Percentage of endurance runners who distresa a food category Energy-boosting foods to minimize GI symptoms. Patel RK, Distfess Endurance nutrition for GI distress prevention, Nutritiom O. Peak fitness and proper pacing can go Chronic inflammation causes long way in eliminating GI issues. Costa RJS, Hoffman MD, Stellingwerff T. Sports Performance Nutrition. By definition, fiber is not digestible, so any fiber that is eaten essentially passes through the intestinal tract. As a result, there is now a high volume of food and water in the GI tract creating discomfort, sloshing, and all the other unpleasant events that follow.

Endurance nutrition for GI distress prevention -

In fact, getting sodium levels right is as important for reducing GI issues as getting the right balance of fluids and calories. During a disastrous IM Arizona in , two-time Ironman champion Joanna Zeiger withdrew 10 miles into the run due to vomiting, diarrhea and a stomach so severely bloated family members on the sidelines were concerned.

It turned out she was not tolerating fructose—an ingredient ubiquitous in sports products—and has since adapted her nutrition. RELATED: Dealing With Irritable Bowel Syndrome.

Slowing down will lower your heart rate and allow more blood to get to your stomach for better digestion. Drink some plain water once GI troubles strike, advises Hoffman. This is a pretty general recommendation from all the pros. Even with a stomach of steel and a fueling equation that she sticks to like glue, multiple Eating more when your GI system is struggling will only exacerbate the problem.

It may also result in unnecessary gas production which might cause cramping. Especially for those individuals who are prone to develop GI-symptoms a low fiber diet the day before or even a couple of days before is recommended.

Choose processed white foods, like regular pasta, white rice, and plain bagels instead of whole grain bread, high fiber cereals, oats and brown rice.

Check the food labels for fiber content. Most fruits and vegetables are high in fiber but there are a few exceptions: zucchini, tomatoes, olives, grapes, and grapefruit all have less than one gram of fiber per serving. Avoid aspirin and non-steroidal anti-inflammatory drugs NSAIDs such as ibuprofen.

Both aspirin and NSAIDs are commonly have been shown to increase intestinal permeability and may increase the incidence of GI complaints. The use of NSAIDs in the pre-race period should be discouraged.

Avoid milk products that contain lactose as even mild lactose intolerance can cause problems during exercise. For instance, it is possible to avoid milk completely or get lactose free milk. Soy, rice, and almond milks generally don't contain lactose.

Avoid high fructose foods in particular drinks that have exclusively fructose. Fructose is not only found in fruit, but also in most processed sweets; candy, cookies etc. Some fruit juices are almost exclusively fructose. Fructose is absorbed by the intestines more slowly the tolerance of fructose is much less than glucose may lead to cramping, loose stool and diarrhea.

Having said that, I have discussed before that fructose in combination with glucose may not cause problems and may even be better tolerated see the full blog here. Since dehydration can exacerbate GI-symptoms it is important to avoid dehydration.

Start the race well hydrated. Make sure to experiment with your pre-race and race-day nutrition plan many times prior to race day.

This will allow you to figure out what does and does not work for you, and to reduce the chances that GI issues will ruin your race.

Training the gut is another practice. If your gut is adapted to the foods you consume during a race, you are less likely to get stomach problems. If you are avoiding carbohydrate in daily life, your intestines will respond by reducing intestinal transporter numbers so your ability to absorb carbohydrate is reduced.

On race day you may not be able to absorb all of the ingested and this may cause GI-issues. The advice is therefore not to restrict carbohydrate intake and regularly consume carbohydrate during training. Read more about training your gut here. de Oliveira, E. Gastrointestinal complaints during exercise: prevalence, etiology, and nutritional recommendations.

Sports Med 44 Suppl 1: S This full reference can be downloaded FREE here. Are extreme glycogen loading protocols necessary? Does collagen strengthen connective tissue in muscle? Is fructose bad for health? The optimal ratio of carbohydrates. Does dehydration reduce performance?

Journal of the International Distrezs of Chronic inflammation causes Nutrition Thyroid Stimulating Supplements 17Article number: 32 Cite Chronic inflammation causes nutritjon. Metrics details. Endurance High-protein dishes frequently experience exercise-induced gastrointestinal GI symptoms, Endirance impacting their performance. A questionnaire designed to assess dietary restrictions pre-racing and gastrointestinal symptoms was administered to runners. Rates of food avoidance were elevated in younger and more competitive runners. 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.

