Exercise-induced Gastrointestinal Symptoms Research Articles

Exploring the Nutrition Strategies Employed by Ultra-Endurance Athletes to Alleviate Exercise-Induced Gastrointestinal Symptoms-A Systematic Review.

(1) Background: Participation in ultra-endurance sports, particularly ultra-running, has increased over the previous three decades. These are accompanied by high energetic demands, which may be further exacerbated by extreme environmental conditions. Preparation is long-term, comprising of sufficient exercise management, supportive dietary habits, and nutritional intakes for optimal adaptations. Gastrointestinal symptoms are often cited as causing underperformance and incompletion of events. Though the majority do not pose serious long-term health risks, they may still arise. It has been suggested that the nutritional interventions employed by such athletes prior to, during, and after exercise have the potential to alter symptom incidence, severity, and duration. A summary of such interventions does not yet exist, making it difficult for relevant personnel to develop recommendations that simultaneously improve athletic performance by attenuating gastrointestinal symptoms. The aim of this research is to systematically review the literature investigating the effects of a nutrition intervention on ultra-endurance athletes exercise-induced gastrointestinal symptom incidence, severity, or duration. (2) Methods: A systematic review of the literature was conducted (PubMed, CINAHL, Web of Science, and Sports Discus) in January 2023 to investigate the effects of various nutrition interventions on ultra-endurance athletes' (regardless of irritable bowel syndrome diagnosis) exercise-induced gastrointestinal symptoms. Variations of key words such as "ultra-endurance", "gastrointestinal", and "nutrition" were searched. The risk of bias in each paper was assessed using the ADA quality criteria checklist. (3) Results: Of the seven eligible studies, one was a single field-based case study, while the majority employed a crossover intervention design. A total of n = 105 participants (n = 50 male; n = 55 female) were included in this review. Practicing a diet low in short-chain, poorly absorbed carbohydrates, known as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), as well as employing repetitive gut challenges of carbohydrates, remain the most promising of strategies for exercise-induced gastrointestinal symptom management. (4) Conclusion: Avoiding high-FODMAP foods and practicing repetitive gut challenges are promising methods to manage gastrointestinal symptoms. However, sample sizes are often small and lack supportive power calculations.

Exercise-Induced Gastrointestinal Symptoms in Endurance Sports: A Review of Pathophysiology, Symptoms, and Nutritional Management

Strenuous exercise can be associated with “Exercise Induced Gastrointestinal Syndrome” (Ex-GIS), a clinical condition characterized by a series of gastrointestinal (GI) disturbances that may impact the physical and psychological performance of athletes. The pathophysiology comprises multi-factorial interactions between the GI tract and the circulatory, immune, enteric, and central nervous systems. There is considerable evidence for increases in the indices of intestinal damage, permeability, and endotoxemia associated with impaired gastric emptying, slowing of small intestinal transit, and malabsorption of nutrients. Heat stress and racing mode seem to exacerbate these GI disturbances. GI symptomatology that derives from strenuous exercise is similar to that of IBS and other GI functional disorders defined in the Rome IV Criteria. To manage Ex-GIS, the exercise modality, state of dehydration, environmental temperature, concomitant therapies, and self-managed diet should be evaluated, and if risk elements are present, an attempt should be made to modify them. Multiple strategies can be successively adopted to manage Ex-GIS. Nutritional and behavioral interventions appear to be the principal ones to avoid symptoms during the exercise. The aim of this review will be to explore the pathophysiology, clinical aspect, and current literature on behavioral and nutritional strategies to manage Ex-GIS, regarding a gluten-free diet and low-fermentable oligo-, di-, and mono-saccharides and polyols (FODMAP) diet.

Recent advances in clinical probiotic research for sport

Purpose of reviewThis is a review of the most up-to-date research on the effectiveness of probiotic supplementation for outcomes related to athletes and physical activity. The focus is on clinical research incorporating exercise and/or physically active participants on the nutritional effectiveness of single and multistrain preparations.Recent findingsFindings of the included clinical studies support the notion that certain probiotics could play important roles in maintaining normal physiology and energy production during exercise which may lead to performance-improvement and antifatigue effects, improve exercise-induced gastrointestinal symptoms and permeability, stimulate/modulate of the immune system, and improve the ability to digest, absorb, and metabolize macro and micronutrients important to exercise performance and recovery/health status of those physically active.SummaryThe current body of literature highlights the specificity of probiotic strain/dose and potential mechanisms of action for application in sport. These novel findings open new areas research, potential use for human health, and reinforce the potential role for probiotic's in exercise performance. While encouraging, more well designed studies of probiotic supplementation in various sport applications are warranted.

