Energy Gels: Why They Cause Stitches and How to Prevent Them

Why Do Energy Gels Give Me a Stitch?

Energy gels can cause a "stitch" (Exercise-Related Transient Abdominal Pain, ETAP) primarily due to their high carbohydrate concentration and osmolality, which can lead to gastrointestinal distress, fluid shifts, and mechanical irritation of the diaphragm during intense physical activity.

Understanding the "Stitch": What is Exercise-Related Transient Abdominal Pain (ETAP)?

The common "stitch" experienced during exercise is medically known as Exercise-Related Transient Abdominal Pain (ETAP). This sharp, cramping, or aching pain typically occurs in the side of the abdomen, most often on the right side below the ribs. While its exact cause remains debated, leading theories point to several contributing factors, including:

• Irritation of the Peritoneum: The membrane lining the abdominal cavity and covering the abdominal organs.
• Ischemia of the Diaphragm: Reduced blood flow to the diaphragm muscle, which plays a crucial role in breathing.
• Mechanical Stress on Ligaments: Specifically, those connecting the stomach and intestines to the diaphragm.
• Gastrointestinal Distress: Bloating, gas, or stomach distension.

ETAP is particularly common in activities involving repetitive torso movement, such as running, swimming, and cycling, and is often exacerbated by recent food or fluid intake.

The Role of Energy Gels: A Closer Look

Energy gels are concentrated sources of carbohydrates designed for rapid absorption during prolonged exercise. While invaluable for fueling endurance athletes, their specific composition can predispose some individuals to developing a stitch.

• High Osmolality and Gastric Emptying: Most energy gels are hypertonic solutions, meaning they have a higher concentration of solutes (sugars) than the body's natural fluids. When consumed, these hypertonic solutions draw water into the digestive tract to dilute them, which can:
  • Delay Gastric Emptying: The stomach takes longer to empty its contents into the small intestine.
  • Cause Bloating and Distension: The influx of water and undigested gel in the stomach and intestines can lead to discomfort, gas, and a feeling of fullness.
• Concentrated Carbohydrate Load: The primary purpose of gels is to deliver a quick burst of energy. However, a high dose of rapidly digestible carbohydrates can overwhelm the digestive system, especially when blood flow is diverted to working muscles during exercise. This can lead to:
  • Malabsorption: If sugars aren't absorbed quickly enough, they can ferment in the gut, producing gas.
  • Osmotic Diarrhea: In some cases, extreme fluid shifts can lead to loose stools.
• Sweeteners and Additives: Some gels contain artificial sweeteners (e.g., sorbitol, xylitol) or other additives that can be difficult for the digestive system to process, particularly under the stress of exercise, leading to further GI upset.
• Lack of Adequate Hydration: Consuming a hypertonic gel without sufficient water can worsen the osmotic effect, exacerbating dehydration and GI distress.

Physiological Mechanisms Linking Gels to Stitches

Understanding how energy gels interact with your body during exercise helps explain the onset of a stitch:

• Gastrointestinal Irritation and Distension: The delayed gastric emptying, increased fluid in the gut, and potential gas production from a hypertonic gel can cause the stomach and intestines to swell. This distension can directly irritate the peritoneum and put mechanical pressure on the diaphragm from below.
• Fluid Shifts and Systemic Dehydration: The osmotic effect of hypertonic gels drawing water into the gut can temporarily reduce the circulating blood volume available to other parts of the body, including the diaphragm. While not outright dehydration, this fluid redistribution can contribute to discomfort.
• Diaphragmatic Stress and Reduced Blood Flow: A distended stomach or intestines pushing upwards can physically restrict the diaphragm's movement, making breathing more labored. Furthermore, during intense exercise, there's a competition for blood flow: muscles demand it, the gut demands it for digestion, and the diaphragm needs it for respiration. If the gut is working harder to process a concentrated gel, it may divert blood flow that would otherwise go to the diaphragm, potentially contributing to localized ischemia and pain.
• Ligamentous Stress: The increased weight and pressure within the abdominal cavity due to a full, distended gut can tug on the ligaments that connect the stomach and intestines to the diaphragm, causing referred pain often felt as a stitch.

Strategies to Prevent Stitches When Using Energy Gels

Preventing stitches involves a combination of smart nutrition, hydration, and training practices:

• "Train Your Gut": Just as you train your muscles, you can train your digestive system. Practice consuming gels and fluids during training sessions, gradually increasing the intake to allow your body to adapt. This helps identify what works best for your body.
• Always Take Gels with Water: This is perhaps the most crucial strategy. Diluting the gel with 150-250ml of water helps reduce its osmolality, aiding quicker absorption and minimizing gastric distress. Avoid taking gels with sports drinks that are already high in carbohydrates, as this can exacerbate the hypertonic effect.
• Choose Isotonic Gels (Where Possible): Some brands offer isotonic gels that are designed to have a similar osmolality to body fluids, often containing more water. These may be gentler on the stomach and absorb more readily without drawing as much fluid into the gut.
• Experiment with Gel Types and Brands: Not all gels are created equal. Ingredients, carbohydrate sources (e.g., maltodextrin vs. fructose), and additives vary. Try different brands and formulations during training to find what your stomach tolerates best.
• Timing and Pacing of Intake:
  • Avoid large boluses: Consume smaller, more frequent portions of a gel rather than trying to down an entire packet at once.
  • Don't take gels immediately before high-intensity efforts: Allow some time for digestion before pushing your limits.
• Optimize Pre-Exercise Nutrition: Avoid heavy, fatty, or high-fiber meals too close to your workout or race, as these also delay gastric emptying and can contribute to stomach upset.
• Focus on Breathing Techniques: During exercise, particularly running, practice deep diaphragmatic breathing rather than shallow chest breathing. This can help stabilize the core and potentially reduce stress on the diaphragm and surrounding ligaments.
• Maintain Good Posture: Slouching can compress the abdomen, increasing pressure and potentially contributing to stitches. Maintain an upright, relaxed posture during exercise.

When to Seek Medical Advice

While a stitch is generally benign, persistent, severe, or unusual abdominal pain should always be evaluated by a healthcare professional. If your pain is accompanied by nausea, vomiting, fever, changes in bowel habits, or does not resolve with rest, it's important to seek medical attention to rule out other underlying conditions.