No one likes a stomach bug, least of all an athlete motivated to train or getting ready for an upcoming event. Whether it is from a bad plate of food (bacteria) or something your kids brought home from school (virus), you have most likely had minor gastroenteritis and the end result will be a physically draining but relatively short-lived experience that encompasses vomiting, diarrhea, or sometimes both.
As coaches, we get plenty of panicky calls from athletes who come down with gastroenteritis. Sometimes it’s during training, especially when kids go back to school or in the winter when people are so close together indoors. During the competitive season, we get a lot of call in the week leading up to a goal event. This is often the time when athletes get sick because they are either traveling to an event and eating/drinking in areas they’re not accustomed to, because they are nervous/stressed due to their events, or because their immune systems are a bit compromised.
Gastroenteritis vs. more serious illnesses
The first thing you need to do is try to differentiate between a minor gastroenteritis and more serious illness. Nausea, vomiting, and diarrhea come with the territory and may be accompanied by a low-grade fever. But a high fever (above 101 degrees F) should be a warning sign of a more serious illness. Similarly, vomiting lasting more than 48 hours, or leading to significant dehydration, is serious and you need to seek medical attention. Honestly, if it’s the week before a big competition seeing a physician is a good choice if you can.
Most of the time athletes get hit by minor gastroenteritis, the type that comes on quickly, makes you feel terrible for 1-2 days, and then goes away. From a performance standpoint, the impact can be huge. You’ll go 24-48 hours with little nourishment, you’ll lose significant amounts of fluid and electrolytes, and you’ll burn through energy stores you would rather save for race day.
Return to exercise or competition after gastroenteritis
So, if you get nailed by gastroenteritis, is there any hope you can still have a good performance in the next few days? The answer is yes, as long as you treat the illness like an endurance event.
Understand the goal:
Gastroenteritis drains you of fluids, electrolytes, and energy. As an athlete who wants to get back to training or compete within a week, your goal is to minimize these losses. One mistake athletes make is to just curl up in a ball and wait for the illness to pass. If you’re not taking anything in to balance the depletion, the fluid, electrolyte, and energy deficits grow and grow. Your goal is to keep those deficits as small as possible, so you have a better chance of closing the gap once you feel better.
Fluids are most important, followed by electrolytes, then calories. Not only are the consequences of dehydration and electrolyte imbalances more detrimental to health and performance than a lack of calories, they take longer to recover from. Your body is very good at packing glycogen into muscle cells and restocking liver glycogen. It takes longer to fully replenish fluid levels in tissues.
Eat like an athlete:
When you’re in a long training session or competition, you primarily consume fluids, electrolytes, and small portions of simple foods. When you’re suffering from gastroenteritis, you pretty much want to do the same thing, and you can even use some of the same foods. Water is an obvious choice, but simple sports drinks (essentially carbohydrate, electrolytes, and water) may be a good choice as well, if you can tolerate them. Salty foods can also be good, just keep your choices bland and simple (like crackers) when you’re nauseous. Most important, you should be consuming something regularly and frequently, just like during an endurance event.
When you finally feel human again, the worst is over but there’s still work to do. Now you must replenish what you lost. Your gut is still irritated so don’t overwhelm it with complex foods. Continue eating simple ingredients in small portions on a frequent basis. Ideally, if you have about 3 days between the end of a 24- to 36-hour bout of gastroenteritis and your event, you can have a strong performance. More time is even better. However, if you have less time, be prepared for a slow day and understand you may reach a point where dropping out is the right choice.
You could also have a surprisingly great performance. Moderate and temporary weight loss is often a consequence of gastroenteritis, and even though most of that weight loss is from dehydration, some athletes are still able to experience weight-related improvements in performance.
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On the other hand, it’s not uncommon for athletes to start out feeling great, and then suffer a rapid decline. This is most likely due to fuel depletion, and it seems to happen more frequently for athletes in high-intensity events like 5k/10km running races, cycling criteriums, sprint triathlons, and cyclocross. Athletes who compete at moderate intensities for longer periods may be able to avoid this sudden feeling of emptiness by consuming calories early during events.
Gastroenteritis sucks, but like most things in life and sport, the worst thing you can do is throw up your hands and give up. Stay focused, work the problem, and be patient. Don’t give up; it’s not pleasant but there have been plenty of champions who have gone from puking to the podium in less than a week.
By Jim Rutberg,
CTS Pro Coach & Co-author “The Time-Crunched Cyclist” and “Training Essentials for Ultrarunning”
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