2013 Hinson Lake 24 Hour

The trail that ascends 'Mount Hinson', which is a shallow if sandy climb the first time around, and then slowly gets steeper with each passing lap. (Copyright Frank Lilly, used with permission.)

At the 2013 in some lake 24 hour ultra classic I suffered from severe nausea and my race was terminated after 47 miles. However, this race gave me some interesting indications of what may be causing my nausea. Here's what happened…

• Before the race, I was feeling strong and my Three Phase Taper had gone well, hitting 190 miles in my peak week.
• I slept well the night before the race, and had a ketogenic eggnog for breakfast. (8oz Heavy Cream and an egg, around 1,000 calories.)
• The race started well, and I ran the first 15 miles without pausing.
• Around mile 16 I started drinking a little, but with hindsight not enough. The weather was cool, and I did not realize quite how much I was sweating.
• My mouth was dry, but I did not have the normal sensation of thirst. I can't explain this (yet).
• Around mile 20 I started fueling with a mixture of coconut oil, Macadamia nut oil, and Nuttela. This mixture seemed to go down remarkably well and I had no digestive problems in the next little while. This formula is liquid, but contains very little water as it is nearly all oil, which may have been misleading as I was drinking, but not hydrating.
• Around mile 24 I did a Morton Stretch and noticed I had symptoms of low blood pressure. On standing up from the stretch I had to bend over to avoid browning out.
• Around 33 miles I started to find my breathing was becoming higher for the same pace. This is something I associate with hitting the wall, or the pre-adaptation stages of the ketogenic diet. I did a blood test that showed my ketones were at 0.8 and glucose was 108, both within my normal range for running.
• Around mile 30 I had a strange quad spasm. The pain went from miles through to a sharp electric pain and onto an un-ignorable pain that forced me to stop running all within the space of less than a minute. If someone had described to the sensation and location I might well have assumed it was Iliotibial band syndrome, but the pain was actually from muscular problems in the lateral side of the quad. I stopped briefly to Massage it with my elbow and the pain went away, and never came back. In fact that bit of mid-race massage really helped the quad.
• Around mile 36 I started to suffer from nausea. I had a cluster of symptoms that I've had on other races; nausea, stomach pain, gas, lightheadedness, and a pervasive sense of weakness. This weakness is more like the feeling you have with a fever than from running long distances.
• By mile 40 I was reduced to a slow walk. I decided to keep moving and trying to drink, but I was having trouble standing upright even.
• At around mile 42 a retired nurse found me holding a post to stay upright, and insisted I laid down with my feet up. An ex-paramedic also stopped to help me, and together they watched over me while I laid there for 30 min. They described my complexion as ashen, and the nurse suspected my blood pressure was extremely low. Within a few minutes of laying down, my nausea subsided. During the lie down my platter also started to fill; I'd only urinated once since the start of the race, at about mile 18. After the 30 min. I gradually got up and walked back to the start area, where they laid me down again and covered me in blankets for another 45 min. or so.
• By this point I was feeling much better, so I persuaded my care givers to let me walk a lap and I felt fine.
• I decided to run a lap to see if the symptoms and really abated, and the paramedic accompanied me around at a steady pace.
• At this point I was feeling pretty good but any chance of a decent result had disappeared. I decided I would not risk another incident, and retired from the race.

So what do I think happened? There are two possibilities, and they're not mutually exclusive.

1. I got a little behind on my hydration, which caused my blood pressure to drop. The drop in blood pressure caused the symptoms of nausea, lightheadedness, and weakness. When I tried to rehydrate, my stomach was too nauseous to absorb any fluid and it just caused stomach pain. When I laid down, my blood pressure normalized, and I started to absorb the fluids I drank earlier and I felt better.
2. I got slightly behind on my dictation, which caused my body to release a hormone that reduces kidney urine output. This hormone (vasopressin) can cause nausea, which further reduced my fluid intake, which in turn reduced my blood pressure. My symptoms were then caused by a combination of vasopressin and low blood pressure.

I will continue to research nausea and Vasopressin, but my main conclusion is that I need to ensure I'm drinking enough fluids to maintain my urine output.