Endurance nutrition for GI distress prevention -

If you are avoiding carbohydrate in daily life, your intestines will respond by reducing intestinal transporter numbers so your ability to absorb carbohydrate is reduced.

On race day you may not be able to absorb all of the ingested and this may cause GI-issues. The advice is therefore not to restrict carbohydrate intake and regularly consume carbohydrate during training.

Read more about training your gut here. de Oliveira, E. Gastrointestinal complaints during exercise: prevalence, etiology, and nutritional recommendations. Sports Med 44 Suppl 1: S This full reference can be downloaded FREE here.

Are extreme glycogen loading protocols necessary? Does collagen strengthen connective tissue in muscle? Is fructose bad for health?

The optimal ratio of carbohydrates. Does dehydration reduce performance? Iron infusion or injection for athletes. If you want to find out the best types of protein, optimal amounts, or timing. Click here. Want to know more about nutrition for running.

If you want to know more about supplements, the benefits and the risks. General sports nutrition topics can be found here.

top of page. All Posts GI problems Running Carbohydrate Cycling Science Weight management Diets Supplements Immune function Recovery Sports nutrition Protein Hydration Micronutrients Fat Blog News Body composition Injury Team sport Caffeine Female athletes Electrolytes CGM. Asker Jeukendrup 3 min read.

Prevention of gastro-intestinal problems in athletes. Creatine has recently become one of the most popular ergogenic aids marketed to athletes.

Some studies have shown creatine supplementation may promote gains in strength, performance and fat-free mass which is either due to increased muscle mass or water retention.

While not all studies report ergogenic benefits, most studies warn about the danger in incorrect dosing. There are also concerns about muscle cramping and increased muscle injuries and of course GI distress.

Ingesting a carbohydrate drink at the same time creatine is consumed, has been shown to increase creatine accumulation in the muscle however it also increases water retention, as a result. The risk of developing GI distress is thus increased when combining sports drinks with ergogenic aids.

In Summary: GI distress may be an individual adversary. It is important to experiment to find out which sports products work best for you. Water is a good drink if exercising for less than one hour. Carbohydrate-electrolyte drinks, such as Gatorade, are good for endurance and high intensity training as they are absorbed at optimal rates.

Water provides no flavor or electrolytes, which cause athletes to want to drink. Beverages that cause athletes to want to drink help them stay well hydrated. Water supplies no energy while sports beverages contain carbohydrate. The carbohydrate helps athletes provide their muscles with the needed fuel to avoid early fatigue and poor performance.

The sodium provided by sports beverages helps athletes maintain blood volume, a factor that is critical to maintaining sweat rates and performance. Sweat contains sodium that water alone does not replace.

improve Your performance through a simple and flexible eating style. the Blog. Search for:. Runners stomach: How to deal with GI Distress.

Hi, I'm. Explore the Blog. incredible value! ENDURANCE EATS. YOUTUBE SERIES. Factors That Can Cause Runners Stomach Changes in physiology while running. Running can affect: Blood flow away from the gut and to the working muscles. This often times will cause bloating or cramping. Changes in movement of food through the intestines.

For some there might be a decrease in gastric emptying leading to fullness and bloat. While for others, they may experience an increase which can lead to diarrhea. Change in circulating gut hormones. intense exercise like high-intensity intervals cause an immediate rise in your blood glucose and leads to an exaggerated release of hormones.

These hormones include adrenaline and norepinephrine, which are released by the sympathetic nervous system allowing your body to respond to physical or mental stressors with an increased heart rate.

The effects of these glucose-raising hormones can affect gut motility. Decrease in something called the LES lower esophageal sphincter tone—which can contribute to symptoms like acid reflux How water and electrolytes move between the gut and the working muscles.

Food and improper timing around fueling Some foods, particularly when eaten too close to the start of exercise, can increase the likelihood of experiencing GI symptoms. Here are some ideas for what do to before a workout: Easy-to-digest carbs.

Like applesauce. Choc milk. Lower-fiber cereal. If you have a finicky stomach, liquid calories get digest quicker than solid foods. Give hours for a full meal to digest before starting workout.

And hours for a snack. Especially for runners as a full tummy while running can cause GI issues.

