Association of Gastrointestinal Distress in Ultramarathoners With Race Diet

Health Sciences Dept., Gettysburg College, Gettysburg, PA.
International Journal of Sport Nutrition and Exercise Metabolism (Impact Factor: 2.44). 04/2013; 23(2):103-9.
Source: PubMed


Context: Gastrointestinal (GI) distress is common during ultrarunning. Purpose: To determine if race diet is related to GI distress in a 161-km ultramarathon. Methods: Fifteen (10 male, 5 female) consenting runners in the Javelina Jundred (6.5 loops on a desert trail) participated. Body mass was measured immediately prerace and after each loop. Runners reported if they had nausea, vomiting, abdominal cramps, and/or diarrhea after each loop. Subjects were interviewed after each loop to record food, fluid, and electrolyte consumption. Race diets were analyzed using Nutritionist Pro. Results: Nine (8 male, 1 female) of 15 runners experienced GI distress including nausea (89%), abdominal cramps (44%), diarrhea (44%), and vomiting (22%). Fluid consumption rate was higher (p = .001) in runners without GI distress (10.9 ± 3.2 ml · kg-1 · hr-1) than in those with GI distress (5.9 ± 1.6 ml · kg-1 · hr-1). Runners without GI distress consumed a higher percentage fat (p = .03) than runners with GI distress (16.5 ± 2.6 vs. 11.1 ± 5.0). In addition, fat intake rate was higher (p = .01) in runners without GI distress (0.06 ± 0.03 g · kg-1 · hr-1) than in runners with GI distress (0.03 ± 0.01 g · kg-1 · hr-1). Lower fluid and fat intake rates were evident in those developing GI distress before the onset of symptoms. Conclusions: A race diet with higher percentage fat and higher intake rates of fat and fluid may protect ultramarathoners from GI distress. However, these associations do not indicate cause and effect, and factors other than race diet may have contributed to GI distress.

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    • "Two studies (Glace et al., 2002; Rehrer et al., 1992) of ultramarathon runners revealed no association between food or fluid consumption and gastrointestinal symptoms. In contrast, another study (Stuempfle et al., 2013) reported that asymptomatic ultramarathon runners consumed fluid and fat at higher rates compared to runners with gastrointestinal distress. Although gastrointestinal problems are pervasive in ultramarathon runners and a common cause of underperformance, the aetiology of these symptoms is not clearly understood. "
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    ABSTRACT: This study explored possible contributing factors to gastrointestinal distress, including endotoxemia, hyperthermia, dehydration and nutrition, during a 161-km ultramarathon. Thirty runners participated in the study and 20 finished the race. At three checkpoints and the finish, runners were interviewed to assess the incidence and severity of 12 gastrointestinal symptoms and to determine dietary intake. Core temperature was measured at the same locations. Runners were weighed pre-race, at the three checkpoints and the finish to monitor hydration status. Blood markers for endotoxemia (sCD14) and inflammation (interleukin-6 and C-reactive protein) were measured pre- and post-race. Gastrointestinal symptoms were experienced by most runners (80%), with nausea being the most common complaint (60%). Runners with nausea experienced significantly greater (P = 0.02) endotoxemia than those without nausea (sCD14 mean increase 0.7 versus 0.5 µg · mL(-1)). There was a significant positive correlation (r = 0.652, P = 0.005) between nausea severity and endotoxemia level. Inflammatory response, core temperature, hydration level and race diet were similar between runners with and without nausea. This study links endotoxemia to nausea in ultramarathon runners. Other possible contributing factors to nausea such as hyperthermia, dehydration and nutrition did not appear to play a role in the symptomatic runners in this study.
    No preview · Article · Dec 2015 · Journal of Sports Sciences
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    • "Severe GI symptoms were rare, maybe because of the distance and environmental conditions and, in this case, probably not having a notable impact on group results. GI complaints are more common during races over longer distances (Stuempfle et al. 2013). "
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    ABSTRACT: The objective of this study was to investigate whether ultramarathon runners were able to meet nutrition recommendations during a training period and on a competition day. In preparation for a 60 or 120 km ultramarathon covering a varied terrain, male and female ultramarathon runners (n=68, age 46.5±7.1 y) reported habitual dietary intake during three independent days using a web-based 24-hour recall and questionnaires. The diet was assessed using probability of inadequacy or by qualitative evaluation using reference dietary intakes or sports nutrition recommendations. A small group of 120 km runners (n=4) was observed continuously during the race. After the race, 60 km runners (n=41) received a questionnaire to assess dietary intake and gastrointestinal (GI) distress on the race day. Spearman rank correlation coefficients (r) were applied to investigate the association between intake and general GI distress symptoms. In men and women, habitual mean carbohydrate (CHO) intake was lower than recommended, as was mean protein intake by women. CHO intake during the race was <60 g/h in 75% of the athletes. A large variation of nutrient and fluid intake was seen. GI distress during the race was reported in 82% of the runners; severe GI distress was low. In general, moderate, mostly negative, correlations with nutrient intake were seen for GI distress. Sports nutrition recommendations for the habitual diet were not achieved. During a competition day, a large variation was found in nutrient intake; this may be related to a high incidence of GI distress.
    Full-text · Article · Mar 2015 · International Journal of Sport Nutrition and Exercise Metabolism
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    • "Nausea, vomiting, abdominal cramping, and diarrhea have been reported in 37–89 % of runners participating in races 67–161 km long [6–9], and fecal blood loss indicating gastrointestinal hemorrhage was reported in 85 % of participants in a 161 km ultra-marathon [6]. A recent study investigated gastrointestinal problems in a group of ultra-marathon runners, and observed that 9 of 15 runners experienced gastrointestinal distress, including nausea (89 %), abdominal cramps (44 %), diarrhea (44 %), and vomiting (22 %) [9]. "
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    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.
    Full-text · Article · May 2014
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