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McCubbin AJ, Irwin CG, Costa RJS. Nourishing Physical Productivity and Performance On a Warming Planet - Challenges and Nutritional Strategies to Mitigate Exertional Heat Stress. Curr Nutr Rep 2024; 13:399-411. [PMID: 38995600 PMCID: PMC11327203 DOI: 10.1007/s13668-024-00554-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE OF REVIEW: Climate change is predicted to increase the frequency and severity of exposure to hot environments. This can impair health, physical performance, and productivity for active individuals in occupational and athletic settings. This review summarizes current knowledge and recent advancements in nutritional strategies to minimize the impact of exertional-heat stress (EHS). RECENT FINDINGS: Hydration strategies limiting body mass loss to < 3% during EHS are performance-beneficial in weight-supported activities, although evidence regarding smaller fluid deficits (< 2% body mass loss) and weight-dependent activities is less clear due to a lack of well-designed studies with adequate blinding. Sodium replacement requirements during EHS depends on both sweat losses and the extent of fluid replacement, with quantified sodium replacement only necessary once fluid replacement > 60-80% of losses. Ice ingestion lowers core temperature and may improve thermal comfort and performance outcomes when consumed before, but less so during activity. Prevention and management of gastrointestinal disturbances during EHS should focus on high carbohydrate but low FODMAP availability before and during exercise, frequent provision of carbohydrate and/or protein during exercise, adequate hydration, and body temperature regulation. Evidence for these approaches is lacking in occupational settings. Acute kidney injury is a potential concern resulting from inadequate fluid replacement during and post-EHS, and emerging evidence suggests that repeated exposures may increase the risk of developing chronic kidney disease. Nutritional strategies can help regulate hydration, body temperature, and gastrointestinal status during EHS. Doing so minimizes the impact of EHS on health and safety and optimizes productivity and performance outcomes on a warming planet.
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Affiliation(s)
- Alan J McCubbin
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia.
| | - Christopher G Irwin
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Ricardo J S Costa
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia
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Chantler S, Wood-Martin R, Holliday A, Davison G, Crabtree DR, Readhead C, Jones B. The Frequency and Severity of Gastrointestinal Symptoms in Rugby Players. Int J Sports Med 2024; 45:323-221. [PMID: 38272040 DOI: 10.1055/a-2206-4751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
This study aimed to assess the self-reported frequency and severity of gastrointestinal symptoms (GIS) at rest and around rugby training and match play in male and female rugby union players. An online questionnaire was sent to registered rugby union players (sevens or fifteens). Thirteen GIS were assessed alongside perceptions of appetite around rugby and rest using Likert and visual analog scales. Questions investigating a range of medical and dietary factors were included. Three hundred and twenty-five players (male n=271, female n=54) participated in the study. More frequent GIS (at least one GIS experienced weekly/more often) was reported by players at rest (n=203; 62%) compared to around rugby (n=154; 47%). The overall severity of GIS was low (mild discomfort), but a portion of players (33%) did report symptoms of moderate severity around rugby. Female players reported more frequent and severe symptoms compared to male counterparts (p<0.001). Self-reported appetite was significantly lower after matches compared to training. There were no dietary or medical factors associated with GIS severity scores. This study describes GIS characteristics in male and female rugby union players. Half of the players assessed experienced some form of GIS that may affect nutrition, training, or performance, and should thus be a consideration for practitioners supporting this cohort.
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Affiliation(s)
- Sarah Chantler
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom of Great Britain and Northern Ireland
| | | | - Adrian Holliday
- Physiology, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Glen Davison
- Centre for Sports Studies, University of Kent, Canterbury, United Kingdom of Great Britain and Northern Ireland
| | - Daniel R Crabtree
- The Rowett Institute, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom of Great Britain and Northern Ireland
| | - Clint Readhead
- Head of Medical services, South African Rugby Union, Newlands, South Africa
| | - Ben Jones
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom of Great Britain and Northern Ireland
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom of Great Britain and Northern Ireland
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom of Great Britain and Northern Ireland
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom of Great Britain and Northern Ireland
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom of Great Britain and Northern Ireland
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Young P, Henningsen K, Snipe R, Gaskell S, Alcock R, Mika A, Rauch C, Costa RJS. Does Age Influence Gastrointestinal Status Responses to Exertional-heat Stress? Int J Sports Med 2024; 45:272-281. [PMID: 38198808 DOI: 10.1055/a-2195-3131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
This meta-data exploration aimed to determine the impact of exertional-heat stress (EHS) on gastrointestinal status of masters age and young adult endurance athletes. Sixteen MASTERS (mean: 44y) and twenty-one YOUNG (26y) recreational endurance athletes completed 2 h of running at 60% ˙V O2max in 35˚C ambient conditions. Blood samples were collected pre-, immediately and 1 h post-EHS, and analyzed for markers of exercise-induced gastrointestinal syndrome (EIGS). Thermo-physiological measures and gastrointestinal symptoms (GIS) were recorded every 10-20 min during EHS. Peak Δ pre- to post-EHS did not substantially differ (p>0.05) between MASTERS and YOUNG for intestinal epithelial injury [I-FABP: 1652pg/ml vs. 1524pg/ml, respectively], bacterial endotoxic translocation [sCD14: -0.09µg/mL vs. 0.84µg/mL, respectively], lipopolysaccharide-binding protein [LBP: 0.26µg/mL vs. 1.76µg/mL, respectively], and systemic inflammatory response profile (SIR-Profile: 92.0arb.unit vs. 154arb.unit, respectively). A significantly higher peak Δ pre- to post-EHS in endogenous endotoxin anti-body IgM (p=0.042), and pro-inflammatory cytokine IL-1β (p=0.038), was observed in YOUNG compared to MASTERS. No difference was observed between incidence (81% and 80%, respectively) and severity (summative accumulation: 21 and 30, respectively) of reported GIS during EHS between MASTERS and YOUNG. Pathophysiology of EIGS in response to EHS does not substantially differ with age progression, since masters and younger adult endurance athletes responded comparably.
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Affiliation(s)
- Pascale Young
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, Victoria, Australia
| | - Kayla Henningsen
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, Victoria, Australia
| | - Rhiannon Snipe
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Stephanie Gaskell
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, Victoria, Australia
| | | | - Alice Mika
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, Victoria, Australia
| | - Christopher Rauch
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, Victoria, Australia
| | - Ricardo J S Costa
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, Victoria, Australia
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Lee BJ, Flood TR, Galan-Lopez N, McCormick JJ, King KE, Fujii N, Kenny GP. Changes in surrogate markers of intestinal epithelial injury and microbial translocation in young and older men during prolonged occupational heat stress in temperate and hot conditions. Eur J Appl Physiol 2024; 124:1049-1062. [PMID: 37815618 DOI: 10.1007/s00421-023-05329-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/16/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Exertional heat stress can cause damage to the intestinal epithelium and disrupt gastrointestinal barrier integrity, leading to microbial translocation (MT) linked to the development of heat stroke. This study aimed to assess age-related differences in markers of intestinal epithelial injury and MT following non-heat stress and high-heat stress exercise in healthy young and older men. METHODS Markers of intestinal epithelial injury (intestinal fatty acid-binding protein-'IFABP') and MT (soluble cluster of differentiation 14-'sCD14'; and lipopolysaccharide-binding protein-'LBP') were assessed in healthy young (18-30 y, n = 13) and older (50-70 y) men (n = 12). Blood samples were collected before, after 180 min of moderate-intensity (metabolic rate: 200 W/m2) walking and following 60 min recovery in either a non-heat stress [temperate: 21.9 °C, 35% relative humidity (RH)] or high-heat stress (hot: 41.4 °C, 35% RH) environment. RESULTS There were no differences in IFABP and sCD14 between the young and older groups in the temperate condition, while LBP was greater in the older group (+ 0.66 ug/mL; + 0.08 to + 1.24 ug/mL). In the hot condition, the older group experienced greater increases in IFABP compared to the young group (+ 712 pg/mL/hr; + 269 to + 1154 pg/mL/hr). However, there were no clear between-group differences for sCD14 (+ 0.24 ug/mL/hr, - 0.22 to + 0.70 ug/mL/hr) or LBP (+ 0.86 ug/mL/hr, - 0.73 to + 2.46 ug/mL/hr). CONCLUSION While older men may experience greater intestinal epithelial injury following exercise in the heat; this did not lead to a greater magnitude of microbial translocation relative to their younger counterparts.
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Affiliation(s)
- Ben J Lee
- Occupational and Environmental Physiology Group, Centre for Sport, Exercise, and Life Sciences, Coventry University, Coventry, UK
| | - Tessa R Flood
- Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | - Natalia Galan-Lopez
- Occupational and Environmental Physiology Group, Centre for Sport, Exercise, and Life Sciences, Coventry University, Coventry, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - James J McCormick
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University Ave., Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada
| | - Kelli E King
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University Ave., Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada
| | - Naoto Fujii
- Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University Ave., Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada.
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Gaskell SK, Henningsen K, Young P, Gill P, Muir J, Henry R, Costa RJS. The Impact of a 24-h Low and High Fermentable Oligo- Di- Mono-Saccharides and Polyol (FODMAP) Diet on Plasma Bacterial Profile in Response to Exertional-Heat Stress. Nutrients 2023; 15:3376. [PMID: 37571312 PMCID: PMC10420669 DOI: 10.3390/nu15153376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Exertional-heat stress (EHS) compromises intestinal epithelial integrity, potentially leading to the translocation of pathogenic agents into circulation. This study aimed to explore the impact of EHS on the systemic circulatory bacterial profile and to determine the impact of a short-term low (LFOD) and high (HFOD) fermentable oligo- di- mono-saccharide and polyol dietary intervention before EHS on this profile. Using a double-blind randomized cross-over design, thirteen endurance runners (n = 8 males, n = 5 females), with a history of exercise-associated gastrointestinal symptoms (Ex-GIS), consumed a 24 h LFOD and HFOD before 2 h running at 60% V.O2max in 35.6 °C. Blood and fecal samples were collected pre-EHS to determine plasma microbial DNA concentration, and sample bacteria and short chain fatty acid (SCFA) profiles by fluorometer quantification, 16S rRNA amplicon gene sequencing, and gas chromatography, respectively. Blood samples were also collected post-EHS to determine changes in plasma bacteria. EHS increased plasma microbial DNA similarly in both FODMAP trials (0.019 ng·μL-1 to 0.082 ng·μL-1) (p < 0.01). Similar pre- to post-EHS increases in plasma Proteobacteria (+1.6%) and Firmicutes (+0.6%) phyla relative abundance were observed in both FODMAP trials. This included increases in several Proteobacteria genus (Delftia and Serratia) groups. LFOD presented higher fecal Firmicutes (74%) and lower Bacteroidota (10%) relative abundance pre-EHS, as a result of an increase in Ruminococcaceae and Lachnospiraceae family and respective genus groups, compared with HFOD (64% and 25%, respectively). Pre-EHS plasma total SCFA (p = 0.040) and acetate (p = 0.036) concentrations were higher for HFOD (188 and 178 μmol·L-1, respectively) vs. LFOD (163 and 153 μmol·L-1, respectively). Pre-EHS total fecal SCFA concentration (119 and 74 μmol·g-1; p < 0.001), including acetate (74 and 45 μmol·g-1; p = 0.001), butyrate (22 and 13 μmol·g-1; p = 0.002), and propionate (20 and 13 μmol·g-1; p = 0.011), were higher on HFOD vs LFOD, respectively. EHS causes the translocation of whole bacteria into systemic circulation and alterations to the plasma bacterial profile, but the FODMAP content of a 24 h diet beforehand does not alter this outcome.
