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Coach Jason Koop covers training, nutrition and recent happenings in the ultramarathon world.
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Training the Gut for Ultramarathons with Isabel Martinez #241
Isabel Martinez is a Research Sports Dietitian In the Department of Nutrition, Dietetics and Food at Monash University. She is the author of several studies on gut training as well as consults with athletes in this area.
The Effect of Gut-Training and Feeding-Challenge on Markers of Gastrointestinal Status in
Response to Endurance Exercise: A Systematic Literature Review
https://pubmed.ncbi.nlm.nih.gov/37061651/
Development of a low-fructose carbohydrate gel for exercise application
https://www.sciencedirect.com/science/article/pii/S2405844024095288
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Trail and ultra runners. What is going on? Welcome to another episode of the CoopCast. As always, I am your host, coach Jason Coop, and this episode of the podcast is about a hot topic in endurance sports and sports nutrition. Today, it is all about if and how you can train your gut to tolerate and absorb more foods during training and racing. I don't need to tell you that gi distress is one of the leading causes of dnfing in an ultra, as well as one of the most common complaints in ultra running, and for years, runners and coaches and nutritionists have been trying to solve this problem with varying products, intake, intake strategies, advanced formulations like the newer hydrogels, and what we are speaking about today, which is training the gut.
Speaker 1:So welcome to the podcast today Isabel Martinez, who's coming to us from Monash University, where she is a research sports dietitian in the Department of Nutrition and Dietetics and Food. She is the author of several studies in this area, including a recent systematic review and meta-analysis on gut training. Links to all of those will be in the show notes. Also on the podcast today, we will hear from CTS coach and nutritionist Stephanie Howe on some of the more practical elements of how and when to implement gut training and who are good candidates for it. All right, so with that out of the way, I am getting right out of the way. Here's my conversation with Isabel Martinez all about training the gut. Isabel, welcome to the podcast. I appreciate it, as always.
Speaker 2:Hey Jason, Nice to be on the CoopCast. I'm a big fan so I'm pretty happy to be on here.
Speaker 1:Thank you for that. I feel that people in nutrition now are kind of getting thrust into the spotlight because there's been kind of a reemergence, so to speak, especially with the carbohydrate feeding and how much athletes can actually tolerate. So people like yourself that have both a research background as well as a practitioner background all of a sudden end up garnering lots of attention, because you can meld all of these things together that athletes are very rapidly trying to figure out.
Speaker 2:Yeah, that's so true. Things have changed, especially with the current trend with running. I'm sure you've noticed the uptick in runners and everything running, so they're going back to actually looking at fueling and there's been a lot of changes in terms of guidelines. If we compare that maybe, let's say, like 20 years back, so we've been getting pretty much the same questions and more people are actually a bit more frustrated because they think before the advice is actually contradictory to what's going on right now. Well, that's just science, right.
Speaker 1:Well, it's the evolution of a lot of things right Before we get into it, just so the listeners can kind of get to know you a little bit better, I mentioned that you have both of this research and this kind of practitioner practical background, but can you give the listeners an overview of just who you are and where you got to, where you're at right now and what you're currently doing?
Speaker 2:yep, and so I pretty much classify as a sports dietitian or and or a nutrition scientist. So that gives you the both research and applied side of things. Um, and I pretty much started out as a nutrition major, similar to other sports dietitians, and when you enroll in a nutrition program it's usually that, especially if you're coming from a developing country, sports nutrition isn't really a thing, it's so niche right. And so that led me to a whole adventure of going across to the other side of the world. So I actually ended up in the very flat plains of Shambana or Urbana-Champaign over in Illinois. That's where I actually studied exercise physiology. So I have that background as well. So my research has evolved pretty much from gains to gut.
Speaker 2:So I used to work in muscle protein metabolism, that sort of stuff. But my background in sports didn't quite that sort of research, so I eventually transitioned into the guts world. But a common line that I've seen is pretty much I like to make guinea pigs out of cyclists and runners and I've been force feeding them anything from potatoes to nut butters or gels. That's what I've been seeing in terms of research. In terms of applied work, I've worked in corporate settings, academia and research, and I've also consulted with various athletes.
Speaker 1:That's perfect. So you mentioned that you like to make guinea pigs out of cyclists and runners, and I think this kind of brings into a perfect dovetail with some of the initial research that we're going to talk about, because a lot of the guinea pig aspect that athletes are doing on themselves is trying to figure out how much they can eat and drink during the run. And in an ultra marathon setting this becomes a really interesting proposition because the competition venue is always longer in duration and also maybe also environmental conditions. It's more challenging from an environmental condition standpoint than what they can actually recreate in training and they're trying to do everything they can in training to mimic what they are going to actually do on race day from a nutrition perspective.
Speaker 1:But many times and we see this play out in the data where GI distress is the number one issue cited for for not finishing ultra marathons is that they just simply can't get it right, even though they know it's exceedingly important. So on one side, we know it's really important. On the other side, we kind of consistently get it, we kind of consistently don't get it right, and so it still becomes a kind of a problem to solve. So in this first paper that I'm going to link up in the that I'm going to link up in the show notes. There's this model of what can actually be trained, and I think that if athletes first understand how we can actually do this and what the things that we are actually training are, then we can take a little bit of a step back and say, okay, how do we actually problem solve these things? So why don't you take the listeners through that model first, and then we can go through what emerged from the meta-analysis second.
