-vibe and all the supporters could cause nausea.
It is important to keep an eye on your symptoms; if the nausea persists even after running and you are unable to consume your normal diet it would be advisable to consult with your doctor. 

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