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Form & Fitness Q & A

Got a question about fitness, training, recovery from injury or a related subject? Drop us a line at Please include as much information about yourself as possible, including your age, sex, and type of racing or riding. Due to the volume of questions we receive, we regret that we are unable to answer them all.

The Cyclingnews form & fitness panel

Carrie Cheadle, MA ( is a Sports Psychology consultant who has dedicated her career to helping athletes of all ages and abilities perform to their potential. Carrie specialises in working with cyclists, in disciplines ranging from track racing to mountain biking. She holds a bachelors degree in Psychology from Sonoma State University as well as a masters degree in Sport Psychology from John F. Kennedy University.

Dave Palese ( is a USA Cycling licensed coach and masters' class road racer with 16 years' race experience. He coaches racers and riders of all abilities from his home in southern Maine, USA, where he lives with his wife Sheryl, daughter Molly, and two cats, Miranda and Mu-Mu.

Kelby Bethards, MD received a Bachelor of Science in Electrical Engineering from Iowa State University (1994) before obtaining an M.D. from the University of Iowa College of Medicine in 2000. Has been a racing cyclist 'on and off' for 20 years, and when time allows, he races Cat 3 and 35+. He is a team physician for two local Ft Collins, CO, teams, and currently works Family Practice in multiple settings: rural, urgent care, inpatient and the like.

Fiona Lockhart ( is a USA Cycling Expert Coach, and holds certifications from USA Weightlifting (Sports Performance Coach), the National Strength and Conditioning Association (Certified Strength and Conditioning Coach), and the National Academy for Sports Nutrition (Primary Sports Nutritionist). She is the Sports Science Editor for Carmichael Training Systems, and has been working in the strength and conditioning and endurance sports fields for over 10 years; she's also a competitive mountain biker.

Eddie Monnier ( is a USA Cycling certified Elite Coach and a Category II racer. He holds undergraduate degrees in anthropology (with departmental honors) and philosophy from Emory University and an MBA from The Wharton School of Business.

Eddie is a proponent of training with power. He coaches cyclists (track, road and mountain bike) of all abilities and with wide ranging goals (with and without power meters). He uses internet tools to coach riders from any geography.

David Fleckenstein, MPT ( is a physical therapist practicing in Boise, ID. His clients have included World and U.S. champions, Olympic athletes and numerous professional athletes. He received his B.S. in Biology/Genetics from Penn State and his Master's degree in Physical Therapy from Emory University. He specializes in manual medicine treatment and specific retraining of spine and joint stabilization musculature. He is a former Cat I road racer and Expert mountain biker.

Since 1986 Steve Hogg ( has owned and operated Pedal Pushers, a cycle shop specialising in rider positioning and custom bicycles. In that time he has positioned riders from all cycling disciplines and of all levels of ability with every concievable cycling problem.They include World and National champions at one end of the performance spectrum to amputees and people with disabilities at the other end.

Current riders that Steve has positioned include Davitamon-Lotto's Nick Gates, Discovery's Hayden Roulston, National Road Series champion, Jessica Ridder and National and State Time Trial champion, Peter Milostic.

Pamela Hinton has a bachelor's degree in Molecular Biology and a doctoral degree in Nutritional Sciences, both from the University of Wisconsin-Madison. She did postdoctoral training at Cornell University and is now an assistant professor of Nutritional Sciences at the University of Missouri-Columbia where she studies the effects of iron deficiency on adaptations to endurance training and the consequences of exercise-associated changes in menstrual function on bone health.

Pam was an All-American in track while at the UW. She started cycling competitively in 2003 and is the defending Missouri State Road Champion. Pam writes a nutrition column for Giana Roberge's Team Speed Queen Newsletter.

Dario Fredrick ( is an exercise physiologist and head coach for Whole Athlete™. He is a former category 1 & semi-pro MTB racer. Dario holds a masters degree in exercise science and a bachelors in sport psychology.