Speaker 2:Yeah.
Speaker 2:So if you ask pretty much any athlete out there whether they know the term gut training, they'll probably say, yes, right, it's a buzzword that's been thrown around here and there, but when you actually ask them your gut the most common answer you'll get is, oh, I practice my race day nutrition, right, right and yes, that is true, right b and what.
Speaker 2:It's actually more than that, if you do know what you're after in terms of the adaptations, the term training itself lends to the fact that it should be a little bit more structured, maybe a little bit more repetitive, maybe a little bit more repetitive, and maybe there are some other factors that you can actually take into account, rather than just how much you eat during these training sessions. So that's one thing, and pretty much when we did this meta-analysis, it was sort of a stepping stone into pretty much looking more into the different protocols of gut training. So we had to make sure that we looked at what the available evidence is first. Right, are there any available evidence in the first place? And so what we looked at was the internet for anything that consisted of athletes pretty much challenging their gut either through volume or dose of carbohydrates, and surprisingly, or not surprisingly, we only found eight studies back then wow and a lot of these actually did some sort of intervention.
Speaker 2:it was kind of like gut training or a feeding challenge, but then again, if you look at their outcomes, they weren't actually measuring gut symptoms, so there may be they were gut training, that that sort of thing. So the three things that are proposed in literature in terms of the adaptations is one can you train your stomach to actually hold larger volumes of food? Right? So if you expose the stomach to greater volume it expands and with that expansion there's a rise in pressure and pretty much as an individual you're sensitive to that increase in pressure and once that increases you feel full. That stops you from actually ingesting your fuel. That's one adaptation that you're after is pretty much being a little bit more comfortable with that increase in pressure when you eat food while you're exercising this is the eating competition style like the joey chestnut, I'm gonna see how many hot dogs I can eat.
Speaker 1:This is the adaptation that those I was going to say athletes but I would cringe to giving them that label but those individuals that's the adaptation that they're essentially craving, essentially are trying to train for.
Speaker 2:That's correct. So there's actually a study where they modeled the stomachs of these competitive eating athletes and they did see that it's actually more the expansion of the stomach rather than how quickly food leaves the stomach. That's the main thing that happens. But it's also proposed that things can move a little bit quicker outside the stomach. But the evidence here is mostly on animal studies and or human studies, but at rest, so they're not exercising. It's a whole different story when we start talking about people who are exercising, because we know that when you exercise, the gut pretty much shuts down, so it's a different scenario.
Speaker 2:There are evidence saying that when you supplement with a certain nutrient whether it's carbohydrates, fat it can accelerate that emptying.
Speaker 2:So that's one thing that would help in terms of delivering the nutrients that we need when we are exercising.
Speaker 2:And the last thing and I think one of the more important adaptations is yes, you can get in your fuel, but how much can you actually get across to the bloodstream to be available to your muscles, right?
Speaker 2:So how much can actually cross from your gut circulation? And eventually your other bottleneck is how much your muscle can actually cross from your gut circulation and eventually your other bottleneck is how much your muscle can actually take up so it's been with not absorbing, for example, carbohydrates is it sits in your gut and that's pretty much food for the bacteria there to ferment, and it also attracts water. So that's what increases your risk of gut symptoms. And there's a cool mechanism within the gut wherein if there's actually nutrients that aren't absorbed in the last part of your intestine, it actually literally puts on a break on your whole gut, meaning it slows down emptying, it slows down how food moves along and, in effect, you also feel a sensation of fullness, so you actually stop eating. So those are the three things, three key things I think that gut training aims to improve so far.
Speaker 1:Okay, so we have this model and, just to kind of quickly synopsize what you just went through, what we're trying to train is, first off, the stomach to handle larger volumes. Second off, to get those volumes through the intestinal tract more quickly, and the third one is to actually absorb primarily carbohydrate through the, through the intestines, in order, so in order for the energy to actually be delivered into the bloodstream, very simply, put right All three of those yes.
Speaker 1:And the way that I think about it as a coach and being, you know, very tangentially involved in some of the nutrition sciences is we kind of attack all three of those problems via two primary mechanisms, the first of which we're talking about today, which is just training the gut and trying to train the gut across all those three, and that's what we're going to spend the majority of the time talking about.
Speaker 1:But, not to be remiss, we're going to get into this a little bit is it also becomes a formulation and a chemistry problem. So what types of stuff are you actually ingesting so that those three elements that you are training are not as stressful on the body because of the composition of macronutrients that you're actually taking in? And those two things I don't know how you would describe it, but they work hand in hand and those two things I don't know how you would describe it, but they work hand in hand, but they can almost be treated separately to a large extent, meaning you're thinking about the training side of it. And then you're also thinking about the composition of the things that you're ingesting and trying to almost maximize the training that you're actually putting forward.
Speaker 2:Yep, yep, no, that's true. So when we actually get into the thick of like the different protocols, you'll see that majority of the factors that have been explored is pretty much varying those putting in more carbohydrates to train the gut, but, similar to what you said, the composition in itself could be another thing that we could actually vary. So that's leaped up nicely to the next study.
