Client keeps throwing up after workout!

[X-Mark-X]

Hey guys,

So I have this one client who I see 4 days/week. He is 22, no health problems, healthy body weight, in good shape for someone who hasn't trained before. I see him 4 days a week, 2 days we do full body circuits, one day we do upper body strength, one day we do lower body strength. The strength days are heavier lifts and he is fine with those, but he keeps throwing up after the damn circuits.

Today I made everything less intense, asked him how he was feeling after every set. He kept saying he felt great, wasn't breathing too heavy, all was fine, etc. Then he puked after we finished, 3rd time it's happened. This time it was after he finished the full workout (5 sets of the circuit), last time he only got through 1.5 sets of the circuit before having to run to the bathroom to puke. I always have him warm up before, and I encourage him to move around after when he finishes but he usually just says he's fine and then ends up throwing up.

I'm not giving him super hard workouts either, we're talking stuff like ball squats, body weight step ups, and modified push ups here.

I made sure he ate ~2 hours before coming, drank plenty, got a lot of sleep, etc.

What should I do? I'm definitely going to have him do a more structured/graduated cool down next time. Should I try progressively decreasing the intensity of the circuits as well? Like lowering the weight/reps for each consecutive set? Usually it gets harder as he goes because he gets more and more fatigued.

He isn't upset about it at all. He actually seems to be enjoying it because he knows he had a good workout and wants me to push him hard, but I feel bad/embarrassed every time he throws up.

[tovlakas]

Hey guys,

So I have this one client who I see 4 days/week. He is 22, no health problems, healthy body weight, in good shape for someone who hasn't trained before. I see him 4 days a week, 2 days we do full body circuits, one day we do upper body strength, one day we do lower body strength. The strength days are heavier lifts and he is fine with those, but he keeps throwing up after the damn circuits.

Today I made everything less intense, asked him how he was feeling after every set. He kept saying he felt great, wasn't breathing too heavy, all was fine, etc. Then he puked after we finished, 3rd time it's happened. This time it was after he finished the full workout (5 sets of the circuit), last time he only got through 1.5 sets of the circuit before having to run to the bathroom to puke. I always have him warm up before, and I encourage him to move around after when he finishes but he usually just says he's fine and then ends up throwing up.

I'm not giving him super hard workouts either, we're talking stuff like ball squats, body weight step ups, and modified push ups here.

I made sure he ate ~2 hours before coming, drank plenty, got a lot of sleep, etc.

What should I do? I'm definitely going to have him do a more structured/graduated cool down next time. Should I try progressively decreasing the intensity of the circuits as well? Like lowering the weight/reps for each consecutive set? Usually it gets harder as he goes because he gets more and more fatigued.

He isn't upset about it at all. He actually seems to be enjoying it because he knows he had a good workout and wants me to push him hard, but I feel bad/embarrassed every time he throws up.

Maybe you're just a sadistic trainer and don't even realize it! All jokes aside, you have him eating at least 2 hours early, but maybe he's eating right before the workout as well? Or anywhere in between 2 hours and the workout? Not that that would cause him to puke... but find out what he's eating, maybe allergic? Maybe he eats 2.5 hours before the workout, and pops a multivitamin right before the workout with no food on a freshly-digested stomach, perfect recipe for bootage?

Also, is he holding his breath or swallowing air while training? Make sure he's breathing properly... also check his heart rate periodically during the workout, reminds me of during football practice first thing in the fall after summer when all the fat ass linemen used to puke from being deconditioned... circuit training can be similar cardiorespiratory workout to traditional cardio for beginners and intermediate clients, so maybe you are upping the intensity too much... E.G. if he's at 85-90% of his heart rate during the whole bout of resistance training i could see how that could encourage him to launch like a frat boy.

If all else fails send him to a doctor because that's not normal... lol...

[trance__dreamer]

reminds me of during football practice first thing in the fall after summer when all the fat ass linemen used to puke from being deconditioned.

i lol'ed.

