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  Last updated: 12/06/2009

Miscellaneous GI Questions

Acid Reflux

Q. I happened across your website "" while looking for some suggestions on my knees. I am 43 years old at 5'9'' tall weighing 200 pounds , I have been riding about three years just out and about with group rides and charity tours , I do not race. I will soon undergo the Nissen fundoplication for GERD and a hiatal hernia. Now this hernia has caused no little distress when part of my stomach gets in the way of breathing and heartbeat but details aside how do you think this stomach rearrangement will affect riding ? I have ridden over three thousand miles this year and am not the fastest and can normally ride at 13 to 17 mile per hour paces in rides up to 100 km. - TH

A.As riding can aggravate reflux in some, my guess is that it will cut down on your reflux while riding and hopefully any chest discomfort associated with that. I can't see where it would have any negative effect once you are over the efffects of surgery - only positives.

Abdominal Cramps

Q. I am 20 years old and, whilst I have always been reasonably fit, I have only been cycling seriously for 2 years. After a number of hard rides (c.2hrs) I have experienced painful stomach cramps, and diarrhoea. My suspicion was that these effects were the consequence of training hard on an over-full stomach. So I try now to use energy drinks as opposed to taking on board large amounts of solid food before training. This has helped. However, I take part in a chain-gang one evening a week for about 1hr 35mins - at 6.45pm - and despite not really eating since c. 1pm, I still frequently experience stomach pains and diarrhoea.

A. Abdominal cramps are usually the result of:

I suspect your problem is the second - Pushing beyond your training limits - your body saying "Hey, slow down". So I'd try slowing down and riding a bit closer to your level of exertion when you are training/riding alone without problems.


Q.The only time I have for my training rides is at 5:30 a.m. (6:30 a.m. on Sat and Sun). These are approximately 80 minute rides (75-85% max. heart rate), plus one long ride of 3-5 hours, a light day and a complete rest day off the bike. I usually eat a bowl of granola and a piece of fruit. This leads me to my problem. Eating and then exercising seems to constipate me. I go 2-3 days without a bowel movement (often needing a dose of mineral oil at night to get things going the next day).

A.I'm not sure why eating before riding would make you constipated. Generally pushing exercise regimens results in diarrhea as a side effect. Dehydration from inadequate fluid replacement might do so. More likely is getting out of the routine of a BM in the AM because you are on the bike which tends to suppresses the normal morning urge. A little MOM every day won't hurt - or mineral oil.

Gastric Bypass Surgery

Q. I just completed my first 100K ride in Wichita Falls this past weekend and I'm also thinking I experienced my first "bonk" on Tuesday night which for me included a trip to the ER for IV fluid replacement with chills and nausea and muscle cramping about 5 hours after I'd done a 2 hour ride in 90 degree or so heat. My problem is this: I've had gastric bypass surgery and I have a stomach capacity of 3-4 oz. I find it's easy to take in plenty of fluids but I can't take in more than 8-10 sugar grams at a time because of the bypass which dumps sugar directly into my intestine and then makes me ill. This makes it difficult to carb load or replace carbs on the ride with the traditional sorts of supplements. I can do the bananas in small qtys and for training that's been sufficient but I'm starting to do longer events. Do you have any recommended supplements or suggestions for me?

A. First, the ER episode sounds more like getting behind on fluids than the bonk. But here are a couple thoughts re energy replacement (which is the bonk for sure).

Crohn's Disease

Q. After 15 years of being "disease free" I recently learned my Crohn's has returned. In 1993 after nearly 10 years with the disease I had a resection and was doing okay until this year. During my post surgery years (med free) I became quite involved with road and mountain bike racing (raced bmx as a kid). Today at 37 I've achieved a Category 2 status on the road and race Expert/Vet Expert on the mountain bike. Currently train 500-550 hours year with about 90% bike and 10% gym. Have always had iron and/or absorption issues which I been able to manage through trial and error. However with the return of active disease I seem to have lost a fair amount of power especially in the more climbing based races. I'm just plain zapped when heading up the climbs. The power loss is dramatic compared to last season. Anyway am currently tapering off Entocort and my GI doc strongly recommends Pantasa as a daily preventative treatment. Am curious as to what I can begin doing to regain some of my strength, weights, low cadence work or combination of both. Have you dealt with a lot of endurance athletes with Crohn's if so what have you typically seen that seems to work.

A. I don't have an answer to your basic question, but a few ideas. I presume they took out your terminal ileum (last part of the small bowel)with your surgery? Except for vitamin B12, you should absorb most everything else well. Now when additional small bowel gets inflamed, that could change. If absorption is the issue, using more elemental supplements such as Ensure and Sustacal that are absorbed higher in the small bowel might give you a boost. I assume you are on a good multivitamin?? If not, I'd add that into the mix.

My guess is that the lack of oomph is the body's recognition of the inflammatory response that is Crohn's. Getting it under control should be the basic strategy. There are a number of newer drugs and biologics out there, but pentasa and entocort would be the place to start. Both should have minimal if any effect on your physical endurance.

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