Gastrointestinal complaints during exercise: prevalence, etiology, and nutritional recommendations

Erick Prado de Oliveira, Roberto Carlos Burini, Asker Jeukendrup, Erick Prado de Oliveira, Roberto Carlos Burini, Asker Jeukendrup

Abstract

Gastrointestinal problems are common, especially in endurance athletes, and often impair performance or subsequent recovery. Generally, studies suggest that 30-50% of athletes experience such complaints. Most gastrointestinal symptoms during exercise are mild and of no risk to health, but hemorrhagic gastritis, hematochezia, and ischemic bowel can present serious medical challenges. Three main causes of gastrointestinal symptoms have been identified, and these are either physiological, mechanical, or nutritional in nature. During intense exercise, and especially when hypohydrated, mesenteric blood flow is reduced; this is believed to be one of the main contributors to the development of gastrointestinal symptoms. Reduced splanchnic perfusion could result in compromised gut permeability in athletes. However, although evidence exists that this might occur, this has not yet been definitively linked to the prevalence of gastrointestinal symptoms. Nutritional training and appropriate nutrition choices can reduce the risk of gastrointestinal discomfort during exercise by ensuring rapid gastric emptying and the absorption of water and nutrients, and by maintaining adequate perfusion of the splanchnic vasculature. A number of nutritional manipulations have been proposed to minimize gastrointestinal symptoms, including the use of multiple transportable carbohydrates, and potentially the use of nutrients that stimulate the production of nitric oxide in the intestine and thereby improve splanchnic perfusion. However, at this stage, evidence for beneficial effects of such interventions is lacking, and more research needs to be conducted to obtain a better understanding of the etiology of the problems and to improve the recommendations to athletes.