[X-Mark-X]

Maybe you're just a sadistic trainer and don't even realize it! All jokes aside, you have him eating at least 2 hours early, but maybe he's eating right before the workout as well? Or anywhere in between 2 hours and the workout? Not that that would cause him to puke... but find out what he's eating, maybe allergic? Maybe he eats 2.5 hours before the workout, and pops a multivitamin right before the workout with no food on a freshly-digested stomach, perfect recipe for bootage?

Also, is he holding his breath or swallowing air while training? Make sure he's breathing properly... also check his heart rate periodically during the workout, reminds me of during football practice first thing in the fall after summer when all the fat ass linemen used to puke from being deconditioned... circuit training can be similar cardiorespiratory workout to traditional cardio for beginners and intermediate clients, so maybe you are upping the intensity too much... E.G. if he's at 85-90% of his heart rate during the whole bout of resistance training i could see how that could encourage him to launch like a frat boy.

If all else fails send him to a doctor because that's not normal... lol...

Well I'm pretty sure the eating is good. The first time it happened he ate RIGHT before the workout so I suggested not to eat so close to it. I'll try checking his heart rate between sets, maybe I'm kicking his ass harder than I think I am. He pushes himself a lot more than most of my other clients, which means maybe I should be encouraging him to slow down rather than push himself more..

[Attaus]

Four things can make me feel sick during workouts..

1) Bad PWO nutrition

2) Not breathing (usually breath deep through my nose)

3) Altitude

4) Water intake


If you find out exactly what he eats/drinks before a workout, ensure he has enough water and breathes properly, it's either the altitude or a condition you can't control.

[Teench]

I've heard this is caused by lactic acid build up. If this is true, keep it up and get some beta-alanine. haha

[Maverick777]

shouldn't be caused by lactic acid buildup...

[jakeratt]

no joke...
Have you seen his vomit....
I ask because that would be one way of telling if its all water.
Is he drinking alot of water that just rolls around in his stomach causing him to get sick?
Is he taking anything else right before workout? aka pre workout, protein, lactic acid remover, or even better SODA.

Caffine can make some people very sensitive.

Those are all questions id figure out

[jando]

he's drinking too much water during the session

[X-Mark-X]

He does drink quite a lot during his workouts, I'll try to get him to cut back and see if that helps, thanks guys.

[KyleAaron]

He pushes himself a lot more than most of my other clients, which means maybe I should be encouraging him to slow down rather than push himself more..

This is probably it, I've had a few people who do that. I had one guy who used to keep going when by the looks of him he should have stopped, he threw up often, one time he fell over gasping so hard, with the gasping not stopping with a few minutes' rest, I thought he might be asthmatic. We jumped in the taxi and went to his doctor, the next week I heard the results straight from the doc, "naw, not asthmatic, just really unfit." He was a guy who pushed himself really hard ignoring any pain or discomfort.

So after that I did the pacing of his exercises for him. No more vomiting or apparent asthma.

You have to watch out for the ones who really want to be thrashed hard. They can be self-destructive in many ways.

[mugeneg6]

Check and see if he has a history of gastrointestinal problems or reflux. I had serious problems with vomiting and actually had to get a nissen gastric bypass last year, I still have the urge to throw up very easily and have to work out accordingly. Some people can have a very light gag reflex most of their life, think it's normal and actually have a medical condition. Just a thought from personal experience.

[popupwindow]

shouldn't be caused by lactic acid buildup...

Why not? It's quite easy to induce enough lactic acid flooding into the bloodstream quickly enough to cause vomiting. This is especially true for people who push hard, are unfamiliar with lactate (anerobic) training and not in great shape. If you don't believe me, grab any crossift workout ('helen', 3 rounds of 400m run, 21 kettlebell swings and 12 pullups should do it) and grab someone who trains in a largely anerobic manner (cardio bunny friend or yourself perhaps even if you don't have the heart to make someone else throw up to test a theory) and put them through the workout. Provided it's their first time doing intense metabolic conditioning style workouts and they have the mental fortitude to push hard, I'd say there's a 7/10 chance they'll lose their lunch.

