‘I think I’m gonna hurl’: A Narrative Review of the Causes of Nausea and Vomiting in Sport

Abstract

Exercise-associated gastrointestinal (GI) distress can negatively impact athletic performance and interfere with exercise training. Although there are a few universal underlying causes of GI distress, each symptom often has its own unique triggers and, therefore, its own prevention and management strategies. One of the most troubling GI symptoms an athlete can experience during training and competition is nausea/vomiting. The prevalence of nausea varies with several factors, two of the most important being exercise intensity and duration. Relatively brief, high-intensity exercise (e.g., sprinting, tempo runs) and ultra-endurance exercise are both associated with more frequent and severe nausea. The potential causes of nausea in sport are numerous and can include catecholamine secretion, hypohydration, heat stress, hyponatremia, altitude exposure, excessive fluid/food consumption, hypertonic beverage intake, pre-exercise intake of fatty- or protein-rich foods (especially in close proximity to exercise), prolonged fasting, various supplements (caffeine, sodium bicarbonate, ketones), certain drugs (antibiotics, opioids), GI infections, and competition-related anxiety. Beyond directly addressing these aforementioned causes, antiemetic drugs (e.g., ondansetron) may also be useful for alleviating nausea in some competitive situations. Given the commonness of nausea in sport and its potential impact on exercise performance, athletes and sports medicine practitioners should be aware of the origins of nausea and strategies for dealing with this troublesome gut complaint.

Physiological Responses and Nutritional Intake during a 7-Day Treadmill Running World Record

“…Field research has indicated an hourly range of EIs from 100 to 430 kcal•hr −1 , and athletes should expect to complete a race with EI of 36% to 54% of EE [30]. Insufficient EI in ultra-running may be attributed to logistical and practical issues but is more often due to suppression of appetite and digestive problems [16,17] (29,229 kcal total). Food and fluid intake during a 100 km off road race equated to a similar 176 Kcals per hour, but almost double the fluid intake at 415 mls per hour.…”

“…Field research has indicated an hourly range of EIs from 100 to 430 kcal·hr −1 , and athletes should expect to complete a race with EI of 36% to 54% of EE [ 30 ]. Insufficient EI in ultra-running may be attributed to logistical and practical issues but is more often due to suppression of appetite and digestive problems [ 16 , 17 ]. Per hour, SG averaged an EI of 126 to 203 kcal·hr −1 (17 to 37 g·CHO·h −1 ) of running, with an EE of 286 kcal·h −1 including rest periods and sleep, or 382 kcal·h − 1 for active periods only.…”

“…Performance and recovery are heavily influenced by appropriate nutritional intake during training and competition [ 14 , 15 ], but it has been demonstrated that ultra-running competitors may not meet nutritional intake guidelines, mainly due to logistical constraints and gastro-intestinal (GI) distress [ 16 , 17 ]. Carbohydrate (CHO) ingestion can enhance endurance performance [ 1 , 18 , 19 ].…”

What Should I Eat before Exercise? Pre-Exercise Nutrition and the Response to Endurance Exercise: Current Prospective and Future Directions

“…The influence of various pre-exercise meals on gut comfort should also be investigated, as a large number of athletes perform fasted-state training to avoid gut discomfort [ 15 ]. Exercise-induced gastrointestinal distress is beyond the scope of this review but has been reviewed elsewhere [ 72 , 73 ].…”

Treatment with Oral Ondansetron for Ultramarathon-Associated Nausea: The TOO FUN Study

“…During exercise, GI distress has a wide range of etiologies, including dehydration, heat stress, catecholamine secretion, use of non-steroidal anti-inflammatories, altitude exposure, hyponatremia, competition anxiety, and the amount and content of food and beverage consumed [ 3 , 4 , 5 ]. In one study of runners during an ultramarathon [ 6 ], those who ingested a higher percentage of calories from fat and drank more fluids had less nausea and vomiting, perhaps due in part to improving the distribution of blood flow to the GI tract [ 7 ].…”