Scott Saifer ( has a Masters Degree in exercise physiology and sports psychology and has personally coached over 300 athletes of all levels in his 10 years of coaching with Wenzel Coaching.

Kendra Wenzel ( is a head coach with Wenzel Coaching with 17 years of racing and coaching experience and is coauthor of the book Bike Racing 101.

Richard Stern ( is Head Coach of Richard Stern Training, a Level 3 Coach with the Association of British Cycling Coaches, a Sports Scientist, and a writer. He has been professionally coaching cyclists and triathletes since 1998 at all levels from professional to recreational. He is a leading expert in coaching with power output and all power meters. Richard has been a competitive cyclist for 20 years

Andy Bloomer ( is an Associate Coach and sport scientist with Richard Stern Training. He is a member of the Association of British Cycling Coaches (ABCC) and a member of the British Association of Sport and Exercise Sciences (BASES). In his role as Exercise Physiologist at Staffordshire University Sports Performance Centre, he has conducted physiological testing and offered training and coaching advice to athletes from all sports for the past 4 years. Andy has been a competitive cyclist for many years.

Kim Morrow ( has competed as a Professional Cyclist and Triathlete, is a certified USA Cycling Elite Coach, a 4-time U.S. Masters National Road Race Champion, and a Fitness Professional.

Her coaching group, eliteFITcoach, is based out of the Southeastern United States, although they coach athletes across North America. Kim also owns, a resource for cyclists, multisport athletes & endurance coaches around the globe, specializing in helping cycling and multisport athletes find a coach.

Advice presented in Cyclingnews' fitness pages is provided for educational purposes only and is not intended to be specific advice for individual athletes. If you follow the educational information found on Cyclingnews, you do so at your own risk. You should consult with your physician before beginning any exercise program.

Fitness questions and answers for June 20, 2005

Eating after training
Herniated Disc
Chills in the summer
Breathing Question
Powercranks mechanics
More hyperthyroid explanation
Quad pull
Ozone and Training
Celiac cyclist

Eating after training


I have a question on how many calories I should be eating directly after training. I typically train 1 1/2 hrs in the morning before work, and according to my polar watch, I am burning approximately 1500 calories. I usually drink 1 to 1 1/2 bottles (180 calories) of a energy drink during the ride, and once I am home I usually have a bowl of muesli with a banana (approximately 350 calories).

I then eat again 1.5 - 2 hours later, either an energy bar or more fruit. It usually takes me until mid-afternoon to replace the 1500 calories I have used in the morning's training session. I am taking too long to replace the calories, or is enough that I have had a high carb meal within an hour of the training session? If I do need to replace the used calories more quickly, do you have any suggestions as to the types/quantity of food to be consumed for the first 1 - 2 meals after training? Thanks.


Pam Hinton Replies


Post-ride nutrition is an important part of the recovery process, but is easily overlooked. Remember that not all of energy that you used during your ride came from glycogen or blood glucose. Depending on the intensity of your ride, approximately 20-40% of the energy will come from stored body fat. What you want to focus on is replenishing the carbohydrate that you used so that you can restock your glycogen stores. The optimal way to do this is to consume 1.5gm carbohydrate per kg of body weight within 30 minutes after exercise and again every two hours for 4-6 hours.

Carbohydrates that are easily digested and absorbed, ie, high glycemic index, will allow for rapid repletion of muscle and liver glycogen. Exercise increases the rate of protein breakdown and synthesis in skeletal muscle and, with adequate nutrition, it will have an anabolic effect on skeletal muscle. Carbohydrate consumed post-exercise is beneficial because it reduces the rate of protein degradation. However, to increase protein synthesis and achieve a net increase in muscle mass, it is important to consume protein after exercise. Studies have shown that consuming about 0.2gm of protein per kg of body weight per hour during the first 2-3 hours post exercise results in net protein synthesis. So, if we do the math, you are consuming approximately 70gm of carbohydrate in the muesli and banana immediately after your ride and another 50gm in the energy bar a couple of hours later. I suggest you eat an additional high carbohydrate snack two hours later.