To the OP, no food/drink 2-3 hours before the workout except some water, lower the intensity (increased rest periods, heavier weights so he can't do the reps as quickly or slightly more technically challenging exercises so there's some control and technique involved, not just smashing reps.

[KyleAaron]

Lactate in the bloodstream does not cause vomiting. I think we have here another graduate of the University of Stuff I Heard Somewhere, Faculty of Broscience.

Illness, adrenalin, and exertion cause vomiting.

In the case of adrenalin and exertion, the vomiting comes about simply because the body only has so much blood, and digestion takes a lot of it; so if the blood is diverted to the muscles instead, the body says, "hmmm, obviously you don't want me to digest the food, I'll get rid of it."

[popupwindow]

Lactate in the bloodstream does not cause vomiting. I think we have here another graduate of the University of Stuff I Heard Somewhere, Faculty of Broscience.

Illness, adrenalin, and exertion cause vomiting.

In the case of adrenalin and exertion, the vomiting comes about simply because the body only has so much blood, and digestion takes a lot of it; so if the blood is diverted to the muscles instead, the body says, "hmmm, obviously you don't want me to digest the food, I'll get rid of it."

That doesn't explain why you still get the same effect on an empty stomach. Yes, a full stomach exacerbates the issue but you can't put that down to being the cause. Also, you said my statement is broscience, yet your statement doesn't seem to have much science behind it either.

[1ADPechal]

The same thing kept happening to my friend, who I work out with daily. We would work out, lift heavy, than after the work out he would get sick and throw up. I came to find out that he was taking 3 scoops of the NO Explode stuff, he thought it would make him keep up during the work out. I know people who take 3 scoops of the stuff, however they started at 1.5 scoops and built up a tolerance. I think you should ask your client if he is taking any pre-workout supplements and if he is than how much? Also ask him if he is drinking those damn energy drinks before, that will also do it. Just my 2 cents.

[whytchapel]

he's drinking too much water during the session

This. Happened with my fairly consistently until I cut down water intake during the session. Doesn't happen anymore.

[BSCSCS]

Find out what supps he's taking. I could really see the NOexlpode causing it. I have also heard of creatine causing upset stomaches. It's also very likely that there is a psychological factor...like how seeing a dead body, or something really gross makes people throw up.

[Ronin4help]

You're training him too hard. Also, he shouldn't eat before his owrkout.

[KyleAaron]

That doesn't explain why you still get the same effect on an empty stomach.

There are two possibilities there. Either the person has low blood sugar, hasn't eaten enough - this falls under the category of illness-caused vomiting. Or they ate plenty but have an empty stomach - so they dry retch. Again, it's a physiological thing. Once the blood supply around the stomach drops to a certain level, the stomach reacts by making you vomit.

Also, you said my statement is broscience, yet your statement doesn't seem to have much science behind it either.

Commonly we don't provided references for things which are widely-known to the audience we're speaking to. This is the personal trainer's forum, I'm not going to provide references for the causes of vomiting during exertion anymore than I would for supercompensation, maximal heart rate, etc. The basics are agreed upon by all educated and/or experienced people, it's only the details under debate.

Some dissent about the basics. You'll note that on these forums, those are the people without any indication of their profession or qualifications in their sigs. Thus, Broscience.

[popupwindow]

Commonly we don't provided references for things which are widely-known to the audience we're speaking to. This is the personal trainer's forum, I'm not going to provide references for the causes of vomiting during exertion anymore than I would for supercompensation, maximal heart rate, etc. The basics are agreed upon by all educated and/or experienced people, it's only the details under debate.

