Acid Reflux

A.As riding can aggravate reflux in some, my guess is that it will cut down on your reflux while riding and hopefully any chest discomfort associated with that. I can't see where it would have any negative effect once you are over the efffects of surgery - only positives.

Abdominal Cramps

A. Abdominal cramps are usually the result of:

• Pushing too hard after eating - doesn't seem to fit your description
• Pushing beyond your training limits - your body saying "Hey, slow down"
• Electrolyte imbalance (usually later in the ride and in hot conditions)

Constipation

Q.The only time I have for my training rides is at 5:30 a.m. (6:30 a.m. on Sat and Sun). These are approximately 80 minute rides (75-85% max. heart rate), plus one long ride of 3-5 hours, a light day and a complete rest day off the bike. I usually eat a bowl of granola and a piece of fruit. This leads me to my problem. Eating and then exercising seems to constipate me. I go 2-3 days without a bowel movement (often needing a dose of mineral oil at night to get things going the next day).

A.I'm not sure why eating before riding would make you constipated. Generally pushing exercise regimens results in diarrhea as a side effect. Dehydration from inadequate fluid replacement might do so. More likely is getting out of the routine of a BM in the AM because you are on the bike which tends to suppresses the normal morning urge. A little MOM every day won't hurt - or mineral oil.

Gastric Bypass Surgery

Q. I just completed my first 100K ride in Wichita Falls this past weekend and I'm also thinking I experienced my first "bonk" on Tuesday night which for me included a trip to the ER for IV fluid replacement with chills and nausea and muscle cramping about 5 hours after I'd done a 2 hour ride in 90 degree or so heat. My problem is this: I've had gastric bypass surgery and I have a stomach capacity of 3-4 oz. I find it's easy to take in plenty of fluids but I can't take in more than 8-10 sugar grams at a time because of the bypass which dumps sugar directly into my intestine and then makes me ill. This makes it difficult to carb load or replace carbs on the ride with the traditional sorts of supplements. I can do the bananas in small qtys and for training that's been sufficient but I'm starting to do longer events. Do you have any recommended supplements or suggestions for me?

A. First, the ER episode sounds more like getting behind on fluids than the bonk. But here are a couple thoughts re energy replacement (which is the bonk for sure).

• Your replacement needs to be in liquid form to facilitate efficient emptying of the small stomach pouch. Solids would tend to "sit there" and just make you uncomfortable without providing the Calories your muscles could use.
• The diarrhea is generally felt to be a response to the osmotic load (number of molecules per ml of fluid ingested) so a complex carbohydrate should theoretically give you more Calories per ml without causing diarrhea.
• You do have to drink this supplement regularly - every 5 to 10 minutes for you as your small pouch will not accept the volumes recommended to those with an intact digestive system.

Crohn's Disease

A. I don't have an answer to your basic question, but a few ideas. I presume they took out your terminal ileum (last part of the small bowel)with your surgery? Except for vitamin B12, you should absorb most everything else well. Now when additional small bowel gets inflamed, that could change. If absorption is the issue, using more elemental supplements such as Ensure and Sustacal that are absorbed higher in the small bowel might give you a boost. I assume you are on a good multivitamin?? If not, I'd add that into the mix.

My guess is that the lack of oomph is the body's recognition of the inflammatory response that is Crohn's. Getting it under control should be the basic strategy. There are a number of newer drugs and biologics out there, but pentasa and entocort would be the place to start. Both should have minimal if any effect on your physical endurance.