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Levine et al.Competitive Speed Eating

G a s t ro i n t e s t i n a l I m ag i n g • O p i n i o n

Competitive Speed Eating: Truth and Consequences

Marc S. Levine1

Geoffrey Spencer2

Abass Alavi3

David C. Metz2

Levine MS, Spencer G, Alavi A, Metz DC

Keywords: barium studies, fluoroscopy, gastric physiology, gastroparesis, speed eating, stomach

DOI:10.2214/AJR.07.2342

M. S. Levine is a consultant for E-Z-EM.

Received March 28, 2007; accepted after revision April 6, 2007.

1Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, 3400 Spruce St., Philadelphia, PA 19104. Address correspondence to M. S. Levine (marc.levine@uphs.upenn.edu).

2Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA.

3Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA.

OBJECTIVE. The purpose of our investigation was to assess the stomachs of a world-classspeed-eating champion and of a control subject during a speed-eating test in our gastrointestinalfluoroscopy suite to determine how competitive speed eaters are able to eat so much so fast.

CONCLUSION. Our observations suggest that successful speed eaters expand the stom-ach to form an enormous flaccid sac capable of accommodating huge amounts of food. Wespeculate that professional speed eaters eventually may develop morbid obesity, profound gas-troparesis, intractable nausea and vomiting, and even the need for a gastrectomy. Despite itsgrowing popularity, competitive speed eating is a potentially self-destructive form of behavior.

ince the inaugural Fourth of JulyHot Dog Eating Contest at Nathan’sflagship restaurant in Coney Island,NY, in 1916, this annual contest has

become the premier event and de facto Olym-pics in the sport of competitive speed eating [1].The contestants are also known as gustatoryathletes, “gurgitators,” and, in France, as “epi-curiators.” The past decade has seen an explo-sive growth in speed-eating competitions notonly in the United States, but also in Canada,Germany, England, Russia, Japan, Thailand,and Scotland. The rise of speed eating as a com-petitive sport has led to the development of theInternational Federation of Competitive Eating(IFOCE), which organizes, promotes, and pub-licizes a series of speed-eating contests eachyear both in the United States and overseas [1].Public interest in competitive speed eating hasresulted in coverage from such diverse mediaoutlets as CNN, “NBC Nightly News,” “TheToday Show,” Sports Illustrated, The New YorkTimes, the Los Angeles Times, TIME magazine,and the Smithsonian magazine [1].

The contestants are professional speed eat-ers who compete in events on an internationalcircuit sanctioned by the IFOCE. These sanc-tioned competitions have led to a formal rank-ing of the top 50 speed eaters on the world-wide circuit. Currently, the number oneranked speed eater is Takeru Kobayashi fromNagano, Japan, a competitor who dominatedthe sport in 2006, winning the annualNathan’s Fourth of July Hot Dog Eating Con-test for the fifth consecutive year, when he

consumed 54 Nathan’s Famous Hot Dogs andbuns in 12 minutes [1]. Kobayashi holdsworld records in five separate categories, in-cluding hot dogs, hamburgers, brats, riceballs, and cow brains [1].

Competitive speed eating has become sopopular that Philadelphia hosts an annual com-petition at the Wachovia Center (home of thePhiladelphia 76ers and Philadelphia Flyers)known as Wing Bowl [2]. This buffalo-stylechicken wings contest is broadcast live by WIP(AM) radio, a Philadelphia sports talk channel.Although this event is not sanctioned by theIFOCE, the annual Wing Bowl routinely drawscrowds of 20,000 or more to the WachoviaCenter—larger crowds than those generally at-tending professional basketball and hockeygames played in this arena. The immense pop-ularity of Wing Bowl reflects the emergence ofspeed eating as a major competitive sport witha growing legion of worldwide fans.

