Why do athletes throw up during intense training?

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Puking or throwing up during exercise training appears to be a common occurrence among athlete. However, it can be prevented. 



Anil is doing his time trial test on the rowing ergometer.  The coach and other fellow athletes are constantly encouraging him to finish the race with a good time. However, he is finding it difficult and says “I think I am going to puke” and I can't stretch further. 

This appears to be a common occurrence in many endurance sport athletes. Gastrointestinal disturbances are seen in 20-70% of athletes among varied sports. 

Nausea and vomiting  during or after a high intensity training session that halts further training can be caused due to various reasons. 

a) Compromised blood supply to digestive tract: During  training, the body delivers the oxygenated blood to the working muscles and that  imposes a reduced blood supply to the GI (gastrointestinal)tract which affects digestion and absorption of foods and fluids consumed before or during the training. 


b)   Excess lactic acid formationTraining at high intensity for longer duration increases lactic acid levels in the body. High lactic acid beyond a threshold of an individual raises the acidic levels.  As a defence mechanism to eliminate acidic content, the brain signals athletes to puke/vomit. 


c)    Exercise-induced hyponatremia: Excess intake of water before and during training session or low sodium intake causes hyponatremia that can also contribute to nausea and vomiting.


d)   Delayed gastric emptying: Eating a meal high in complex carbohydrates (high in fibre, high protein foods, high fat foods( fried food) takes a longer time to digest and in turn delays gastric emptying. While training at high intensities this undigested food refluxes causing nausea and vomiting.


e)    Dehydration: Dehydration can also cause digestive tract disturbances, another reason to experience nausea and vomiting. 

In very rare cases it may occur due to acute renal failure, Food-dependent exercise-induced anaphylaxis, and Heat stroke.

How to prevent nausea and vomiting? 

·      Stay hydrated: Drink enough water before and during training to keep yourself well hydrated.


·    Carbohydrates and electrolytes: Sports drinks/Diluted fruit juices with salt containing different transportable sugars such as glucose, sucrose and fructose, and electrolytes(sodium and potassium) should be consumed during exercise. 


·    Plan mealsPlan your meals wisely with proper nutrient composition that aids proper digestion before training sessions. Do not have a large meal right before the session, always eat 2 or 3 hours before training. A small snack can be consumed an hour before training- e.g. Banana/fresh dates or raisins. 


·     Beet it:  Nitrates/nitric oxide is known to increase blood supply to the GI tract.It also improves oxygen supply to working muscles. Drink beetroot juice 1-2 hours before training. 


·      Rest and recovery: Avoid training when already very tired. Focus on getting adequate rest and recovery. 


·      Training: Well-structured training will help to improve lactate threshold- delay the onset of lactate production and also aid its removal


·      Avoid junk: Avoid fried, spicy foods just before exercise.



How to curb the puky feeling during exercise

·      Slow down: Do not stop but lower the intensity


·      Sip on: carbohydrate and electrolyte drink-do not gulp 

·      Stretch and relax- to slowly eliminate lactic acid from muscle. 


In conclusionThrowing up or Puking due to intense exercise is common among athletes, but it can be prevented or taken care off.  Athletes can avert this following the above tips and guidelines. 

Author: Lavanya Kotagadda, Dr Geetanjali Bhide  


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  3. de Oliveira, E.P., Burini, R.C. & Jeukendrup, A. Gastrointestinal Complaints During Exercise: Prevalence, Etiology, and Nutritional Recommendations. Sports Med 44 (Suppl 1), 79–85 (2014)

https://www.medicalnewstoday.com/articles/nausea-after-a-workout#is-it-normal(Cassoobhoy & Martinez, 2020)