Speaker 1:Okay, so let's play a little game here. Right, we've got these three things right Hold the stomach, holding larger volumes, faster gastric emptying rates and the absorption side of things. After you scour the literature, what seems to be more trainable? Is there an area where we can say, hey, listen, if we did a lot of work in this thing, it's going to improve the most? Because we think, if you kind of can put your physiology hat back on, going back to you know, way back to your, way back to your studies as a coach and athletes think about this the same way. They tend to think about what's the most trainable system. I have 10 hours per week. What's the thing that I can kind of train the most? Or what are the gains? Going back to your strength training days, right, are the gains that I can kind of like make the most? Is there any one out of those three that like fit that bill of hey, listen, this thing is the most adaptable system, so to speak?
Speaker 2:yep. So, based on the very scarce evidence from this study, the most gut gains that we get are pretty much first one is training, how you know the volume of food that your stomach can hold without you being uncomfortable. And the third one, which is pretty much absorption, so gastric emptying. Not much evidence as of now, because one it's hard to measure right. It's very invasive and I don't think athletes want tubes down their throat in studies.
Speaker 1:So it's interesting because you present this one thing of the most trainable thing is either the stomach handling larger volumes, or the absorption side of things. If we take a really simplistic view of this, the second thing that you mentioned, the absorption side, would probably make a bigger impact for performance than the former side, because it kind of doesn't matter if you have a lot, if you can tolerate, you know, a hundred hot dogs in your stomach, if you can't get those nutrients through the intestinal wall to to serve a purpose essentially. Yeah, how does that get teased out in the literature as well? Because those are two. We're kind of talking about two different things. We're talking about a comfort thing and then we're talking about actually delivering macronutrients on the second side of it so I guess it's how you view the impact of gut issues on actual performance, right?
Speaker 2:So one is if you don't get enough fuel, then you're going to bonk, then you're not going to perform well, right. But at the same time, if you actually get like really severe issues, when we're talking about the stomach side of things, that's mostly upper gut symptoms, so, for example, regurgitation, vomiting, that sort of stuff, that's also going to cost you a DNF, right?
Speaker 1:So in the early 2010s and he asked finishers and non-finishers of the Western States 100 in Rio do Lago what affected their performance. And GI distress comes to the top of the list, and we know that can be caused from a number of different things and a lot of times we tend to trivialize it as oh well, I just can't consume, I just don't have the capacity to consume more food and fluid. But in reality, there are also like downstream effects that need to be, quote-unquote, considered and trained for as well. We just don't have like the best, or at least at the time, we don't have like the best vocabulary to describe it as the way that I'm internalizing it.
Speaker 2:Yep, Yep. So if you want to read up more on, like that whole mechanism, it's very actually it's very detailed and it's called exercise induced gastrointestinal syndrome. It's a whole pathway of whether or not the function of your gut shuts down and also in terms of how your brain controls the gut. There are many factors.
Speaker 1:So let's kind of skip to what the interventions are, because people are going to want to know what do I actually do, and you already mentioned practice, your rest, race day, nutrition, and it's likely more complicated than that, where we need to start thinking about training your gut in the same way we think about training other aspects of our physiology from an overload standpoint. We overload the system. It then creates some sort of compensatory mechanisms that start to kick in so that the next time you have a similar or the same type of load, it has greater capacity to handle whatever that stress or strain actually is.
Speaker 2:Correct. So, I pretty much. I think of it as you know, when you're training and then you have harder sessions actually during training than the actual competition. That's how I think of it, as you know, when you're training and then you have harder sessions actually during training than the actual competition. That's how I think of it, because doing gut training sessions aren't at all pleasant.
Speaker 1:No, they're not, and not a lot of people. And once again, we work with athletes all the time and once again, my bias is kind of from a training standpoint, I'm always looking how do we maximize this component? No-transcript nutrition, although we could start there but, what are the intervention. What are like the interventions that have tried and what are the like? Can we synopsize the outcomes of those?
Speaker 2:so I think we go back to what the literature says. So the first time that this management strategy has been proposed is probably in the early 99 piece, and it was just termed as the gut being trained to cope with exercise, not specifically through nutrition, right, but anyway, there were a couple of review papers that were published in 2000s and that's where the proposed methods were actually outlined by people, however mostly citing animal evidence, or a lot of them were actually anecdotal from like these competitive eating competitions. So one is actually training with a high carbohydrate intake and that means your daily diet, which one study actually did, but then they didn't really measure gut symptoms. The other common thing that's proposed is training right after eating a meal, so training with a full stomach, and that's really is training right after eating a meal, so training with a full stomach, and that's really not something very new when you think about cyclists who are on rides right, they take a break, they eat their meals and then they go on right yeah, exactly that's something very new.
Speaker 2:The third one is what we call as a repetitive eating challenge, or pretty much training with high carbohydrates during exercise, and that means it's back-to-back sessions of this. The other two methods is pretty much training with a high volume of fluids, so a lot of water and or carbohydrate solutions. But those are some of the methods that were actually mentioned in these studies, but only three of those have studies to back them up.
Speaker 1:And what does that practically look like?
Speaker 2:Sorry, the last one is practicing race day nutrition.