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Affiliation(s)
- Stephanie K. Gaskell
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, VIC 3168, Australia; (S.K.G.); (K.H.); (P.Y.)
| | - Kayla Henningsen
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, VIC 3168, Australia; (S.K.G.); (K.H.); (P.Y.)
| | - Pascale Young
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, VIC 3168, Australia; (S.K.G.); (K.H.); (P.Y.)
| | - Paul Gill
- Department of Gastroenterology, Monash University, Melbourne, VIC 3004, Australia; (P.G.); (J.M.)
| | - Jane Muir
- Department of Gastroenterology, Monash University, Melbourne, VIC 3004, Australia; (P.G.); (J.M.)
| | - Rebekah Henry
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia;
- Department of Civil Engineering, Monash University, Clayton, VIC 3168, Australia
| | - Ricardo J. S. Costa
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, VIC 3168, Australia; (S.K.G.); (K.H.); (P.Y.)
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Henningsen K, Mika A, Alcock R, Gaskell SK, Parr A, Rauch C, Russo I, Snipe RMJ, Costa RJS. The increase in core body temperature in response to exertional-heat stress can predict exercise-induced gastrointestinal syndrome. Temperature (Austin) 2023; 11:72-91. [PMID: 38577295 PMCID: PMC10989703 DOI: 10.1080/23328940.2023.2213625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/09/2023] [Indexed: 04/06/2024] Open
Abstract
Utilizing metadata from existing exertional and exertional-heat stress studies, the study aimed to determine if the exercise-associated increase in core body temperature can predict the change in exercise-induced gastrointestinal syndrome (EIGS) biomarkers and exercise-associated gastrointestinal symptoms (Ex-GIS). Endurance-trained individuals completed 2 h of running exercise in temperate (21.2-30.0°C) to hot (35.0-37.2°C) ambient conditions (n = 132 trials). Blood samples were collected pre- and post-exercise to determine the change in gastrointestinal integrity biomarkers and systemic inflammatory cytokines. Physiological and thermoregulatory strain variables were assessed every 10-15 min during exercise. The strength of the linear relationship between maximal (M-Tre) and change (Δ Tre) in rectal temperature and EIGS variables was determined via Spearman's rank correlation coefficients. While the strength of prediction was determined via simple and multiple linear regression analyses dependent on screened EIGS and Ex-GIS confounding factors. Significant positive correlations between Tre maximum (M-Tre) and change (Δ Tre) with I-FABP (rs = 0.434, p < 0.001; and rs = 0.305, p < 0.001; respectively), sCD14 (rs = 0.358, p < 0.001; and rs = 0.362, p < 0.001), systemic inflammatory response profile (SIR-Profile) (p < 0.001), and total Ex-GIS (p < 0.05) were observed. M-Tre and Δ Tre significantly predicted (adjusted R2) magnitude of change in I-FABP (R2(2,123)=0.164, p < 0.001; and R2(2,119)=0.058, p = 0.011; respectively), sCD14 (R2(2,81)=0.249, p < 0.001; and R2(2,77)=0.214, p < 0.001), SIR-Profile (p < 0.001), and total Ex-GIS (p < 0.05). Strong to weak correlations were observed between M-Tre and Δ Tre with plasma concentrations of I-FABP, sCD14, SIR-Profile, and Ex-GIS in response to exercise. M-Tre and Δ Tre can predict the magnitude of these EIGS variables and Ex-GIS in response to exercise.
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Affiliation(s)
- Kayla Henningsen
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Alice Mika
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Rebekah Alcock
- Department of Dietetics and Human Nutrition, La Trobe University, Bundoora, Victoria, Australia
| | - Stephanie K. Gaskell
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Alexandra Parr
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Christopher Rauch
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Isabela Russo
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Rhiannon M. J. Snipe
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Ricardo J. S. Costa
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
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Alhadad SB, Chua MCY, Lee JKW, Low ICC. The effects of low and normal dose ice slurry ingestion on endurance capacity and intestinal epithelial injury in the heat. J Sci Med Sport 2023:S1440-2440(23)00078-6. [PMID: 37179242 DOI: 10.1016/j.jsams.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVES Compare the effects of ice slurry ingestion at low and normal doses on endurance capacity and exertional heat stress-induced gastrointestinal perturbations. DESIGN Randomised, cross-over design. METHODS Twelve physically active males completed four treadmill running trials, ingesting ice slurry (ICE) or ambient drink (AMB) at 2 g·kg-1 (Normal; N) or 1 g·kg-1 (Low; L) doses every 15-min during exercise and 8 g·kg-1 (N) or 4 g·kg-1 (L) pre- and post-exercise. Pre-, during and post-exercise serum intestinal fatty-acid binding protein ([I-FABP]) and lipopolysaccharide ([LPS]) concentrations were determined. RESULTS Pre-exercise gastrointestinal temperature (Tgi) was lower in L + ICE than L + AMB (p < 0.05), N + ICE than N + AMB (p < 0.001) and N + ICE than L + ICE (p < 0.001). Higher rate of Tgi rise (p < 0.05) and lower estimated sweat rate (p < 0.001) were observed in N + ICE than N + AMB. Rate of Tgi rise was similar at low dose (p = 0.113) despite a lower estimated sweat rate in L + ICE than L+AMB (p < 0.01). Time-to-exhaustion was longer in L + ICE than L + AMB (p < 0.05), but similar between N + ICE and N + AMB (p = 0.142) and L + ICE and N + ICE (p = 0.766). [I-FABP] and [LPS] were similar (p > 0.05). CONCLUSIONS L + ICE elicited a lower heat dissipation compensatory effect with similar endurance capacity as N + ICE. Ice slurry conferred no protection against exertional heat stress-induced gastrointestinal perturbations.
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Affiliation(s)
- Sharifah B Alhadad
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Melissa C Y Chua
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jason K W Lee
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Heat Resilience and Performance Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; The N.1 Institute for Health, National University of Singapore, Singapore; Institute for Digital Medicine, National University of Singapore, Singapore
| | - Ivan C C Low
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Young P, Russo I, Gill P, Muir J, Henry R, Davidson Z, Costa RJS. Reliability of pathophysiological markers reflective of exercise-induced gastrointestinal syndrome (EIGS) in response to 2-h high-intensity interval exercise: A comprehensive methodological efficacy exploration. Front Physiol 2023; 14:1063335. [PMID: 36895638 PMCID: PMC9989174 DOI: 10.3389/fphys.2023.1063335] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
The study aimed to determine the test-retest reliability of exercise-induced gastrointestinal syndrome (EIGS) biomarkers, and assess the association of pre-exercise short chain fatty acid (SCFA) concentration with these biomarkers in response to prolonged strenuous exercise. Thirty-four participants completed 2 h of high-intensity interval training (HIIT) on two separate occasions with at least 5-days washout. Blood samples were collected pre- and post-exercise, and analysed for biomarkers associated with EIGS [i.e., cortisol, intestinal fatty-acid binding protein (I-FABP), sCD14, lipopolysaccharide binding protein (LBP), leukocyte counts, in-vitro neutrophil function, and systemic inflammatory cytokine profile]. Fecal samples were collected pre-exercise on both occasions. In plasma and fecal samples, bacterial DNA concentration was determined by fluorometer quantification, microbial taxonomy by 16S rRNA amplicon sequencing, and SCFA concentration by gas-chromatography. In response to exercise, 2 h of HIIT modestly perturbed biomarkers indicative of EIGS, including inducing bacteremia (i.e., quantity and diversity). Reliability analysis using comparative tests, Cohen's d, two-tailed correlation, and intraclass correlation coefficient (ICC) of resting biomarkers presented good-to-excellent for IL-1ra (r = 0.710, ICC = 0.92), IL-10 (r = 0.665, ICC = 0.73), cortisol (r = 0.870, ICC = 0.87), and LBP (r = 0.813, ICC = 0.76); moderate for total (r = 0.839, ICC = 0.44) and per cell (r = 0.749, ICC = 0.54) bacterially-stimulated elastase release, IL-1β (r = 0.625, ICC = 0.64), TNF-α (r = 0.523, ICC = 0.56), I-FABP (r = 0.411, ICC = 0.21), and sCD14 (r = 0.409, ICC = 0.38), plus fecal bacterial α-diversity; and poor for leukocyte (r = 0.327, ICC = 0.33) and neutrophil (r = 0.352, ICC = 0.32) counts. In addition, a medium negative correlation was observed between plasma butyrate and I-FABP (r = -0.390). The current data suggest a suite of biomarkers should be used to determine the incidence and severity of EIGS. Moreover, determination of plasma and/or fecal SCFA may provide some insight into the mechanistic aspects of EIGS instigation and magnitude in response to exercise.
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Affiliation(s)
- Pascale Young
- Department of Nutrition Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Isabella Russo
- Department of Nutrition Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Paul Gill
- Department of Gastroenterology, Monash University, Melbourne, VIC, Australia
| | - Jane Muir
- Department of Gastroenterology, Monash University, Melbourne, VIC, Australia
| | - Rebekah Henry
- Department of Civil Engineering, Monash University, Clayton, VIC, Australia
| | - Zoe Davidson
- Department of Nutrition Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Ricardo J S Costa
- Department of Nutrition Dietetics and Food, Monash University, Notting Hill, VIC, Australia
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Heydenreich J, Koehler K, Braun H, Grosshauser M, Heseker H, Koenig D, Lampen A, Mosler S, Niess A, Schek A, Carlsohn A. Effects of internal cooling on physical performance, physiological and perceptional parameters when exercising in the heat: A systematic review with meta-analyses. Front Physiol 2023; 14:1125969. [PMID: 37113693 PMCID: PMC10126464 DOI: 10.3389/fphys.2023.1125969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Background: An elevated core temperature (Tcore) increases the risk of performance impairments and heat-related illness. Internal cooling (IC) has the potential to lower Tcore when exercising in the heat. The aim of the review was to systematically analyze the effects of IC on performance, physiological, and perceptional parameters. Methods: A systematic literature search was performed in the PubMed database on 17 December 2021. Intervention studies were included assessing the effects of IC on performance, physiological, or perceptional outcomes. Data extraction and quality assessment were conducted for the included literature. The standardized mean differences (SMD) and 95% Confidence Intervals (CI) were calculated using the inverse-variance method and a random-effects model. Results: 47 intervention studies involving 486 active subjects (13.7% female; mean age 20-42 years) were included in the meta-analysis. IC resulted in significant positive effects on time to exhaustion [SMD (95% CI) 0.40 (0.13; 0.67), p < 0.01]. IC significantly reduced Tcore [-0.19 (22120.34; -0.05), p < 0.05], sweat rate [-0.20 (-0.34; -0.06), p < 0.01], thermal sensation [-0.17 (-0.33; -0.01), p < 0.05], whereas no effects were found on skin temperature, blood lactate, and thermal comfort (p > 0.05). IC resulted in a borderline significant reduction in time trial performance [0.31 (-0.60; -0.02), p = 0.06], heart rate [-0.13 (-0.27; 0.01), p = 0.06], rate of perceived exertion [-0.16 (-0.31; -0.00), p = 0.05] and borderline increased mean power output [0.22 (0.00; 0.44), p = 0.05]. Discussion: IC has the potential to affect endurance performance and selected physiological and perceptional parameters positively. However, its effectiveness depends on the method used and the time point of administration. Future research should confirm the laboratory-based results in the field setting and involve non-endurance activities and female athletes. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022336623.