References

    1. Brouns F, Beckers E. Is the gut an athletic organ? Digestion, absorption and exercise. Sports Med. 1993;15:242–257. doi: 10.2165/00007256-199315040-00003.
    1. Jeukendrup AE, Vet-Joop K, Sturk A, et al. Relationship between gastro-intestinal complaints and endotoxaemia, cytokine release and the acute-phase reaction during and after a long-distance triathlon in highly trained men. Clin Sci (Lond) 2000;98:47–55. doi: 10.1042/CS19990258.
    1. Moses FM. The effect of exercise on the gastrointestinal tract. Sports Med. 1990;9:159–172. doi: 10.2165/00007256-199009030-00004.
    1. Peters HP, Bos M, Seebregts L, et al. Gastrointestinal symptoms in long-distance runners, cyclists, and triathletes: prevalence, medication, and etiology. Am J Gastroenterol. 1999;94:1570–1581. doi: 10.1111/j.1572-0241.1999.01147.x.
    1. ter Steege RW, Van der Palen J, Kolkman JJ. Prevalence of gastrointestinal complaints in runners competing in a long-distance run: an internet-based observational study in 1281 subjects. Scand J Gastroenterol. 2008;43:1477–1482. doi: 10.1080/00365520802321170.
    1. Baska RS, Moses FM, Graeber G, et al. Gastrointestinal bleeding during an ultramarathon. Dig Dis Sci. 1990;35:276–279. doi: 10.1007/BF01536777.
    1. Hoffman MD, Fogard K. Factors related to successful completion of a 161-km ultramarathon. Int J Sports Physiol Perform. 2011;6:25–37.
    1. Rehrer NJ, Brouns F, Beckers EJ, et al. Physiological changes and gastro-intestinal symptoms as a result of ultra-endurance running. Eur J Appl Physiol. 1992;64:1–8. doi: 10.1007/BF00376431.
    1. Stuempfle KJ, Hoffman MD, Hew-Butler T. Gastrointestinal distress in ultramarathoners is associated with race diet. Int J Sport Nutr Exerc Metab. 2013;23:103–109.
    1. Pfeiffer B, Stellingwerff T, Hodgson AB, et al. Nutritional intake and gastrointestinal problems during competitive endurance events. Med Sci Sports Exerc. 2012;44:344–351. doi: 10.1249/MSS.0b013e31822dc809.
    1. Pfeiffer B, Cotterill A, Grathwohl D, et al. The effect of carbohydrate gels on gastrointestinal tolerance during a 16-km run. Int J Sport Nutr Exerc Metab. 2009;19:485–503.
    1. Choi SC, Choi SJ, Kim JA, et al. The role of gastrointestinal endoscopy in long-distance runners with gastrointestinal symptoms. Eur J Gastroenterol Hepatol. 2001;13:1089–1094. doi: 10.1097/00042737-200109000-00016.
    1. Moses FM. Exercise-associated intestinal ischemia. Curr Sports Med Rep. 2005;4:91–95. doi: 10.1097/01.CSMR.0000306079.74945.ea.
    1. Heer M, Repond F, Hany A, et al. Acute ischaemic colitis in a female long distance runner. Gut. 1987;28:896–899. doi: 10.1136/gut.28.7.896.
    1. Schaub N, Spichtin HP, Stalder GA. Ischemic colitis as a cause of intestinal bleeding after marathon running. Schweiz Med Wochenschr. 1985;115:454–457.
    1. Lucas W, Schroy PC., III Reversible ischemic colitis in a high endurance athlete. Am J Gastroenterol. 1998;93:2231–2234. doi: 10.1111/j.1572-0241.1998.00621.x.
    1. de Oliveira EP, Burini RC. Food-dependent, exercise-induced gastrointestinal distress. J Int Soc Sports Nutr. 2011;8:12. doi: 10.1186/1550-2783-8-12.
    1. ter Steege RW, Geelkerken RH, Huisman AB, et al. Abdominal symptoms during physical exercise and the role of gastrointestinal ischaemia: a study in 12 symptomatic athletes. Br J Sports Med. 2012;46:931–935. doi: 10.1136/bjsports-2011-090277.
    1. van Wijck K, Lenaerts K, Grootjans J, et al. Physiology and pathophysiology of splanchnic hypoperfusion and intestinal injury during exercise: strategies for evaluation and prevention. Am J Physiol. 2012;303:G155–G168.
    1. Wright H, Collins M, Villiers RD, et al. Are splanchnic hemodynamics related to the development of gastrointestinal symptoms in ironman triathletes? A prospective cohort study. Clin J Sport Med. 2011;21:337–343. doi: 10.1097/JSM.0b013e31822148b8.
    1. Otte JA, Geelkerken RH, Oostveen E, et al. Clinical impact of gastric exercise tonometry on diagnosis and management of chronic gastrointestinal ischemia. Clin Gastroenterol Hepatol. 2005;3:660–666. doi: 10.1016/S1542-3565(05)00155-2.
    1. Otte JA, Oostveen E, Geelkerken RH, et al. Exercise induces gastric ischemia in healthy volunteers: a tonometry study. J Appl Physiol. 2001;91:866–871.
    1. Qamar MI, Read AE. Effects of exercise on mesenteric blood flow in man. Gut. 1987;28:583–587. doi: 10.1136/gut.28.5.583.
    1. Pals KL, Chang RT, Ryan AJ, et al. Effect of running intensity on intestinal permeability. J Appl Physiol. 1997;82:571–576.
    1. de Oliveira EP, Burini RC. The impact of physical exercise on the gastrointestinal tract. Curr Opin Clin Nutr Metab Care. 2009;12:533–538. doi: 10.1097/MCO.0b013e32832e6776.
    1. ter Steege RW, Kolkman JJ. Review article: the pathophysiology and management of gastrointestinal symptoms during physical exercise, and the role of splanchnic blood flow. Aliment Pharmacol Ther. 2012;35:516–528. doi: 10.1111/j.1365-2036.2011.04980.x.
    1. Peters HP, Wiersma JW, Koerselman J, et al. The effect of a sports drink on gastroesophageal reflux during a run-bike-run test. Int J Sports Med. 2000;21:65–70. doi: 10.1055/s-2000-8858.