Health ConcernsCompetitive speed eaters are much less

likely to suffer athletic injuries than profes-sional athletes in other sports such as football,basketball, and hockey. That does not neces-sarily mean, however, that speed eating is asafe sport. In fact, concern about potential risksto the competitors has caused the IFOCE to in-stitute a policy in which all sanctioned speed-eating competitions are supervised and regu-lated to help ensure the safety of the sport [1].To our knowledge, no cases of gastric perfora-tion, Boerhaave’s syndrome, or Mallory-Weiss

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tear have been reported as a sequela of compet-itive speed eating. On the other hand, we knowof no studies on the short- or long-term effectsof speed eating on its competitors. Nor arethere any data in the literature about the scienceof speed eating and how its competitors areable to consume such enormous quantities offood in such short periods of time.

We recently had the opportunity to assessthe stomach of a world-class speed-eatingchampion and a control subject during aspeed-eating test in our gastrointestinal fluo-roscopy suite. We therefore present our pre-liminary observations and speculate about thelong-term ramifications of competitive speedeating for its participants.

Speed-Eating TestThe Participants

A 29-year-old competitive male speedeater came to our institution to film a Na-tional Geographic special on the science ofspeed eating. He currently is ranked by theIFOCE as one of the top 10 competitivespeed eaters in the world, holding individualrecords in three food categories. Despite hisprodigious eating skills, he was surprisinglyslim and fit, with a height of 5 ft 10 inches(178 cm) and a weight of 165 lb (75 kg).Given his auspicious credentials, we be-lieved this individual was representative ofthe top echelon of competitive speed eatersand therefore concluded that his physiologicresponses to a simulated speed-eating eventwere likely to be similar to those of othercompetitive speed eaters. Because our goalwas to observe the physiologic effects ofspeed eating on the stomach in our fluoros-copy suite, and because this type of observa-tional study has not been performed previ-ously, we thought it was important to have acontrol for comparison. A 35-year-old malecontrol subject was chosen because he had ahearty appetite and because he was largerthan the competitive speed eater, with aheight of 6 ft 2 inches (188 cm) and a weightof 210 lb (95 kg).

Before testing, both study subjects signedstandard university “Consent to Record andRelease” and “Authorization for Use and/orDisclosure of Protected Health InformationIncluding Recordings” forms and standardconsent forms notifying them of the potentialrisks associated with the studies, includingexposure to radionuclides and ionizing radia-tion. Our institutional review board was satis-fied with the consent process and approvedsubmission of the manuscript for publication.

Preliminary TestingIt is presently unknown whether speed eat-

ers are born with the ability to rapidly ingestvast amounts of food or whether they are ableto train their stomachs to perform in this man-ner during competitions. When speed eatershave been questioned on this subject, somethought that they always have had this abilitybut that training helped to hone their skills. Itcould well be that these skills result from acombination of an inherently compliant stom-ach and adaptive training. Speed eaters de-scribe varying methods of training for compe-tition. Some ingest vast amounts of cabbage,and others ingest increasing amounts of otherspecific food items to prepare for theseevents. Many speed eaters also use waterloading as a means of expanding their stom-achs without ingesting unneeded calories.(We caution readers who may wish to try thisat home that such behavior may be associatedwith adverse side effects, including hypother-mia, water intoxication, and cerebral edema.)Fortunately, water load testing has been welldescribed and validated in normal individualsand in patients with dyspepsia [3].

We performed two different water loadtests on our subjects. The WL5 was per-formed by having the subjects drink room-temperature water at their own pace during a5-minute period or until they felt sated (nor-mal, 648 ± 204 mL), and the WL100 wasperformed by having the subjects drink room-temperature water at a rate of 100 mL/min un-til they felt sated (normal, 1,128 ± 355 mL)[3]. Both subjects exhibited higher than nor-mal capacities with both water load tests, butthe competitive speed eater outperformed thecontrol subject by a large enough margin thatthe tests were terminated prematurely (WL5results of < 2 L vs 4.5 L [stopped before 2minutes] and WL100 results of 2 L vs 2.4 L[stopped before subjects felt sated], for thecontrol subject and the competitive speedeater, respectively). These studies indicatedthat the competitive speed eater either couldsequester larger volumes of ingested fluid inhis stomach or could empty his stomach morequickly than the control subject.

