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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 2024:10.1007/s13668-024-00554-8. [PMID: 38995600 DOI: 10.1007/s13668-024-00554-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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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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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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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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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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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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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Guan L, Li T, Wang X, Yu K, Xiao R, Xi Y. Predictive Roles of Basal Metabolic Rate and Body Water Distribution in Sarcopenia and Sarcopenic Obesity: The link to Carbohydrates. Nutrients 2022; 14:nu14193911. [PMID: 36235562 PMCID: PMC9571591 DOI: 10.3390/nu14193911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/13/2022] [Accepted: 09/18/2022] [Indexed: 11/23/2022] Open
Abstract
Sarcopenic obesity is a new category of obesity and is a specific condition of sarcopenia. This study aimed to find the relationship of the basal metabolic rate (BMR) and body water distribution with muscle health and their prospective roles in screening for sarcopenic obesity and sarcopenia. The role of nutrients such as carbohydrates in the relationship was further detected. A total of 402 elderly subjects were recruited. Body composition was estimated by bioelectrical impedance analysis. Sarcopenia was defined by the Asian Working Group for Sarcopenia 2019. The cutoff values were determined by the receiver operating characteristic curve. Mediation analyses were performed using SPSS PROCESS. Higher BMR and BMR/body surface area (BSA) were protective factors against sarcopenic obesity (OR = 0.047, p = 0.004; OR = 0.035, p = 0.002) and sarcopenia (OR = 0.085, p = 0.001; OR = 0.100, p = 0.003) in elderly people. Low extracellular water (ECW)/intracellular water (ICW) and ECW/total body water (TBW) were negatively correlated with the skeletal muscle index (SMI). The intake of dietary carbohydrates in people with sarcopenic obesity was the lowest, but in subjects with obesity, it was the highest (p = 0.023). The results of the moderated mediation model showed that BMR fully mediated the positive relationship between carbohydrates and SMI, which was more obvious in the population with an abnormal body water distribution. BMR or BMR/BSA had the potential role of predicting a higher risk of sarcopenic obesity and sarcopenia. Higher BMR and lower ECW/ICW and ECW/TBW may benefit muscle health. The overconsumption of carbohydrates (especially > AMDR) might be a risk factor for obesity. Moderate dietary carbohydrate intake might promote SMI by regulating BMR and body water distribution in the elderly.
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Affiliation(s)
- Lizheng Guan
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Tiantian Li
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Xuan Wang
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Kang Yu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing 100730, China
| | - Rong Xiao
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Yuandi Xi
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing 100069, China
- Correspondence:
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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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Kaplan M, Baydemir B, Günar BB, Arslan A, Duman H, Karav S. Benefits of A2 Milk for Sports Nutrition, Health and Performance. Front Nutr 2022; 9:935344. [PMID: 35911103 PMCID: PMC9326461 DOI: 10.3389/fnut.2022.935344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Bovine milk is one of the best pre-and pro-workout sources for athletes owing to its rich nutritional content. Even though bovine milk consumption significantly benefits athletes' health and performance, many athletes cannot consume bovine milk since they struggle with gastrointestinal problems caused after milk consumption. Especially, the consumption of regular milk, which contains A1 β-casein, is associated with a variety of diseases ranging from gastrointestinal discomfort to ischemic heart diseases. The main reason behind this is related to β-casomorphine 7 (BCM-7), which is derived from A1 β-casein during the digestion of A1 milk. A1 β-casein is formed as a result of a point mutation in the position of 67th in the amino acid sequence A2 β-casein by changing proline to histidine. Therefore, this mutated form of β-casein in regular milk cannot easily be digested by the human-associated digestion enzymes. A2 milk, which includes A2 β-casein instead of A1 β-casein, is the best substitute for regular milk with the same nutritional content. This natural form of milk positively affects the athlete's health as well as performance without causing any gastrointestinal discomfort or more serious problems which are seen in the consumption of regular milk. In this review, A2 milk and its potential health effects in comparison to diseases related to A1 milk consumption are discussed.
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Affiliation(s)
- Merve Kaplan
- Department of Molecular Biology and Genetics, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Barış Baydemir
- Department of Coaching Education, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Bilgetekin Burak Günar
- Department of Physical Education and Sports Teaching, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ayşenur Arslan
- Department of Molecular Biology and Genetics, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Hatice Duman
- Department of Molecular Biology and Genetics, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Sercan Karav
- Department of Molecular Biology and Genetics, Canakkale Onsekiz Mart University, Canakkale, Turkey
- *Correspondence: Sercan Karav
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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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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)
- Christopher E Rauch
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - Alan J McCubbin
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - Stephanie K Gaskell
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - Ricardo J S Costa
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
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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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