53 Miles and Counting: A Story of Gastric Bypass Endurance Nutrition
 

The Historian is calling me out. I gotta respond to that.

I want to ride long distances - randonneuring distances - where 100 miles is a good training ride. I'm training for the 2011 North Carolina Tour de Cure; it's my personal goal to ride 100 miles on both June 4th and 5th, and I've got other distance goals for 2011 that lead me up to that.

I had gastric bypass January of 2010. Post-bypass patients have their own unique dietary issues. One of these is called dumping syndrome, which is what happens when you eat high-sugar food that passes through what's left of your stomach too quickly, and causes headaches, muscle cramps, general body aches, nausea, and the entire gamut of dehydration-related symptoms as your body tries to dilute the highly-concentrated sugars in your small intestine. Non-gastric patients can experience the same issues, but they'd have to eat sugar in much higher concentrations. I'm not supposed to drink within an hour before or after eating, and I'm not supposed to eat within than 3-4 hours after my previous meal.

Now, if you're going to ride (or run) more than a couple of hours, you have to replenish energy, or you bonk when your body uses up it's easily accessed energy. Now, the easiest way to do this is to eat and/or drink carb-loaded foods, energy gels, and sports drinks as you go. And, as the activity level increases, it's better to go with more liquid nutritions to compensate for the fact that your digestive system starts to shut down.

While you're doing all of this, you also have to stay hydrated - which isn't an issue, unless, for example, you have some crazy dietary restriction that prevents you from drinking within an hour of eating.

So... best solution for most people is sugary drinks that hit your digestive tract quickly. But that doesn't seem to jive with post-op dietary restrictions, and that's a problem.

I talked to my nutritionist and physician - both gastric bypass specialists, and they gave me the same guidelines they give every other post-op patient - eat every four hours, don't drink an hour after eating, and 'gosh, I don't know how you'll be able to do that'. They said I could fudge the 'before eating' drinks as long as I stopped 15 minutes before. Basically? Worthless advice. If I followed their guidelines, I'd never be able to ride and eat, because I wouldn't be able to stay hydrated or get enough nutrition. Now, I'm NOT their typical patient, but it wasn't until my one-year appointment when they asked if I would be a 'success story' for their clinic and do speeches at the support groups that I realized how atypical I am. So, if I'm so atypical, then maybe all of their advice doesn't really apply to my particular needs.

Mind you, there is basically NOTHING available for endurance nutrition for gastric bypass patients. It just isn't out there. I realized I was going to have to do research that was a bit more in-depth than googling up an answer.



So, I've been doing a lot of trial-and-error. I figured, I had to have enough protein to prevent dumping syndrome. I also figured that I'd have to go with something liquid or semi-liquid so I could ignore the 'don't drink after eating' guideline, and I'd also have to completely ignore the 'eat every four hours' guideline.

In the past, I've tried finding a solution, and I've come up short. Tried traditional sports drinks - great for staying hydrated, but they don't have enough energy, and I bonked after 30 miles. I tried high protein bars that I eat all the time - too heavy on my stomach, and sat like a lead brick in my stomach for an hour, and bonked after 40 miles. I tried protein/carb drinks like Boost and Muscle Milk - not enough energy, heavy on the stomach, and bonked after 40 miles.

This is a huge problem for me. If I can't find a fix for it, I can't safely ride more than about 40 miles. After that, I bonk, and for me, riding after a bonk is dangerous, deadly, in fact. I get dizzy, weak, lose mental focus, and start making bad decisions. If you're an insurance salesman & want to sell me a whole life insurance policy, your best bet is to catch me while I'm slowly weaving dangerously down the road, thinking I'm still doing 'OK'.

So, after several weeks of research, I had an epiphany. If dumping is caused by the body's response to excess sugars - specifically, temporary dehydration by redirecting water to the small intestine to dilute the sugars, then what if I supplied the liquid it needed in the first place???

Would it work? I had to try. If it does, then the solution is simple: eat and/or drink whatever mix of complex/simple carbs I needed to stay energized, and take with it 'enough' liquid to keep me from having an adverse reaction.

