What does science suggest about the health risks of competitive speed eating?

I watched the annual Nathan’s July Fourth Hot Dog Eating Contest this year, in which the champ Joey Chesnut consumed 54 hot dogs and buns (over 15,000 Calories) in 10 minutes.  Some observations:

The majority of the eaters appeared to be thin (some very) in good shape.  I know little about how these people “train” for eating competitions, but I suspect (as the study below suggests) it is mostly a practice of extreme self-control.

I have never heard of any warnings to health of competitive eating, which is increasing in popularity, in the media.  There is a very vague IFOCE (the main international organization that holds contests and rankings) safety page but there is no information on potential health risks of competitive eating.  This seems to be because we don’t know much yet.

But I did recall a paper (open access) on a study from 2007 that should be highlighted.  Their preliminary results and warning on the lack of science should be noted:

To our knowledge, no cases of gastric perforation, Boerhaave’s syndrome, or Mallory-Weiss tear have been reported as a sequela of competitive speed eating. On the other hand, we know of no studies on the short- or long-term effects of speed eating onits competitors. Nor are there any data in the literature about the science of speed eating and how its competitors are able to consume such enormous quantities of food in such short periods of time.

They took one of the top IFOCE ranked eaters and one control subject and did a few tests.

It seems like speed eaters have to some degrees both a birth given ability to eat and develop it further with training, in which there are a number of methods.  They note that eaters often use water loading to expand the stomach without the need for calories.  They caution potential adverse effects of this such as hypothermia, water intoxication, and cerebral edema.  Two water load tests were done on the subjects: WL5 (drinking water at own pace for 5-minutes or until sated) and a WL100 (water consumed at 100mL/min until sated.  The speed eater outperformed the control subject in both tests: 4.5 Liters vs less than 2 L respectively for the WL5 (was stopped before 2 minutes) and 2.4 L vs 2 L respectively for the WL100 (stopped before sated).  With a solid-phase nuclear gastric emptying scan (involves consuming a radioactive meal to follow where it goes), they found that at 2 hours, the speed eater emptied only 25% of the meal from the stomach at 2 hours vs 75% for the control.  This suggests that this speed eater (possibly all are like this but it needs to be tested) has an increased ability to store water in the stomach rather than an increased ability to empty it into the intestines. 

The next test for the subjects was to eat as many hot dogs as possible during a 12 minute period, and this was tracked by fluoroscopy.  This produced some very cool images of the stomach filling as each ate (check the full text to see them).  The control subject consumed 7 hot dogs before he was uncomfortably full.  The fluoroscopic images showed no distention and little dilatation of the stomach and there was no outward difference in the appearance of his abdomen.  The speed eater, unlike the control showed mild distention and decreased peristalsis prior to eating.  He consumed 36 hot dogs in 10 minutes, and fluoroscopic images showed distention with little/no peristalsis.  They noted that the eater stated that he felt no sensation of satiety/fullness/bloating/discomfort, but because of “a small theoretic risk of gastric performation,” the test was ended with 2 minutes left.  The abdomen was extremely protruded.  This eater described a gradual flattening of the abdomen over several days after competitions, and during that time he consumed nothing.

Interestingly, the authors make comparisons to professional athletes in other sports after interviews with the speed eater:

…In effect, he was slowly able to overcome theusual checks and balances associated with eating by exercisingextraordinary will power and self-discipline during his training,consuming more and more food when others wouldn’t be able toswallow another bite without feeling sick (as our control subjectdid). Only as a result of this prolonged and intensive trainingprocess was the speed eater gradually able to adapt his stomachuntil it could withstand the rigors and stresses of competitivespeed eating. In that sense, a world-class speed eater requiresthe same level of will power, self-discipline, and commitmentas any professional athletes honing their skills in gymnastics,track, or other athletic endeavors.

They make an evolutionary comparison, of which I am skeptical:

…a predatory carnivore that periodically gorges itself on its kills, ingesting massive amounts of food for sustenance until it captures another prey days or even weekslater.

Eaters seem to lose the ability to sense satiety with the dramatic alterations in gastric physiology.  However, many competitors are very fit and not overweight.  The authors noted that this man had to practice extreme self-discipline and willpower by measuring portions instead of relying on satiety signals.  But competitive eating is a relatively new “sport,” and competitors are young.  If they lose their self-control with age, their risk of obesity may be much higher than the general population.  I would also add that contents are often highly processed junk foods which may not provide sufficient micronutrient intakes.  Also of concern is that their stomaches may be permanently damaged by losing the ability to shrink to a normal size, the ability to peristalse or emptying solid food.  This could lead to neasea, vomiting, and the need for gastric surgery.  The authors suggest IFOCE perform follow ups in their athletes to assess risks.

This WSJ blog about the study includes quotes from the authors that show they don’t think the risk of injury is as great as other sports, though.  As I quoted from the study before, no health problems have apparently been formally reported yet.  But it certainly deserves further study, and eaters should be aware of the evidence – or in this case lack of study to this point.

Reference

Levine MS, Spencer G, Alavi A, & Metz DC (2007). Competitive speed eating: truth and consequences. AJR. American journal of roentgenology, 189 (3), 681-6 PMID: 17715117