Effects Of Protein Intake On Gastrointestinal Symptoms In Runners - A Pilot Study

PURPOSE: Gastrointestinal (GI) symptoms often hinder running performance and are responsive to nutrient intakes. Currently, the recommendation is to “limit” protein intakes to minimize symptoms, but a threshold has not been established. The purpose of this study was to examine the effect of a highprotein (HP) vs a low protein (LP) shake on running induced GI symptoms. METHODS: Five (n=2 male) endurance trained runners were administered a HP (0.4 g/kg body weight) or LP (0.15 g/kg/ body weight) shake one hour prior to a 10 km run at 85% of their race pace in a single-blind, randomizedcross-over design. Carbohydrate and water intakes remained consistent across trials. Exercise induced GI symptoms were measured pre-shake, 60 minutes post-shake, and post-run. Symptoms were rated on a 10 point scale and included six upper abdominal problems, seven lower abdominal problems, and five systemic problems. RESULTS: Symptoms experienced during the LP run included belching (2), stomach cramps (2), intestinal cramps (3), flatulence (1), urge to defecate (1), stitch (1), dizziness (1), muscle cramp (1), urge to urinate (2), and fullness (1). Severity was consistently low with only urge to urinate rated as a 4. Symptoms experienced during the HP run included re-flux (1), belching (2), bloating (1),stomach cramps (2), intestinal cramps (1), flatulence (1), stitch (1), and fullness (1). Severity was consistently low with a maximum of 3. There was no significant difference in the severity of symptoms experienced between the two trials and no difference in the number of symptoms. CONCLUSIONS: A pilot trial indicates no difference in exercise-induced GI symptoms with a HP or LP shake pre-run and suggests intakes up to 0.4g/kg body weight can be well tolerated. Supported by a Mount Royal UniversityInnovation Grant.

Exhaustive Exercise Induces Gastrointestinal Syndrome through Reduced ILC3 and IL-22 in Mouse Model.

This study was to investigate the mechanism of intestinal physical and immune barriers in the occurrence of high-intensive exercise-induced gastrointestinal symptoms. An overtraining model of male C57BL/6 mice was established by running-to-exhaustive exercise. Then, the mice were sacrificed, and a series of evaluation indicators, including the routine blood analysis as well as histological examinations, inflammatory factors, ultrastructure observation, and intestinal permeability of the gut, were measured based on this model. The expressions of inflammatory factors tumor necrosis factor α, interferon-γ, and interleukin (IL)-6 as well as the tight junction and adherence junction proteins ZO-1, Occludin, Claudin-1, and E-cadherin were measured, respectively. Furthermore, the mRNA level of IL-22 and the proportion of ILC3 and IL-22 produced in CD4 T cells in lamina propria lymphocytes (LPL) were analyzed by flow cytometry. Besides, the liver glycogen and the expressions of sirtuins-3 and hypoxia-inducible factor-1a, which were associated with the intestinal metabolism phenotype, were analyzed by Western blotting. Exhaustive exercise induced a disrupted intestinal barrier integrity, an aggravated intestinal inflammation, increased gut permeability, and the reduced IL-22 mRNA level. Compared with the nonexercise mice, the IL-22 produced in LPL was reduced followed by exhaustive exercise, whereas the proportion of IL-22 produced in CD4 T cells was still unchanged. Significantly, the proportion of ILC3 in the LPL was decreased obviously, including the NCR ILC3. Furthermore, the intestinal metabolism phenotype assessment showed lower liver glycogen and blood glucose as well as higher blood lactic acid and hypoxia-inducible factor-1a, respectively. The data indicated that the acute high-intensity running-induced gastrointestinal symptom is closely associated with a reduced percentage of ILC3 and IL-22 level in the LPL, possibly due to the glycogen exhaustion and intestinal mucosa hypoperfusion.

Dietary restrictions in endurance runners to mitigate exercise-induced gastrointestinal symptoms

BackgroundEndurance runners frequently experience exercise-induced gastrointestinal (GI) symptoms, negatively impacting their performance. Food choices pre-exercise have a significant impact on the gut’s tolerance to running, yet little information is available as to which foods runners restrict prior to exercise.MethodsA questionnaire designed to assess dietary restrictions pre-racing and gastrointestinal symptoms was administered to 388 runners. Fisher’s exact tests determined differences in gender, age, performance level, and distance with follow-up multivariable logistic regression modeling.ResultsRunners regularly avoided meat (32%), milk products (31%), fish/seafood (28%), poultry (24%), and high-fiber foods (23%). Caffeinated beverages were commonly avoided in events 10 km or less (p < .001); whereas in females, increased running distance was a predictor of avoiding high-fiber foods (OR = 6.7; 95% CI = 1.6–28.5). Rates of food avoidance were elevated in younger and more competitive runners. Common GI symptoms included stomach pain/cramps (42%), intestinal pain/discomfort (23%), side ache/stitch (22%), urge to defecate (22%), and bloating (20%). The prevalence of GI symptoms was higher in younger athletes, especially females, which may explain their propensity to avoid foods. Lower recreational athletes were the least likely to report GI symptoms. Diarrhea incidence increased with running distance. Conclusions: Identification of voluntary food restrictions in the pre-running meal highlights trends that can direct further research.