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Affiliation(s)
- Juliane Heydenreich
- Working Group Sports Nutrition of German Nutrition Society, Bonn, Germany
- Institute of Sports Sciences, Johannes Gutenberg-University of Mainz, Mainz, Germany
- *Correspondence: Juliane Heydenreich,
| | - Karsten Koehler
- Working Group Sports Nutrition of German Nutrition Society, Bonn, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Hans Braun
- Working Group Sports Nutrition of German Nutrition Society, Bonn, Germany
- Manfred Donike Institute for Doping Analysis, Institute of Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Mareike Grosshauser
- Working Group Sports Nutrition of German Nutrition Society, Bonn, Germany
- Olympic Center Rhineland-Palatinate/Saarland, Saarbrücken, Germany
| | - Helmut Heseker
- Working Group Sports Nutrition of German Nutrition Society, Bonn, Germany
- Institute of Nutrition, Consumption and Health, University of Paderborn, Paderborn, Germany
| | - Daniel Koenig
- Working Group Sports Nutrition of German Nutrition Society, Bonn, Germany
- Division of Sports Medicine, Exercise Physiology and Prevention, Center for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Alfonso Lampen
- Working Group Sports Nutrition of German Nutrition Society, Bonn, Germany
- Risk Assessment Strategies, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Stephanie Mosler
- Working Group Sports Nutrition of German Nutrition Society, Bonn, Germany
- Olympic Center Stuttgart, Stuttgart, Germany
| | - Andreas Niess
- Working Group Sports Nutrition of German Nutrition Society, Bonn, Germany
- Department of Sports Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Alexandra Schek
- Working Group Sports Nutrition of German Nutrition Society, Bonn, Germany
- Editorial Team of the Journal Leistungssport, German Olympic Sports Confederation, Frankfurt, Germany
| | - Anja Carlsohn
- Working Group Sports Nutrition of German Nutrition Society, Bonn, Germany
- Department of Nutrition and Home Economics, University of Applied Science Hamburg, Hamburg, Germany
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10
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Gaskell SK, Burgell R, Wiklendt L, Dinning PG, Costa RJS. Impact of exercise duration on gastrointestinal function and symptoms. J Appl Physiol (1985) 2023; 134:160-171. [PMID: 36476157 DOI: 10.1152/japplphysiol.00393.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The study aimed to determine the impact of exercise duration on gastrointestinal functional responses and gastrointestinal symptoms (GISs) in response to differing exercise durations. Endurance runners (n = 16) completed three trials on separate occasions, randomized to 1 h (1-H), 2 h (2-H), and 3 h (3-H) of running at 60% V̇o2max in temperate ambient temperature. Orocecal transit time (OCTT) was determined by lactulose challenge, with concomitant breath hydrogen (H2) determination. Gastric slow wave activity was recorded using cutaneous electrogastrography (cEGG) before and after exertion. GIS was determined using a modified visual analog scale (mVAS). OCTT response was classified as very slow on all trials (∼93-101 min) with no trial difference observed (P = 0.895). Bradygastria increased postexercise on all trials (means ± SD: 1-H: 10.9 ± 11.7%, 2-H: 6.2 ± 9.8%, and 3-H: 13.2 ± 21.4%; P < 0.05). A reduction in the normal gastric slow wave activity (2-4 cycles/min) was observed postexercise on 1-H only (-10.8 ± 17.6%; P = 0.039). GIS incidence and gut discomfort was higher on 2-H (81% and 12 counts) and 3-H (81% and 18 counts), compared with 1-H (69% and 6 counts) (P = 0.038 and P = 0.006, respectively). Severity of gut discomfort, total-GIS, upper-GIS, and lower-GIS increased during exercise on all trials (P < 0.05). Steady-state exercise in temperate ambient conditions for 1 h, 2 h, and 3 h instigates perturbations in gastric slow wave activity compared with rest and hampers OCTT, potentially explaining the incidence and severity on exercise-associated GIS.NEW & NOTEWORTHY Exercise stress per se appears to instigate perturbations to gastric myoelectrical activity, resulting in an increase in bradygastria frequency, inferring a reduction in gastric motility. The perturbations to gastrointestinal functional responses instigated by exercise per se, likely contribute to the high incidence and severity level of exercise-associated gastrointestinal symptoms. Cutaneous electrogastrography is not commonly used in exercise gastroenterology research, however, may be a useful aid in providing an overall depiction of gastrointestinal function. Particularly relating to gastrointestinal motility and concerning gastroparesis.
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Affiliation(s)
- Stephanie K Gaskell
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Rebecca Burgell
- Medicine, Nursing and Health Sciences, Monash University, Prahan, Victoria, Australia.,Department of Gastroenterology, Alfred Health, Prahan, Victoria, Australia
| | - Lukasz Wiklendt
- Department of Surgery, College of Medicine and Public Health, The Flinders University, Bedford Park, South Australia, Australia
| | - Phil G Dinning
- Department of Surgery, College of Medicine and Public Health, The Flinders University, Bedford Park, South Australia, Australia.,Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Ricardo J S Costa
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
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11
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Rauch CE, Mika AS, McCubbin AJ, Huschtscha Z, Costa RJS. Effect of prebiotics, probiotics, and synbiotics on gastrointestinal outcomes in healthy adults and active adults at rest and in response to exercise-A systematic literature review. Front Nutr 2022; 9:1003620. [PMID: 36570133 PMCID: PMC9768503 DOI: 10.3389/fnut.2022.1003620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction A systematic literature search was undertaken to assess the impact of pre-, pro-, and syn-biotic supplementation on measures of gastrointestinal status at rest and in response to acute exercise. Methods Six databases (Ovid MEDLINE, EMBASE, Cinahl, SportsDISCUS, Web of Science, and Scopus) were used. Included were human research studies in healthy sedentary adults, and healthy active adults, involving supplementation and control or placebo groups. Sedentary individuals with non-communicable disease risk or established gastrointestinal inflammatory or functional diseases/disorders were excluded. Results A total of n = 1,204 participants were included from n = 37 papers reported resting outcomes, and n = 13 reported exercise-induced gastrointestinal syndrome (EIGS) outcomes. No supplement improved gastrointestinal permeability or gastrointestinal symptoms (GIS), and systemic endotoxemia at rest. Only modest positive changes in inflammatory cytokine profiles were observed in n = 3/15 studies at rest. Prebiotic studies (n = 4/5) reported significantly increased resting fecal Bifidobacteria, but no consistent differences in other microbes. Probiotic studies (n = 4/9) increased the supplemented bacterial species-strain. Only arabinoxylan oligosaccharide supplementation increased total fecal short chain fatty acid (SCFA) and butyrate concentrations. In response to exercise, probiotics did not substantially influence epithelial injury and permeability, systemic endotoxin profile, or GIS. Two studies reported reduced systemic inflammatory cytokine responses to exercise. Probiotic supplementation did not substantially influence GIS during exercise. Discussion Synbiotic outcomes resembled probiotics, likely due to the minimal dose of prebiotic included. Methodological issues and high risk of bias were identified in several studies, using the Cochrane Risk of Bias Assessment Tool. A major limitation in the majority of included studies was the lack of a comprehensive approach of well-validated biomarkers specific to gastrointestinal outcomes and many included studies featured small sample sizes. Prebiotic supplementation can influence gut microbial composition and SCFA concentration; whereas probiotics increase the supplemented species-strain, with minimal effect on SCFA, and no effect on any other gastrointestinal status marker at rest. Probiotic and synbiotic supplementation does not substantially reduce epithelial injury and permeability, systemic endotoxin and inflammatory cytokine profiles, or GIS in response to acute exercise.
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Affiliation(s)
- Christopher E. Rauch
- Department of Nutrition Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
| | - Alice S. Mika
- Department of Nutrition Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
| | - Alan J. McCubbin
- Department of Nutrition Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
| | - Zoya Huschtscha
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Ricardo J. S. Costa
- Department of Nutrition Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia,*Correspondence: Ricardo J. S. Costa
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12
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Does exertional heat stress impact gastrointestinal function and symptoms? J Sci Med Sport 2022; 25:960-967. [DOI: 10.1016/j.jsams.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/02/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
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13
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Assessment of Exercise-Associated Gastrointestinal Perturbations in Research and Practical Settings: Methodological Concerns and Recommendations for Best Practice. Int J Sport Nutr Exerc Metab 2022; 32:387-418. [PMID: 35963615 DOI: 10.1123/ijsnem.2022-0048] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/26/2022] [Accepted: 07/07/2022] [Indexed: 12/14/2022]
Abstract
Strenuous exercise is synonymous with disturbing gastrointestinal integrity and function, subsequently prompting systemic immune responses and exercise-associated gastrointestinal symptoms, a condition established as "exercise-induced gastrointestinal syndrome." When exercise stress and aligned exacerbation factors (i.e., extrinsic and intrinsic) are of substantial magnitude, these exercise-associated gastrointestinal perturbations can cause performance decrements and health implications of clinical significance. This potentially explains the exponential growth in exploratory, mechanistic, and interventional research in exercise gastroenterology to understand, accurately measure and interpret, and prevent or attenuate the performance debilitating and health consequences of exercise-induced gastrointestinal syndrome. Considering the recent advancement in exercise gastroenterology research, it has been highlighted that published literature in the area is consistently affected by substantial experimental limitations that may affect the accuracy of translating study outcomes into practical application/s and/or design of future research. This perspective methodological review attempts to highlight these concerns and provides guidance to improve the validity, reliability, and robustness of the next generation of exercise gastroenterology research. These methodological concerns include participant screening and description, exertional and exertional heat stress load, dietary control, hydration status, food and fluid provisions, circadian variation, biological sex differences, comprehensive assessment of established markers of exercise-induced gastrointestinal syndrome, validity of gastrointestinal symptoms assessment tool, and data reporting and presentation. Standardized experimental procedures are needed for the accurate interpretation of research findings, avoiding misinterpreted (e.g., pathological relevance of response magnitude) and overstated conclusions (e.g., clinical and practical relevance of intervention research outcomes), which will support more accurate translation into safe practice guidelines.
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14
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Costa RJS, Mika AS, McCubbin AJ. The impact of exercise modality on exercise-induced gastrointestinal syndrome and associated gastrointestinal symptoms. J Sci Med Sport 2022; 25:788-793. [PMID: 35868987 DOI: 10.1016/j.jsams.2022.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This study aimed to determine the impact of running and cycling exercise modalities on the magnitude of exercise-induced gastrointestinal syndrome (EIGS) and associated gastrointestinal symptoms (GIS). DESIGN Parallel group trial design. METHODS Twenty-eight endurance athletes (male n = 14, female n = 14) completed 2 h running at 55 % of maximal oxygen uptake or cycling at 55 % of maximal aerobic power in Tamb 35 °C and 22 % RH. Pre- and post-exercise blood samples were collected and analysed for markers of intestinal epithelial integrity perturbations (i.e., plasma intestinal fatty acid protein (I-FABP), soluble (s)CD14, and lipopolysaccharide binding protein (LBP)) and systemic inflammatory cytokines (i.e., plasma IL-1β, TNFα, IL-10, and IL-1ra). GIS were assessed pre-exercise and every 10 min during exercise. RESULTS Exercise-associated Δ for plasma I-FABP (191 and 434 pg‧ml-1) and LBP (-1228 and 315 ng‧ml-1) did not differ between running and cycling, respectively; however for sCD14 was higher (p = 0.030) on cycling (116 ng‧ml-1) vs running (96 ng‧ml-1). There were no differences in absolute pre- and post-exercise systemic inflammatory cytokine concentration, with large individual variation observed. Exercise-associated plasma TNF-α, (p = 0.041) and IL-10 (p = 0.019) responses were greater in running than cycling, but did not lead to a greater systemic inflammatory response profile (p = 0.305) between running (5.0arb.units) and cycling (-2.5arb.units). Although greater GIS incidence occurred in running (44 %) compared with cycling (25 %), there was no difference between groups for GIS severity. CONCLUSIONS When running and cycling exercise is performed with similar duration, intensity, ambient conditions, and with confounder control, the exercise modality does not substantially impact the magnitude of EIGS or associated GIS severity.