I could say the exact same thing about my statement, so perhaps it's more a case of your opinion is broscience, my opinion is universally-regarded-as-fact-by-everyone mentality? I'm open to ideas, I know that what you're saying is right for most cases, eating too much/not enough food, blood, digestion etc, my post is referring specifically to anaerobic style circuit training and why that produces vomiting. If someone said they went for a 5K run and threw up, I'd give a different answer. Look up 'lactic acidosis.'

You'll note that on these forums, those are the people without any indication of their profession or qualifications in their sigs. Thus, Broscience.

So if I don't bother putting anything in my sig, I'm some moron who knows nothing? How does putting something in my sig mean anything? I could say in my sig I have a PhD, but that wouldn't make it true.

[askthetrainer]

Hey guys,

So I have this one client who I see 4 days/week. He is 22, no health problems, healthy body weight, in good shape for someone who hasn't trained before. I see him 4 days a week, 2 days we do full body circuits, one day we do upper body strength, one day we do lower body strength. The strength days are heavier lifts and he is fine with those, but he keeps throwing up after the damn circuits.

Today I made everything less intense, asked him how he was feeling after every set. He kept saying he felt great, wasn't breathing too heavy, all was fine, etc. Then he puked after we finished, 3rd time it's happened. This time it was after he finished the full workout (5 sets of the circuit), last time he only got through 1.5 sets of the circuit before having to run to the bathroom to puke. I always have him warm up before, and I encourage him to move around after when he finishes but he usually just says he's fine and then ends up throwing up.

I'm not giving him super hard workouts either, we're talking stuff like ball squats, body weight step ups, and modified push ups here.

I made sure he ate ~2 hours before coming, drank plenty, got a lot of sleep, etc.

What should I do? I'm definitely going to have him do a more structured/graduated cool down next time. Should I try progressively decreasing the intensity of the circuits as well? Like lowering the weight/reps for each consecutive set? Usually it gets harder as he goes because he gets more and more fatigued.

He isn't upset about it at all. He actually seems to be enjoying it because he knows he had a good workout and wants me to push him hard, but I feel bad/embarrassed every time he throws up.

Sounds like electrolyte imbalance to me....

http://www.livestrong.com/article/31...yte-imbalance/

I had an old client who had the vomit problem, (called him as "throw-up guy" to other clients who used to throw up under all conditions.... I referred him to a doctor and stopped training him because i find it quite disgusting...

[fishpat86]

I used to throw up after every session.

[jdmalm123]

I could say the exact same thing about my statement

but you'd still be wrong...it's actually the accumulation of Hydrogen ions that causes the burn...lactic acid is what the body produces to re-create ATP. Lactic acid as the cause of "the burn" is outdated science...it turns out lactic acid production curve mirrors the H+ curve.

http://www.brianmac.co.uk/lactic.htm

The expression "lactic acid" is used most commonly by athletes to describe the intense pain felt during exhaustive exercise, especially in events like the 400 metres and 800 metres. When energy is required to perform exercise, it is supplied from the breakdown of Adenosine Triphosphate (ATP). The body has a limited store of about 85 grms of ATP and would use it up very quickly if we did not have ways of resynthesising it. There are three systems that produce energy to resynthesise ATP: ATP-PC, lactic acid and aerobic.

The lactic acid system is capable of releasing energy to resynthesise ATP without the involvement of oxygen and is called anaerobic glycolysis. Glycolysis (breakdown of carbohydrates) results in the formation of pyruvic acid and hydronium ions (H+). The pyruvic acid molecules undergo oxidation in the mitochondrion and the Krebs cycle begins. A build up of H+ will make the muscle cells acidic and interfere with their operation so carrier molecules, called nicotinamide adenine dinucleotide (NAD+), remove the H+. The NAD+ is reduced to NADH that deposit the H+ at the electron transport gate (ETC) in the mitrochondria to be combined with oxygen to form water (H2O).