Assuming you weight about 70 kg, you probably would benefit from some additional protein. If you put one cup of milk on your muesli, you are getting about 7gm of protein, which is only one half of the recommendation. If your snack is an energy bar, you may get some protein. If you eat fruit, you need to eat some protein along with it - yogurt, cheese, nuts, or nut butters would be good choices. With a little tweaking, you will have your post-ride nutrition perfected. Take care.

Herniated Disc

Hi there I have been diagnosed with 2 herniated disc between 4 and 5 , 5 and 6. I have been cycling for 10 years now and have had no problems until last year when this happened. I took some time off the bike and did some swimming over the winter to try to strengthen the back as well as other exercises, but nothing seem to be working and is only getting worse. Now my problem is that I live in Japan and am finding it hard to get a good physio so I need to do things myself, can you suggest what would be best to do? I'm 173cm tall and weigh 68kg I do about 10 races a year, as they are expensive over here, I don't know what category I would be in I usually race age group, I'm 32 years old. Thanks for your time.

Terry Colbert

Kelby Bethards Replies


Without looking at you, I can't be entirely accurate...but, another thing to consider is to make sure you develop strong enough abdominal muscles. This may be oversimplifying your problem. However a lot of cyclists develop very strong back muscles - it's the nature of the sport - but not strong enough abs. These compensate for the paraspinous muscle tightness and keep your spine in a more anatomic position...thus reducing stress and strain on the spine and disks.

Chills in the summer

Last summer while riding I would get chills a lot. I wasn't cold but I would get chill bumps on my legs and arms. This was a pretty common thing to happen. I would usually just slow down and wait for them to finish and then finish the ride. Last Saturday it started happening again.

Last summer I would wear my camelback (72 oz) and take a large polar water bottle with Accelerade mixed w/ water. My fear was to be without I always had plenty of water with me. I have started using just water bottles. This year I have changed to Hammer Heed (1.5 scoops) and Hammer Endurolytes (1-2 scoops). Last Saturday at Roadkill Rally I took a large polar bottle w/ drink mix (Heed drink mix) in one, one large polar w/ Hammer Endurolytes and one another small bottle w/ Hammer Endurolytes. It was a 60 mile ride and I stopped and got water at a rest stop (filled my small bottle). By the end of the ride I had consumed all the bottles plus the water from the rest stop. I started getting the chills about 1.5 hours into the ride. During this time I was riding as hard as I could. I was trying to stay with the lead group and did so for awhile. When I got dropped I still tried to keep riding hard. The ride took us 3.5 hrs. The chills seemed to come while I was trying to go up some of the hills.

I drink enough water during the day. I have an office job and usually consume approx 48 oz of water there. I drink water or chocolate milk in the mornings, and drink water in the evenings. I am 5' 5" and weigh 123 lbs. During the summer I usually ride about 10 hours per week.

Anyone have any knowledge of this problem or point me in the right direction. Thanks!


Pam Hinton Replies

Hi Leah,

You have discovered the importance of getting fluid and electrolytes into your blood and not just into your body. Despite your valiant attempts to replenish the water and sodium lost through sweat, you both seem to have been afflicted by dehydration and exertional heat illness. You describe the classic symptoms: chills, cessation of sweating, nausea and bloating. There has been quite a lot of research done to determine how to optimize fluid absorption during exercise and to reduce the risk of dehydration. What you drink, how much you drink and how often you drink it, all affect your body's ability to absorb fluid.

Ideally, you want to consume enough fluid to replace what is lost in sweat and urine in order to prevent dehydration. This requires that you drink early and often. You need to drink early in the ride, because dehydration slows gastric emptying which then exacerbates the dehydration. You need to drink often in order to keep up with the losses. Fluid needs will vary with individual sweat rates, degree of heat acclimatization, and environmental conditions, but the general recommendation is that athletes consume 8-12 ounces every 15-20 minutes during exercise.