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Affiliation(s)
- Ricardo J S Costa
- Monash University, Department of Nutrition Dietetics & Food, Australia.
| | - Alice S Mika
- Monash University, Department of Nutrition Dietetics & Food, Australia
| | - Alan J McCubbin
- Monash University, Department of Nutrition Dietetics & Food, Australia
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15
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King AJ, Etxebarria N, Ross ML, Garvican-Lewis L, Heikura IA, McKay AKA, Tee N, Forbes SF, Beard NA, Saunders PU, Sharma AP, Gaskell SK, Costa RJS, Burke LM. Short-Term Very High Carbohydrate Diet and Gut-Training Have Minor Effects on Gastrointestinal Status and Performance in Highly Trained Endurance Athletes. Nutrients 2022; 14:nu14091929. [PMID: 35565896 PMCID: PMC9105618 DOI: 10.3390/nu14091929] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023] Open
Abstract
We implemented a multi-pronged strategy (MAX) involving chronic (2 weeks high carbohydrate [CHO] diet + gut-training) and acute (CHO loading + 90 g·h−1 CHO during exercise) strategies to promote endogenous and exogenous CHO availability, compared with strategies reflecting lower ranges of current guidelines (CON) in two groups of athletes. Nineteen elite male race walkers (MAX: 9; CON:10) undertook a 26 km race-walking session before and after the respective interventions to investigate gastrointestinal function (absorption capacity), integrity (epithelial injury), and symptoms (GIS). We observed considerable individual variability in responses, resulting in a statistically significant (p < 0.001) yet likely clinically insignificant increase (Δ 736 pg·mL−1) in I-FABP after exercise across all trials, with no significant differences in breath H2 across exercise (p = 0.970). MAX was associated with increased GIS in the second half of the exercise, especially in upper GIS (p < 0.01). Eighteen highly trained male and female distance runners (MAX: 10; CON: 8) then completed a 35 km run (28 km steady-state + 7 km time-trial) supported by either a slightly modified MAX or CON strategy. Inter-individual variability was observed, without major differences in epithelial cell intestinal fatty acid binding protein (I-FABP) or GIS, due to exercise, trial, or group, despite the 3-fold increase in exercise CHO intake in MAX post-intervention. The tight-junction (claudin-3) response decreased in both groups from pre- to post-intervention. Groups achieved a similar performance improvement from pre- to post-intervention (CON = 39 s [95 CI 15−63 s]; MAX = 36 s [13−59 s]; p = 0.002). Although this suggests that further increases in CHO availability above current guidelines do not confer additional advantages, limitations in our study execution (e.g., confounding loss of BM in several individuals despite a live-in training camp environment and significant increases in aerobic capacity due to intensified training) may have masked small differences. Therefore, athletes should meet the minimum CHO guidelines for training and competition goals, noting that, with practice, increased CHO intake can be tolerated, and may contribute to performance outcomes.
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Affiliation(s)
- Andy J. King
- Exercise & Nutrition Research Program, The Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3065, Australia; (M.L.R.); (L.G.-L.); (I.A.H.); (A.K.A.M.); (L.M.B.)
- Correspondence:
| | - Naroa Etxebarria
- Research Institute for Sport and Exercise, University of Canberra, Bruce, ACT 2617, Australia;
| | - Megan L. Ross
- Exercise & Nutrition Research Program, The Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3065, Australia; (M.L.R.); (L.G.-L.); (I.A.H.); (A.K.A.M.); (L.M.B.)
- Australian Institute of Sport, Leverrier Street, Canberra, ACT 2617, Australia; (N.T.); (P.U.S.)
| | - Laura Garvican-Lewis
- Exercise & Nutrition Research Program, The Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3065, Australia; (M.L.R.); (L.G.-L.); (I.A.H.); (A.K.A.M.); (L.M.B.)
- Australian Institute of Sport, Leverrier Street, Canberra, ACT 2617, Australia; (N.T.); (P.U.S.)
| | - Ida A. Heikura
- Exercise & Nutrition Research Program, The Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3065, Australia; (M.L.R.); (L.G.-L.); (I.A.H.); (A.K.A.M.); (L.M.B.)
- Australian Institute of Sport, Leverrier Street, Canberra, ACT 2617, Australia; (N.T.); (P.U.S.)
| | - Alannah K. A. McKay
- Exercise & Nutrition Research Program, The Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3065, Australia; (M.L.R.); (L.G.-L.); (I.A.H.); (A.K.A.M.); (L.M.B.)
| | - Nicolin Tee
- Australian Institute of Sport, Leverrier Street, Canberra, ACT 2617, Australia; (N.T.); (P.U.S.)
| | - Sara F. Forbes
- UniSA Online, University of South Australia, Adelaide, SA 5001, Australia;
| | - Nicole A. Beard
- Faculty of Science and Technology, University of Canberra, Bruce, ACT 2617, Australia;
| | - Philo U. Saunders
- Australian Institute of Sport, Leverrier Street, Canberra, ACT 2617, Australia; (N.T.); (P.U.S.)
| | - Avish P. Sharma
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD 4222, Australia;
| | - Stephanie K. Gaskell
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC 3800, Australia; (S.K.G.); (R.J.S.C.)
| | - Ricardo J. S. Costa
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC 3800, Australia; (S.K.G.); (R.J.S.C.)
| | - Louise M. Burke
- Exercise & Nutrition Research Program, The Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3065, Australia; (M.L.R.); (L.G.-L.); (I.A.H.); (A.K.A.M.); (L.M.B.)
- Australian Institute of Sport, Leverrier Street, Canberra, ACT 2617, Australia; (N.T.); (P.U.S.)
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16
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Young P, Rauch C, Russo I, Gaskell S, Davidson Z, Costa RJ. Plasma endogenous endotoxin core antibody response to exercise in endurance athletes. Int J Sports Med 2022; 43:1023-1032. [PMID: 35426092 PMCID: PMC9622302 DOI: 10.1055/a-1827-3124] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The study aimed to investigate the impact of laboratory-controlled exertional and
exertional-heat stress on concentrations of plasma endogenous endotoxin core
antibody (EndoCAb). Forty-four (males
n=
26 and females
n=
18) endurance trained (
V̇ O2max
56.8min/kg/min) participants completed either: P1–2h
high intensity interval running in 23°C ambient temperature
(T
amb
), P2–2h running at 60% V̇
O
2max
in 35°C T
amb
, or P3–3h running
at 60% V̇ O
2max
in 23°C T
amb
.
Blood samples were collected pre- and post-exercise to determine plasma IgM,
IgA, and IgG concentrations. Overall resting pre-exercise levels for plasma Ig
were 173MMU/ml, 37AMU/ml, and 79GMU/ml, respectively.
Plasma IgM concentration did not substantially change pre- to post-exercise in
all protocols, and the magnitude of pre- to post-exercise change for IgM was not
different between protocols (p=0.135). Plasma IgA and IgG increased pre-
to post-exercise in P2 only (p=0.017 and p=0.016, respectively),
but remained within normative range (35–250MU/ml). P2 resulted
in greater disturbances to plasma IgA (p=0.058) and IgG
(p=0.037), compared with P1 and P3. No substantial differences in
pre-exercise and exercise-associated change was observed for EndoCAb between
biological sexes. Exertional and exertional-heat stress resulted in modest
disturbances to systemic EndoCAb responses, suggesting EndoCAb biomarkers
presents a low sensitivity response to controlled-laboratory experimental
designs within exercise gastroenterology.
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Affiliation(s)
- Pascale Young
- Nutrition Dietetics & Food, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Australia
| | - Christopher Rauch
- Nutrition Dietetics & Food, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Australia
| | - Isabella Russo
- Nutrition Dietetics & Food, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Australia
| | - Stephanie Gaskell
- Nutrition Dietetics & Food, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Australia
| | - Zoe Davidson
- Nutrition Dietetics & Food, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Australia
| | - Ricardo J.S. Costa
- Nutrition Dietetics & Food, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Australia
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17
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Chantler S, Griffiths A, Matu J, Davison G, Holliday A, Jones B. A systematic review: Role of dietary supplements on markers of exercise-associated gut damage and permeability. PLoS One 2022; 17:e0266379. [PMID: 35417467 PMCID: PMC9007357 DOI: 10.1371/journal.pone.0266379] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 03/19/2022] [Indexed: 12/12/2022] Open
Abstract
Nutrition strategies and supplements may have a role to play in diminishing exercise associated gastrointestinal cell damage and permeability. The aim of this systematic review was to determine the influence of dietary supplements on markers of exercise-induced gut endothelial cell damage and/or permeability. Five databases were searched through to February 2021. Studies were selected that evaluated indirect markers of gut endothelial cell damage and permeability in response to exercise with and without a specified supplement, including with and without water. Acute and chronic supplementation protocols were included. Twenty-seven studies were included. The studies investigated a wide range of supplements including bovine colostrum, glutamine, probiotics, supplemental carbohydrate and protein, nitrate or nitrate precursors and water across a variety of endurance exercise protocols. The majority of studies using bovine colostrum and glutamine demonstrated a reduction in selected markers of gut cell damage and permeability compared to placebo conditions. Carbohydrate intake before and during exercise and maintaining euhydration may partially mitigate gut damage and permeability but coincide with other performance nutrition strategies. Single strain probiotic strains showed some positive findings, but the results are likely strain, dosage and duration specific. Bovine colostrum, glutamine, carbohydrate supplementation and maintaining euhydration may reduce exercise-associated endothelial damage and improve gut permeability. In spite of a large heterogeneity across the selected studies, appropriate inclusion of different nutrition strategies could mitigate the initial phases of gastrointestinal cell disturbances in athletes associated with exercise. However, research is needed to clarify if this will contribute to improved athlete gastrointestinal and performance outcomes.
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Affiliation(s)
- Sarah Chantler
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- Yorkshire Carnegie Rugby Union Club, Leeds, United Kingdom
| | - Alex Griffiths
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Jamie Matu
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Glen Davison
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Canterbury, United Kingdom
| | - Adrian Holliday
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- School of Science and Technology, University of New England, Armidale, NSW, Australia
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, the University of Cape Town and the Sports Science Institute of South Africa, Cape Town, South Africa
- Leeds Rhinos Rugby League Club, Leeds, United Kingdom
- England Performance Unit, Rugby Football League, Leeds, United Kingdom
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18
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Rauch CE, McCubbin AJ, Gaskell SK, Costa RJS. Feeding Tolerance, Glucose Availability, and Whole-Body Total Carbohydrate and Fat Oxidation in Male Endurance and Ultra-Endurance Runners in Response to Prolonged Exercise, Consuming a Habitual Mixed Macronutrient Diet and Carbohydrate Feeding During Exercise. Front Physiol 2022; 12:773054. [PMID: 35058795 PMCID: PMC8764139 DOI: 10.3389/fphys.2021.773054] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/16/2021] [Indexed: 12/31/2022] Open
Abstract
Using metadata from previously published research, this investigation sought to explore: (1) whole-body total carbohydrate and fat oxidation rates of endurance (e.g., half and full marathon) and ultra-endurance runners during an incremental exercise test to volitional exhaustion and steady-state exercise while consuming a mixed macronutrient diet and consuming carbohydrate during steady-state running and (2) feeding tolerance and glucose availability while consuming different carbohydrate regimes during steady-state running. Competitively trained male endurance and ultra-endurance runners (n = 28) consuming a balanced macronutrient diet (57 ± 6% carbohydrate, 21 ± 16% protein, and 22 ± 9% fat) performed an incremental exercise test to exhaustion and one of three 3 h steady-state running protocols involving a carbohydrate feeding regime (76-90 g/h). Indirect calorimetry was used to determine maximum fat oxidation (MFO) in the incremental exercise and carbohydrate and fat oxidation rates during steady-state running. Gastrointestinal symptoms (GIS), breath hydrogen (H2), and blood glucose responses were measured throughout the steady-state running protocols. Despite high variability between participants, high rates of MFO [mean (range): 0.66 (0.22-1.89) g/min], Fatmax [63 (40-94) % V̇O2max], and Fatmin [94 (77-100) % V̇O2max] were observed in the majority of participants in response to the incremental exercise test to volitional exhaustion. Whole-body total fat oxidation rate was 0.8 ± 0.3 g/min at the end of steady-state exercise, with 43% of participants presenting rates of ≥1.0 g/min, despite the state of hyperglycemia above resting homeostatic range [mean (95%CI): 6.9 (6.7-7.2) mmol/L]. In response to the carbohydrate feeding interventions of 90 g/h 2:1 glucose-fructose formulation, 38% of participants showed breath H2 responses indicative of carbohydrate malabsorption. Greater gastrointestinal symptom severity and feeding intolerance was observed with higher carbohydrate intakes (90 vs. 76 g/h) during steady-state exercise and was greatest when high exercise intensity was performed (i.e., performance test). Endurance and ultra-endurance runners can attain relatively high rates of whole-body fat oxidation during exercise in a post-prandial state and with carbohydrate provisions during exercise, despite consuming a mixed macronutrient diet. Higher carbohydrate intake during exercise may lead to greater gastrointestinal symptom severity and feeding intolerance.