Speaker 1:Yeah, no, we already went on that we think about the same day, I mean honestly. So we have a number of different nutritionists and registered dietitians that work on our high performance within our high performance program, specifically for elite athletes, and a lot of the times that's where they're starting, because it kind of accomplishes two things is one, they're practicing the race day nutrition. But two, that's a challenge in of itself because they're not taking in. Let's just say, their goal carbohydrate per hour range for a race would be 80 to 90 grams an hour. They're normally not doing that during training, so you get this like dual effect of overloading the GI system with their race day nutrition that they're actually practicing. Okay, let's get a little bit more detail on how to implement this with CTS coach and nutritionist Stephanie Howe.
Speaker 3:Those specific strategies we use for gut training are to one back it up all the way until before an athlete starts a training run and think about their pre-run breakfast and really dial in what they're going to have before they take off running, to mimic what they would have race day and playing around with the timing a little bit here too and thinking about what it's going to be like race day if it's a 4 am start. Obviously that's going to be different than if it's a 10 am start. So having the athlete both pick the type of food they want to eat and the time they want to eat before they go out and run, that's going to help get energy in their system but also prepare their gut for doing it on race day. And then during the training runs, we really want to identify the goal in terms of grams of carbohydrate per hour and the type that the athlete's going to be taking. And usually it depends on the athlete and what they've struggled with or what they've had success with in the past as to where we're going to start, but normally it's around 50 to 60 grams of carbohydrate per hour for the average person.
Speaker 3:If they've had issues in the past. We're going to start a little bit lower and try to get their gut a little happier, have them have a more positive experience and then kind of titrate it up, but start with the specific type. So if they want to use gels, we're going to use gels. If they want to use blocks, we're going to use blocks. And then just kind of figure out the timing of what that looks like every 20 or 30 minutes and dial that in in every single long run they do leading up to their race.
Speaker 1:What we're starting to see is a lot of athletes are actually moving beyond that. They're saying okay, if my target is X, we're just going to use 80 grams per hour just to make the number consistent. Not that should be the range for everybody, but if my target is 80 grams per hour, here's how I can make that more effective. I can make that more effective by introducing this intervention or that intervention that you had just mentioned. What does that look like? Practically Like you're consulting with an athlete and they say listen, I want to make this X grams of carbohydrates per hour more tolerable for longer periods of time, with less GI distress, and I want to absorb more of the carbohydrate more quickly. Practically, what do those interventions actually look like in the field?
Speaker 2:So in the field, if you are after greater absorption, the stimulus needs to be a little bit more chronic. So practicing race day nutrition whether that means for most athletes you know, during long runs that's when I actually target 80 grams that might not be the case. That can help you tolerate the larger volumes. But then if we are after making the transporters a little bit more efficient, that has to be a bit more of a chronic stimulus, which means that you might be trying to eat 80 grams of carbs even in your shorter sessions and easy runs, and it has to be a back-to-back session based on the evidence.
Speaker 1:I mean, it's almost like an endurance adaptation at that point, if I'm understanding what you're describing correctly, where we don't just train two or three times a week, we train six or seven times a week. Is that the frequency that you would be advocating for in terms of trying to create some of those initial adaptations?
Speaker 2:So the longest one was a two-week protocol which pretty much looked like five days straight, two days break, five days straight Not really feasible considering a normal endurance training program, right, because it's not every day that you do easy runs.
Speaker 2:So this follow-up study that we did, we tried seven days straight and when I put that into translational relevance, it's pretty much doable when you actually taper for a race, right, that's where you fit that in. So when you taper, you actually go on your easier runs and at the same time, another goal for you is pretty much load up on carbohydrates. And the problem with trying to define when these sessions should occur is one we don't know how long these effects last. So that's a key gap in knowledge. So if I'm just practicing race day nutrition every long run and then I stop my long runs two weeks out, I don't know whether I'll still be able to have those benefits come race day. That's a key thing that we don't know how long this adaptation lasts. And still, we're still kind of in the gray area on how much. How long is the duration of the protocol to be able to get these adaptations?
Speaker 1:So you already skipped ahead to my next two questions so you preemptively answered them with we kind of don't know, but I think you're kind of getting to like what most practitioners that I've been working with come to is just a reasonable, a reasonable extension of the research.
Speaker 1:Quickly do these adaptations come about and how quickly do they fade away? How transient are they in nature? And, interestingly enough and I don't know whether this is just like hive mind mentality coming through or whatever, but this two weeks ish type of timeframe tends to come through a lot when I actually consult with people and they all say that they all say kind of the exact same thing is like well, we don't know, but this is kind of what a little bit of what the literature teases out and a little bit of what we actually see in practice that you need roughly five days per week for two weeks to create some of these initial adaptations and you want to try to do that closer to the race as opposed to further away. It's not a chronic adaptation, which is kind of fools a lot of people because that's what we think about our traditional endurance adaptations is taking a long time to produce and then sticking around for a long period of time. This would be much more transient in nature.
Speaker 2:Yeah, that's correct. So I think that five days two days came from those original gut training studies. But a lot of the athletes, interestingly, in that study actually said that they had a hard time following that protocol. It's just not realistic. So really the next step for this sort of research is to go into the nuances of designing a feasible and realistic protocol within an endurance training program.
Speaker 1:Let's bring that to light, because a lot of athletes are thinking, yeah, this isn't very realistic for me on a 90 minute run to try to take in 150 grams of carbohydrates. There's a few pieces of this that we can kind of like that back and forth. But what do you hear from athletes in terms of, hey, this isn't realistic for me.