Epiphany #2: Is that why all the sports energy gels tell you to take a big drink from your hydration bottle after you suck down their product?? Makes you wonder, eh?

Last Sunday, I tried it. I HAD to try something.

For my main fuel source, I picked generic fig bars (Fig Newton wannabes). At less than two bucks for a container, they're a bargain, especially when compared to energy gels that run you that much for one gel pack (cost ratio: 24-to-1 in favor of fig bars). Took two right when I started, then about two every 45 minutes. Each time, I washed them down with a generous mouthful from my water bottle (full of my normal 'low-carb' sports drink).

Now this _mostly_ worked. I say mostly, because I felt a little light-headed around 40 miles into the ride, but not anywhere close to how I normally feel when I bonk. When I started getting that feeling, I ate an energy gel, switched to a full-calorie sports drink, and kept riding. After a few miles, I felt better.

End result?

I rode 53 miles, about 4 1/2 hours with a stop, and when I got home, I felt good*. I didn't bonk. At mile 50, I felt good enough that I considered extending the ride to hit the 63 mile mark (for the metric century), but I decided against it because my wife was waiting and worrying, and keeping her happy is critical to my training success.

This is big. BIG. BIG.

It means I've solved my nutrition problem, and without complicated a formula that to follow requires a calculator, a sliderule and a stopwatch. I'm not yet sure I can stay energized with only simple stuff like fig bars, but I can keep energized. If I can get that far past my normal bonk point, while staying hydrated, then I can theoretically keep riding as long as I can keep my eyes open.

Next up: A metric century in better-quality cycling [strike]shorts[/strike] bibs.

* - Well, mostly good - I discovered that my cheap cycling shorts are fine for short rides, but they just don't cut it for that long. Or they do cut it, if by 'it', you mean my skin.

This is fascinating to read. The one question I always had about surgical weight-loss solutions for athletes was how do you keep yourself suitably fueled and hydrated.

Richard,

One thing that might help is extra water, not in you, on you. Water loss is because of sweat, and sweat happens because the body is trying to keep cool. If you do other things to keep cool it will at last minimize water loss through sweat.

Richard -- THANK YOU for sharing this. I've had weight loss surgery as well, and one of the reasons I chose the Band instead of bypass was that I just couldn't reconcile long rides with the dietary restrictions from bypass. This is, indeed, BIG -- and you are Awesome.

Richard, I had forgotten about your bypass. I just thought it a nice long ride. I'm pleased as punch it turned into someone more, something BIG. Thanks for sharing it.

My surgery was almost 8 years ago now (unbelievable!) so I don't think about these issues too much any more, but it sure was important for the first couple of years (when I was walking and running more than bike riding.) At this point I've adapted to the point where I don't think I do anything different from most other folks on long rides.

I stay away from guzzling a big jug of gatorade or something, but I've never had a problem eating a Clif bar or a GU pack, especially if it was followed by more riding. I've been known to take in half a Snickers bar or some trail mix loaded with M&Ms without issues. Sometimes a Snickers bar just beats a Powerbar all to heck...

Congratulations on your success, and let me know if you want any more input from an "old timer"... :)

Richard,

Thanks for posting this, I'm a post-op myself (6/23/10) so I understand your problems a lot. I pretty much throw the rules out the window when I'm riding too. Though I do try to watch my sugar intake as it still causes me problems. I do eat and drink at the same time when riding though, and I do use some of the high carb gels and such while riding. Honestly my biggest problem is remembering to stay hydrated, I end up keeping a bottle up on my bars in a bar back all the time and "drink, drink, drink."

Your long rides are giving me a lot to think about since at this point I've not been out for longer than a couple of hours, planning some longer endurance events this year though.