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Affiliation(s)
| | | | | | - Ricardo J. S. Costa
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
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19
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Gaskell SK, Rauch CE, Costa RJS. Gastrointestinal Assessment and Therapeutic Intervention for the Management of Exercise-Associated Gastrointestinal Symptoms: A Case Series Translational and Professional Practice Approach. Front Physiol 2021; 12:719142. [PMID: 34557109 PMCID: PMC8452991 DOI: 10.3389/fphys.2021.719142] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/05/2021] [Indexed: 12/31/2022] Open
Abstract
This translational research case series describes the implementation of a gastrointestinal assessment protocol during exercise (GastroAxEx) to inform individualised therapeutic intervention of endurance athletes affected by exercise-induced gastrointestinal syndrome (EIGS) and associated gastrointestinal symptoms (GIS). A four-phase approach was applied. Phase 1: Clinical assessment and exploring background history of exercise-associated gastrointestinal symptoms. Phase 2: Individual tailored GastroAxEx laboratory simulation designed to mirror exercise stress, highlighted in phase 1, that promotes EIGS and GIS during exercise. Phase 3: Individually programmed therapeutic intervention, based on the outcomes of Phase 2. Phase 4: Monitoring and readjustment of intervention based on outcomes from field testing under training and race conditions. Nine endurance athletes presenting with EIGS, and two control athletes not presenting with EIGS, completed Phase 2. Two athletes experienced significant thermoregulatory strain (peak core temperature attained > 40°C) during the GastroAxEx. Plasma cortisol increased substantially pre- to post-exercise in n = 6/7 (Δ > 500 nmol/L). Plasma I-FABP concentration increased substantially pre- to post-exercise in n = 2/8 (Δ > 1,000 pg/ml). No substantial change was observed in pre- to post-exercise for systemic endotoxin and inflammatory profiles in all athletes. Breath H2 responses showed that orocecal transit time (OCTT) was delayed in n = 5/9 (90-150 min post-exercise) athletes, with the remaining athletes (n = 4/9) showing no H2 turning point by 180 min post-exercise. Severe GIS during exercise was experienced in n = 5/9 athletes, of which n = 2/9 had to dramatically reduce work output or cease exercise. Based on each athlete's identified proposed causal factors of EIGS and GIS during exercise (i.e., n = 9/9 neuroendocrine-gastrointestinal pathway of EIGS), an individualised gastrointestinal therapeutic intervention was programmed and advised, adjusted from a standard EIGS prevention and management template that included established strategies with evidence of attenuating EIGS primary causal pathways, exacerbation factors, and GIS during exercise. All participants reported qualitative data on their progress, which included their previously presenting GIS during exercise, such as nausea and vomiting, either being eliminated or diminished resulting in work output improving (i.e., completing competition and/or not slowing down during training or competition as a result of GIS during exercise). These outcomes suggest GIS during exercise in endurance athletes are predominantly related to gastrointestinal functional and feeding tolerance issues, and not necessarily gastrointestinal integrity and/or systemic issues. GastroAxEx allows for informed identification of potential causal pathway(s) and exacerbation factor(s) of EIGS and GIS during exercise at an individual level, providing a valuable informed individualised therapeutic intervention approach.
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Affiliation(s)
| | | | - Ricardo J. S. Costa
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
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Hydrogel Carbohydrate-Electrolyte Beverage Does Not Improve Glucose Availability, Substrate Oxidation, Gastrointestinal Symptoms or Exercise Performance, Compared With a Concentration and Nutrient-Matched Placebo. Int J Sport Nutr Exerc Metab 2021; 30:25-33. [PMID: 31629348 DOI: 10.1123/ijsnem.2019-0090] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/04/2019] [Accepted: 07/01/2019] [Indexed: 11/18/2022]
Abstract
The impact of a carbohydrate-electrolyte solution with sodium alginate and pectin for hydrogel formation (CES-HGel), was compared to a standard CES with otherwise matched ingredients (CES-Std), for blood glucose, substrate oxidation, gastrointestinal symptoms (GIS; nausea, belching, bloating, pain, regurgitation, flatulence, urge to defecate, and diarrhea), and exercise performance. Nine trained male endurance runners completed 3 hr of steady-state running (SS) at 60% V˙O2max, consuming 90 g/hr of carbohydrate from CES-HGel or CES-Std (53 g/hr maltodextrin, 37 g/hr fructose, 16% w/v solution) in a randomized crossover design, followed by an incremental time to exhaustion (TTE) test. Blood glucose and substrate oxidation were measured every 30 min during SS and oxidation throughout TTE. Breath hydrogen (H2) was measured every 30 min during exercise and every 15 min for 2 hr postexercise. GIS were recorded every 15 min throughout SS, immediately after and every 15-min post-TTE. No differences in blood glucose (incremental area under the curve [mean ± SD]: CES-HGel 1,100 ± 96 mmol·L-1·150 min-1 and CES-Std 1,076 ± 58 mmol·L-1·150 min-1; p = .266) were observed during SS. There were no differences in substrate oxidation during SS (carbohydrate: p = .650; fat: p = .765) or TTE (carbohydrate: p = .466; fat: p = .633) and no effect of trial on GIS incidence (100% in both trials) or severity (summative rating score: CES-HGel 29.1 ± 32.6 and CES-Std 34.8 ± 34.8; p = .262). Breath hydrogen was not different between trials (p = .347), nor was TTE performance (CES-HGel 722 ± 182 s and CES-Std: 756 ± 187 s; p = .08). In conclusion, sodium alginate and pectin added to a CES consumed during endurance running does not alter the blood glucose responses, carbohydrate malabsorption, substrate oxidation, GIS, or TTE beyond those of a CES with otherwise matched ingredients.
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Sports Dietitians Australia Position Statement: Nutrition for Exercise in Hot Environments. Int J Sport Nutr Exerc Metab 2021; 30:83-98. [PMID: 31891914 DOI: 10.1123/ijsnem.2019-0300] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/15/2019] [Indexed: 11/18/2022]
Abstract
It is the position of Sports Dietitians Australia (SDA) that exercise in hot and/or humid environments, or with significant clothing and/or equipment that prevents body heat loss (i.e., exertional heat stress), provides significant challenges to an athlete's nutritional status, health, and performance. Exertional heat stress, especially when prolonged, can perturb thermoregulatory, cardiovascular, and gastrointestinal systems. Heat acclimation or acclimatization provides beneficial adaptations and should be undertaken where possible. Athletes should aim to begin exercise euhydrated. Furthermore, preexercise hyperhydration may be desirable in some scenarios and can be achieved through acute sodium or glycerol loading protocols. The assessment of fluid balance during exercise, together with gastrointestinal tolerance to fluid intake, and the appropriateness of thirst responses provide valuable information to inform fluid replacement strategies that should be integrated with event fuel requirements. Such strategies should also consider fluid availability and opportunities to drink, to prevent significant under- or overconsumption during exercise. Postexercise beverage choices can be influenced by the required timeframe for return to euhydration and co-ingestion of meals and snacks. Ingested beverage temperature can influence core temperature, with cold/icy beverages of potential use before and during exertional heat stress, while use of menthol can alter thermal sensation. Practical challenges in supporting athletes in teams and traveling for competition require careful planning. Finally, specific athletic population groups have unique nutritional needs in the context of exertional heat stress (i.e., youth, endurance/ultra-endurance athletes, and para-sport athletes), and specific adjustments to nutrition strategies should be made for these population groups.
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The Effects of an Acute "Train-Low" Nutritional Protocol on Markers of Recovery Optimization in Endurance-Trained Male Athletes. Int J Sports Physiol Perform 2021; 16:1764-1776. [PMID: 34044369 DOI: 10.1123/ijspp.2020-0847] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/14/2021] [Accepted: 02/22/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE This study aimed to determine the effects of an acute "train-low" nutritional protocol on markers of recovery optimization compared to standard recovery nutrition protocol. METHODS After completing a 2-hour high-intensity interval running protocol, 8 male endurance athletes consumed a standard dairy milk recovery beverage (CHO; 1.2 g/kg body mass [BM] of carbohydrate and 0.4 g/kg BM of protein) and a low-carbohydrate (L-CHO; isovolumetric with 0.35 g/kg BM of carbohydrate and 0.5 g/kg BM of protein) dairy milk beverage in a double-blind randomized crossover design. Venous blood and breath samples, nude BM, body water, and gastrointestinal symptom measurements were collected preexercise and during recovery. Muscle biopsy was performed at 0 hour and 2 hours of recovery. Participants returned to the laboratory the following morning to measure energy substrate oxidation and perform a 1-hour distance test. RESULTS The exercise protocol resulted in depletion of muscle glycogen stores (250 mmol/kg dry weight) and mild body-water losses (BM loss = 1.8%). Neither recovery beverage replenished muscle glycogen stores (279 mmol/kg dry weight) or prevented a decrease in bacterially stimulated neutrophil function (-21%). Both recovery beverages increased phosphorylation of mTORSer2448 (main effect of time = P < .001) and returned hydration status to baseline. A greater fold increase in p-GSK-3βSer9/total-GSK-3β occurred on CHO (P = .012). Blood glucose (P = .005) and insulin (P = .012) responses were significantly greater on CHO (618 mmol/L per 2 h and 3507 μIU/mL per 2 h, respectively) compared to L-CHO (559 mmol/L per 2 h and 1147 μIU/mL per 2 h, respectively). Rates of total fat oxidation were greater on CHO, but performance was not affected. CONCLUSION A lower-carbohydrate recovery beverage consumed after exercise in a "train-low" nutritional protocol does not negatively impact recovery optimization outcomes.
