Nausea: Don’t Let It Be A Showstopper, Part 1

By Coach John Hughes

Nausea while riding in the summer is almost as common a complaint as cramps. Like cramping, there are multiple factors that may cause nausea. Often, no one factor causes nausea but the combination of several factors can create a perfect storm when you want to blow chunks over the handlebars.

This sick feeling can be a showstopper. A showstopper is anything that causes you to either quit a ride before you planned to or, like Tom last week dealing with cramps, causes you only to do short rides out of fear of the problem emerging. Diagnosing any showstopper uses a step-by-step approach, listing all the possible factors and trying to identify those that are causing the problem.

Andy wrote me about problems that he was having with nausea. At best, it took the fun out of riding and sometimes caused a DNF (did not finish). He is an endurance rider, one of the faster riders in his club. He likes to go 50 miles before taking a break. It’s hot and humid where he lives. He’s a very experienced rider who has:

  • Completed a fully loaded, unsupported tour across the U.S.
  • Been riding 200K and longer brevets since 2005, including several 1200Ks
  • Raced in Calvin's Challenge 12-hour with 217 miles this year (cold, bad weather), 231 miles in 2015 (great weather!), 202 miles in 2013 (nausea)

You may not ride as many miles as he does; however, nausea is sometimes a problem for riders I coach who aren’t riding such long distances.

Coach-Rider Dialogue Holds Clues to Causal Factors

Following is the dialogue that I had with Andy about his nausea problem. Let's test your knowledge. Carefully read the back-and-forth and see if you can identify the factors at work that may be contributing to this particular rider's problem (again, it's usually a combination of factors that create that "perfect storm").

Next week, I'll give you my own diagnosis, and you can see how well it syncs up with yours!

Coach Hughes: Have you seen a health care professional?

Andy: No, and probably should. I do tend get stomach-aches more often than the average person.

Coach Hughes comments: Sometimes there is an underlying condition such as Andy’s stomach-aches that doesn’t cause nausea by itself but may be a contributing factor while riding. If there is an underlying medical condition, then it may be linked to a more serious problem — worth checking out.

Coach Hughes: When does the nausea occur?

Andy: With the combination of the following:

  • Temperatures and humidity are high. Sweat won't evaporate and I can't throw off the heat;
  • I'm pushing to go fast, riding harder than a conversational pace;
  • A longer ride, after 100 miles; and
  • Not being able to drink or eat enough (perhaps of the right fuels) in a ride with the above conditions.

Coach Hughes: Does it happen on every ride?

Andy: Nope. Only with above conditions.

I am fine doing high mileage and going fast in cooler temps and low humidity. It does not happen when:

  • Temperatures and humidity are low (dew point is below 60);
  • Rides are shorter, less than 100 miles.

Coach Hughes: How long into a ride?

Andy: 100 to 150 miles into a ride with high heat, humidity, and heart rate.

Coach Hughes: How hard are you riding?

Andy: Perhaps too hard for the conditions and given my age of 47 years old. For the first 100 miles, I'm fine with an average HR of 140. In terms of perceived exertion I can still talk in short sentences, but don’t have enough breath to whistle.

Coach Hughes: What and how much have you been eating? What and how much have you been drinking?

Andy: Typical ride day:

6 a.m.: Peanut butter-and-jelly sandwich and hot coffee with milk and stevia or sugar

8 a.m.: Ride start (Oops, I should drink more at this point!)

Every hour:

  • ~20 oz. mix of 1 or 2 scoops Perpetuem (per scoop: 135 total calories, 108 calories of carbs, 105 mg sodium, no potassium)
  • ~20 oz. mix of 1 or 2 scoops Skratch (per scoop: 48 total calories, 48 calories carbs, 180 mg sodium, 20 mg potassium) with water or unsweetened iced tea
  • ~15 oz. plain water

Every 1 to 2 hours:

  • 1/4 cup of trail mix (140 total calories, 68 calories of carbs, 86 mg sodium, 257 mg potassium)
  • 1 Endurolyte capsule

About every 6 hours:

  • 1/2 turkey-and-cheese or ham-and-cheese sandwich (330 total calories, 120 calories of carbs, 970 mg sodium)
  • 3 oz. salty potato chips (480 total calories, 180 calories of carbs, 510 mg sodium)
  • Coca-Cola – 1/2 bottle, if I feel an ebb in energy (80 total calories, 80 calories of carbs)
  • Salt tablet (if very sweaty/crusty)

Coach Hughes: What's your mental state? Anxious or worried? These can cause an upset stomach.

Andy: The nausea has been happening during my personal training rides, when I’m not anxious or worried. Perhaps I'm just pushing too hard. If it’s a big event, I can be anxious and worried — especially the night before. And yes, this can add to my getting sick.

Andy Has His Own Ideas About His Problems 

Andy’s diagnosis: From writing this up, I'd answer my own question and say that 1) I'm not eating nor drinking enough; and 2) I need to slow down for the tough weather conditions. Any additional thoughts? Like different nutrition?

RBR readers: Do you agree with Andy’s diagnosis? What’s your diagnosis?

Don't forget, I will offer my own diagnosis in Part 2 of this 2-part article next week. Stay tuned!

Coach John Hughes earned coaching certifications from USA Cycling and the National Strength and Conditioning Association. John’s cycling career includes course records in the Boston-Montreal-Boston 1200-km randonnée and the Furnace Creek 508, a Race Across AMerica (RAAM) qualifier. He has ridden solo RAAM twice and is a 5-time finisher of the 1200-km Paris-Brest-Paris. He has written nearly 30 eBooks and eArticles on cycling training and nutrition, available in RBR’s eBookstore at Coach John Hughes. Click to read John's full bio.


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