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Runner’s Diarrhea: A Summertime Favorite?

A blogger friend of mine referred me to an article about a female runner struggling with gastrointestinal distress. She asked for advice regarding how to prevent the “runner’s trots” and felt fairly mystified regarding its cause. Since up to half of runners face this problem at some point (especially women), I thought I’d post some advice that comes from experience… ahem.

The urge to use the restroom during exercise is caused by increased intestinal motility, likely triggered by any (or all) of the following:  jostling of internal organs, relative intestinal ischemia (decreased oxygen getting to the intestines as blood is diverted to the muscles for work and to the skin to cool the body), dehydration, and adrenaline-related anxiety/stress hormones. I’ve noticed that hot weather greatly increases the likelihood of runner’s diarrhea as it contributes to additional blood diversion as well as dehydration through excessive sweating. Basically, don’t be surprised if you need to plan your summer runs around bathroom stops.

That being said, there are a few things that can decrease the urgency and frequency of this unpleasant intestinal drama:

1. Watch what you eat before your run – avoid fiber, caffeine, fake sugar, or anything that generally makes YOU have to move your bowels more frequently (milk and/or soy products are a culprit for some). Ideally, these things should be avoided up to 12-24 hours before you run.

2. Stay hydrated. Get ahead of the game by drinking a liter of water before your run and continue to hydrate during exercise (as appropriate for the climate and your effort level.)

3. Run at a slower pace if the weather is hot. I often find that dropping the pace by a minute or two per mile can magically reduce the intestinal symptoms.  Interval training can help you challenge your speed limits while offering active recovery periods for your body to cool down and let your gut chill out.

4. Run in the morning when it’s cooler and you’ve had less to eat. Running after a day full of eating is looking for trouble.

5. Try to evacuate your bowels before your run – this is fairly obvious, but take the time you need to get this taken care of.

If the weather is hotter than 85 degrees, I’d consider running on a treadmill in an air conditioned space.

I found this comprehensive list of strategies to avoid the trots quite helpful. Please check it out – and good luck on your summer runs and races. Perhaps we’ll cross paths at a rest stop near you!

Why Do Mosquitoes Bite You More Than Others?

Are you one of those people who’s been singled out for constant attack by mosquitoes? Ever felt like the designated bug decoy at a party? It does seem that those pesky biting insects have a preference for certain individuals, so the real question is: why you?

I wish there were a simple answer, but scientists have only isolated a few potential causes. It is likely that the full story remains to be elucidated – and may be related to small genetic variations in human odor. However, we do know that mosquitoes are attracted to carbon dioxide (that we expel as we breathe), and warmer skin temperatures. So I guess if you’re a heavy-breathing, hot-blooded person then you might need an extra layer of DEET? Or maybe hold your breath and wear a scuba suit when you’re in the presence of mosquitoes? Just kidding.

Interestingly, one small study notes that mosquitoes are more likely to land on people who are drinking beer. Since alcohol tends to cause vasodilation of blood vessels, the enhanced skin warmth could be a mosquito attractant. Others have postulated that tipsy people are slower at swatting off mosquitoes and are therefore more likely to be bitten.

My personal suspicion is that some of us react to mosquito proteins (injected when they bite us) more robustly than others. That means that while a mosquito’s bite may leave only a tiny, fleeting mark on one person, another might develop a large red hive that itches intensely. So if your immune system is hyper-reactive to mosquito proteins, you’re likely to suffer more from each bite that you receive. That alone could make you feel as if you’re being singled out by the nasty insects, when the reality is that others are being bitten just as frequently.

I guess the take home message here is that insect-repellent is still the best defense against mosquito bites, although some might argue that keeping a heavy-breathing, sweaty, beer-drinking guy nearby might provide an alternative decoy?

Enjoy your summer – and don’t scratch yourself to death!

Dr. Val Tells ABC News About Hospital Errors And How To Avoid Them


I kick off this segment with a surprising twist: I describe a hospital error that I experienced as a patient in the ER of a famous academic medical center.  And yes, I give a shout out to Paul Levy at minute 5 for his courageous efforts to reduce infection rates at Beth Israel Deaconess Medical Center in Boston.

How To Reduce Your Risk Of A Shark Attack

First, about sharks and shark attacks:

Sharks are found in oceans, tropical rivers and lakes. They range in size from 10 centimeters to over 15 meters (whale sharks). Approximately 30 out of 350 species have been implicated in human attacks. On average, there are fewer than 100 attacks reported each year worldwide, and less than 10% of these attacks are fatal. Sharks are superbly equipped predators, and can detect motion, chemicals, electrical signals, and vibration in the water, with a sensitivity that enables them to easily hone in on prey. The most dangerous sharks from a frequency-of-attack perspective are the white (“great white”, “white pointer”), tiger, bull, blue, dusky, hammerhead, and grey reef sharks. However, it is important to note that any shark, including the seemingly docile nurse shark, will bite a human if sufficiently provoked. Read more »

This post, How To Reduce Your Risk Of A Shark Attack, was originally published on by Paul Auerbach, M.D..

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