Those of us who live in climates where are there are significant seasonal changes in temperature have to acclimatize to the heat every summer. During the first week of warmer weather, you will sweat more on a given ride than you would when the temperature is mild. As you acclimate, the sweat rate increases so your body cools more readily. The composition of your sweat also changes. As you spend more time in warm temperatures, the amount of sodium in sweat decreases. As a result, we are not as susceptible to dehydration and heat exhaustion after 10-14 days in the heat. The composition of the beverage that you consume while riding also will affect the rate of fluid absorption. Drinks that are 6-8% carbohydrate will be absorbed most rapidly, while allowing adequate carbohydrate to be consumed in a reasonable volume, ie, 1 litre of a 6% carbohydrate solution consumed in one hour would provide 60 g of carbohydrate per hour.

Beverages containing glucose, sucrose, and glucose polymers are preferable to those containing exclusively fructose or those with a fructose concentration greater than 2-3%. The downside of fructose is that the absorption rate is slower and the fructose that lingers in the intestine may cause gastrointestinal distress. (More stops at the gas station, if you know what I mean). When riding for extended periods of time, especially in hot and humid conditions, it is important to drink a beverage that includes some sodium (0.5-0.7 g sodium per liter). The sodium increases voluntary fluid intake and reduced the risk of hyponatremia.

Give your body time to adjust to the heat. Each of you were putting in a hard effort (race or trying to keep up with the guys) when you got into trouble. After riding a couple of weeks in the warmer temperatures, you should be ready to put the hammer down again--as long as you keep hydrating.

Breathing Question

A question for Kelby Bethards regarding your response to Vic on breathing.

You suggested the possibility that he may have experienced exercise induced asthma. I experience, probably most noticeably in climbs but also at times in hard efforts, an inability to breathe that I simply cannot explain. If one is experiencing exercise induced asthma, how is that determined and how is it treated? Thanks.


Cookeville, Tn USA

Kelby Bethards Replies


In order to best determine if you are having bronchospasm, it may be difficult to 100% know if it only happens on the climbs.

One way to actually test this out is to see your MD, and get from him/her a peak flow metre. Looks like a plastic cone, like an old days rain meter. Explain to your doc what you are up too. Otherwise you may be able to get a peak flow meter from the drug store. This way this works is to measure your highest air flow rate you can produce. Do it 3 times and keep track of the values...they should be all about the same range. The best way to do it is to completely exhale, as much as you can, then take a deep breath and blow HARD. It doesn't measure how long you can exhale, just the force of which you can exhale.

Why is this important you may ask? Well, with bronchospasm (Exercise induced asthma), will limit your ability to do this well. So, measure your peak flow while you feel "fine". Then, you could take it in your jersey pocket (it is small enough) to the climbs in question and use it again. If your peak flows have not changed, then I would say you do not have exercise induced asthma and it's more of a conditioning problem.

If it is EIA, then there are many meds used to treat it. I have had the best luck treating EIA with just the simple Albuterol inhaler, but also with Singulair (pills) and with other types of inhalers..that part is sort of trial and error. A lot of the physicians I know start with the albuterol inhaler, but Singulair real close behind in my practice (especially if there is a seasonal allergy problem at the same time).

Powercranks mechanics

The last two posts (May 23 and June 6) on Powercranks were interesting. I bought Powercranks (PCs) a little more than a month ago, and am using them full time on a Cardgirus trainer and a road bike. I have about 24 workouts on them and they occupy my thoughts. The experience has been mentally and physically exhausting and fascinating all at once (the body as experiment).

The issue of "under-recruitment" of glutes and quad requires more explanation. The perception of under-recruitment has a basis in fact. When you pedal with PCs at low power (yawn), most of the work being done is lifting your leg on the pedal stroke recovery. Once lifted, you conceptually are just "tossing" your leg back onto the pedal for the downstroke. There really isn't much actual pushing you have to do. Gravity does the work.