Great job in finding a workable solution! I hope to read about your exploits at the Tour de Cure. Remember to post pictures :)

Judy

Pictures?? That means I'd have to bring along a digital camera (my cell phone cam won't cut it). Which is extra weight - you know, those extra 3 ounces are really gonna matter.... :rollseyes:

Honestly, I don't own a digital camera. I'd borrow my wife's, but I think she'll be taking pics at the start and finish (both days), so I may have to appropriate one of the kids' if I wanna snap any mid-ride pics. Not gonna even try to set up a tripod and video people riding by... I'll leave that for MrBeanz.

OK, now to get Sayre to post about his century a month plan, and how one morning he got up and felt like riding 100 miles.

OK, Richard the Rocket, anything new to report? Yes, I am calling you out again.

Interesting and inspiring read, and congratulations on your solutions. Doctors give you very conservative advice so you don't sue them in case something goes wrong. In the end, you have to do what works for your own situation, without compromising your health or safety. Nice job of breaking through those barriers.

Swear to G-d, I'm gonna dump you from my FB feed. :lol:

Now for the 'and counting' part.

TL;DR Version: I rode a lot; didn't bonk, using cheap fig bars and a sugary sports drink.

Full Length Version:

Saturday, the weather was great, so I went with step #2 in my pseudo-scientific search for a nutrition solution: Verification through Repeatability.

This ride, my primary goal was to see if low-cost fig bars + a sugary sports drink combo would provide sufficient fuel. I also wanted to conquer the metric century mark I'd been so close to last week.

Set out on my bike, in my now-standard weekend ride format: strip off the back rack, leave the h-bar bag. I wanted to have enough fuel for a six hour ride, even though I figured I'd be done in less than that. But... that's a lot of food & liquid to carry, so I settled for packing 12 fig bars (2 less than a half pack, those 2 being the ones I ate right before I started), 2 bottles of Gatorade in the racks, and another 20oz gatorade in my Hbar bag. Enough for a 3-hour ride, but no more, so I knew I'd have to stop along the way no matter what.


Ride went pretty well. My nutrition plan was based on last week's information: 2 fig bars every 45 was a little light, but back then I was using a diet hydration drink. This week, I was riding with full-sugar gatorade; my plan was to eat 1 fig bar every 15 minutes. This was to slightly increase the amount of carbs I was downing, and to spread them out more - trying to eat two at a time was a bit much.

At about the 30 minute mark, my stomach felt a bit full. I compensated by delaying by 5 minutes my next couple of bars, until I felt better, then I went back to my normal schedule. I think, in retrospect, I'll either drop one of the pre-ride bars, or not start on-bike eating until the 30 minute mark (which nets the same 1-bar reduction).

So, I pretty much stuck with this food plan the whole ride. I stopped at a C-store after about 10 miles for a bio break, and picked up another tube of 14 fig bars since they had them on sale. That was my last stop until about the 27 mile mark, where I had all but burned my two water bottles, and needed more liquid. This C-store was just a hundred yards further down the road from where I turned around last week - had I ridden another 100 feet last Sunday, I'd have seen it. It felt pretty good to roll past that point feeling as good as I did. I stopped then, picked up two gatorade bottles (one 32 oz, one 20), and used them to refill my caged bottles (leaving me with my original spare 20oz gatorade in my hbar bag).

Until this point, I'd been riding almost exclusively into a headwind, with rolling hills that start at mile 5 and never end. My avg mph was about 14.1, which is low for me, but ... headwinds, so I didn't stress too much over it.

Kept riding from that store until I hit my my-mileage turn-around point about 10 miles down the road. Since that was at the top of a hill, I set my sites on the top of the next hill, and mentally set that as my turn-around. I still felt great, but knew that time was burning, and wanted to get home with plenty of daylight.

Got back to the 27-mile C-Store, where I needed another bio break, and to reapply some chamois cream (note to self: don't store chamois cream in the front of your hbar bag on a chilly day). Bought a chocolate milk for a post-ride recovery drink; I'd read in the LD forums that it's the perfect post-ride drink, so I figured I'd give it a shot (figured it'd stay nice and cold in the front of my hbar bag!). While there, the owner/manager/whoever asked if I was part of the big group that had recently passed. It seems I stumbled onto one of the controls for the local Brevet group, who was out riding that day.

Went outside right as another group of cyclists pulled in. Shed a layer, then took off down the road again... Tailwind! Oh, man, it felt good. My GPS crapped out on me about this point (I don't think it picked up the 'resume workout' like I thought it did), so I lost my detailed return speed calcs. Pity, but correctable via the web site.

Managed to find a good tuck position with my trekker bars, settled in, and just rode and rode those rolling hills for miles. This was when everything came together. Good riding position, no discomfort on my saddle or hands, and somewhere around the four hour mark I realized my nutrition plan was working!

I stopped one last time (roadside) to refill an empty bottle with my spare Gatorade, stripped off my last spare layer, and moved my remaining fig bars to a jersey pocket so I could close up my hbar bag for the rest of the ride. At this point, temps were in the low 60's (or maybe the high 50's and I just felt too damned good), and I was down to bibs, a LS compression shirt, and a jersey over that.

Rode the last 10 miles or so without a problem - except for a missed turn. The missed turn turned out to be an adventure in itself. I got to ride a road I hadn't been on in 5 years, and they'd completed some roadwork. Got to ride a long easy downhill, with a couple of gentle curves in it. Tucked and spun my highest gear for all it was worth in a spectacularly enjoyable waste of energy. Rode the last several miles home almost feeling like a real cyclist. Hey... that 75 mile milestone wasn't too far away, was it? Aww, man... I've gotta leave something for next time, and at this point, I need to start watching that I don't overtrain. Made a decision to not ride past predetermined milestones, and to give myself a day of rest on Sunday, no matter how good the weather is. I rolled up to my front door a bit less than 5 1/2 hours after I left, 66 miles traveled, feeling like I could ride a bunch more.


Next Week: 75 miles.

OK RichardTheRocket, question: aren't you concerned about lactose intolerance with the dairy products, including the chocolate milk?

BTW, cut the garbage about "almost a real cyclist." If I'm not allowed to get away with saying that, you aren't either.

Yea, what he said!!

I was allergic to dairy products as a kid; now I'm not. /shrug

Haven't had a problem with them. Although, I didn't drink the chocolate milk until after the ride. I don't think I could handle milk while exercising.

Well, I am a real cyclist... I just don't always feel like one. First off, I ride a commuter instead of a road bike, and I normally am in the 'sit up and beg' position. This isn't normally a problem around town, but on weekend rides, I'm the only person out there not riding a road bike with drop bars.

The trekker bars I installed a few weeks ago help; the fact that I adjusted my seat, rotated my hips, and finally figured out a good tuck position help tremendously; I can probably tuck as good as most long-distance cyclists using drop or aero bars.

Second, I'm usually in my kitbash winter gear, which is about half cycling gear, and half whatever I could find on the clearance racks. But the weather warmed up so much on Saturday that I'd shed all of my outer layers, and was down to cycling bibs, a long sleeve compression shirt, and a cycling jersey over that. Add the fact that I'd learned a good way to tuck in on my new handlebars, and I actually felt like I'd fit in (more or less) if I were in a group of other riders. Although I'll have to shave my legs as the weather warms up. It's tradition.

Leg shaving isn't traditional on this forum. Just say no. Step away from the razor....

Richard, I have to say you are an inspiration.

Welcome to the club, RichardGlover. :-)

Thanks for this. I has a RNY in 2004 and lost about 220 lbs. I am new to cycling, but I have a different problem now in that I've developed an autoimmune disease. I got sick in Oct 09 and I am just now starting to improve because it took this long to be diagnosed (they think) with Behcet's Syndrome.

My issue now is that I can barely eat anything because it's affecting my mouth. I get sores on my tongue and lips, and I've lost my sense of taste and in addition, somethings make my mouth burn badly - mainly sugar. I can't do any of the protein bars or gels. I also can not do anything rough like oats, granola, cereal, etc. I'm basically stuck on a soft food diet and I exist on soups for the most part.

Right now I am keeping it to 5 miles or less because I just run out of energy after that, but I would like to be able to do 20-30 by summer.

Because of the mouth issues, I am barely able to manage 800-1000 calories a day. I'm going to give the fig bars a try - They're soft and not really too much sugar, so maybe I can tolerate it. I will let you know how it works out :D

Fig bars may not be suitable for your particular needs. They still need to be chewed, and when they hit your stomach, they are a mix of simple and complex carbs that need to be digested and need a sufficient quantity of water to dilute the sugar content.

If you can't handle high sugar, and can't handle rough foods, have you looked into Hammer Nutrition's HEED Sports Drink Mix? It's a powder that mixes with water, creating a gatorade-like drink that has 100 calories per serving.

Most of the calories are from complex carbs (mostly maltodextrin), not simple sugars. Also, they contain no citric acids (which may irritate your mouth), and their sweeteners (stevia and xylitol) are supposed to be easy on the stomach.

They're not cheap - you'd be looking at about 60 cents per 100 calories if you buy the big containers, so it may not be a good long-term solution. But you can probably get single serving sizes at your LBS, sporting goods or vitamin/nutrition store, and find out if they work for you.

If they DO work, you might want to look at buying pure maltodextrin from your vitamin/nutrition store. The employees probably won't know what you're talking about, so you'll have to look in the endurance sports energy/recovery section and read a bunch of labels to find what you're looking for. With maltodextrin, you may be able to mix your own energy drink that'll get you the calories you need without running into sugar issues....

But as you know better than most, everybody's post surgery dietary needs are different. You're well down the road of trial-and-error yourself, and I'd be very interested to hear what your future test results are.

Thanks! I'm going to check into making the sports drinks.

Luckily, since I am so far post-op, I have a pouch of steel. Nothing - and I mean nothing - bothers it. I can pretty much consume anything as long as I can manage to chew it. This is probably one of the reasons I gained so much back but I'm back to 200 now (which is my goal, forever, anything else is bonus) but I'm hoping cycling will help keep it off this time.
Todays ride I took along some pasta salad (with EVOO and Parmesean) and a ham and provelone tortilla wrap and I didn't feel burned out an after after the ride and need a nap like normal. I'm going to keep trying 5 miles this week (every other day) then I'm going to go for 10 one day next week when the kid is in school and I'm not pulling an extra 60 lbs! (kid + trailer)

Richard - Good on you and keep up the great riding!

Little jealous of you getting your build-up on a commuter. I did everything from my first 8-mile suckfest up my first 3 centuries (including a back-to-back like you're planning) on my budget-minded mountain bike with giant cushy cruiser tires in place of the knobbies. Eff the roadies, ride your ride, it's going to be awesome. Treat yourself to a new bike for next year :-)

On solving the nutrition problem and rando riding. I hate to be the buzzkill, but you're not all the way there yet on the nutrition issues. I think you're going to be fine for quite a while longer on distances, but things change around the 8-10 hour mark for the day. I have a lapband and I've gotten up to a 200-mile one day ride and I have been awesome on up to centuries using a mix of perpeteum, HEED, and hammer gel, augmented with the occasional more solid snack. Past the 8-10 hour mark, rando stomach becomes an issue. If you've been reading the long-distance forum, you'll see it discussed in detail, but basically many rando guys with normal digestive plumbing have just had to work at trial and error to figure out what works on very long rides. The crappy part is that what works under 8-10 hours may have no relation to what's good for over that mark, so there's no good way to work on solving the problem other than riding long. I've been going through it and it kind of sucks, hopefully I'll hit upon the right combo soon with an Ironman in my near future.

That's my plan... well, maybe later this year.

Thanks for the info. I guess I'll just have to cross that bridge when I get there. I definitely want to get into Randonneuring (PBP in 2015?), so I appreciate your advice.

Wow! Congrats Richard. I am inspired by your post and though I am not considering the surgery, I do want to have weight loss with the bike riding. My rides (if you could call them rides) so far are simply around my neighborhood. Very hilly for the coast and so far very exhausting. I can only make one lap so far but am wanting to move it up.