Speaker 2:Yeah, so for one thing cost right.
Speaker 1:Yeah, gels are expensive now. Like gels are like four bucks a pop right now. It's kind of crazy.
Speaker 2:Exactly so, especially with with athletes, and there are certain athletes who are very like, particular about I want to train with this, because this is what I want, this is what I'm going to use that phrase, so cost the logistics of things as well. I think sometimes you just want to go for a run and not worry about you know, ingesting so much carbs, but also trying to plan this out, thinking of your training. I think this is where coaches will help, because usually when you try to think about your fueling plan for a race, you want about three to four months. I'd say three to four months. Usually, when I take in athletes and coach them in terms of nutrition, I want at least 12 weeks out to think about everything and to lay out the plan. So I think that's the most challenging part in terms of translating these findings to actual real life scenario is the implementation part of it.
Speaker 1:Is the primary. So we've been thinking about gut training challenges from a minimum effective dose angle. What's the minimum amount of time and the minimum amount of frequency that it takes to produce the adaptation? And part of that you mentioned is just that people don't want to spend that much money on gels and it's like you just said, it's just inconvenient to want to take five gels on an hour and a half run. It just kind of gets old. But are there any other potential consequences for elongating that intervention? Meaning if you had an athlete and say I don't care, I have a sponsored athlete, I get all the nutrition product.
Speaker 3:I like taking, all taking all these.
Speaker 1:I like taking them in on runs. Is there any potential negative that you would and this is kind of going outside of the meta-analysis box a little bit, but it's people are going to be curious about it. Is there any potential negative for elongating that very specific intervention, let's say over months or an entire training cycle?
Speaker 2:yeah, well, we all know that, similar to training, nutrition needs to be periodized, right? So if you are doing this long term and you know that there are benefits to actually sometimes training with lower carbohydrates, that's potentially one thing that could be impacted by this.
Speaker 1:So just your body's more like reliance on that particular substrate is what you're kind of saying yeah, specifically for ultras, right.
Speaker 1:Yeah, I mean, we ultra runners tend to be really good fat burners. Just as a byproduct of their high training volumes and low training intensities the combination of those two, they tend to just metabolically be pretty decent fat burners. But I do foresee a world where the pendulum swings the other way and this is what I kind of get worried about with trends too. Right, Typically a trend is started with good and healthy intentions but being kind of more obsessive minded endurance athletes, they tend to take those trends to the extreme, because if a little bit is good, if a two week intervention is good, then a 20 week intervention is 10 times as good as the is the typical thought process and I'm trying I'm just trying to get some more mentality on what would be any potential negatives of doing something for so long, and this one once again kind of keeps coming up. As well as that, you just become over-reliant on that particular substrate and your fat burning capacity gets diminished to a point to where the positives, the negatives, outweigh the positives, Positive.
Speaker 2:Yep, I guess the other thing. So gut training is really a strategy that's meant for people who actually get gut issues. So I think that's also a measure or an outcome that once you see that you actually are doing a little bit better, it might be a signal for you to actually lay down or lay off the golf.
Speaker 1:Yeah, I mean, we all know the athletes that have, like, the iron gut right. They can kind of take anything and huge quantities and they don't need to quote, unquote, train it, and they're probably just as curious as would. Are these interventions any you know different for them? And kind of what you're saying is is yes, it's not. You already have that kind of innate part of your physiology baked in and it's not something that you either have to focus on as much or maybe not even focus on at all.
Speaker 2:Yep, that's true. So usually when we do assess athletes, that's one of the first things that we ask you actually get gut issues during exercise and is it recurrent or is it, like this, one fine thing during this race? Because that's going to differentiate our approach when it comes to fueling right so ultimately, if you say yes to gut issues, then okay, we kind of try to see, all right, what's going on with your fueling? What stuff are you eating right before a race or leading up into a long run?
Speaker 1:the other factors that might actually impact gut issues what you I think what you're trying to say is you're kind of like titrating this solution to an appropriate amount given the problem that the athlete is actually identifying, meaning there's not like a blanket solution and saying everybody has to do x?
Speaker 1:y or z you're looking at okay, this person has these types of issues, and then we're either focusing we're either putting a lot of focus on the interventions or a little bit of focus on the interventions based on the problem. That's kind of in front of you.
Speaker 2:Yes, and that pretty much is the comprehensive assessment of how their gut is doing during exercise.
Speaker 1:Yeah, exactly Because, like I said, I know people that for their entire careers have never had any GI distress at all.
Speaker 1:Yeah, lucky them, they do 100 grams carbohydrates per hour and they just kind of get it for whatever reason, and I'm sure we'll figure out at some point that that's an innate part of their physiology that has a lot of has a large genetic component to it. Uh, just like other aspects of our physiology that kind of that tend to be genetically predisposed, that tend to be genetically predisposed. Okay, one final break in the action. Let's go back to CTS coach and nutritionist Stephanie Howe and hear her thoughts on who are good candidates for gut training.