If there is insufficient oxygen then NADH cannot release the H+ and they build up in the cell. To prevent the rise in acidity pyruvic acid accepts H+ forming lactic acid that then dissociates into lactate and H+. Some of the lactate diffuses into the blood stream and takes some H+ with it as a way of reducing the H+ concentration in the muscle cell. The normal pH of the muscle cell is 7.1 but if the build up of H+ continues and pH is reduced to around 6.5 then muscle contraction may be impaired and the low pH will stimulate the free nerve endings in the muscle resulting in the perception of pain (the burn). This point is often measured as the lactic threshold or anaerobic threshold (AT) or onset of blood lactate accumulation (OBLA).

The process of lactic acid removal takes approximately one hour, but this can be accelerated by undertaking an appropriate cool down that ensures a rapid and continuous supply of oxygen to the muscles.

The normal amount of lactic acid circulating in the blood is about 1 to 2 millimoles/litre of blood. The onset of blood lactate accumulation (OBLA) occurs between 2 and 4 millimoles/litre of blood. In non athletes this point is about 50% to 60% VO2 max and in trained athletes around 70% to 80% VO2 max.

[jdmalm123]

I used to throw up after every session.

Until your hormones and nervous system stopped getting overloaded in situ by exercise.

OP: As long as it's not as simple as too much water, etc, the trainee will get used to it. Dial back the program a notch so you don't lose a client who gets tired of retching every session.

[X-Mark-X]

but you'd still be wrong...it's actually the accumulation of Hydrogen ions that causes the burn...lactic acid is what the body produces to re-create ATP. Lactic acid as the cause of "the burn" is outdated science...it turns out lactic acid production curve mirrors the H+ curve.

http://www.brianmac.co.uk/lactic.htm

The expression "lactic acid" is used most commonly by athletes to describe the intense pain felt during exhaustive exercise, especially in events like the 400 metres and 800 metres. When energy is required to perform exercise, it is supplied from the breakdown of Adenosine Triphosphate (ATP). The body has a limited store of about 85 grms of ATP and would use it up very quickly if we did not have ways of resynthesising it. There are three systems that produce energy to resynthesise ATP: ATP-PC, lactic acid and aerobic.

The lactic acid system is capable of releasing energy to resynthesise ATP without the involvement of oxygen and is called anaerobic glycolysis. Glycolysis (breakdown of carbohydrates) results in the formation of pyruvic acid and hydronium ions (H+). The pyruvic acid molecules undergo oxidation in the mitochondrion and the Krebs cycle begins. A build up of H+ will make the muscle cells acidic and interfere with their operation so carrier molecules, called nicotinamide adenine dinucleotide (NAD+), remove the H+. The NAD+ is reduced to NADH that deposit the H+ at the electron transport gate (ETC) in the mitrochondria to be combined with oxygen to form water (H2O).

If there is insufficient oxygen then NADH cannot release the H+ and they build up in the cell. To prevent the rise in acidity pyruvic acid accepts H+ forming lactic acid that then dissociates into lactate and H+. Some of the lactate diffuses into the blood stream and takes some H+ with it as a way of reducing the H+ concentration in the muscle cell. The normal pH of the muscle cell is 7.1 but if the build up of H+ continues and pH is reduced to around 6.5 then muscle contraction may be impaired and the low pH will stimulate the free nerve endings in the muscle resulting in the perception of pain (the burn). This point is often measured as the lactic threshold or anaerobic threshold (AT) or onset of blood lactate accumulation (OBLA).

The process of lactic acid removal takes approximately one hour, but this can be accelerated by undertaking an appropriate cool down that ensures a rapid and continuous supply of oxygen to the muscles.

The normal amount of lactic acid circulating in the blood is about 1 to 2 millimoles/litre of blood. The onset of blood lactate accumulation (OBLA) occurs between 2 and 4 millimoles/litre of blood. In non athletes this point is about 50% to 60% VO2 max and in trained athletes around 70% to 80% VO2 max.

Well first of all, lactic acid dissociates into lactate and H+ ions, so without the lactic acid you wouldn't have the H+ ions, and you wouldn't have the burn, so it isn't entirely ridiculous to say that lactic acid causes the burn. Just technically incorrect I suppose.

