N, an avid marathoner, reached out to improve severe bouts of exercise-associated intestinal ischemia (cramping, vomiting, nausea, or diarrhea that occurs in response to blood being shunted away from digestive organs to the muscles, heart, lungs and brain during strenuous exercise). After long runs, N commonly experienced severe cramping and urgent diarrhea – to the point where it was disrupting her daily life and work. A dietary recall revealed her diet was often too low in carbohydrate and calories to support training, inconsistent day-to-day, and hydration and mid-race fueling were not a priority – even for 10+ mile days. We employed a daily fueling plan to achieve consistency and support performance, with special attention to nutrient timing, the digestibility of carbohydrate and protein choices and hydration practices. Implementation of these goals resulted in almost complete absence of GI symptoms post-run within 2 weeks of the first appointment, allowing N to shift her focus to performance and improving splits rather than the fear she used to face during those hard and long runs.