Speaker 3:I think all athletes can be candidates for gut training. The ones that are going to benefit most from it are the athletes who have struggled with their fueling in the past, maybe don't take in enough carbohydrate or they take in the wrong type of carbohydrate, and they need to really kind of strategically plan that and fix it so that they don't have issues race day. And then the other end of the spectrum is the athletes who really want to maximize the grams of carbohydrate per hour. So an athlete who's going to be trying to take in, let's say, 90, 100, maybe even 120 grams of carbohydrate an hour, they definitely need to use some gut training strategies so that they're able to, one, absorb that much carbohydrate and then, two, be able to use it without issues absorb that much carbohydrate and then to be able to use it without issues.
Speaker 1:I'm going to pivot a little bit, because we've been talking, naturally, about a lot about carbohydrate because it's in the news, it's at the forefront, you know everybody's trying to like push the envelope there, yeah, but that's not the only way that you can train the gut, and you've been at the forefront of a few studies now that looks at different using different types of macronutrients and different types of basic strategies to train the gut. I'm wondering if you could kind of give an overview of those and then we'll dive into what that actually looks like as well and why you might want to use that type of intervention versus an all-carbohydrate intervention.
Speaker 2:So, based on the available studies, the majority of them use carbohydrates and it does make sense, especially in endurance and ultra endurance, because that's the primary fuel that we want. Right? There is just one study that looked at carbohydrate with protein. However, it was only in Australian footy players, so it's a little bit more of a different exercise stress, right, it's a little bit more intermittent, so similar to like American football, I'd say, and you wouldn't expect a lot of gut issues to actually happen in that sort of scenario. So, in terms of endurance and ultra endurance, it's mostly carbohydrates.
Speaker 2:Some of the other things that have been observed were whether you use carbohydrate solutions. So one study actually looked at a non-repetitive protocol. So they just drank larger volumes of carbohydrate drinks in five repeated trials. So that's sort of more like similar to what you'll do when you practice your race day. Nutrition, right form of carbohydrates, whether you get it from gels or solids, and equally they improve gut symptoms, but in terms of absorption, it was only seen in the carbohydrate gels. So that shows you that the composition as well of what you intake also impacts those outcomes. And, interesting, if you actually put in a placebo, nothing happens. So even if you have that same volume, but there's no nutrient in it. You actually don't get improvements in gut symptoms.
Speaker 1:So you can't trick your body into. It is what you're trying to say no it's pretty smart. Well, I mean, it's important to know because, like placebo effect in a lot of compounds and especially medicine and things like that, is actually very real. But here you're actually saying there needs to be a stimulus of delivering the nutrients in order to see, in order to see the outcome that you actually want same thing.
Speaker 2:If you actually ask me, can I just drink a lot of water with drink a lot of water?
Speaker 1:yeah, no, and I can see I know athletes that that think that they're doing that because they've seen how, going back to the hot dog eating competition, they're going back to how joey chestnut would change train by drinking a whole lot of water to, you know, expand the of his stomach, which you're saying is that's a poor strategy for endurance, athletes.
Speaker 2:Yes.
Speaker 1:Okay, let's talk a little bit about composition.
Speaker 1:One of the limiting factors with a lot of athletes that we previously mentioned that want to train their gut and they find that there's some sort of barrier is just the cost of the products, and this is just a reality I work with.
Speaker 1:I'm very fortunate. I work with a lot of professional athletes that don't have this barrier in front of them because they have all their nutrition products provided for them. But I also work with a lot of real athletes that look at the proposition of spending 20 or $30 a run and do they want to fork over that kind of cost, and the solution that they've come back to is trying to formulate their own stuff, which you guys kind of did in one of your studies, and when I was reading it with my research assistant, fred, this is exactly what I was thinking is is the athletes that are at home that are trying to buy a lot of this stuff in bulk and trying to formulate and try to formulate their own gels, and I'm wondering if we can. I'll link that paper, I'll link that paper up, but I'm wondering if there's anything that we can kind of like take take from that that the athletes that are trying to do this at home can actually kind of like like learn from, because you guys were doing it for purpose.
Speaker 2:You were like building to suit, so to speak yeah, and so funny you mentioned that paper, because when that paper come out it was right about the time that you actually had that little expose on one of these gels.
Speaker 1:Oh funny.
Speaker 3:You're like oh perfect.
Speaker 2:And then your follow-up paper recently was a perfect like it was the same theme with this paper.
Speaker 1:Yeah, yeah.
Speaker 2:And so my idea behind that and even runner myself, I've always tried to reduce costs. Even runner myself, I've always tried to reduce costs and I know that these products are easy to make and you can make them using readily available products in your supermarket, right? So in this paper we sort of built a pathway it's sort of like a guide for athletes and practitioners to create their own gels if they think that the gels out there in the market do not suit their needs. So this is in terms of like taste, flavor or the blend of carbohydrates, or even like the actual texture. So in this way you can actually customize it to what you actually want.
Speaker 2:So in that pathway it's like a six-stage process, but you pretty much look at number one, especially the ingredients that you put in, and what is the goal with your own formulation? Do you want something that doesn't have a taste? Do you want something that's very sweet? Do you want something that's fruity or maybe salty? Yeah, so in that way you can actually make your own preferences and the in terms of the ingredients. So the gel that we made in that study, all the ingredients were bought from a grocery store, so it is actually possible amazing and this is what I tell people that you can actually mix it.
Speaker 2:If you have the time and patience to actually mix your own gels, you can absolutely do it and that will help you also train your gut if you plan to use that during races.
Speaker 1:And so I'll link that study up with that six stage process, and whether or not athletes want to go to their own grocery store to try to figure this out or not, it's kind of like up to them. But I guess what I'm trying to say is it is possible and you can actually build it to suit. There are also companies out there that are realizing this and almost acting as like an intermediate. I mean, the original company that did this they've been around for a long time before this got popular was Infinite, where you could go and you could kind of customize your own, you know, your own kind of whatever. Yeah, exactly, but since then I'm actually pulling it up on my phone right now, pulling it up on my phone right now. There's this company in the US that you might not, may or may not be familiar with, called bulk supplements, where you can buy all of these in bulk online and then put them together in your kitchen, kind of like, however you want to, yep.
Speaker 2:So all these sugar powders are available online and, mind you, if you actually make your own gels, it's probably going to cost maybe 20 cents a pop.
Speaker 1:It's crazy. It's crazy and I'd be remiss not to mention. I actually like the nutrition manufacturers. Like they're all my friends and you know I like their products and I think they do a good job. I think they do a good job with product formulation. But more and more and this has only been within the past like three or four years I'm running into more and more resistance against those because the consumption part in part, I guess, because the consumption rate is coming up so much and I'd be remiss to say that going to your local run store and buying a gel for three dollars is the only solution out there. There are also other solutions there.
Speaker 2:Exactly, and like these carbohydrate gels. You know, even before they came, like people were running and eating solid foods like right. They came like people were already running and eating solid foods like right, exactly. So it's not your only option and there are ways to like navigate this issue.
Speaker 1:When it comes to cost, like not all athletes are sponsored, unfortunately yeah, okay, let's bring it back full circle, because we started out with training the gut. Let's go back to training the gut. I kind of want to go. I kind of want to leave the listeners with a few steps that they can take away to try to implement this during their training. This podcast is going to come out in April.
Speaker 1:The racing season is starting to heat up. If we're looking at an intervention that's kind of meant to be close to the close to race time, this is the perfect time of year to try to release this to race time. This is the perfect time of year to try to release this. So can you leave the listeners with a just a very quick overview of if you want to do something like this? Here's where you'd stop. This is how much you would do and this is where you would end, so that they have some initial framework to go off of and then they can dive into this podcast and the resources that'll be linked up if they want to get more specific.
Speaker 2:Yeah, the first thing you ask yourself as a runner and endurance athlete is one whether you get gut issues. I'm not going to recommend gut training at all if you're not suffering from this and if yes, it might be worth looking at what sort of gut issues you get, because that's going to pinpoint what sort of intervention you want. For example, you get a lot more of belching or things coming up when you're running that sort of stuff. Well, that's going to target more of your upper gut. So that means that's where volume comes in. So how much you put in and we're trying to train that capacity of your stomach and that can be trained again based on protocols.
Speaker 2:It can be across repeated trials, so not back-to-back. So every long run you actually increase your volume in terms of carbohydrates and or fluids. If you're getting a little bit more of lower gut symptoms so lower bloating, flatulence, the dreaded run to find a port-a-loo, that sort of stuff well, that's going to be a little bit more of a different approach, because we think that a lot of this has something to do more with the absorption of carbohydrates, right? So in this scenario, you probably want a bit more of a stronger stimulus, meaning that the duration and the frequency of your gut training session should be a little bit longer. So back-to-back sessions, at least from what we see right now. 10 days works with carbohydrates.
Speaker 1:You're speaking my language on the back-to-back sessions because that's something I do, that from an interval protocol, and people used to criticize me a lot. Now we're seeing it more and more often, so we'll also advocate for back-to-back gut training sessions, just to keep the theme consistent.
Speaker 2:So, when you pinpoint this, also try to discuss as well with your coach how you're going to fit this into your program, because we don't want these sessions to be the reason why you don't get the training adaptations that you want from your race as well. So it's working hand-in-hand with your coach. Consider consulting a sports dietitian as well to help you try to plan out and even try to figure out which products, if or whether or not you want to make your own. So, yeah, there's a lot of help that you can seek, perfect.
Speaker 1:I think that's a brilliant place to stop the official like intellectual dialogue. I have one more question for you. This is not on the outline. I always like to surprise people kind of at the very end, just for a little bit of banter and for a little bit of fun. Where do you think that this ultimately goes?
Speaker 1:Because you and I we've been I've kind of tracked your, you know career and you know how long I've been coaching, for We've gone seemingly from 60 to 90 grams of carbohydrates per hour to 90 to 120 grams per hour. And I was seeing in the pro peloton where some of those athletes are pushing 140 and 150, yeah, 150, even 150, and I always like to, I always just like to. What's next? You know, I always like to try to figure that. What like? What do you think? What do you think it's like it doesn't have to be a rate? You know we've been kind of like focusing on that, but what do you think? What do you think it doesn't have to be a rate? You know we've been kind of like focusing on that, but what do you think is next in the whole evolution?
Speaker 2:here. I think it depends on the sport for one thing. So if we're just talking about running, I think that's going to cap out at around 120. I can't imagine people actually carrying that amount of carbohydrates, especially in road running, to be able to actually feasibly get that amount of carbohydrates. But again, with science it always swings from one side to the other. Maybe now we're in the high carbohydrate trend and who knows?