    1. Fordtran JS, Saltin B. Gastric emptying and intestinal absorption during prolonged severe exercise. J Appl Physiol. 1967;23:331–335. doi: 10.1007/BF00698042.
    1. Leiper JB, Prentice AS, Wrightson C, et al. Gastric emptying of a carbohydrate-electrolyte drink during a soccer match. Med Sci Sports Exerc. 2001;33:1932–1938. doi: 10.1097/00005768-200111000-00020.
    1. Neufer PD, Young AJ, Sawka MN. Gastric emptying during exercise: effects of heat stress and hypohydration. Eur J Appl Physiol Occup Physiol. 1989;58:433–439. doi: 10.1007/BF00643521.
    1. Rehrer NJ, Beckers EJ, Brouns F, et al. Effects of dehydration on gastric emptying and gastrointestinal distress while running. Med Sci Sports Exerc. 1990;22:790–795. doi: 10.1249/00005768-199012000-00010.
    1. Rao KA, Yazaki E, Evans DF, et al. Objective evaluation of small bowel and colonic transit time using pH telemetry in athletes with gastrointestinal symptoms. Br J Sports Med. 2004;38:482–487. doi: 10.1136/bjsm.2003.006825.
    1. Ryan AJ, Lambert GP, Shi X, et al. Effect of hypohydration on gastric emptying and intestinal absorption during exercise. J Appl Physiol. 1998;84:1581–1588.
    1. Lambert GP, Chang RT, Xia T, et al. Absorption from different intestinal segments during exercise. J Appl Physiol. 1997;83:204–212.
    1. Lambert GP, Lang J, Bull A, et al. Fluid restriction during running increases GI permeability. Int J Sports Med. 2008;29:194–198. doi: 10.1055/s-2007-965163.
    1. Oktedalen O, Lunde OC, Opstad PK, et al. Changes in the gastrointestinal mucosa after long-distance running. Scand J Gastroenterol. 1992;27:270–274. doi: 10.3109/00365529209000073.
    1. van Nieuwenhoven MA, Brouns F, Brummer RJ. Gastrointestinal profile of symptomatic athletes at rest and during physical exercise. Eur J Appl Physiol. 2004;91:429–434. doi: 10.1007/s00421-003-1007-z.
    1. Rudzki SJ, Hazard H, Collinson D. Gastrointestinal blood loss in triathletes: its etiology and relationship to sports anaemia. Aust J Sci Med Sport. 1995;27:3–8.
    1. Waterman JJ, Kapur R. Upper gastrointestinal issues in athletes. Curr Sports Med Rep. 2012;11:99–104. doi: 10.1249/JSR.0b013e318249c311.
    1. Rehrer NJ, van Kemenade M, Meester W, et al. Gastrointestinal complaints in relation to dietary intake in triathletes. Int J Sport Nutr. 1992;2:48–59.
    1. Wallis GA, Yeo SE, Blannin AK, et al. Dose–response effects of ingested carbohydrate on exercise metabolism in women. Med Sci Sports Exerc. 2007;39:131–138. doi: 10.1249/01.mss.0000241645.28467.d3.
    1. Jentjens RL, Underwood K, Achten J, et al. Exogenous carbohydrate oxidation rates are elevated after combined ingestion of glucose and fructose during exercise in the heat. J Appl Physiol. 2006;100:807–816. doi: 10.1152/japplphysiol.00322.2005.
    1. Jeukendrup AE, Moseley L, Mainwaring GI, et al. Exogenous carbohydrate oxidation during ultraendurance exercise. J Appl Physiol. 2006;100:1134–1141. doi: 10.1152/japplphysiol.00981.2004.
    1. Jentjens RL, Achten J, Jeukendrup AE. High oxidation rates from combined carbohydrates ingested during exercise. Med Sci Sports Exerc. 2004;36:1551–1558. doi: 10.1249/01.MSS.0000139796.07843.1D.
    1. Jentjens RL, Venables MC, Jeukendrup AE. Oxidation of exogenous glucose, sucrose, and maltose during prolonged cycling exercise. J Appl Physiol. 2004;96:1285–1291. doi: 10.1152/japplphysiol.01023.2003.
    1. Rowlands DS, Swift M, Ros M, et al. Composite versus single transportable carbohydrate solution enhances race and laboratory cycling performance. Appl Physiol Nutr Metab. 2012;37:425–436. doi: 10.1139/h2012-013.
    1. Murray R. Training the gut for competition. Curr Sports Med Rep. 2006;5:161–164. doi: 10.1097/01.CSMR.0000306307.10697.77.
    1. Jeukendrup AE, McLaughlin J. Carbohydrate ingestion during exercise: effects on performance, training adaptations and trainability of the gut. Nestle Nutr Inst Workshop Ser. 2011;69:1–12 (discussion 13–7).
    1. Cox GR, Clark SA, Cox AJ, et al. Daily training with high carbohydrate availability increases exogenous carbohydrate oxidation during endurance cycling. J Appl Physiol. 2010;109:126–134. doi: 10.1152/japplphysiol.00950.2009.
    1. Lambert GP, Lang J, Bull A, et al. Fluid tolerance while running: effect of repeated trials. Int J Sports Med. 2008;29:878–882. doi: 10.1055/s-2008-1038620.
    1. Gorski T, Cadore EL, Pinto SS, et al. Use of NSAIDs in triathletes: prevalence, level of awareness and reasons for use. Br J Sports Med. 2011;45:85–90. doi: 10.1136/bjsm.2009.062166.
    1. Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis. Ann Intern Med. 1991;115:787–796. doi: 10.7326/0003-4819-115-10-787.
    1. Smetanka RD, Lambert GP, Murray R, et al. Intestinal permeability in runners in the 1996 Chicago marathon. Int J Sport Nutr. 1999;9:426–433.
    1. van Wijck K, Lenaerts K, van Bijnen AA, et al. Aggravation of exercise-induced intestinal injury by Ibuprofen in athletes. Med Sci Sports Exerc. 2012;44:2257–2262. doi: 10.1249/MSS.0b013e318265dd3d.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere