Competitive Consumption: Ten Minutes

News sume such enormous quantities of food pletely relax all the muscles in their tors increase the capacity of their stom - in such short periods of time.” esophagus, creating a hollow tube, in achs through training, such as chugging In the study, a world-class eater and effect, that can be crammed with food. gallons of water. This can be danger - a control subject were asked to eat as But it is the unusual stomachs of gus - ous, though, posing risks such as water many hot dogs (without buns) as possi - tatory athletes that seem to hold the most intoxication, a potentially deadly dilu - ble. Both ingested barium and were potential for helping people with dyspep - tion of electrolytes in the body. Then placed on a fluoroscopy table, in a sia. A normal stomach is around the size there are people like Czerwinski, who semiupright position, to allow the cap - of two fists and can hold 2–4 litres of don’t need to train. ture of x-ray images of their stomachs food. When someone eats, the brain “Part of it is natural, being born with in real time. The control subject ate informs the muscles in the stomach to a big stomach and the ability to fill it seven hot dogs before stopping. The relax to accommodate the food. The up, to relax and expand it,” says Metz. competitive eater ate 36 hot dogs in 10 stomach contracts when full, pushing A better understanding of the ability minutes and still didn’t feel bloated or food into the intestine, and sends a signal of a competitive eater to consume such full, only stopping at the insistence of of discomfort to the brain to stop the con - large quantities of food without experi - the researchers, who observed his mas - sumption. In people with dyspepsia, this encing pain, however that comes about, sively distended abdomen and worried signal is sent prematurely. In competitive may be the key to helping those for he would suffer a gastric perforation. eaters, on the other hand, the signal is whom eating regular-sized meals are There are several theories about how delayed. Or perhaps it isn’t sent at all. discomforting experiences, suggests people such as Czerwinski are able to “People usually feel full after 20 Metz. “Our hope is that for people with eat so much, so quickly. It has been minutes,” says Czerwinski. “I never dyspepsia, we could potentially train attributed to factors such as a strong really get that sensation.” them to take bigger volumes of food.” jaw, extreme mental focus, high pain In Metz’s study, the stomach of the — Roger Collier, CMAJ tolerance and a deadened gag reflex. competitive eater was described as an Some competitors seem able to com - “enormous flaccid sac.” Some competi - CMAJ 2013. DOI:10.1503/cmaj.109-4394

Competitive consumption: Ten minutes. 20 000 calories. Long-term trouble?

t all started, according to legend, as 10 minutes. Mullen had eaten just over nationally on ESPN. Then there are those an argument between four immi - one hot dog per minute. Chestnut ate who find the whole affair grotesque. Cel - Igrants about who loved their adopted one every nine seconds. ebrating overconsumption in a nation homeland the most. The heated discus - The annual contest at Nathan’s suffering an obesity epidemic, they sion took place in 1916 at Nathan’s Famous is but one of dozens of events argue, is just plain wrong, and competi - Famous, a hot dog stand that had recently sanctioned by Major League Eating, the tive eaters are setting themselves up for a opened on Coney Island in New York franchise behind the professional com - lifetime of health problems. City. The establishment’s owner, Nathan petitive eating circuit. Other competi - But are participants in speed-eating Handwerker, feared fisticuffs might tions include Ben’s Chilli Bowl’s World contests really putting their health at ensue, so he proposed a contest. Chilli Eating Championship (total cash risk? And if so, to what extent? Whoever could eat the most hot dogs purse: US$3000), Western Days Festival “The bottom line is, there is such in 12 minutes would be declared the most World Tamale Eating Championship minimal data that we are doing a lot of patriotic of the bunch. James Mullen, a (total cash purse: US$3500) and the conjecture,” says Dr. David Metz, pro - native of Ireland, claimed the title by Oktoberfest Zinzinnati World Bratwurst- fessor of medicine at the University of downing 13 hot dogs, buns included. Eating Championship (total cash purse: Pennsylvania in Philadelphia, who con - That contest continues to this day. Held US$2000). tributed to a study of competitive eating annually on July 4, it is considered the If an item is edible, there is probably (Am J Roentgenol 2007;189: 681-6). top dog of all eating competitions, with somebody somewhere eating a whole That said, physicians do know US$10 000 going to the champ. lot of them in hopes of winning a prize. enough about how the human body Do today’s winners eat more than 13 Reactions to the rise in popularity of works to take some educated guesses hot dogs? Ah, yeah, a few more. Let’s the “sport” of extreme eating generally about the possible effects of repeatedly just say masticating a baker’s dozen of fall into two categories. There are those bingeing on massive quantities of food. sodium-rich beef tubes isn’t much to who marvel at the ability of these rub - According to the study, these risks brag about anymore. Reigning six-time ber-bellied gurgitators to wolf down include gastroparesis (slowing of food champion Joey Chestnut took Nathan’s (and keep down) mountains of food. The movement out of the stomach), coveted Mustard Belt in 2012 by laying Nathan’s Famous contest draws about intractable nausea, vomiting, gastric waste to a record-tying 68 hot dogs in 40 000 spectators and is broadcast inter - perforation, Mallory-Weiss tear (tear in

