I have IBS, better known as irritable bowel syndrome, or as my ex-brother in law used to call it, "I'll be stoppin'". For years I've struggled with finding foods that don't make me have to run to the bathroom. It was a struggle for me to complete even a 5 mile run without a pit stop. When I'm planning a run, I make sure that I run by at least one bathroom! You just never know when you have to make a stop. The guys at the Speedway near my house don't blink an eye when I run in to make a pit stop. So naturally, I buy all my gas there. Small price to pay, right? According to a recent article in Runner's World, I'm not alone. It is estimated that 30-50% of distance runners struggle with gastrointestinal issues at one time or another.
You've all seen this shot:
and hope that it never happens to you!
Three years ago, while training for the Chicago Marathon, I came to the realization that I needed to figure out what was going to make me have to stop stopping. My long runs were plagued with frequent pit stops. And as I continued to train, the number of stops increased as well. I always worried about making it to the next location where there was a bathroom. The final breaking point was when I ran a half marathon during my training and had to stop 3 times to use the porta-potty. Even the imodium I took prior to the race was no match for my intestines. The great long distance runner Bill Rodgers once said it best:
"More marathons are won or lost in the porta toilets than at the dinner table."
Ok, so even while I laugh about it, because let's face it, poop is funny, my IBS was really starting to get to me. I'm training for a marathon and I have to worry about my stomach? This is what is going to hold me back? REALLY?
I started to do my research on IBS. There are several types of IBS, constipation-type, diarrhea-type, and the mixed type where people have constipation but occasionally have giant blowouts of diarrhea. In the spirit of full disclosure, I have the diarrhea type. In a normal day, multiple trips to the bathroom are not uncommon for me. No one has figured out what actually causes IBS. I have my theories, and I do think our crappy American diet has a lot to do with it. Food additives and junk food cannot be what nature intended for us to eat. I spend a great deal of my day as a nurse practitioner talking to parents and their children about their bowel habits. It really is a huge issue for the majority of people. Some proposed causes include food intolerance, anxiety and depression, bacterial overgrowth, motility issues, genetics...pretty much anything can be blamed for IBS. Over the years, I have tried a variety of probiotics, thinking maybe it was a bacterial imbalance, but I never had a lot of luck. I read about a new antibiotic, rifaximin, which had been trialled and shown to be effective in patients with my type of IBS, and made an appointment to see my internist.
I love my internist, because she gets me. Instead of telling me to suck it up (like the GI specialist told me years ago), we talked about different options. She offered me one other option I hadn't considered, a drug that slows down the motility of the GI tract. Because there had been some issues with bowel obstruction with this drug, there was special paperwork she and I would have to complete should I choose to go this route. She was very positive about this drug, and had had several patients take it without problems. But after a lengthy discussion, we decided to first try the antibiotic rifaximin. I picked my prescription up and almost had a heart attack when I saw my copay...and what the med actually cost. But I was determined to feel better, and after about a week on the drug, I noticed a big difference. And who can put a price on that?
Because I knew the antibiotic would make me better but not last forever, I also began to evaluate my diet to see if there were any patterns to foods I was eating and subsequent pit stops. I was able to identify 2 culprits for sure: corn and anything that contained corn, including corn syrup and the evil high fructose corn syrup; and beef. I even further speculated that because cattle are corn fed, perhaps the cows' diet was affecting me! I tried grass fed beef with mixed results and eventually learned that even most grass fed cattle are "finished off" with corn before they go to market. Who knew? Anyways, once I became a label reader and eliminated those items from my diet, things continued to improve and I was able to run farther distances without those pesky bathroom stops. I have since tried reintroducing beef back into my diet and as long as I limit the frequency, I seem to be ok. But just recently, I ate some steak and that set me back for about a week. I was miserable. Lower fat cuts of beef seem to be much better for me, such as skirt steak and flank steak. Live and learn, right?
What about gels? I experimented with several different gels and learned that the ones that contain fructose, such as GU, are not an option for me. Fructose is a complex carbohydrate well known to cause GI issues in susceptible individuals. Interestingly, the combination of fructose and glucose seems to negate the GI problems associated with fructose alone in most people. But I stick with Clif Razz Gel, which contains cane sugar, for fueling during long distances. And water only. Gatorade is not my friend. No fancy fuels for this girl. I can drink Nuun, tho.
A few years ago, I was treated for Lyme disease, and because I know antibiotics can stir up trouble for me, I started taking the probiotic, Culturelle. I found that also seemed to help me with ongoing issues. So to this day, I continue to take it, once a day.
Ibuprofen (Motrin, Advil) has been implicated as a culprit in IBS. Several studies have shown ibuprofen to aggravate exercise induced GI injury and increased GI symptoms. After learning that, I kicked the habit of popping 3 ibuprofens for every ache and pain and just learned to tough it out. This also forces me to stretch and foam roll more, and that is a good thing.
Finally, prior to a race, I really simplify my diet. Lots of pasta and easy to digest foods. Nothing high in fiber. I didn't make all these changes right away. A lot of what I've learned is trial and error from running long distances over many years. But once I found what works, it was easy for me to incorporate these changes into my life. After all, it sure beats running to the bathroom all the time!
Oh and that Chicago Marathon? I had 99 problems but a potty stop wasn't one!