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Eating, Competitively: Penn Gastroenterologists Break It Down

20090617-nathanshotdogThe names Bill ″El Wingador″ Simmons, Sonya "The Black Widow" Thomas, and Joey Chestnut might ring a bell to followers of the Wing Bowl, the annual speed eating competition that takes place right here in the City of Brotherly Love on the Friday before the Super Bowl.

Chestnut is, as of a few days ago, also now the eight-year reigning champion in the Nathan’s Hot Dog eating contest, devouring 61 hot dogs in 10 minutes. His record, set in the 2013, is 69 hot dogs in 10 minutes. The contest is held every July 4th on Coney Island in Brooklyn, NY.

These two festivals of gluttony are not for the weak-stomached among us, says David Metz, MD, a gastroenterologist at Penn Medicine who has studied the subject. In fact, these contests might only be for, shall we say, the gastronomically-gifted. “We believe that these competitors’ stomachs have the (rare) ability to remain relaxed and continue to expand” as more and more food is ingested.

In most people, the stomach will stretch to the point where we are sated and then tighten and go no further, giving the sensation of fullness. Essentially, Metz is saying that in competitive eaters, the stomach only gets to this point after massive amounts are ingested and the “full” feeling is completely avoided under normal eating conditions.

The other amazing thing about this group of people Metz found is that, even with massive amounts of food in their stomach, the normal processes of digestion continue, well, normally. "A normal-size meal takes about two to four hours to digest," Metz told the Philadelphia Inquirer last year. "While food sits in the top half of our stomach during muscle relaxation, the bottom half grinds its contents with acid to turn it into a paste and then squirts it into the small bowel in measured  amounts for further digestion and absorption. [Competitive eaters'] stomachs can expand to retain all of the food without increasing gastric pressure, but it may take many hours or even days for them to release the partially digested paste into the bowel."

This amount of food would normally cause dyspepsia, the technical term for indigestion in most of us, but in the stomach of a speed eater it all seems to sit quite well.

Metz and colleague Mark S. Levine, MD, performed the most in-depth research on record on the subject. Their study, Competitive Speed Eating: Truth and Consequences, was published in 2007 in the Journal of Roentenology. The two compared the stomach of a speed-eater with a control subject and performed gastrointestinal fluoroscopy to show the differences. They started with water loading. The 29-year-old fit and trim nationally-ranked speed eater and the control subject, a 35-year-old, 6-foot-2- inch man weighing 210 pounds, each drank as much water as necessary to feel “full”. Their research states that “both subjects exhibited higher than normal capacities with both water load tests, but the competitive speed eater outperformed the control subject by a large enough margin that the tests were terminated prematurely.”

The subjects then ingested as many hot dogs, sans buns, for this experiment within 12 minutes, the allotted time in most speed-eating competitions. The competitive eater consumed 36 and indicated that he could continue eating more, while the control subject felt “sick” at just seven hot dogs. The stomach of the speed eater was much larger than the control when examined under fluoroscopy as was the visible outward appearance of his abdomen. Both subjects’ stomachs were flat at the start of the test and at completion, the control’s remained flat while the test subject’s “created the distinct impression of a developing intrauterine pregnancy,” the paper states.

The speed eater indicated that his stomach flattened after competition following several days of eating nothing and lots of exercise, without any nausea, vomiting or diarrhea.

While there is training involved to become an accomplished speed eater, Drs. Levine and Metz equate it to learning a triple axel or running a four-minute mile; there are simply those among us who are more physiologically pre-disposed for successful careers in this arena, but that even with training, success at speed-eating was not attainable for much of the population.

That’s the truth Metz and Levine came to.

The consequences are largely unknown, as the sport has not been around long enough for researchers to fully understand the long-term consequences of this level of stress on the stomach and digestive processes. As competitors age, is obesity likely since they can stretch their stomachs without feeling full? The stomach could also cease to work at digestion and become a flaccid sac in the abdomen, thus requiring a total or partial removal.

In addition, cautions Metz, “obesity is an epidemic; praising or promoting overeating or gluttonous behavior is not healthy nor what we want to do. It is important to keep in mind that this study was one subject and one control. There is still a lot we don’t know about speed-eating.”

In other words, don’t try this at home.

Photo: Speed eaters Takeru Kobayashi and Joey Chestnut competing in Nathan's Hot Dog-Eating Contest 2008 during overtime. Photo credit: Erin Zimmer

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