We also performed solid-phase nuclear gas-tric emptying scanning [4] on our participantsto help determine which of these two mecha-nisms is more important for competitive speedeating. The professional speed eater emptiedonly 25% of the radioactive meal at 2 hours,whereas the control subject emptied 75% ofthe meal at 2 hours (the normal rate for solid-phase gastric emptying at 2 hours is > 50% at

our institution). Although it is difficult to ex-trapolate from a sample size of one, these datasuggested that competitive speed eaters areable to consume unusually large volumes offood before feeling sated because of increasedgastric accommodation rather than because ofmore rapid gastric emptying in comparisonwith control subjects.

SetupBoth participants were asked to consume

as many hot dogs as possible during a 12-minute period, the standard time allotted for ahot dog eating contest. In actual speed-eatingevents, the competitors typically eat the hotdogs on buns, often lubricating the buns withwater to facilitate rapid swallowing. Becauseof concern that water might dilute preingestedbarium in the stomach, a decision was madeto have the subjects eat the hot dogs withoutbuns for this speed-eating test.

The participants were both asked to lift theirshirts before and after eating hot dogs so wecould assess any physically evident changes inthe appearance of their abdomens. They werethen positioned on the fluoroscopy table andasked to ingest an effervescent agent (Baros,Mallinckrodt Pharmaceutical) and a standarddose of high-density barium (E-Z-HD, E-Z-EM)in the upright position before being rotated onthe table in a recumbent position to coat thestomach with barium. Several spot images ofthe stomach were obtained to document the ap-pearance of the stomach and duodenum imme-diately before the speed-eating test. We antici-pated that the ingested hot dogs would appear aslesions etched in white by residual barium in thestomach or as filling defects in the surroundingbarium pool. No pharmacologic agents were ad-ministered, and both subjects had nothing bymouth on the day of the test. The subjects wereplaced in a semiupright position on the fluoros-copy table for the speed-eating test to facilitateingestion of the hot dogs. Intermittent fluoros-copy of the stomach was performed to observethe physiologic effects on the stomach, and oc-casional spot images were obtained to docu-ment the fluoroscopic findings.

Speed-Eating TestThe control subject was our first participant.

When he lifted his shirt at the outset, his abdo-men was flat. A preliminary double-contrastexamination showed a normal-appearing stom-ach with free emptying of barium into theduodenum and no evidence of gastric dilatationor retained fluid or debris (Fig. 1A). Normalgastric peristalsis was observed at fluoroscopy.

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The control subject then began eating hotdogs one at a time as rapidly as possible. Ashe consumed the hot dogs, intermittent fluo-roscopy showed hot dog pieces in the stomachwithout evidence of gastric distention(Fig. 1B). After eating a total of seven hotdogs, the control indicated that he felt an un-

comfortable sensation of fullness and satietyand that he would be “sick” if he ate anotherbite, so this portion of the test was terminated.Final fluoroscopic images of the stomachshowed progressive accumulation of hot dogpieces in the stomach with minimal gastric di-latation (Fig. 1C) and emptying of barium

into nondilated small bowel. When he liftedhis shirt afterward, there was no noticeabledifference in the appearance of his abdomen.

The world-class competitive speed eaterwas our second participant. When he lifted hisshirt at the outset, his abdomen was also flat.A preliminary double-contrast examination

A B

C

Fig. 1—Appearance of stomach in 29-year-old male control subject on double-contrast barium study during rapid ingestion of seven hot dogs for speed-eating test.A, Preliminary frontal spot image of stomach shows normal-appearing stomach with no evidence of gastric dilatation or retained debris. Gastric peristalsis was normal at fluoroscopy.B, Repeat frontal spot image during speed-eating test shows hot dog pieces (arrows) in stomach and no gastric distention. Note barium in small bowel.C, Final frontal spot image (after control subject had ingested seven hot dogs) shows progressive accumulation of hot dog pieces (arrows) in stomach and minimal gastric dilatation.

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showed mild gastric distention with notice-ably decreased gastric peristalsis at fluoros-copy (Fig. 2A), although some barium emp-tied into the duodenum. No retained fluid ordebris was in the stomach.

The speed eater then began consuming hotdogs two at a time to facilitate rapid ingestion.It was truly remarkable how quickly hedowned each pair of hot dogs without any no-ticeable letup during the test. As he ate the hotdogs, intermittent fluoroscopy revealed pro-gressive accumulation of an ever-increasingvolume of hot dog pieces outlined by residualbarium in the stomach (Fig. 2B). There waslittle if any gastric peristalsis with increasinggastric distention. Fluoroscopy also revealedintermittent accumulation of hot dog pieces inthe distal esophagus, as their progress into thestomach was impeded by food in the fundus(Fig. 2B). At 6 minutes, the stomach had be-come a dilated, flaccid sac in the upper abdo-men (Fig. 2C). At 10 minutes, the speed eaterhad eaten a total of 36 hot dogs. His stomachnow appeared as a massively distended, food-filled sac occupying most of the upper abdo-men (Fig. 2D), with little or no gastric peri-stalsis and emptying of a small amount of bar-ium into the duodenum.

Despite the speed eater’s insistence that hefelt no sensation of satiety, fullness, bloating,or abdominal discomfort, we became con-cerned that further dilation of his already enor-mous stomach could be associated with a smalltheoretic risk of gastric perforation. Therefore,a decision was made to terminate the speed-eating test over the objections of our partici-pant. When the speed eater lifted his shirt after-ward, his previously flat abdomen protrudedenough to create the distinct impression of adeveloping intrauterine pregnancy. It wouldhave been interesting to obtain follow-up ra-diographic images over a period of severaldays to determine how much time was requiredfor his stomach to shrink to its original size, butthe speed eater had other commitments thatmade this unfeasible. He did indicate, however,that his abdomen usually became flat againover a period of several days after a speed-eat-ing competition (during which time he atenothing) without any regurgitation of the in-gested food items, so we assume his stomachgradually emptied its contents and returned toits original size during this period.

TruthCompetitive speed eating, by definition, en-

tails the rapid consumption of unusually largequantities of food, a nearly impossible feat for

those without experience or training in thissport. In our opinion, average eaters have asmuch chance of ingesting 50 hot dogs in 12minutes as executing a triple axel on the ice orrunning a 4-minute mile. How then are compet-itive speed eaters able to eat so much so fast?

Logic and gastric physiology suggest twopossibilities. Either the speed eater’s stomachempties much faster than a normal stomach,or the speed eater’s stomach is capable of ex-panding to the point that it can accommodatethe rapid influx of an enormous quantity offood. Our water load tests and solid-phase nu-clear gastric emptying scans suggested thelatter scenario, which subsequently was con-firmed during our speed-eating test.

Unlike the control subject, the speed eaterhad markedly altered gastric physiology thatenabled his stomach to rapidly accommodatean enormous quantity of ingested food byprogressively expanding until it became a gi-ant, flaccid sac occupying most of his upperabdomen (Fig. 2). In other words, his stom-ach acted as a compliant, expansile recepta-cle, dilating to a degree that it could accept analmost unlimited volume of food. Conversely,gastric peristalsis was absent or near absent,so virtually none of the consumed hot dogsemptied into the duodenum.

We recognize that we may be extrapolatingunfairly based on a sample size of one, and thatfluoroscopic observation of a series of speedeaters is needed to draw more definitive con-clusions about the science of speed eating.Nevertheless, the fluoroscopic findings in ourspeed eater were so dramatic that we suspectour observations in this case can be applied tocompetitive speed eaters in general. Rapidemptying of large unground pieces of hot doginto the small bowel also would likely haveprecipitated a dumping syndrome [5], whichdid not occur during our speed-eating test andwhich also has not been described by othercompetitive speed eaters during these contests.

Another important question is how speedeaters are able to alter their gastric physiol-ogy so their stomachs can become huge,flaccid sacs. Discussions with our speed-eat-ing champion revealed that he spent severalyears training for the sport, forcing himselfto consume larger and larger amounts offood despite the sensation of fullness and sa-tiety to develop his speed-eating capabili-ties. In effect, he was slowly able to over-come the usual checks and balancesassociated with eating by exercising extraor-dinary will power and self-discipline duringhis training, consuming more and more food

when others wouldn’t be able to swallow an-other bite without feeling sick (as our controlsubject did). Only as a result of this pro-longed and intensive training process wasthe speed eater gradually able to adapt hisstomach until it could withstand the rigorsand stresses of competitive speed eating. Inthat sense, a world-class speed eater requiresthe same level of will power, self-discipline,and commitment as any professional athleteshoning their skills in gymnastics, track, orother athletic endeavors. Whether suchspeed-eating individuals possess intrinsiceating abilities before beginning their train-ing is unclear. Although some speed eatersmay have stomachs that are inherently com-pliant, the only way to confirm this hypoth-esis would be to perform baseline bariumstudies on a group of speed eaters beforethey trained for competition in comparisonwith a group of control subjects.