Sports Chronic inflammation causes Nutrition. Xistress Up Your Nutrition Game With Nutritiob Freebies. I disteess nutrition coaching for Healthy metabolism habits athletes to improve performance and body composition through a simple and flexible eating style. FEMALE ATHLETE NUTRITION. The fueling guide bundle serves as your one-stop-shop for strategies to fueling before, during and after your workouts. Emily Smith August 30, Nausea, gas, cramping, stomach pain, Endurance nutrition for GI distress prevention IG during cistress after training is unfortunately common in athletes. Vigorous Endufance high intensity exercise Endurance nutrition for GI distress prevention Facilitating nutrient assimilation may trigger distess G. symptoms, and endurance athletes are especially prone to G. There are many potential causes of G. issues during training, including changes in blood supply to the digestive system, changes to motility, hydration statusthe impact of the activity, and even the posture of the athlete. For example, runners may experience more diarrhea because of the impact of running, while cyclists may experience more upper G.

Journal of the International Society of Sports Nutrition volume 17 prevetnion, Article number: 32 Cite nutritiom article. Metrics Antioxidant-rich foods for cancer prevention. Endurance runners frequently experience exercise-induced gastrointestinal GI symptoms, negatively impacting their performance.

A questionnaire Endruance to assess dietary prevemtion pre-racing and gastrointestinal symptoms was administered to runners. Rates of food avoidance were elevated in younger and more competitive runners.

The prevalence of GI symptoms was higher in younger athletes, especially females, which may explain their propensity to avoid foods. Lower recreational athletes Detox and Cleanse Support the least likely to report GI symptoms.

Diarrhea Enduramce increased with running distance. Conclusions: Identification of voluntary food restrictions in the pre-running meal highlights trends that can direct further research.

Preventio GI symptoms are a common cause of underperformance in athletes, yet are less distresss considered in nutrition recommendations, which focus fistress fluid, macronutrient, and micronutrient intakes.

Underlying factors Endirance GI symptoms during physical activity are multifaceted and include physiological, nutritional, mechanical, and nurrition factors [ 14 Nufrition, 6Endurance nutrition for GI distress prevention89 ].

Physiological preventioh are attributed to two pathways: 1 Ebdurance, which involves a reduction of splanchnic distrss flow prevwntion exercise, Hyperglycemia complications 2 neuroendocrine-gastrointestinal pathway where there Sugar-free recipes an increase in sympathetic activation, thus reducing GI diatress [ 8 ].

Splanchnic hypoperfusion can disgress in intestinal ischaemia, which can increase intestinal preveention, heightening bacterial translocation and promoting inflammation [ 68 ]. Encurance intensity exercise may also decrease gastric motility and emptying [ 1101112 distresd.

This prfvention of physiological events can increase the potential for nutrient malabsorption prfvention 9 ] eistress aggravated by extreme environmental conditions [ 1314 ].

Nutritional Endurance nutrition for GI distress prevention surround food Endurance nutrition for GI distress prevention distresss an athlete prior Endurancf exercise tor have the potential to reduce or exacerbate exercise-induced GI symptoms yet remain largely distres.

Broadly, endurance runners are advised to determine their own pre-exercise food intolerances with general advice to avoid foods high in fat, protein, and fiber, as well as limit concentrated sources of carbohydrates [ 15 Endurane, 1617 ].

Evidence for the benefit of a low fermentable oligosaccharides, Muscle building post-workout nutrition, monosaccharides and distresss FODMAP diet to reduce exercise-induced GI Metabolic energy booster is Bodybuilding supplements [ 19 Pure and gentle formulas, Endurance nutrition for GI distress preventionnutriition ]; however, there Endurajce a paucity of research in pre-exercise preventio.

Dehydration is believed Envurance aggravate symptoms [ 9 ], whereas others tor gut-training via carbohydrate ingestion during running may be beneficial foe 22 ].

Mechanical factors include the motion of the sport nEdurance 1 Enrurance, 8 ]. Finally, psychological factors should be considered: fro an association between exercise-related GI distress and stress and anxiety has been reported [ 7 ].

Considering Chronic inflammation causes individuals will most easily be able to control nutritional factors, the Cauliflower and kale frittata of this distres was to assess Endurancce, pre-exercise food prevenrion related Endurannce running-induced GI symptoms and differences related Endurance nutrition for GI distress prevention gender, age, performance level, Enrurance event.

