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Opinion |
1 Department of Radiology, Hospital of the University of Pennsylvania,
University of Pennsylvania School of Medicine, 3400 Spruce St., Philadelphia,
PA 19104.
2 Division of Gastroenterology, Department of Medicine, Hospital of the
University of Pennsylvania, University of Pennsylvania School of Medicine,
Philadelphia, PA.
3 Division of Nuclear Medicine, Department of Radiology, Hospital of the
University of Pennsylvania, University of Pennsylvania School of Medicine,
Philadelphia, PA.
Received March 28, 2007;
accepted after revision April 6, 2007.
M. S. Levine is a consultant for E-Z-EM.
Abstract
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CONCLUSION. Our observations suggest that successful speed eaters expand the stomach to form an enormous flaccid sac capable of accommodating huge amounts of food. We speculate that professional speed eaters eventually may develop morbid obesity, profound gastroparesis, intractable nausea and vomiting, and even the need for a gastrectomy. Despite its growing popularity, competitive speed eating is a potentially self-destructive form of behavior.
Keywords: barium studies • fluoroscopy • gastric physiology • gastroparesis • speed eating • stomach
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The contestants are professional speed eaters who compete in events on an international circuit sanctioned by the IFOCE. These sanctioned competitions have led to a formal ranking of the top 50 speed eaters on the worldwide circuit. Currently, the number one ranked speed eater is Takeru Kobayashi from Nagano, Japan, a competitor who dominated the sport in 2006, winning the annual Nathan's Fourth of July Hot Dog Eating Contest for the fifth consecutive year, when he consumed 54 Nathan's Famous Hot Dogs and buns in 12 minutes [1]. Kobayashi holds world records in five separate categories, including hot dogs, hamburgers, brats, rice balls, and cow brains [1].
Competitive speed eating has become so popular that Philadelphia hosts an annual competition at the Wachovia Center (home of the Philadelphia 76ers and Philadelphia Flyers) known as Wing Bowl [2]. This buffalo-style chicken wings contest is broadcast live by WIP (AM) radio, a Philadelphia sports talk channel. Although this event is not sanctioned by the IFOCE, the annual Wing Bowl routinely draws crowds of 20,000 or more to the Wachovia Center—larger crowds than those generally attending professional basketball and hockey games played in this arena. The immense popularity of Wing Bowl reflects the emergence of speed eating as a major competitive sport with a growing legion of worldwide fans.
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We recently had the opportunity to assess the stomach of a world-class speed-eating champion and a control subject during a speed-eating test in our gastrointestinal fluoroscopy suite. We therefore present our preliminary observations and speculate about the long-term ramifications of competitive speed eating for its participants.
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Before testing, both study subjects signed standard university "Consent to Record and Release" and "Authorization for Use and/or Disclosure of Protected Health Information Including Recordings" forms and standard consent forms notifying them of the potential risks associated with the studies, including exposure to radionuclides and ionizing radiation. Our institutional review board was satisfied with the consent process and approved submission of the manuscript for publication.
Preliminary Testing
It is presently unknown whether speed eaters are born with the ability to
rapidly ingest vast amounts of food or whether they are able to train their
stomachs to perform in this manner during competitions. When speed eaters have
been questioned on this subject, some thought that they always have had this
ability but that training helped to hone their skills. It could well be that
these skills result from a combination of an inherently compliant stomach and
adaptive training. Speed eaters describe varying methods of training for
competition. Some ingest vast amounts of cabbage, and others ingest increasing
amounts of other specific food items to prepare for these events. Many speed
eaters also use water loading as a means of expanding their stomachs without
ingesting unneeded calories. (We caution readers who may wish to try this at
home that such behavior may be associated with adverse side effects, including
hypothermia, water intoxication, and cerebral edema.) Fortunately, water load
testing has been well described and validated in normal individuals and in
patients with dyspepsia
[3].
We performed two different water load tests on our subjects. The WL5 was performed by having the subjects drink room-temperature water at their own pace during a 5-minute period or until they felt sated (normal, 648 ± 204 mL), and the WL100 was performed by having the subjects drink room-temperature water at a rate of 100 mL/min until they felt sated (normal, 1,128 ± 355 mL) [3]. 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 (WL5 results of < 2 L vs 4.5 L [stopped before 2 minutes] and WL100 results of 2 L vs 2.4 L [stopped before subjects felt sated], for the control subject and the competitive speed eater, respectively). These studies indicated that the competitive speed eater either could sequester larger volumes of ingested fluid in his stomach or could empty his stomach more quickly than the control subject.
We also performed solid-phase nuclear gastric emptying scanning [4] on our participants to help determine which of these two mechanisms is more important for competitive speed eating. The professional speed eater emptied only 25% of the radioactive meal at 2 hours, whereas the control subject emptied 75% of the meal at 2 hours (the normal rate for solidphase gastric emptying at 2 hours is > 50% at our institution). Although it is difficult to extrapolate from a sample size of one, these data suggested that competitive speed eaters are able to consume unusually large volumes of food before feeling sated because of increased gastric accommodation rather than because of more rapid gastric emptying in comparison with control subjects.
Setup
Both participants were asked to consume as many hot dogs as possible during
a 12-minute period, the standard time allotted for a hot dog eating contest.
In actual speed-eating events, the competitors typically eat the hot dogs on
buns, often lubricating the buns with water to facilitate rapid swallowing.
Because of concern that water might dilute preingested barium in the stomach,
a decision was made to have the subjects eat the hot dogs without buns for
this speed-eating test.