Speaker 1:later on, in 20 years, maybe fat will come back again. It will Trust me it will. I've seen this is my third swing of the pendulum Right Possibly it will.
Speaker 2:I've seen this is my third swing of the pendulum. So maybe people are going to be so good at handling carbohydrates and then you know something else within the body changes. Maybe it's your I don't know microbiome or whatever and then we start seeing things that are not good and then we point back oh, it's because we ate too much carbs. And then we go back straight to zero, which is I can see why it's frustrating for individuals to follow nutrition and science, but at the same time, it's also exciting, because there's always more questions to answer, right?
Speaker 1:yeah, no, it's great. I I appreciate you putting up with a little bit of the banter in the in, in the theory.
Speaker 2:Here, finally, is my question jason, my question to you is years back or now, that you've seen athletes get faster and faster?
Speaker 1:No, what you the first part of that cut out, you're going to repeat it again.
Speaker 2:Or have you the trend of athletes getting faster, that you see that 10 years or 20 years back, or is it now with the high carbohydrate?
Speaker 1:Well, I mean, somebody actually asked me this just the other day, so I've had a little bit of time to think about it, to think about it and I'm prefacing how, maybe how good this answer is going to be, with the fact that it's not quite going to be off the tip of my tongue. But athletes are always getting better across all facets, and athletes across all sports stick and ball sports, endurance sports and things like that and alongside that we always have technology to help us along the way. The shoe revolution was a big piece of technology. There's nutrition technology that comes along in cycling. We have, you know, technology that helps us analyze training better. We also have technology that helps kind of in real time, so to speak, perform at a higher level.
Speaker 1:All of those things are happening concurrently, all to the benefit of athletes and performances. So it's never just one thing, like a lot of people will say. Oh well, it's this quote unquote revolution. Sure, that might take a little bit of a little bit of a disproportionate amount of the spotlight at the time, based on everything else that's going on. But make no mistakes that this physical evolution and technological evolution has always happened in sports since sports have kind of been around and that's why you see the improvements. It's never linear, it's always in a stair-step type of fashion, but it's kind of always present. So I wouldn't chalk it up, and I would never chalk it up to just this or just that. Everything's happening concurrently, it's just a different proportions.
Speaker 2:Exactly Now, just to see you saying technology and development of evidence. I think the future really is actually going into more personalized nutrition. I think that's where it is like, where some people will be doing better with high carbohydrate and maybe some people will be doing better with high fat and maybe then by then we'll be able to have some objective measures and actually reliable measures of being able to say whether or not someone can purely fuel with x, y or z yeah, it means it's interesting.
Speaker 1:Now we're really going off the rails. It's really interesting that you say that because there have been any number of attempts at that personalization and you can look at the ways that we've tried to do that. It's been from tracking things, that are things metabolically that are happening, like the use of CGMs or even metabolic testing or even sweat sodium testing. That is a way of individualizing things. We can look at the genetic level and what an athlete might be more predisposed to in terms of higher volume, higher intensity, more frequency and things like that.
Speaker 1:Higher volume, higher intensity, more frequency and things like that there have been all these proposed mechanisms that certain genotypes are going to respond to certain types of workload or a frequency of workload differently, and then we get to the outcome piece of it, which is kind of what I rely on the most is you have an athlete do a certain thing and they respond to that certain thing better.
Speaker 1:That's a level of individualization as well. If you're looking at the training and you're looking at the interventions and you're putting it under a high level of scrutiny, you can individualize it in arrears, so to speak, after you've actually done the intervention. And I don't know which one of those is going to and there's probably a few more permutations that I'm not thinking of off the top of my head. I don't know like mix of those is going to kind of like dominate the landscape, just like the technological piece. We've seen the genetic piece start to try to get a foothold and it really didn't kind of like pan out. Some of the bio, some of the real-time bio monitoring has kind of come in fits and starts, so to speak, and you know, I just look at it as something to where I agree with you on the individual side of things. That's always what we're trying to do, but it's just how we go about doing and what tools we deploy within our arsenal of tools to actually figure that out.
Speaker 2:I see them as sprinkles honestly sprinkles on top of the cake. Your basics will always hold out, right yeah?
Speaker 1:exactly 100% percent. Awesome. Let's not go off the rails too much more. Although we could do this all day, maybe we'll bring you back and we'll just have a complete open conversation about gels. Oh, geez, and we'll do it Bring in Nick.
Speaker 1:Yeah, we'll do that. We'll bring in Nick, we'll bring in all the people who make the gels I mean, I know those quite well at this point and we can go over the hydrogels and the different types of fructose to glucose ratios and their claims. And then do you add sodium, do you add amino acids, or you could just go make your own grocery store stuff like you did. Links to everything is going to be in the show notes, but where can people go to find just more about you and the work that you're doing?
Speaker 2:I'm on Instagram, facebook and LinkedIn pretty much as Isabel Martinez. I'm not yet very active with social stuff because I'm currently writing my dissertation. It feels like an open marathon writing to think so I haven't really science calmed a lot of things, but I will get there once I finish this race.
Speaker 1:Well, we look forward to it. I look forward to seeing the finish line of that race kind of published. I can't wait to see more of your work because it's been just fantastic so far and we'll have to bring you back on the podcast to talk more practical stuff. Like I said, I've just really appreciated your work.
