Fueling for your ironman (or ultra-distance event) post-bariatric surgery. It is not easy.

Many people find a new or renewed passion for fitness and sport after they have had a bariatric surgery. I have clients that participated in sports in high school and college. They stopped being active after they graduated and continued to eat like an athlete. Over the years the weight gain added up and after several attempts to lose it, they turned to the surgery as a tool to lose weight and get back to being active.


The weight loss post surgery can be inspiring and many start an exercise program to keep the weight off. Some people will take that to the next level and start competing in local running events or sign up for a sprint triathlon. I work with many bariatric athletes that get the endurance bug and pretty soon they sign up for a marathon or half-ironman. They come to me because they struggle a bit with your energy levels and nutrition with the longer distance events. Some people stay here and are satisfied with these events. I help them with fueling strategies and mostly they are able to balance their post-bariatric diet with the demands of their sport.


Some bariatric endurance athletes want to take it even further and they decide to sign up for an ironman or ultra distance run. This is when it gets complicated and really hard to balance the goals post surgery with the energy demands of training and racing.


For months and even years these individuals have been told you need to eat high protein, low fat, and low carb and stick to under 1,200 calories per day. Some people develop a real fear of carbohydrate foods. Getting enough fluids can be a challenge on a day without training, let alone during a long training day. They literally have to be taking fluids in all day long.


I don’t want it to sound like I don’t think it is possible to train and race for these events post-surgery. It is possible, but it is not going to be easy. In fact, it is going to involve spending time eating and fueling. More time than a person who has not had the surgery. I had a client recently who had a sleeve 2-3 years ago, has a demanding job, and is trying to train for an ironman. This client struggled to get fluids and enough food. This client get very frustrated when they had to take several days off of training to catch up on hydration. Unfortunately, they placed the blame on me as their nutrition coach. This experience inspired me to write this blog post. I have decided that I want to be real instead of try to sugar coat it and make it seem like this is going to be easy.


If you decide that you want to continue to eat 1,200 calories per day and train for these ultra endurance events, go ahead. I know for a fact that you are going to struggle and you will likely not finish the race. In the process you will likely develop a significant endocrine issues and possibly cause damage to your body through under-fueling which may be irreversible.


Here are the adjustments and considerations you will NEED to make to be successful:


1. You are going to HAVE to increase your carbohydrate intake. This means eating foods like fruits, potatoes, rice, pasta, bread, beans, and possibly more simple sugars during training. This is where is gets tricky. Dumping syndrome is still a concern, so this involves careful adjustments and possibly needing to munch on small amounts of food or other sports products and sip fluids during most of your event and training. This is tedious and frustrating. It is VITAL that you consume energy during your training and racing. If you think you can get by with no fuel during your race, good luck.


2. You are going to have to increase your calorie intake. You will not be able to sustain training for an ironman on a measly 1,200 calories per day. This will lead to some severe metabolic and endocrine issues over time. Your body will break down muscle to fuel exercise, even if you are getting the amount of protein your surgeon or dietitian recommended post surgery. Calorie needs to train for a long distance event can be as high as 5,000 per day (probably closer to 2,000-3,000 for most people post surgery). It is nearly impossible with your new anatomy post surgery to get this amount of calories. I am not saying that you can’t train and compete, but there may be consequences long term. You will have to get comfortable increasing your calorie intake on training days and even on non-training days. You must let go of the post surgery diet when you are training and racing and be able to re-adapt it during times of rest or when you are not training or racing. This can be challenging. You are going to feel as though you are going against everything the surgeon and bariatric dietitian has told you to do. You are going to feel like you are grazing all day long. This is exactly what the surgeon said would cause you to regain weight. This can cause some anxiety for many people who have seen success following the post surgery nutrition plan.


3. You are going to have to find a way to increase fluids. That means you are going to have to rely on liquid calories to get both fluids and fuel. This is another thing the surgeons and bariatric dietitians warn against. They tell you to decrease or eliminate liquid calories and absolutely no sugary beverages. There is no way to get the nutrition and calories you need for training on just solids. Your stomach can’t fit enough solids to achieve this. Often people feel too full when they consume calories only from solids and this means they do not have enough room for fluids. They end up dehydrated and on a liquid IV.


4. You are also going to have to increase protein and fat. In order to get your calories you need, you will also need to find a way to increase these nutrients. Fat is another dreaded nutrient for many post surgery so this can also be a challenge. Fat may also cause other issues such as the feeling of fullness and some individuals do not digest fat as well post surgery. You will not be able to increase these nutrients too much without feeling overly full. This is where #3 becomes so important. You may have to rely on smoothies made with fruit, peanut butter or avocado, and protein powder. You can do the high protein, low carb shakes, but they do not have many calories. Likely your premier protein shake is not going to be enough.


5. You are going to have to switch back and forth from the athlete mentality to the bariatric patient mentality. Remember you are now an athlete that had bariatric surgery. The anatomy stays the same. This is the only way to be successful with both the surgery and maintaining weight loss, while also being able to complete as an athlete. This is something you will have to always remember. If for some reason you decrease your activity, you will need to go back to the bariatric guidelines. This leads to my next point.


6. If you have not dealt with your relationship with food, all of the above might cause you anxiety and you will feel a loss of control. Most of the people I work who have had the surgery do not have a good relationship with food and the surgery often makes this worse. When they start to increase their calories in an effort to fuel their training, they struggle big time. I have lost clients due to this. I am telling them they need to eat more and this creates anxiety. They decide they can no longer work with me.


7. Your surgeon does not know anything about fueling and competing for these long distance events. Often my clients are being told two different things. I am telling them one thing and the surgeon is telling them something else. Keep in mind that your surgeon does not know anything about sports nutrition. They do these surgeries all day long, and all they know is bariatric surgery. When you go to them telling them you want to do an ironman, they don’t know how to help you so they keep recommending the same post-surgery diet. You need to go to someone who has experience with both bariatric patients and athletes. The most important thing it to trust that person.


8. Everyone is different in what they can tolerate. It takes some trial and error. Not all things are going to work the first time. When I work with a clients, my job is to coach them and guide them. Sometimes I act like a detective. Sometimes I might recommend something that does not work and that is okay. Nutrition is not a one size fits all and part of the process is trying different things and seeing what is going to work the best. I am there to help streamline the process for my clients.

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