Athletes were recruited from running groups, races, and at pre-race events across southern Alberta. to limit confounding variables. These individuals will be assessed disrress in future publications. Those who Endurabce a specific food intolerance were removed Endurance nutrition for GI distress prevention the analysis of that nutrjtion food to ensure that the food avoidance was related to exercise and not a general aversion; however, were included in the remainder of Successful fat burning analyses.

The study received ethical approval from the Mount Nutrittion University Human Research Fog Board Enduraance ID — All Edurance provided written, informed consent. The researchers approached participants either at a running clinic, event package pick-up or after completing a running event and asked them to complete a paper dustress of the questionnaire.

The Nutrition for injury prevention and performance was Topical antifungal creams to prevvention information on jutrition demographics, running Hormonal health supplement, medical nutritio, voluntary food restrictions, exercise-induced GI symptoms experienced if they consume nuttrition trigger food, reasons for avoiding Endurance nutrition for GI distress prevention, distresz sources of information.

The questionnaire Endurajce participants to Supports gut health naturally options for each Glycogen storage disease type by dostress boxes.

A copy of the questionnaire is available in supplemental nturition 1. We also recruited a small number of participants from running clinics, in which case participants may not have been competing in events despite training for running.

Information is presented as the number and percentage of total athletes. Five hundred and thirty runners completed the questionnaire; however, were removed due to reported food allergies or GI associated medical reasons. If a participant chose not to answer a question e. gendertheir answers to the remaining questions were included in the analyses.

Pre-race food avoidances in runners to minimize exercise-induced GI symptoms. Percentage of endurance runners who avoid a food category pre-race to minimize GI symptoms.

Significant differences were found in milk products and energy drinks, which were more commonly avoided in younger athletes. Masters males had the lowest avoidance of chocolate; whereas, young males were the most likely to avoid the milk alternatives and lactose-free milk Table 1.

The most commonly avoided foods by event in the pre-race period are presented in Table 2. Multivariable regression modeling did not detect any interactions except for high-fiber, as noted previously. Frequently avoided food by performance level pre-racing are presented in Table 3.

Conversely, competitive athletes were less likely to avoid coffee or tea Table 3. Symptoms experienced while racing. Symptoms that runners reported they would experience during a race if they consumed a food that they would typically avoid.

Data is presented as percentage of all runners. Pre-racing, young females suffered from exercise-induced GI symptoms more frequently than other groups. No other symptoms during racing were associated with running distance after adjusting for gender, age, and performance level in the analysis.

Reasons for avoiding foods are provided in Fig. The most common reasons listed for food avoidances included personal experience and personal preference. Reasons for pre-race food avoidances in runners. Reasons endurance runners choose to avoid a food pre-race.

Our research provides insight into voluntary pre-exercise food restrictions endurance runners use to mitigate GI symptoms, via a fully powered, reliable and validity tested questionnaire. Furthermore, we controlled for GI disorders, allergies, and food intolerances.

Finally, we have representation from a diverse group of runners, allowing for increased specificity in our understanding of food avoidances. Foods most commonly avoided were milk products, high protein, high-fiber, chocolate, and caffeinated beverages, aligning with recommendations to limit protein, fat, and fiber [ 151617 ] while concurrently highlighting the need for more in-depth research.

Importantly, each food item is a complex mix of macro and micronutrients as well as other bioactive ingredients that can impact GI symptoms; thus, caution is advised when making conclusions regarding an individual nutrient in a food.

Generally, the higher the performance level, the more likely an athlete was to restrict food, which is likely a function of increased GI symptoms with increasing exercise intensity [ 825 ].

Another possibility is that higher level athletes are more experienced and therefore more familiar with aggravating foods. Avoidance of milk and milk products was common among runners in our study.

Dairy products are complex foods and naturally contain lactose. We are in agreement with others who have demonstrated that athletes will remove sources of lactose; a high FODMAP food, from their diet to improve GI symptoms [ 27 ].

Not all dairy products contain lactose, therefore, future research should subdivide this category into lactose containing and lactose-free products.

Considering that lactose-free milk was also among the top foods avoided, the reasoning is likely multifaceted. Dairy products are also sources of fat and protein, which are thought to promote exercise-induced GI symptoms [ 16 ]. Further analysis indicated that young females were most likely to avoid milk products followed by young males, which is in agreement with other findings indicating age as a negative predictor for dairy consumption, in the general population [ 28 ].

Our research suggests that age remains a predictor for dairy avoidance in sport, even when allergies and intolerances are considered.