The impact of physical exercise on the gastrointestinal tract

Physical exercise can be both beneficial and harmful for the gastrointestinal tract in a dose-effect relationship between its intensity and health. Mild-to-moderate intensity exercises play a protective role against colon cancer, diverticular disease, cholelithiasis and constipation, whereas acute strenuous exercise may provoke heartburn, nausea, vomiting, abdominal pain, diarrhea and even gastrointestinal bleeding. This review focuses on mechanisms involved in those symptoms and their associations with type of exercises in humans. One quarter to one half of elite athletes are hampered by the gastrointestinal symptoms that may deter them from participation in training and competitive events. Vigorous exercise-induced gastrointestinal symptoms are often attributed to altered motility, mechanical factor or altered neuroimmunoendocrine secretions. Training, lifestyle modifications, meal composition, adequate hydration and avoidance of excessive use of some medications are the recommendations. Strenuous exercise and dehydrated states would be the causes of gastrointestinal symptoms referred by 70% of the athletes. Gut ischemia would be the main cause of nausea, vomiting, abdominal pain and (bloody) diarrhea. The frequency is almost twice as high during running than during other endurance sports as cycling or swimming and 1.5-3.0 times higher in the elite athletes than the recreational exercisers.

Exercise-Induced Gastrointestinal Symptoms.

In brief A triathlete and two distance runners sought medical advice for gastrointestinal (GI) symptoms that were brought on by increased training and hard runs. Collectively, their symptoms included heartburn, nausea, abdominal cramping, diarrhea, and bloody diarrhea. One patient had an up-per-GI motility disorder; one had a lower-GI motility disorder; the third had ischemia-related GI bleeding. The first two patients' symptoms improved with pharmacologic therapy and dietary changes, respsectively. The third patient did not require treatment.

Changes in jejunal myoelectrical activity during exercise in fed untrained dogs.

Seven female dogs (15-20 kg) were instrumented with seven bipolar electrodes sutured at 3-cm intervals to the serosal surface of the proximal jejunum and were exercised at different intensities and durations on a motor-driven treadmill. Slow-wave frequency increased (P less than 0.05) from preexercise control during prolonged (90 min) exercise and during recovery after short-term exercise (30 min) at 70% heart rate reserve (HRR). These changes were associated with an increase in core temperature. Spike-burst frequency (SBF) increased (P less than 0.05) with moderate exercise (50% HRR), but the magnitude was small. When exercise was extended beyond 30 min and during all recovery periods, SBF decreased significantly. Exercise produced migrating myoelectrical complexes in three experiments and less dramatic pattern changes characterized as "clustered contractions" (regular spike bursts preceded and followed by the absence of spike bursts) in at least nine other experiments. We conclude that exercise does alter jejunal myoelectrical activity, but myoelectrical patterns may be more important in explaining exercise-induced gastrointestinal symptoms than changes in spike-burst frequency or duration.

EXERCISE-INDUCED GASTROESOPHAGEAL REFLUX

The effect of exercise on gastroesophageal function was assessed in 7 children who were referred for evaluation of gastroesophageal reflux (GER). Four males and three females whose ages were 12.6 ± 4.4 yr were studied. Three patients presented with exercise-induced gastrointestinal symptoms (nausea, vomiting, substernal or epigastric pain). Cardiac or pulmonary disease was present in 3 children. Maximal treadmill exercise testing using the Bruce protocol with continuous monitoring of electrocardiogram and blood pressure was performed simultaneously with an esophageal pH probe study. Other diagnostic studies included upper GI series, 24-h pH probe, esophageal motility, gastroesophageal endoscopy, and biopsies. Results demonstrated that in one patient with exercise-induced gastrointestinal symptoms, significant symptomatic GER was present throughout strenuous exercise and during recovery ⩾ 40 min); no episodes of pathologic GER occurred throughout 24-h pH probe monitoring by Euler's criteria. Exercise-induced GER also was associated with biopsy-proven esophagitis. Motility studies demonstrated esophageal sphincter competency. None of the other patients demonstrated exercise-induced GER, despite the presence of pathologic GER. Physical work capacity was normal in all children. There were no pathologic ST changes associated with exercise. This is the first report of the association between exercise-induced gastrointestinal symptoms and GER. The pathophysiology of this entity is unknown. Exercise stress testing may aid in the diagnosis of exercise-induced GER.