Member Case Study: High Intensity Exercise Causing Flu-like Symptoms

author : AMSSM
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Member Question from broompatrol:
Is there any documentation of high intensity exercise causing flu like symptoms afterward? After finishing a sprint triathlon I ate a large meal and about 8 hours later I became very ill with chills, fever and diarrhea. I attributed it to food poisoning. But, recently after completing a strenuous brick I became ill again with the same symptoms. Is this a coincidence? If not, what steps can I take to prevent this in the future?

 

Answer from Gary Arends, DO
Member AMSSM

Typically, when a patient, athlete or non-athlete, discusses acute “flu-like” symptoms of “fever, chills, and diarrhea,” a gastrointestinal (GI) infection comes to mind. It is rare to have a fever in an otherwise healthy individual (i.e. triathlete) without some exogenous cause. This could include bacterial, viral, or parasitic infection, metabolic GI disease, or ingestion of toxins or certain medications (Clinical Journal of Sports Med 11(2) 1992).

 

Diarrhea is characterized by an increase in daily stool weight above 200 grams. It is classified as three or more episodes of frequent, abnormally liquid stools in one day (Harrison’s 1998). A fever is defined as a temperature of 100.4 degrees Fahrenheit or above. Diarrhea (bloody or watery) and fever are commonly found in infection. The acute GI infection typically lasts less than two weeks, and chronic diarrhea lasts greater than 14 days. However, loose stools can also occur from extensive, intense physical exercise, such as during endurance events (Harrison’s 1998). This is commonly known as “runner’s trots.” This is not an infection, and also does not present with fever.

 

Assuming the triathlete is healthy and not taking any offending medication, these symptoms are most likely due to an acute self-limiting GI infection. However, if chronic, other more serious infections and conditions such as inflammatory bowel disease or other exotic GI diseases need to be ruled out by a healthcare professional.

 

With regard to developing these symptoms after eating a large meal several hours after a sprint triathlon, the first concern would be food poisoning and not the triathlon itself. Without detailing the type of food eaten, it is impossible to surmise if this is the reason for these symptoms. This is, of course, assuming the swim portion of the race was done in clean water. It is not uncommon for people to get sick after swimming in contaminated water. To determine the water safety in your area, click on www.surfrider.org/stateofthebeach.

 

As it relates to future workouts, studies have shown that mucosal injury can occur in the setting of food poisoning / infection. If the intestinal tract has not had sufficient time to heal, the normal bacterial flora in the gut can release endotoxins, which may result in fever and diarrhea. This can occur intermittently or on a regular basis, depending on the level of stress involved on the system (Clinical Journal of Sports Med 24 2005). It is recommended to reduce temporarily or to modify the workout intensity and duration, cross-train with exercises that will not induce diarrhea (i.e. weight training), reduce and / or eliminate GI triggers and fiber from the diet, and replace lost fluid with an electrolyte solution as necessary (Sports Medicine, Just The Facts 2005). This should be done for seven to fourteen days.

 

If the symptoms persist beyond two weeks, it is necessary to follow up with your physician to obtain a work-up for possible causes. Most acute diarrheal conditions are self-limiting. In a high-level athlete, such as a triathlete however, it can be debilitating and very frustrating. If symptoms persist beyond two weeks or are recurrent, it is recommended to be evaluated by your physician to rule out more ominous or serious causes. Even after the major symptoms have resolved, minor annoying symptoms may persist for a time until the intestinal tract has had time to heal. It is advised to be prudent in dietary choices and modify workouts until the symptoms no longer persist.

Happy Training!

Gary Arends, DO
Primary Care Sports Medicine
Burbank, California

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date: August 7, 2007

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AMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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