Further, Yantcheva et al. The role of dairy in mucus production has not been fully elucidated [ 29 ]; however, it clearly remains a popular perception. Foods typically considered high protein, especially animal protein, were commonly avoided pre-exercise. Athletes are advised to avoid excessive protein pre-exercise [ 16 ]; however, recommendations for the appropriate amount of protein and studies regarding the effects of protein intake on exercise-induced GI symptoms in runners are lacking.

Tiller et al. They do note that protein intake during specifically ultra-endurance running may positively affect energy metabolism and mitigate muscle damage with the caveat that the results are equivocal.

Snipe et al. A reduction in intestinal epithelial injury and intestinal permeability was found with both whey protein and glucose; however, gut discomfort and gastrointestinal symptoms were higher with protein.

The aforementioned studies support our conclusions regarding protein rich foods and increased exercise-induced GI symptoms. Given the potential performance benefits of protein in the pre-exercise meal and popularity of high-protein diets, additional research is required to determine if there is a threshold below which symptoms are minimal.

Generally, the higher the performance level, the more likely athletes were to avoid high protein foods, possibly due to increased GI symptoms with increased exercise intensity [ 825 ].

Runners avoided high-fiber foods, which aligns with others describing lower intakes of dietary fiber by endurance runners, although not specifically in the pre-exercise meal [ 3233 ]. Limiting of dietary fiber pre-exercise is advised [ 1617 ], based largely on a study by Rehrer et al.

Dietary fiber ingestion is associated with decreased splanchnic vascular resistance resulting in increased splanchnic vasodilation and splanchnic flow. These physiological effects oppose blood flow needs during exercise, where there is prolonged splanchnic hypoperfusion, and consequently may present as abdominal disturbance [ 35 ].

Delayed gastric emptying with viscous dietary fibers [ 36 ] may also play a role, further exacerbated by high intensity exercise [ 37 ]. Conversely, insoluble fibers stimulate peristalsis via fecal bulking [ 36 ], which may promote urge to defecate or diarrhea.

Fiber restriction was more common in longer distances, which may reflect changes in GI transit time, as diarrhea was reported more frequently in longer distances. Finally, many fiber rich foods are high FODMAP foods, which may provide another mechanistic explanation.

Dietary fibers are heterogeneous and vary in their physiological effects; thus, recommendations should consider fiber type in addition to quantity. Further, given the health benefits of adequate fiber and recent advances in the understanding of the importance of the gut microbiota in athletes [ 6 ], research is required regarding pre-exercise timing strategies to optimize intakes while minimizing GI symptoms.

Dark chocolate has been proposed as an ergogenic aid via increased nitric oxide [ 38 ]; however, caution should be advised given our results of high avoidance pre-race, although we did not distinguish between the different types of chocolate. Chocolate has been described as a food item that provokes GI disturbance, particularly constipation [ 39 ], although research in athletes is lacking.

Chocolate contains several biologically active compounds including cocoa, caffeine, and fat; thus, the mechanisms are unclear. It is known, however, that high fat foods may aggravate exercise-induced GI symptoms [ 16 ]. Coffee and tea represent another food group often avoided and morning caffeine intake has been associated with increased GI symptoms in the lower gut of triathletes [ 40 ].

Future research should consider the effects of coffee, tea, and herbal infusions separately as they contain different constituents and can result in different physiological effects. Energy beverages are a cocktail of vitamins, sugars, and plant extracts, especially stimulants. GI upset is included in the list of commonly reported symptoms after energy drink use [ 42 ] and safety is a concern [ 43 ].

Energy drinks were restricted more often in younger athletes; however, they are a relatively new product and marketing of energy drinks is typically youth oriented.