typical hot dog has around 300 calories. So eating 68 at the Nathan’s Famous contest works out to more than 20 000 calories — in 10 minutes. Then again, perhaps the body doesn’t actually use all those calories. “There are only so many calories you can consume in 10 minutes,” says Peter Czerwinski, a professional eater known as Furious Pete. “A lot of stuff goes through undigested.” Like many of the top eaters, Czer - winski remains fit through exercise and controlling calories when not compet -

r ing. Many competitive eaters fast before e y a

h and after an event. In fact, being thin T c i r allows you to eat more during a contest, E / s r e according to the “belt of fat” theory, t u e

R which posits that belly fat restricts the Joey Chestnut (centre) ate 68 hot dogs in 10 minutes to win the 2012 Nathan’s Famous stomach’s ability to expand. Fourth of July International Eating Contest. The part of competitive eating that may be most risky isn’t the competition. the lining of the lower esophagus), dogs in 12 minutes as executing a triple “It’s a very dangerous thing to train for,” Boerhaave syndrome (rupture of axel on the ice or running a 4-minute says Czerwinski, who is something of a esophageal wall) and morbid obesity mile,” states the study. natural and never really took to training (due to loss of ability to feel satiated). One of the greatest risks to average to expand his already-pliable belly. The repetitive stretching of the stomach individuals who enter eating contests One common technique used to may also damage its muscles. appears to be choking. In 2002, a 14- stretch the stomach, for example, is “My concern is if they do this for year-old in Japan choked to death dur - called water loading. It involves chug - years and years and years, this long-term ing a competition against friends at his ging one or two gallons of water, which chronic overeating may lead to some kind school. In 2004, a 36-year-old man could dilute the electrolytes in the body of muscular dysfunction,” says Metz. from Canada choked to death after a enough to cause death. The risks posed to world-class masti - chicken wing –eating contest in Regina, Despite finding a way to stay fit cators are likely different than those faced Saskatchewan. In late 2012, a Florida while gorging on high-calorie foods, by average individuals who try their hand man choked and died following a bug- though, Czerwinski acknowledges that (and mouth) at speed eating. The stom - eating contest. the lifestyles of professional eaters are achs of competitive eaters appear to have The professionals who compete in somewhat crazy. “I think it’s stupid for unique properties, including the ability to many contests put themselves at risk of anyone to do, to be frank, though I’m expand by an incredible amount. A typi - becoming obese. Or at least you would having fun with it,” says Czerwinski. “I cal eater simply could not put away the think so, considering the amount of don’t encourage anyone to do it.” — same amount of food in one sitting. calories they consume during an event. Roger Collier, CMAJ “In our opinion, average eaters have The recommended daily caloric intake as much chance of ingesting 50 hot for the average man is 2000–2500. A CMAJ 2013. DOI:10.1503/cmaj.109-4397

Limited options for redress

hen Douglas Fraser’s back friends that prison officials escalate his convinced the Correctional Service of pain became acute in April health services, before Fraser was finally Canada (CSC) issued just such a W2011, he asked to see a doctor taken to Kingston General Hospital for decree. “My son was clearly denied his at the Bath Institution, a medium-security assessment. He was soon diagnosed with right to health care equal to what non- federal prison in southern Ontario where pancreatic cancer. In the remaining three prisoners expect.” he’d been incarcerated for four years. But months of his life, Fraser contended the Dr. Ivan Stewart, the palliative care it was two months before the 58-year-old delay in providing him access to external physician who treated Fraser in the got his wish, and another four months of care, constituted a death warrant. final months of his life, doesn’t go quite searing pain and weight loss, as well as Fraser’s mother, Muriel, a softspo - that far. But Stewart does believe CSC constant demands from family and ken native of Tillsonburg, Ontario, is failed to provide equitable health care