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Gaskell SK, Rauch CE, Parr A, Costa RJS. Diurnal versus Nocturnal Exercise-Effect on the Gastrointestinal Tract. Med Sci Sports Exerc 2021; 53:1056-1067. [PMID: 33065594 DOI: 10.1249/mss.0000000000002546] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The study aimed to determine the effect of diurnal versus nocturnal exercise on gastrointestinal integrity and functional responses, plasma lipopolysaccharide binding protein (LBP) and soluble CD14 (sCD14) concentrations (as indirect indicators of endotoxin responses), systemic inflammatory cytokine profile, gastrointestinal symptoms, and feeding tolerance. METHODS Endurance runners (n = 16) completed 3 h of 60% V˙O2max (22.7°C, 45% relative humidity) running, on one occasion performed at 0900 h (400 lx; DAY) and on another occasion at 2100 h (2 lx; NIGHT). Blood samples were collected pre- and postexercise and during recovery to determine plasma concentrations of cortisol, catecholamines, claudin-3, I-FABP, LBP, and sCD14 and inflammatory cytokine profiles by ELISA. Orocecal transit time (OCTT) was determined by lactulose challenge test given at 150 min, with concomitant breath hydrogen (H2) and gastrointestinal symptom determination. RESULTS Cortisol increased substantially pre- to postexercise on NIGHT (+182%) versus DAY (+4%) (trial-time, P = 0.046), with no epinephrine (+41%) and norepinephrine (+102%) trial differences. I-FABP, but not claudin-3, increased pre- to postexercise on both trials (mean = 2269 pg·mL-1, 95% confidence interval = 1351-3187, +143%) (main effect of time [MEOT], P < 0.001). sCD14 increased pre- to postexercise (trial-time, P = 0.045, +5.6%) and was greater on DAY, but LBP decreased (MEOT, P = 0.019, -11.2%) on both trials. No trial difference was observed for systemic cytokine profile (MEOT, P = 0.004). Breath H2 responses (P = 0.019) showed that OCTT was significantly delayed on NIGHT (>84 min, with n = 3 showing no breath H2 turning point by 180 min postexercise) compared with DAY (mean = 54 min, 95% confidence interval = 29-79). NIGHT resulted in greater total gastrointestinal symptoms (P = 0.009) compared with DAY. No difference in feeding tolerance markers was observed between trials. CONCLUSION Nocturnal exercise instigates greater gastrointestinal functional perturbations and symptoms compared with diurnal exercise. However, there are no circadian differences to gastrointestinal integrity and systemic perturbations in response to the same exertional stress and controlled procedures.
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Affiliation(s)
- Stephanie K Gaskell
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, AUSTRALIA
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Russo I, Della Gatta PA, Garnham A, Porter J, Burke LM, Costa RJS. Assessing Overall Exercise Recovery Processes Using Carbohydrate and Carbohydrate-Protein Containing Recovery Beverages. Front Physiol 2021; 12:628863. [PMID: 33613323 PMCID: PMC7890126 DOI: 10.3389/fphys.2021.628863] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/12/2021] [Indexed: 12/31/2022] Open
Abstract
We compared the impact of two different, but commonly consumed, beverages on integrative markers of exercise recovery following a 2 h high intensity interval exercise (i.e., running 70-80% V̇O2 max intervals and interspersed with plyometric jumps). Participants (n = 11 males, n = 6 females) consumed a chocolate flavored dairy milk beverage (CM: 1.2 g carbohydrate/kg BM and 0.4 g protein/kg BM) or a carbohydrate-electrolyte beverage (CEB: isovolumetric with 0.76 g carbohydrate/kg BM) after exercise, in a randomized-crossover design. The recovery beverages were provided in three equal boluses over a 30 min period commencing 1 h post-exercise. Muscle biopsies were performed at 0 h and 2 h in recovery. Venous blood samples, nude BM and total body water were collected before and at 0, 2, and 4 h recovery. Gastrointestinal symptoms and breath hydrogen (H2) were collected before exercise and every 30 min during recovery. The following morning, participants returned for performance assessment. In recovery, breath H2 reached clinical relevance of >10 ppm following consumption of both beverages, in adjunct with high incidence of gastrointestinal symptoms (70%), but modest severity. Blood glucose response was greater on CEB vs. CM (P < 0.01). Insulin response was greater on CM compared with CEB (P < 0.01). Escherichia coli lipopolysaccharide stimulated neutrophil function reduced on both beverages (49%). p-GSK-3β/total-GSK-3β was greater on CM compared with CEB (P = 0.037); however, neither beverage achieved net muscle glycogen re-storage. Phosphorylation of mTOR was greater on CM than CEB (P < 0.001). Fluid retention was lower (P = 0.038) on CEB (74.3%) compared with CM (82.1%). Physiological and performance outcomes on the following day did not differ between trials. Interconnected recovery optimization markers appear to respond differently to the nutrient composition of recovery nutrition, albeit subtly and with individual variation. The present findings expand on recovery nutrition strategies to target functionality and patency of the gastrointestinal tract as a prerequisite to assimilation of recovery nutrition, as well as restoration of immunocompetency.
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Affiliation(s)
- Isabella Russo
- Department of Nutrition and Dietetics, Monash University, Notting Hill, VIC, Australia
| | - Paul A. Della Gatta
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Andrew Garnham
- Department of Nutrition and Dietetics, Monash University, Notting Hill, VIC, Australia
| | - Judi Porter
- Department of Nutrition and Dietetics, Monash University, Notting Hill, VIC, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Louise M. Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Ricardo J. S. Costa
- Department of Nutrition and Dietetics, Monash University, Notting Hill, VIC, Australia
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Devrim-Lanpir A, Hill L, Knechtle B. Efficacy of Popular Diets Applied by Endurance Athletes on Sports Performance: Beneficial or Detrimental? A Narrative Review. Nutrients 2021; 13:nu13020491. [PMID: 33540813 PMCID: PMC7912997 DOI: 10.3390/nu13020491] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/12/2022] Open
Abstract
Endurance athletes need a regular and well-detailed nutrition program in order to fill their energy stores before training/racing, to provide nutritional support that will allow them to endure the harsh conditions during training/race, and to provide effective recovery after training/racing. Since exercise-related gastrointestinal symptoms can significantly affect performance, they also need to develop strategies to address these issues. All these factors force endurance athletes to constantly seek a better nutritional strategy. Therefore, several new dietary approaches have gained interest among endurance athletes in recent decades. This review provides a current perspective to five popular diet approaches: (a) vegetarian diets, (b) high-fat diets, (c) intermittent fasting diets, (d) gluten-free diet, and (e) low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diets. We reviewed scientific studies published from 1983 to January 2021 investigating the impact of these popular diets on the endurance performance and health aspects of endurance athletes. We also discuss all the beneficial and harmful aspects of these diets, and offer key suggestions for endurance athletes to consider when following these diets.
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Affiliation(s)
- Aslı Devrim-Lanpir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Medeniyet University, 34862 Istanbul, Turkey;
| | - Lee Hill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster University, Hamilton, ON L8N 3Z5, Canada;
| | - Beat Knechtle
- Medbase St. Gallen, am Vadianplatz, 9001 St. Gallen, Switzerland
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-(0)-71-226-93-00
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Russo I, Della Gatta PA, Garnham A, Porter J, Burke LM, Costa RJS. Does the Nutritional Composition of Dairy Milk Based Recovery Beverages Influence Post-exercise Gastrointestinal and Immune Status, and Subsequent Markers of Recovery Optimisation in Response to High Intensity Interval Exercise? Front Nutr 2021; 7:622270. [PMID: 33521041 PMCID: PMC7840831 DOI: 10.3389/fnut.2020.622270] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/10/2020] [Indexed: 12/18/2022] Open
Abstract
This study aimed to determine the effects of flavored dairy milk based recovery beverages of different nutrition compositions on markers of gastrointestinal and immune status, and subsequent recovery optimisation markers. After completing 2 h high intensity interval running, participants (n = 9) consumed a whole food dairy milk recovery beverage (CM, 1.2 g/kg body mass (BM) carbohydrate and 0.4 g/kg BM protein) or a dairy milk based supplement beverage (MBSB, 2.2 g/kg BM carbohydrate and 0.8 g/kg BM protein) in a randomized crossover design. Venous blood samples, body mass, body water, and breath samples were collected, and gastrointestinal symptoms (GIS) were measured, pre- and post-exercise, and during recovery. Muscle biopsies were performed at 0 and 2 h of recovery. The following morning, participants returned to the laboratory to assess performance outcomes. In the recovery period, carbohydrate malabsorption (breath H2 peak: 49 vs. 24 ppm) occurred on MBSB compared to CM, with a trend toward greater gut discomfort. No difference in gastrointestinal integrity (i.e., I-FABP and sCD14) or immune response (i.e., circulating leukocyte trafficking, bacterially-stimulated neutrophil degranulation, and systemic inflammatory profile) markers were observed between CM and MBSB. Neither trial achieved a positive rate of muscle glycogen resynthesis [-25.8 (35.5) mmol/kg dw/h]. Both trials increased phosphorylation of intramuscular signaling proteins. Greater fluid retention (total body water: 86.9 vs. 81.9%) occurred on MBSB compared to CM. Performance outcomes did not differ between trials. The greater nutrient composition of MBSB induced greater gastrointestinal functional disturbance, did not prevent the post-exercise reduction in neutrophil function, and did not support greater overall acute recovery.
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Affiliation(s)
- Isabella Russo
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, VIC, Australia
| | - Paul A. Della Gatta
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Andrew Garnham
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, VIC, Australia
| | - Judi Porter
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, VIC, Australia
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Louise M. Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Ricardo J. S. Costa
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, VIC, Australia
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Chantler S, Griffiths A, Matu J, Davison G, Jones B, Deighton K. The Effects of Exercise on Indirect Markers of Gut Damage and Permeability: A Systematic Review and Meta-analysis. Sports Med 2021; 51:113-124. [PMID: 33201454 PMCID: PMC7806566 DOI: 10.1007/s40279-020-01348-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM Exercise appears to cause damage to the endothelial lining of the human gastrointestinal tract and elicit a significant increase in gut permeability. OBJECTIVE The aim of this review was to determine the effect of an acute bout of exercise on gut damage and permeability outcomes in healthy populations using a meta-analysis. METHODS PubMed, The Cochrane Library as well as MEDLINE, SPORTDiscus and CINHAL, via EBSCOhost were searched through February 2019. Studies were selected that evaluated urinary (ratio of disaccharide/monosaccharide excretion) or plasma markers [intestinal Fatty Acid Binding Protein (i-FABP)] of gut permeability and gut cell damage in response to a single bout of exercise. RESULTS A total of 34 studies were included. A random-effects meta-analysis was performed, and showed a large and moderate effect size for markers of gut damage (i-FABP) (ES 0.81; 95% CI 0.63-0.98; n = 26; p < 0.001) and gut permeability (Disaccharide Sugar/Monosaccharide Sugar) (ES 0.70; 95% CI 0.29-1.11; n = 17; p < 0.001), respectively. Exercise performed in hot conditions (> 23 °C) further increased markers of gut damage compared with thermoneutral conditions [ES 1.06 (95% CI 0.88-1.23) vs. 0.66 (95% CI 0.43-0.89); p < 0.001]. Exercise duration did not have any significant effect on gut damage or permeability outcomes. CONCLUSIONS These findings demonstrate that a single bout of exercise increases gut damage and gut permeability in healthy participants, with gut damage being exacerbated in hot environments. Further investigation into nutritional strategies to minimise gut damage and permeability after exercise is required. PROSPERO database number (CRD42018086339).
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Affiliation(s)
- Sarah Chantler
- Carnegie Applied Rugby Research (CARR) Centre, Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Cavendish G08, Headingley Campus, Leeds, LS6 3QT, UK.
- Yorkshire Carnegie Rugby Union Club, Leeds, UK.
| | - Alex Griffiths
- Carnegie Applied Rugby Research (CARR) Centre, Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Cavendish G08, Headingley Campus, Leeds, LS6 3QT, UK
| | - Jamie Matu
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
| | - Glen Davison
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Canterbury, UK
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) Centre, Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Cavendish G08, Headingley Campus, Leeds, LS6 3QT, UK
- School of Science and Technology, University of New England, Armidale, NSW, Australia
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, The University of Cape Town and the Sports Science Institute of South Africa, Cape Town, South Africa
- Leeds Rhinos Rugby League Club, Leeds, UK
- England Performance Unit, Rugby Football League, Leeds, UK
| | - Kevin Deighton
- Carnegie Applied Rugby Research (CARR) Centre, Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Cavendish G08, Headingley Campus, Leeds, LS6 3QT, UK
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Willingham BD, Ragland TJ, Ormsbee MJ. Betaine Supplementation May Improve Heat Tolerance: Potential Mechanisms in Humans. Nutrients 2020; 12:nu12102939. [PMID: 32992781 PMCID: PMC7599524 DOI: 10.3390/nu12102939] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 11/16/2022] Open
Abstract
Betaine has been demonstrated to increase tolerance to hypertonic and thermal stressors. At the cellular level, intracellular betaine functions similar to molecular chaperones, thereby reducing the need for inducible heat shock protein expression. In addition to stabilizing protein conformations, betaine has been demonstrated to reduce oxidative damage. For the enterocyte, during periods of reduced perfusion as well as greater oxidative, thermal, and hypertonic stress (i.e., prolonged exercise in hot-humid conditions), betaine results in greater villi length and evidence for greater membrane integrity. Collectively, this reduces exercise-induced gut permeability, protecting against bacterial translocation and endotoxemia. At the systemic level, chronic betaine intake has been shown to reduce core temperature, all-cause mortality, markers of inflammation, and change blood chemistry in several animal models when exposed to heat stress. Despite convincing research in cell culture and animal models, only one published study exists exploring betaine's thermoregulatory function in humans. If the same premise holds true for humans, chronic betaine consumption may increase heat tolerance and provide another avenue of supplementation for those who find that heat stress is a major factor in their work, or training for exercise and sport. Yet, this remains speculative until data demonstrate such effects in humans.