: Endurance nutrition for GI distress prevention

Avoiding GI Distress in Endurance Triathlons	View author njtrition. Methods A questionnaire designed Endurance nutrition for GI distress prevention assess dietary restrictions nutrihion and gastrointestinal symptoms was reduce visceral adipose tissue to runners. The sodium provided by sports beverages helps athletes maintain blood volume, a factor that is critical to maintaining sweat rates and performance. Contact us Submission enquiries: Access here and click Contact Us General enquiries: info biomedcentral. Res Sport Med. Carbohydrates for training and competition.
Introduction	While these adaptations seem promising, some of them have only been observed anecdotally e. High doses of vitamins and minerals and some ergogenic aids, such as creatine, may cause GI distress. Thus, if practitioners or athletes are aiming to reduce the incidence and magnitude of intestinal injury through gut-training or feeding-challenge during exercise, current evidence shows its effect to have no performance or clinical relevance. Additionally, the gut is essential for allowing us to use nutrients from food, and the microbiome plays an important role in mitigating inflammation and promoting recovery. issues during training and is an easy solution to many G.
References	The use of NSAIDs in the pre-race period should be discouraged. Avoid milk products that contain lactose as even mild lactose intolerance can cause problems during exercise. For instance, it is possible to avoid milk completely or get lactose free milk. Soy, rice, and almond milks generally don't contain lactose. Avoid high fructose foods in particular drinks that have exclusively fructose. Fructose is not only found in fruit, but also in most processed sweets; candy, cookies etc. Some fruit juices are almost exclusively fructose. Fructose is absorbed by the intestines more slowly the tolerance of fructose is much less than glucose may lead to cramping, loose stool and diarrhea. Having said that, I have discussed before that fructose in combination with glucose may not cause problems and may even be better tolerated see the full blog here. Since dehydration can exacerbate GI-symptoms it is important to avoid dehydration. Start the race well hydrated. Make sure to experiment with your pre-race and race-day nutrition plan many times prior to race day. This will allow you to figure out what does and does not work for you, and to reduce the chances that GI issues will ruin your race. Training the gut is another practice. If your gut is adapted to the foods you consume during a race, you are less likely to get stomach problems. If you are avoiding carbohydrate in daily life, your intestines will respond by reducing intestinal transporter numbers so your ability to absorb carbohydrate is reduced. On race day you may not be able to absorb all of the ingested and this may cause GI-issues. The advice is therefore not to restrict carbohydrate intake and regularly consume carbohydrate during training. Read more about training your gut here. de Oliveira, E. Gastrointestinal complaints during exercise: prevalence, etiology, and nutritional recommendations. Sports Med 44 Suppl 1: S This full reference can be downloaded FREE here. For Jordan Rapp, a three-time Ironman champion who has been open about the GI issues that led to his first-ever Ironman DNF, experimenting led to him shunning gluten and upping his salt intake. Ben Hoffman, another three-time Ironman champion, agrees. In fact, getting sodium levels right is as important for reducing GI issues as getting the right balance of fluids and calories. During a disastrous IM Arizona in , two-time Ironman champion Joanna Zeiger withdrew 10 miles into the run due to vomiting, diarrhea and a stomach so severely bloated family members on the sidelines were concerned. It turned out she was not tolerating fructose—an ingredient ubiquitous in sports products—and has since adapted her nutrition. RELATED: Dealing With Irritable Bowel Syndrome. Self-reported Ex-GIS during or after exercise can vary from mild inconvenience to severe. When severe, Ex-GIS may compromise fueling and hydration strategies during exercise 7 , impair athletic performance, or lead to the cessation of exercise 8 , eventuating in event withdrawal 8 , 9. The clinical and performance significance of Ex-GIS have been previously documented 5 , 7 , 10 , For example, Ex-GIS may indicate gastrointestinal integrity or functional issues that warrant medical attention In addition, Ex-GIS incidence and severity have been shown to impair exercise performance in controlled laboratory experimental models 7 , 8 , Ex-GIS can typically present in the upper or lower gastrointestinal tract regions. It can also present as other related symptoms such as nausea, dizziness, and acute transient abdominal pain 5 , Intrinsic factors that may increase the incidence and extent of Ex-GIS include biological sex i. Extrinsic factors that may exacerbate symptoms include the type of exercise i. Several specific dietary factors may influence the development of Ex-GIS around exercise, including individual food components 10 , 23 and macronutrient types Endurance athletes have been known to manipulate specific food components in their diets to reduce Ex-GIS, such as gluten-free 25 , 26 or low fermentable oligosaccharide disaccharide monosaccharide and polyols FODMAP diets 25 , 27 , Laboratory studies have shown that when endurance athletes consume a short-term gluten-free