I wandered around the house and found a chair (actually the toilet) where in a sitting position, my thighs and arms were in a position similar to on the bike (at the top of the pedal stroke). I put a scale under my feet and tried to weight my hands (on a stool in front) and butt like it feels on the bike. Not scientific or particularly repeatable, but good enough for conceptualization. I'm 186 cm and 75 kg, mostly leg and thigh, and it appears each leg is about 14-15 kg. That's the equivalent of ~250W just to lift the leg. There's a lot of simplification here but go with the concept.

Once you exceed your "weighted power", then you become aware of normal pushing down on the pedals...except of course you don't lift the upstroke leg with the leg that's on the downstroke. While I suffer at a measly 200W to get my cadence up, it really isn't any harder to pedal at 300-325W (more like I used to). The upstroke power doesn't change (lifting your leg is lifting your leg), but the downstroke power increases and, voila, no more under-recruitment.

This also explains my initial PC impression that I had to dial up the power on the Cardgirus to pedal the damn things at all. On my first PC workouts, I was just trying to spin (easier than recovery), but my legs weren't used to the "opposite logic" of working on the upstroke and basically coasting on the downstroke (letting gravity to its thing). On normal cranks, when you're just spinning/coasting, it's clear to me we're significantly "back-weighting" the upstroke. The downstroke leg is pushing harder than it needs to, but since the total demand is very low, you never notice.

I don't know yet if I'm actually going to be better than before as measured on the Cardgirus (my aerobics have taken a beating because of reduced volume), but I'm game to try and I'm having a lot of [painful] fun to boot.

Darrel Stickler

San Mateo, CA

Scott Saifer Replies

Hi Darrel,

I like your analysis, particularly your calculation that simply getting the weight off the back pedal and dropping it on the front pedal gives you somewhere around 250 Watts. That certainly explains why riders who spin smoothly with an unweighted rear pedal outride those who have yet to achieve that goal, and also why simply training in a particular power-zone doesn't mean that you are training to produce that level of power in an optimal way.

More hyperthyroid explanation

This is in relation to why someone with thyroid problems will not be a good racing cyclist.

I am a cat 4 masters 35+ racer from New England who was diagnosed with graves in 1999. In 2002 they performed radiation treatment to knock down my T gland; the doctor advised me I needed to do a lot of vigorous exercise. I have been racing since; admittedly it took a long time to get back in shape, but I'm doing ok in the cat 4 races and training races and am starting to be able to finish the (much) harder masters 35+ races with the field. So why is it that someone with Graves won't do well in cycling? I can ride 5-6 hours a day no problem, etc. I ride 15 hours a week and commute to and from work and race 2-3 times a week from March through December. Admittedly I don't have a sprint, but I thought that was because I don't train much for sprinting - I'm more interested in personal bests in stage races like the Longsjo and Green Mountain. Please let me know as you have really whetted my curiosity.

Chris Rehm

Kelby Bethards Replies


I will include an article about hyperthyroidism, but I am sure you have read a bunch about it already. It may help explain some of my brief 'monkey brained' answers.

Graves Disease usually starts out as a hyperthyroid problem, that can either cause the thyroid to poop out or needs treatment to "throttle it back". In either case, many times people become hypothyroid (low thyroid levels, high TSH).

SO, a person with TREATED thyroid problems should be a fine cyclist. Untreated thyroid troubles on the other hand could limit ones full capabilities. HOW? Well, let me try to tell you. The way I think about to simplify it for myself is as follow: I think of the thyroid as the energy regulator for the body - like a carburetor for a car - if it is TOO HIGH (high T3, T4 : Low TSH) its like a car idling at 2500 rpm all the time, your body would be burning energy reserves just sitting around, causing fatigue, heat intolerance, weight loss etc because the body's metabolism is running way "too high", and burning up more energy for everything than it should.

On the flip side: If you have hypothyroidism (low T3, T4 : High TSH), it is sort of the opposite. Now the carburetor can't hit redline and it's idling too low, the opposite symptoms ensue......wt gain, fatigue (excessive sleepiness), hair loss (all you bald guys don't get to use this as an excuse), even depression, cold intolerance (when one shouldn't be cold). Low thyroid causes the body to not use the energy stores or metabolize efficiently at all, allowing a far less than maximal performance.