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Affiliation(s)
- Brandon D. Willingham
- Institute of Sports Sciences and Medicine, Department of Nutrition, Food, and Exercise Science, Florida State University, Tallahassee, FL 32306, USA; (B.D.W.); (T.J.R.)
| | - Tristan J. Ragland
- Institute of Sports Sciences and Medicine, Department of Nutrition, Food, and Exercise Science, Florida State University, Tallahassee, FL 32306, USA; (B.D.W.); (T.J.R.)
| | - Michael J. Ormsbee
- Institute of Sports Sciences and Medicine, Department of Nutrition, Food, and Exercise Science, Florida State University, Tallahassee, FL 32306, USA; (B.D.W.); (T.J.R.)
- Department of Biokinetics, Exercise and Leisure Sciences, University of KwaZulu-Natal, Westville, Durban 4041, South Africa
- Correspondence:
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Bennett CJ, Henry R, Snipe RMJ, Costa RJS. Is the gut microbiota bacterial abundance and composition associated with intestinal epithelial injury, systemic inflammatory profile, and gastrointestinal symptoms in response to exertional-heat stress? J Sci Med Sport 2020; 23:1141-1153. [PMID: 32620352 DOI: 10.1016/j.jsams.2020.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/24/2020] [Accepted: 06/02/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The study aimed to examine if the α-diversity and relative abundance of the gastrointestinal bacterial taxa is associated with the response magnitude of markers characteristic of exercise-induced gastrointestinal syndrome in response to exertional-heat stress. DESIGN Cross-sectional. METHODS Twenty-two endurance-trained athletes completed 2h running at 60% V.O2max in hot ambient conditions (35.2°C, 25% relative humidity). Faecal samples were collected pre-exercise to determine bacterial taxonomy by 16S rRNA amplicon sequencing (Illumina MiSeq platform). Data were processed using the QIIME2 pipeline (v2019.1) establishing taxonomic classification with >95% confidence using SILVA. Pre- and post-exercise blood samples were used to determine plasma I-FABP and cortisol concentrations, and systemic inflammatory response profile. Markers of physiological and thermoregulatory strain, and gastrointestinal symptoms were measured every 10min during exercise. Associations were determined by partial correlation controlled for body mass variables. RESULTS Positive associations between Tenericutes (r(18)=0.446, p=0.049) and Verrucomicrobia (r(18)=0.450, p=0.046) phylum, Akkermansiaceae (r(18)=0.486, p=0.030) and Ruminococcaceae (r(18)=0.449, p=0.047) family and aligned genus groups with I-FABP were observed. Whilst, associations between Faecalibacterium (r(12)=0.668, p=0.009) and Ruminoclostridium-9 (r(12)=-0.577, p=0.031) genus with systemic inflammatory profile were observed. Association between bacterial phyla, family, and genus groups were also observed for gastrointestinal symptoms and markers of thermoregulatory strain (r(18) >0.400, p<0.05). CONCLUSIONS The relative abundance of several commensal bacterial groups showed modest favourable (i.e., low perturbations) or detrimental associations with the magnitude of gastrointestinal integrity perturbations and symptoms, and potentially influences body temperature change, in response to exertional-heat stress.
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Affiliation(s)
| | - Rebekah Henry
- Monash University, Department of Civil Engineering, Australia
| | | | - Ricardo J S Costa
- Monash University, Department of Nutrition Dietetics & Food, Australia.
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Gaskell SK, Taylor B, Muir J, Costa RJ. Impact of 24-h high and low fermentable oligo-, di-, monosaccharide, and polyol diets on markers of exercise-induced gastrointestinal syndrome in response to exertional heat stress. Appl Physiol Nutr Metab 2020; 45:569-580. [DOI: 10.1139/apnm-2019-0187] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The study aimed to determine the effects of 24-h high (HFOD) and low (LFOD) fermentable oligo-, di-, monosaccharide, and polyol (FODMAP) diets before exertional heat stress on gastrointestinal integrity, function, and symptoms. Eighteen endurance runners consumed a HFOD and a LFOD (double-blind crossover design) before completing 2 h of running at 60% maximal oxygen uptake in 35 °C ambient temperature. Blood samples were collected before and after exercise to determine plasma cortisol and intestinal fatty acid binding protein (I-FABP) concentrations, and bacterial endotoxin and cytokine profiles. Breath hydrogen (H2) and gastrointestinal symptoms (GIS) were determined pre-exercise, every 15 min during, and in recovery. No differences were observed for plasma cortisol concentration between diets. Plasma I-FABP concentration was lower on HFOD compared with LFOD (p = 0.033). A trend for lower lipopolysaccharide binding protein (p = 0.088), but not plasma soluble CD14 (p = 0.478) and cytokine profile (p > 0.05), responses on HFOD was observed. A greater area under the curve breath H2 concentration (p = 0.031) was observed throughout HFOD (mean and 95% confidence interval: HFOD 2525 (1452–3597) ppm·4 h−1) compared with LFOD (1505 (1031–1978) ppm·4 h−1). HFOD resulted in greater severity of GIS compared with LFOD (pre-exercise, p = 0.017; during, p = 0.035; and total, p = 0.014). A 24-h HFOD before exertional heat stress ameliorates disturbances to epithelial integrity but exacerbates carbohydrate malabsorption and GIS severity in comparison with a LFOD. Novelty Twenty-four-hour high FODMAP diet ameliorated disturbances to gastrointestinal integrity. Twenty-four-hour high FODMAP diet results in greater carbohydrate malabsorption compared with low FODMAP diet. Incidence of GIS during exertional heat stress were pronounced on both low and high FODMAP diets, but greater GIS severity was observed with high FODMAP diet.
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Affiliation(s)
- Stephanie K. Gaskell
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria 3168, Australia
| | - Bonnie Taylor
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria 3168, Australia
| | - Jane Muir
- Department of Gastroenterology - The Alfred Hospital, Monash University, Melbourne, Victoria 3004, Australia
| | - Ricardo J.S. Costa
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria 3168, Australia
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The Impact of a Dairy Milk Recovery Beverage on Bacterially Stimulated Neutrophil Function and Gastrointestinal Tolerance in Response to Hypohydration Inducing Exercise Stress. Int J Sport Nutr Exerc Metab 2020; 30:237-248. [PMID: 32460239 DOI: 10.1123/ijsnem.2019-0349] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/03/2020] [Accepted: 03/19/2020] [Indexed: 11/18/2022]
Abstract
The study aimed to determine the impact of a dairy milk recovery beverage immediately after endurance exercise on leukocyte trafficking, neutrophil function, and gastrointestinal tolerance markers during recovery. Male runners (N = 11) completed two feeding trials in randomized order, after 2 hr of running at 70% V˙O2max, fluid restricted, in temperate conditions (25 °C, 43% relative humidity). Immediately postexercise, the participants received a chocolate-flavored dairy milk beverage equating to 1.2 g/kg body mass carbohydrate and 0.4 g/kg body mass protein in one trial, and water volume equivalent in another trial. Venous blood and breath samples were collected preexercise, postexercise, and during recovery to determine the leukocyte counts, plasma intestinal fatty acid binding protein, and cortisol concentrations, as well as breath H2. In addition, 1,000 µl of whole blood was incubated with 1 μg/ml Escherichia coli lipopolysaccharide for 1 hr at 37 °C to determine the stimulated plasma elastase concentration. Gastrointestinal symptoms and feeding tolerance markers were measured preexercise, every 15 min during exercise, and hourly postexercise for 3 hr. The postexercise leukocyte (mean [95% confidence interval]: 12.7 [11.6, 14.0] × 109/L [main effect of time, MEOT]; p < .001) and neutrophil (10.2 [9.1, 11.5] × 109/L; p < .001) counts, as well as the plasma intestinal fatty acid binding protein (470 pg/ml; +120%; p = .012) and cortisol (236 nMol/L; +71%; p = .006) concentrations, were similar throughout recovery for both trials. No significant difference in breath H2 and gastrointestinal symptoms was observed between trials. The total (Trial × Time, p = .025) and per cell (Trial × Time, p = .001) bacterially stimulated neutrophil elastase release was greater for the chocolate-flavored dairy milk recovery beverage (+360% and +28%, respectively) in recovery, compared with the water trial (+85% and -38%, respectively). Chocolate-flavored dairy milk recovery beverage consumption immediately after exercise prevents the decrease in neutrophil function during the recovery period, and it does not account for substantial malabsorption or gastrointestinal symptoms over a water volume equivalent.
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Ogden HB, Child RB, Fallowfield JL, Delves SK, Westwood CS, Layden JD. The Gastrointestinal Exertional Heat Stroke Paradigm: Pathophysiology, Assessment, Severity, Aetiology and Nutritional Countermeasures. Nutrients 2020; 12:E537. [PMID: 32093001 PMCID: PMC7071449 DOI: 10.3390/nu12020537] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 02/14/2020] [Accepted: 02/15/2020] [Indexed: 12/12/2022] Open
Abstract
Exertional heat stroke (EHS) is a life-threatening medical condition involving thermoregulatory failure and is the most severe condition along a continuum of heat-related illnesses. Current EHS policy guidance principally advocates a thermoregulatory management approach, despite growing recognition that gastrointestinal (GI) microbial translocation contributes to disease pathophysiology. Contemporary research has focused to understand the relevance of GI barrier integrity and strategies to maintain it during periods of exertional-heat stress. GI barrier integrity can be assessed non-invasively using a variety of in vivo techniques, including active inert mixed-weight molecular probe recovery tests and passive biomarkers indicative of GI structural integrity loss or microbial translocation. Strenuous exercise is strongly characterised to disrupt GI barrier integrity, and aspects of this response correlate with the corresponding magnitude of thermal strain. The aetiology of GI barrier integrity loss following exertional-heat stress is poorly understood, though may directly relate to localised hyperthermia, splanchnic hypoperfusion-mediated ischemic injury, and neuroendocrine-immune alterations. Nutritional countermeasures to maintain GI barrier integrity following exertional-heat stress provide a promising approach to mitigate EHS. The focus of this review is to evaluate: (1) the GI paradigm of exertional heat stroke; (2) techniques to assess GI barrier integrity; (3) typical GI barrier integrity responses to exertional-heat stress; (4) the aetiology of GI barrier integrity loss following exertional-heat stress; and (5) nutritional countermeasures to maintain GI barrier integrity in response to exertional-heat stress.