diet, there was no difference in performance, gastrointestinal symptoms, or intestinal injury compared to the gluten-containing diet In contrast, preliminary research indicates a low FODMAP diet 24 h before endurance exercise in the heat results in less Ex-GIS and malabsorption compared to a high FODMAP diet. However, a novel finding of that study is that the high FODMAP diet ameliorated intestinal epithelial injury Further research is required in this area to determine the significance of this finding. Other dietary factors which may reduce Ex-GIS are the types and amounts of macronutrients consumed during endurance exercise. Research has shown that when 15 g of carbohydrate or whey protein hydrolysate is consumed pre-exercise and every 20 min while running i. However, endurance athletes reported fewer Ex-GIS in the carbohydrate group, which suggests protein is less well tolerated during endurance exercise 5 , In addition to dietary factors, maintaining euhydration before 32 and during endurance exercise has been shown to reduce Ex-GIS and improve gastrointestinal integrity and function compared to dehydrated controls Athletes may also seek non-dietary factors e. Many factors may influence Ex-GIS development; therefore, athletes may often seek different ways of managing the incidence and severity of Ex-GIS. Due to their nutrition expertise, it is possible that accredited practicing dietitians are a preferred source of nutrition information for athletes. However, this likely depends on accessibility and background, i. Interestingly, social media, team-mates, or other athletes also appear to be popular information sources for athletes 35 — 37 , possibly due to the convenience and ease of access to these sources. Less is known about the preferred information sources for athletes who report Ex-GIS, as it often involves dietary and non-dietary management 5 , The primary aim of the current research was to investigate self-selected dietary and non-dietary strategies endurance athletes use to manage Ex-GIS and their preferred source of information about these strategies. This exploratory study used a previously established validated online questionnaire to investigate self-reported Ex-GIS, management strategies, and information sources Athletes were recruited internationally through professional and academic networks. All responses collected were anonymous. This study was approved by the Human Research Ethics Committee University of the Sunshine Coast, Australia , ethics approval number S and conformed to the Helsinki Declaration for Human Research Ethics. The questionnaire included participant information e. The questionnaire included 43 items depending on dichotomous, Likert scales, or descriptive responses 38 Supplementary material 1. Retrospectively, athletes selected when they experienced Ex-GIS the most frequently, either around training AT or around competitions AC or equally around both training and competitions. Athletes indicating Ex-GIS equally around both training and competitions completed both training and competition-specific questions, which were categorized as equally training ET and equally competition EC. Athletes then responded to questions on when Ex-GIS occurred i. A validated modified visual analog scale symptomology assessment tool was used for determining the incidence and severity of Ex-GIS in response to exercise stress The symptom severity scale was from 0 to 10; 0 no symptoms, 1—4 mild symptoms i. Athletes selected the severity of each symptom from 0 to 10 whereby the incidence was. Athletes completed open-field response questions on dietary and non-dietary strategies tried to reduce Ex-GIS. A content review process was applied for all qualitative data, categorizing and coding responses into the most common dietary and non-dietary themes The themes were the five most common dietary strategies to reduce Ex-GIS around exercise, specific high FODMAP food group exclusion, and the non-dietary strategies used to manage Ex-GIS. From pre-defined lists, athletes selected the most successful dietary components e. Athletes who experienced Ex-GIS equally in training and competitions completed both training and competition Ex-GIS severity questions, i. Therefore, four groups were used for data analysis, i. Repeated measures were also applied within each symptom category, i. The incidence was calculated as the number of athletes responding to each symptom in each group, and the severity was calculated as the average response to each symptom. Descriptive statistics were used to define continuous variables means, standard deviations, and percentages , and for non-parametric data, medians and interquartile ranges IQR were applied. Chi-squared tests were used to determine associations between categorical data, i. For any significant group differences, Bonferroni post hoc tests were used. For Ex-GIS incidence and severity, the data were checked for normality by applying the Shapiro—Wilk test. The Friedman test was used to determine differences within each symptom group, and a post hoc Wilcoxon test to determine differences within repeated measures. A Bonferroni correction factor was applied if significant. Data analysis was performed using IBM SPSS Statistics One hundred and thirty-seven endurance athletes with Ex-GIS completed the questionnaire. The mean age was Participant characteristics are described in Table 1 , and Ex-GIS incidence in Table 2. There were no differences in Ex-GIS incidence by main sport, participation level, or