The participants were both asked to lift their shirts before and after eating hot dogs so we could assess any physically evident changes in the appearance of their abdomens. They were then positioned on the fluoroscopy table and asked to ingest an effervescent agent (Baros, Mallinckrodt Pharmaceutical) and a standard dose of high-density barium (E-Z-HD, E-Z-EM) in the upright position before being rotated on the table in a recumbent position to coat the stomach with barium. Several spot images of the stomach were obtained to document the appearance of the stomach and duodenum immediately before the speed-eating test. We anticipated that the ingested hot dogs would appear as lesions etched in white by residual barium in the stomach or as filling defects in the surrounding barium pool. No pharmacologic agents were administered, and both subjects had nothing by mouth on the day of the test. The subjects were placed in a semiupright position on the fluoroscopy table for the speed-eating test to facilitate ingestion of the hot dogs. Intermittent fluoroscopy of the stomach was performed to observe the physiologic effects on the stomach, and occasional spot images were obtained to document the fluoroscopic findings.
Speed-Eating Test
The control subject was our first participant. When he lifted his shirt at
the outset, his abdomen was flat. A preliminary double-contrast examination
showed a normal-appearing stomach with free emptying of barium into the
duodenum and no evidence of gastric dilatation or retained fluid or debris
(Fig. 1A). Normal gastric
peristalsis was observed at fluoroscopy.
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The world-class competitive speed eater was our second participant. When he lifted his shirt at the outset, his abdomen was also flat. A preliminary double-contrast examination showed mild gastric distention with noticeably decreased gastric peristalsis at fluoroscopy (Fig. 2A), although some barium emptied into the duodenum. No retained fluid or debris was in the stomach.
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Logic and gastric physiology suggest two possibilities. Either the speed eater's stomach empties much faster than a normal stomach, or the speed eater's stomach is capable of expanding to the point that it can accommodate the rapid influx of an enormous quantity of food. Our water load tests and solid-phase nuclear gastric emptying scans suggested the latter scenario, which subsequently was confirmed during our speed-eating test.
Unlike the control subject, the speed eater had markedly altered gastric physiology that enabled his stomach to rapidly accommodate an enormous quantity of ingested food by progressively expanding until it became a giant, flaccid sac occupying most of his upper abdomen (Figs. 2A, 2B, 2C, and 2D). In other words, his stomach acted as a compliant, expansile receptacle, dilating to a degree that it could accept an almost unlimited volume of food. Conversely, gastric peristalsis was absent or near absent, so virtually none of the consumed hot dogs emptied into the duodenum.
We recognize that we may be extrapolating unfairly based on a sample size of one, and that fluoroscopic observation of a series of speed eaters is needed to draw more definitive conclusions about the science of speed eating. Nevertheless, the fluoroscopic findings in our speed eater were so dramatic that we suspect our observations in this case can be applied to competitive speed eaters in general. Rapid emptying of large unground pieces of hot dog into the small bowel also would likely have precipitated a dumping syndrome [5], which did not occur during our speed-eating test and which also has not been described by other competitive speed eaters during these contests.
Another important question is how speed eaters are able to alter their gastric physiology so their stomachs can become huge, flaccid sacs. Discussions with our speed-eating champion revealed that he spent several years training for the sport, forcing himself to consume larger and larger amounts of food despite the sensation of fullness and satiety to develop his speed-eating capabilities. In effect, he was slowly able to overcome the usual checks and balances associated with eating by exercising extraordinary will power and self-discipline during his training, consuming more and more food when others wouldn't be able to swallow another bite without feeling sick (as our control subject did). Only as a result of this prolonged and intensive training process was the speed eater gradually able to adapt his stomach until it could withstand the rigors and stresses of competitive speed eating. In that sense, a world-class speed eater requires the same level of will power, self-discipline, and commitment as any professional athletes honing their skills in gymnastics, track, or other athletic endeavors. Whether such speed-eating individuals possess intrinsic eating abilities before beginning their training is unclear. Although some speed eaters may have stomachs that are inherently compliant, the only way to confirm this hypothesis would be to perform baseline barium studies on a group of speed eaters before they trained for competition in comparison with a group of control subjects.
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Yet our speed eater looked trim and fit without an ounce of spare fat on him. How did he avoid becoming overweight under these circumstances? By carefully monitoring his oral intake, he told us, and by taking measured portions of food at mealtime without refilling his plate despite the fact that he never felt full or sated. He therefore exercised extraordinary self-discipline and willpower to avoid becoming overweight in a setting ripe for gaining weight.
But the competitive speed eater was a young man. What will happen over the next 20 years, as he enters middle age and perhaps begins to lose the self-motivation critical for avoiding weight gain? It is easy to envision a scenario in which aging speed eaters lose their willpower and engage in chronic binge eating because they never feel sated. In this setting, long-time speed eaters and former speed eaters may be at substantial risk of developing morbid obesity and all the health risks associated with this condition.
Even more worrisome is the potential risk that a chronically dilated, flaccid stomach may eventually decompensate, so that it becomes an enormous sac incapable of shrinking to its original size and incapable of peristalsing or emptying solid food. If this happens, long-term competitive speed eaters ultimately could develop intractable nausea and vomiting, necessitating a partial or total gastrectomy to relieve their symptoms and restore their ability to eat. Thus, speed eating is a potentially self-destructive form of behavior that over time could lead to morbid obesity, intractable nausea and vomiting, and even the need for gastric surgery. For all these reasons, we believe the IFOCE should make it a high priority to follow up their athletes and former athletes to fully assess the long-term risks of competitive speed eating for its participants.
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