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Affiliation(s)
- Henry B. Ogden
- Faculty of Sport, Health and Wellbeing, Plymouth MARJON University, Derriford Rd, Plymouth PL6 8BH, UK; (C.S.W.); (J.D.L.)
| | - Robert B. Child
- School of Chemical Engineering, University of Birmingham, Birmingham B15 2QU, UK;
| | | | - Simon K. Delves
- Institute of Naval Medicine, Alverstoke PO12 2DW, UK; (J.L.F.); (S.K.D.)
| | - Caroline S. Westwood
- Faculty of Sport, Health and Wellbeing, Plymouth MARJON University, Derriford Rd, Plymouth PL6 8BH, UK; (C.S.W.); (J.D.L.)
| | - Joseph D. Layden
- Faculty of Sport, Health and Wellbeing, Plymouth MARJON University, Derriford Rd, Plymouth PL6 8BH, UK; (C.S.W.); (J.D.L.)
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Test-Retest Reliability of a Modified Visual Analog Scale Assessment Tool for Determining Incidence and Severity of Gastrointestinal Symptoms in Response to Exercise Stress. Int J Sport Nutr Exerc Metab 2019; 29:411–419. [PMID: 30632417 DOI: 10.1123/ijsnem.2018-0215] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Considering the recent growth of exercise gastroenterology research focusing on exercise-induced gastrointestinal syndrome mechanisms, response magnitude, prevention and management strategies, the standardized assessment of gastrointestinal symptoms (GIS) is warranted. The current methodological study aimed to test the reliability of a modified visual analog scale for assessing GIS during exercise, in response to a variety of exertional-stress scenarios, with and without dietary intervention. Recreational endurance runners (n = 31) performed one of the three exercise protocols, which included: 2-hr running at 70% V˙O2max in temperate (24.7 °C) ambient conditions, with fluid restriction; 2-hr running at 60% V˙O2max in hot (35.1 °C) ambient conditions, while consuming chilled water immediately before and every 15 min during exercise; and 2-hr running at 60% V˙O2max in temperate (23.0 °C) ambient conditions, while consuming 30 g/20 min carbohydrate (2∶1 glucose∶fructose, 10% temperate w/v), followed by a 1-hr distance test. GIS was monitored pre-exercise, periodically during exercise, and immediately postexercise. After wash out, participants were retested in mirrored conditions. No significant differences (p > .05) were identified between test-retest using Wilcoxon signed-rank test for all GIS (specific and categorized), within each exercise protocol and the combined protocols. Strong correlations were observed for gut discomfort, total GIS, upper GIS, and nausea (rs = .566 to rs = .686; p < .001), but not for lower GIS (rs = .204; p = .232). Cohen's magnitude of difference was minimal for all GIS (specific δ < 0.14 and categorized δ < 0.08). The modified visual analog scale for assessing GIS during exercise appears to be a reliable tool for identifying incidence and severity of GIS in cohort populations and is sensitive enough to detect exertional and intervention differences.
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Costa RJS, Gaskell SK, McCubbin AJ, Snipe RMJ. Exertional-heat stress-associated gastrointestinal perturbations during Olympic sports: Management strategies for athletes preparing and competing in the 2020 Tokyo Olympic Games. Temperature (Austin) 2019; 7:58-88. [PMID: 32166105 PMCID: PMC7053925 DOI: 10.1080/23328940.2019.1597676] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/05/2019] [Accepted: 03/14/2019] [Indexed: 12/15/2022] Open
Abstract
Exercise-induced gastrointestinal syndrome (EIGS) is a common characteristic of exercise. The causes appear to be multifactorial in origin, but stem primarily from splanchnic hypoperfusion and increased sympathetic drive. These primary causes can lead to secondary outcomes that include increased intestinal epithelial injury and gastrointestinal hyperpermeability, systemic endotoxemia, and responsive cytokinemia, and impaired gastrointestinal function (i.e. transit, digestion, and absorption). Impaired gastrointestinal integrity and functional responses may predispose individuals, engaged in strenuous exercise, to gastrointestinal symptoms (GIS), and health complications of clinical significance, both of which may have exercise performance implications. There is a growing body of evidence indicating heat exposure during exercise (i.e. exertional-heat stress) can substantially exacerbate these gastrointestinal perturbations, proportionally to the magnitude of exertional-heat stress, which is of major concern for athletes preparing for and competing in the upcoming 2020 Tokyo Olympic Games. To date, various hydration and nutritional strategies have been explored to prevent or ameliorate exertional-heat stress associated gastrointestinal perturbations. The aims of the current review are to comprehensively explore the impact of exertional-heat stress on markers of EIGS, examine the evidence for the prevention and (or) management of EIGS in relation to exertional-heat stress, and establish best-practice nutritional recommendations for counteracting EIGS and associated GIS in athletes preparing for and competing in Tokyo 2020.
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Affiliation(s)
- Ricardo J S Costa
- Monash University, Department of Nutrition Dietetics and Food, Notting Hill, Victoria, Australia
| | - Stephanie K Gaskell
- Monash University, Department of Nutrition Dietetics and Food, Notting Hill, Victoria, Australia
| | - Alan J McCubbin
- Monash University, Department of Nutrition Dietetics and Food, Notting Hill, Victoria, Australia
| | - Rhiannon M J Snipe
- Deakin University, Centre for Sport Research, School of Exercise and Nutrition Science, Burwood, Victoria, Australia
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Costa RJS, Camões-Costa V, Snipe RMJ, Dixon D, Russo I, Huschtscha Z. Impact of exercise-induced hypohydration on gastrointestinal integrity, function, symptoms, and systemic endotoxin and inflammatory profile. J Appl Physiol (1985) 2019; 126:1281-1291. [DOI: 10.1152/japplphysiol.01032.2018] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
It is commonly believed that gastrointestinal issues during exercise are exacerbated by hypohydration. This study aimed to determine the effect of exercise-induced hypohydration on gastrointestinal integrity, function, symptoms, and systemic endotoxin and inflammatory profiles. In a randomized crossover design, male endurance runners ( n = 11) performed 2 h of running at 70% of maximum oxygen uptake in 25°C ambient temperature with water provision [euhydration (EuH)] and total water restriction [hypohydration (HypoH)] during running, which accounted for 0.6 ± 0.6% and 3.1 ± 0.7% body mass loss, respectively. Blood and fecal samples were collected before and after exercise. Breath samples (H2 determination) were collected and gastrointestinal symptoms (GIS) recorded before, during, and after exercise. HypoH resulted in a higher, yet insignificant, ∆ preexercise to postexercise plasma cortisol concentration (+286 nmol/l vs. +176 nmol/l; P = 0.098) but significantly higher intestinal fatty acid-binding protein (I-FABP) (+539 pg/ml vs. +371 pg/ml; P = 0.047) concentration compared with EuH. A greater breath H2 response ( P = 0.026) was observed on HypoH (1,188 ppm/3 h, peak +12 ppm) vs. EuH (579 ppm/3 h, peak +6 ppm). Despite greater GIS incidence on HypoH (82%) vs. EuH (64%), GIS severity scores were not significant between trials. Exercise-induced leukocytosis (overall pre- to postexercise: 5.9 × 109/l to 12.1 × 109/l) was similar on both trials. Depressed in vitro neutrophil function was observed during recovery on HypoH (−36%) but not on EUH (+6%). A pre- to postexercise increase ( P < 0.05) was observed for circulating cytokine concentrations but not endotoxin values. Hypohydration during 2 h of running modestly perturbs gastrointestinal integrity and function and increases GIS incidence but does not affect systemic endotoxemia and cytokinemia. NEW & NOTEWORTHY Despite anecdotal beliefs that exercise-induced hypohydration exacerbates perturbations to gastrointestinal status, the present study reports only modest perturbations in gastrointestinal integrity, function, and symptoms compared with euhydration maintenance. Exercise-induced hypohydration does not exacerbate systemic endotoxemia and cytokinemia compared with euhydration maintenance. Programmed water intake to maintain euhydration results in gastrointestinal symptom severity similar to exercise-induced hypohydration. Maintaining euhydration during exertional stress prevents the exercise-associated depression in bacterially stimulated neutrophil function.
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Affiliation(s)
- Ricardo J. S. Costa
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Vera Camões-Costa
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
- The Health & Aging Research Group, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Rhiannon M. J. Snipe
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - David Dixon
- Writtle University College, Chelmsford, United Kingdom
| | - Isabella Russo
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Zoya Huschtscha
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
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Ad libitum drinking adequately supports hydration during 2 h of running in different ambient temperatures. Eur J Appl Physiol 2018; 118:2687-2697. [PMID: 30267225 DOI: 10.1007/s00421-018-3996-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/18/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE To examine if ad libitum drinking will adequately support hydration during exertional heat stress. METHODS Ten endurance-trained runners ran for 2 h at 60% of maximum oxygen uptake under different conditions. Participants drank water ad libitum during separate trials at mean ambient temperatures of 22 °C, 30 °C and 35 °C. Participants also completed three trials at a mean ambient temperature of 35 °C while drinking water ad libitum in all trials, and with consumption of programmed glucose or whey protein hydrolysate solutions to maintain euhydration in two of these trials. Heart rate, oxygen uptake, rectal temperature, perceived effort, and thermal sensation were monitored, and nude body mass, hemoglobin, hematocrit, and plasma osmolality were measured before and after exercise. Water and mass balance equations were used to calculate hydration-related variables. RESULTS Participants adjusted their ad libitum water intake so that the same decrease in body mass (1.1-1.2 kg) and same decrease in body water (0.8-0.9 kg) were observed across the range of ambient temperatures which yielded significant differences (p < .001) in sweat loss. Overall, water intake and total water gain replaced 57% and 66% of the water loss, respectively. The loss in body mass and body water associated with ad libitum drinking resulted in no alteration in physiological and psychophysiological variables compared with the condition when hydration was nearly fully maintained (0.3 L body water deficit) relative to pre-exercise status from programmed drinking. CONCLUSIONS Ad libitum drinking is an appropriate strategy for supporting hydration during running for 2 h duration under hot conditions.
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Snipe RMJ. Exertional heat stress-induced gastrointestinal perturbations: prevention and management strategies. Br J Sports Med 2018; 53:1312-1313. [PMID: 30232061 DOI: 10.1136/bjsports-2018-099660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Rhiannon M J Snipe
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia.,Centre for Sport Research (CSR), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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Costa RJS, Hoffman MD, Stellingwerff T. Considerations for ultra-endurance activities: part 1- nutrition. Res Sports Med 2018; 27:166-181. [PMID: 30056753 DOI: 10.1080/15438627.2018.1502188] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Ultra-endurance activities (≥ 4h) present unique challenges that, beyond fatigue, may be exacerbated by sub-optimal nutrition during periods of increased requirements and compromised gastrointestinal function. The causes of fatigue during ultra-endurance exercise are multi-factorial. However, mechanisms can potentially include central or peripheral fatigue, thermal stress, dehydration, and/or endogenous glycogen store depletion; of which optimising nutrition and hydration can partially attenuate. If exercise duration is long enough (e.g. ≥ 10h) and exercise intensity low enough (e.g. 45-60% of maximal oxygen uptake), it is bio-energetically plausible that ketogenic adaptation may enhance ultra-endurance performance, but this requires scientific substantiation. Conversely, the scientific literature has consistently demonstrated that daily dietary carbohydrates (3-12g/kg/day) and carbohydrate intake (30-110g/h) during ultra-endurance events can enhance performance at individually tolerable intake rates. Considering gastrointestinal symptoms are common in ultra-endurance activities, effective dietary prevention and management strategies may provide functional, histological, systemic, and symptomatic benefits. Taken together, a well-practiced and individualized fuelling approach is required to optimize performance in ultra-endurance events.
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Affiliation(s)
- Ricardo J S Costa
- a Department of Nutrition Dietetics and Food , Monash University , Notting Hill, Victoria , Australia
| | - Martin D Hoffman
- b Physical Medicine and Rehabilitation Service, Department of Veterans Affairs , Northern California Health Care System , Sacramento , CA , USA.,c Department of Physical Medicine and Rehabilitation , University of California Davis Medical Center , Sacramento , CA , USA.,d Ultra Sports Science Foundation , El Dorado CA , USA
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