Furthermore, it has always been my understanding that the absorption of H+ ions into the blood stream caused metabolic acidosis (more specifically, lactic acidosis) which could, in turn, could cause vomiting?

I did a wingate test once and after 30 seconds of work I felt like I was going to throw up for 15 minutes. I thought that was why.

[jdmalm123]

I did a wingate test once and after 30 seconds of work I felt like I was going to throw up for 15 minutes. I thought that was why.

i hiked in the grand canyon and barely stopped for 3 hours...i was sweating, drinking lots, breathing hard and my legs were burning...felt great.

the first few times i squatted, i threw up.

my personal opinion is it's the nervous system. it gets switch on and lights up where it 'should not' i.e. the stomach and ... boom, you've got amino acids on your shoes!

[X-Mark-X]

i hiked in the grand canyon and barely stopped for 3 hours...i was sweating, drinking lots, breathing hard and my legs were burning...felt great.

the first few times i squatted, i threw up.

my personal opinion is it's the nervous system. it gets switch on and lights up where it 'should not' i.e. the stomach and ... boom, you've got amino acids on your shoes!

Right, but if you did it for 3 hours non stop, then you're relying largely on aerobic metabolism, which means lactic acid is likely being used as fast as it is being produced, so no net lactate accumulation. Versus 30 seconds of EXTREMELY intense activity that pushes your anaerobic metabolism to its limits (wingate test, heavy ass squats). Also, the enzyme lactate dehydrogenase in fast-twitch fibers favors conversion of pyruvate to lactate. Higher workout intensities means more fast-twitch fiber recruitment (hennemen's size principle), which means more lactate.

Not saying that's the definitive cause of throwing up. Just pointing out that it's not a ridiculous suggestion.

[Emoore]

I used to know a guy who threw up after every workout for years. It got to be a standing joke and everybody called him "El Puke-o." Wonder if it's the same guy?

[ironhead_88]

Hey guys,

So I have this one client who I see 4 days/week. He is 22, no health problems, healthy body weight, in good shape for someone who hasn't trained before. I see him 4 days a week, 2 days we do full body circuits, one day we do upper body strength, one day we do lower body strength. The strength days are heavier lifts and he is fine with those, but he keeps throwing up after the damn circuits.

Today I made everything less intense, asked him how he was feeling after every set. He kept saying he felt great, wasn't breathing too heavy, all was fine, etc. Then he puked after we finished, 3rd time it's happened. This time it was after he finished the full workout (5 sets of the circuit), last time he only got through 1.5 sets of the circuit before having to run to the bathroom to puke. I always have him warm up before, and I encourage him to move around after when he finishes but he usually just says he's fine and then ends up throwing up.

I'm not giving him super hard workouts either, we're talking stuff like ball squats, body weight step ups, and modified push ups here.

I made sure he ate ~2 hours before coming, drank plenty, got a lot of sleep, etc.

What should I do? I'm definitely going to have him do a more structured/graduated cool down next time. Should I try progressively decreasing the intensity of the circuits as well? Like lowering the weight/reps for each consecutive set? Usually it gets harder as he goes because he gets more and more fatigued.

He isn't upset about it at all. He actually seems to be enjoying it because he knows he had a good workout and wants me to push him hard, but I feel bad/embarrassed every time he throws up.

this reminds me when i was in college and guys on the football team would throw up because of how intense our workout were... not saying that your workouts are too intense nor saying you overdue it but maybe its too much for him and his body isnt use to the circuit since he never worked out before..... is it a circuit that they go straight through without rest or do they get rest. if they do get rest how long do you give them? not saying this is the problem but should start here. dont feel bad or embarrassed about him throwing up its happens to some of those who are not use to working out..... I know that hes probably not a athlete but even the top notch athletes throws up during workouts (but due to intensity). its just throw up im pretty sure he throws up after he had too many to drink on the weekends. or maybe hes throwing up because of the night before you never know just some areas to start out at.