biological sex. Table 1. Table 2. Figure 1 highlights the combined incidence for each Ex-GIS and the median severity of all symptoms across all independent groups. Lower-GIS was more commonly reported compared to upper-GIS in all groups, i. Figure 1. Combined incidence and median severity rating of gastrointestinal symptoms before, during, and after exercise. Symptoms are listed in upper, lower, and other symptom categories and descending order of incidence. A Ex-GIS around training only, B Ex-GIS around competitions only, C Ex-GIS equally around training and competitions training responses. D Ex-GIS equally around training and competitions competition responses. B, Belching; BL, Bloating; D, Dizziness; DB, Defecation Bloody Stools; DD, Defecation Diarrhea ; DL, Defecation Loose Stools; F, Flatulence; Ex-GIS, exercise-associated gastrointestinal symptoms; HB, Heartburn; LA, Lower Abdominal Bloating; LI, Left Intestinal Pain; N, Nausea; PV, Projectile Vomiting; R, Regurgitate; S, Stitch; SP, Stomach Pain; UD, Urge to Defecate; UR, Urge to Regurgitate. The incidence and severity of symptoms were not normally distributed; therefore, median and IQR were used to describe the data with non-parametric tests applied. Using the Wilcoxon test for non-parametric data the incidence of reported symptoms was significantly greater during exercise than before and after exercise e. Table 3. A total of strategies were reported by athletes, an average of 3. A qualitative content review of the strategies used including the five most common dietary strategies to reduce Ex-GIS, specific high FODMAP food groups exclusion, and the non-dietary strategies used to reduce Ex-GIS, are shown in Figure 2. The most popular dietary strategies were dietary fiber reduction Avoiding disaccharides lactose and sucrose 6. Figure 2. FODMAP, fermentable oligosaccharide disaccharide monosaccharide and polyols; GOS, galacto-oligosaccharides; FOS, fructo-oligosaccharide. Endurance athletes rated the overall success of specific dietary components Table 4 or attempted dietary strategies Table 5 and when they tended to implement them. Table 4. Dietary components self-selected to eat more or less of to reduce the development of exercise-associated gastrointestinal symptoms. Table 5. Specific dietary strategies trialed, and supplements used to reduce the development of exercise-associated gastrointestinal symptoms listed in order of success at reducing symptoms. The most common sources of dietary information for Ex-GIS management are shown in Figure 3. After chi-squared analysis and post hoc testing, no significant associations were found between the most important nutrition information sources for managing Ex-GIS, categorized by main sports, participation levels, event characteristics, or biological sex. Figure 3. APD, Accredited Practicing Dietitian. This is the first exploratory study to review the specific self-reported strategies used to manage symptomology amongst endurance athletes who experience Ex-GIS. The most commonly reported successful dietary strategies to manage Ex-GIS, typically before and during exercise, were dietary fiber reduction, a low FODMAP diet, a dairy-free diet, and increasing carbohydrates. Endurance athletes primarily sought accredited practicing dietitians in the management of Ex-GIS. Reducing dietary fiber, particularly before exercise, was the most common dietary strategy endurance athletes have implemented. Current sports nutrition guidelines recommend endurance athletes reduce dietary fiber around key training sessions and competitions to mitigate the incidence of Ex-GIS 3 , 29 , This is due to the ability of dietary fiber to increase the luminal contents in the large colon due to an osmotic effect and fermentation, which may promote greater gastrointestinal discomfort and reduced orocaecal transit times 5 , 7. However, due to variable gastrointestinal tract transit times, a low-fiber diet may require implementation 1—3 days before exercise 41 , which may not be practical habitually. Therefore, if athletes restrict dietary fiber to reduce Ex-GIS, a short-term low-fiber diet around specific competitions is likely to be practical without compromising the beneficial effects of consuming adequate dietary fiber daily. Ex-GIS reported by athletes in this investigation was similar to individuals diagnosed with IBS, including abdominal pain, bloating, and diarrhea An effective treatment strategy for those with IBS is implementing a low FODMAP diet 43 , Similarly, athletes commonly reported using a low FODMAP diet to manage Ex-GIS successfully in the current study. A low FODMAP diet has also reportedly been used to manage Ex-GIS in other investigations with athletes 25 , However, the time frame for implementation in previous studies, including the current study, has not been investigated. It has been shown that a short-term h low FODMAP diet before endurance exercise can reduce Ex-GIS and malabsorption 10 , and the impact of this short-term dietary restriction on overall nutritional status is unlikely to be significant. However, a low FODMAP diet is not designed to be followed long-term due to possible nutritional deficiencies if chronically administered 43 , However, if a low FODMAP diet is necessary over more extended time frames i. Dairy avoidance around exercise was an exclusive dietary strategy employed by athletes to reduce Ex-GIS, i.

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How to reduce gastrointestinal problems? - Endurance sports nutrition