THE GOOD NEWS: As tricky and intricate as the thyroid hormone levels are to understand, the treatments we have are pretty good and getting people back to "normal". Once treated, the body can do what it needs to. As far as your sprint goes, that might not have anything to do with your thyroid. As you mentioned, it may be your physiology or training.


Firstly, let me say thanks for all the advice you have all been giving to us poor humans trying to beat Lance and company. My question is simple, but I´ve been given so many answers that I´m confused - what is the negative effect of alcohol on cyclists in training? Thanks in advance.



Kelby Bethards Replies


The quick and simple answer to your question has 2 parts:

1. Alcohol dehydrates us. How? By acting on the "brain center" (turns off ADH: Anti-Diuretic Hormone, which tells our kidneys to retain water) to cause a diuresis (excess urination) even though we don't need to and it dumps a lot of water from our blood volume...thus urine is clear when imbibing lots of alcohol.

2. Alcohol is broken down to an aldehyde byproduct which is a sort of toxin to our system, making the body perform at a less than desirable level.

Pam Hinton Replies

Hello Valdes,

I wish I could give you a simple answer, but there just isn't one. The effects of alcohol on an athlete's training will depend on how much they consume and when. Having a beer or glass of wine at dinner isn't going to adversely affect your training. Consuming large quantities of alcohol will hurt your performance--especially if you are imbibing less than 24 hours before your race or if you don't consume adequate carbohydrate.

That's the short answer, now here are the details…when ethanol is metabolized in the liver, it forms acetate and acetaldehyde. ATP can be made from acetate using the metabolic pathway by which ATP is made from fat. Acetate (like fat) cannot be used to make glucose, so it cannot be used to replenish glycogen stores. So, as long as you consume adequate carbohydrate with your beer, you are still going to replenish your muscle glycogen. This was shown in a study of well-trained cyclists who exercised for two hours to deplete their glycogen stores and then consumed one of three test meals to look at the effects of alcohol ingestion on glycogen synthesis in muscle.

The three test meals were: carbohydrate (CHO), providing 7gm CHO and 24 kcal per kg of body weight; alcohol (A), providing 1gm CHO, 1.5 gm alcohol and 24 kcal per kg body weight; and carbohydrate + alcohol (CHO+A), providing 7gm CHO, 1.5gm alcohol, and 34 kcal per kg body weight. The alcohol, equivalent to about 10 drinks, was consumed in the first three hours after exercise. Muscle biopsies of the quad were taken 8 and 24 hours after the subjects finished exercising.

Although both groups that consumed alcohol had lower blood glucose levels - at 8 and 24 hours - than the CHO group, muscle glycogen was lower only in the A group. So moderate amounts of alcohol that are metabolized before you go out for a training ride or race, are not going to hurt your fitness.

Trying to train with alcohol on board is another matter. The acute effects of alcohol ingestion on performance tend to be negative and are dose-dependent. Psychomotor function is impaired and small to moderate doses of alcohol (2-4 ounces of alcohol): slow reaction time; interfere with eye-hand coordination, accuracy and balance; and make performing gross motor skills more difficult. Alcohol causes vasodilation of blood vessels and loss of body heat, increasing the risk of hypothermia when exercising in the cold. Another reason not to drink and ride is that alcohol lowers blood glucose and decreases glucose uptake by skeletal muscle, which means you're more likely to bonk. Take care.

Quad pull

I just pulled the interior part of my right quad muscle about 24 hours ago. It's very tender to the touch and limits how far I can stretch my quad when walking. I've never had a muscle pull like this before. My question is, I have a 24 hour mtb. race in 6 days. Will I have enough time to recover and ride this race? I'm 36, and I'm in good shape. I was planning to take this week off anyway, do you think this is the right course of action? And what could I do to help speed up the recovery? Thank you.