ConsequencesBased on our observations, the key to suc-

cess in competitive speed eating is the abilityto slowly train and adapt the stomach so thatit can expand and dilate to a remarkable de-gree, enabling the speed eater to consume anextraordinary volume of food in an ex-tremely short time (possibly superimposedon an innately compliant stomach). In thatsense, a top competitive speed eater may becompared with a predatory carnivore that pe-riodically gorges itself on its kills, ingestingmassive amounts of food for sustenance un-til it captures another prey days or evenweeks later. The trade-off is that the speedeater no longer experiences the sensation offullness and satiety that normally occurs atthe end of a meal. In effect, the speed eater’sstomach becomes so compliant and distensi-ble that he or she never feels sated. Whenquestioned on this subject, the competitivespeed eater indicated unequivocally that hisparticipation in the sport left him incapableof experiencing the usual sensation of full-ness and satiety after meals.

Yet our speed eater looked trim and fitwithout an ounce of spare fat on him. How didhe avoid becoming overweight under thesecircumstances? By carefully monitoring hisoral intake, he told us, and by taking mea-sured portions of food at mealtime without re-filling his plate despite the fact that he neverfelt full or sated. He therefore exercised ex-traordinary self-discipline and willpower toavoid becoming overweight in a setting ripefor gaining weight.

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A B

C D

Fig. 2—Appearance of stomach in 35-year-old male world-class competitive speed eater on double-contrast barium study during rapid ingestion of 36 hot dogs for speed-eating test.A, Preliminary frontal spot image of stomach shows mild gastric distention. Although some barium has emptied into duodenum, gastric peristalsis was noticeably decreased at fluoroscopy.B, Repeat frontal spot image during early portion of speed-eating test shows moderate gastric distention and hot dog pieces (white arrows) in stomach. Also note food in distal esophagus (black arrows). No gastric peristalsis was observed at fluoroscopy.C, Frontal spot image at 6 minutes shows innumerable retained hot dog pieces in dilated, flaccid stomach and absent gastric peristalsis at fluoroscopy.D, Final frontal spot image of stomach at 10 minutes (after competitive speed eater had ingested 36 hot dogs) shows stomach as massively distended, food-filled sac occupying most of upper abdomen. Despite absence of gastric peristalsis, note emptying of barium into nondilated duodenum (arrows).

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But the competitive speed eater was ayoung man. What will happen over the next20 years, as he enters middle age and per-haps begins to lose the self-motivation crit-ical for avoiding weight gain? It is easy toenvision a scenario in which aging speedeaters lose their willpower and engage inchronic binge eating because they neverfeel sated. In this setting, long-time speedeaters and former speed eaters may be atsubstantial risk of developing morbid obe-sity and all the health risks associated withthis condition.

Even more worrisome is the potentialrisk that a chronically dilated, flaccidstomach may eventually decompensate, sothat it becomes an enormous sac incapable

of shrinking to its original size and incapa-ble of peristalsing or emptying solid food.If this happens, long-term competitivespeed eaters ultimately could develop in-tractable nausea and vomiting, necessitat-ing a partial or total gastrectomy to relievetheir symptoms and restore their ability toeat. Thus, speed eating is a potentially self-destructive form of behavior that over timecould lead to morbid obesity, intractablenausea and vomiting, and even the need forgastric surgery. For all these reasons, webelieve the IFOCE should make it a highpriority to follow up their athletes andformer athletes to fully assess the long-term risks of competitive speed eating forits participants.

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The water load test: observations from healthy

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scintigraphy. Semin Nucl Med 2006; 36:110–118

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