Kelby Bethards Replies


See what the other panelists suggest, but you may not be ready for the mtn bike race in 6 days. These "pulls" can take a while to heal, sometimes weeks and weeks. I would definitely suggest rest. I would also suggest anti-inflammatories...such as ibuprofen 600 mg, 3 times a day for the next 10 days straight, pain or no pain.

Do not over stretch it right now...give it a few days to heal. Then you can get back on your bike and just pedal around, see how it feels. If it hurts quite a bit, I hate to say this, but you may want to skip the race…for fear of doing more damage to that muscle group, causing a longer recovery and the possibility of more chronic problems.

Ozone and Training

Not only is it finally hot in Phoenix, but we are getting the summer Ozone Alerts. These alerts state that exercising during times of high ozone may cause long term lung damage. What is your take on this; is it safe to train or just do maintenance miles?

Kevin Lockart

Scott Saifer Replies

Hi Kevin,

I'm not the world's leading expert on this topic, but I did once participate in an experiment that involved doing very low intensity exercise for three hours in a gas chamber with ozone levels that corresponded to what the air-quality measuring folks call moderately high concentrations. By the end of two hours I had lost half my usable lung volume and couldn't take a deep breath without coughing. By the end of the third hour I couldn't take anything deeper than a normal breath without coughing. (By the way, this was a 'double blind' study in which I rode in normal air on one day and ozone air another day. There was no question which was which).

I don't know about permanent lung damage, but I do know that it took a week for my lungs to feel normal again. I'd suggest following the standard advice which says avoid times and places of peak ozone concentrations. Train early in the morning before traffic time, and train beyond the edge of town in the upwind direction if possible.

Celiac cyclist


I am a 36 years old male and have been cycling pretty much my whole life. I started racing BMX as a teenager, then Cross-Country mountain bikes in 1991, Road in 1997 and Cyclo-cross and Track in the last few years. 2.5 years ago I was diagnosed with Celiac disease. I cannot find any information in regards to the disease and endurance sports.

Since being diagnosed and following a very strict gluten-free diet, my recovery has improved dramatically, but I still seem to suffer towards the end of long races.

Any information in regards to athletes with this disease would be much
appreciated. Thanks.

Michael LeBlanc

Pam Hinton Replies

Hi Michael,

I am assuming that by "suffer at the end of the race" you mean that you are experiencing gastrointestinal distress and, as a result, are not getting enough fluid, sodium, and carbohydrates.

Celiac disease (gluten-induced enteropathy) is caused by ingestion of gluten, a protein found in wheat, barley, and rye. In affected individuals, gluten is toxic to the cells that line the intestine. Over time, consumption of gluten results in loss of the absorptive cells that line the wall of the intestine and a decrease in the activity of the digestive enzymes in the cells that remain. As a result, an individual with Celiac disease will lose the ability to absorb nutrients and weight loss will result.

The treatment for Celiac disease is a gluten-free diet, and as you mention, the intestine will recover and the symptoms diminish if the diet is followed strictly. In your case, even though your symptoms are markedly improved, you may still have a decreased ability to digest and absorb nutrients. The disaccharide (two sugars) sucrose is digested by the absorptive cells of the small intestine into fructose and glucose. If the sucrose cannot be broken down, it will not be absorbed and will remain in your intestine. Sugars that remain in your gut cause gastrointestinal distress and do nothing to increase your blood glucose concentration. I recommend that you drink a sports beverage that provides carbohydrate in the form of glucose, which requires no digestion.

Fructose also may be problematic because it is absorbed relatively slowly. Avoid hitting your gut with a large chunk of carbohydrate all at once, such as could happen with ingestion of carbohydrate gels. Instead, sip from your bottle frequently to lessen the amount that has to be absorbed. After a while this might even become second nature. The celiac disease makes the cells of your intestine more porous and likely to lose potassium and other electrolytes. So be sure to include those in your sports drink as well. Take care.

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