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Andy J. King, Joshua T. Rowe and Louise M. Burke

e6776 10.1097/MCO.0b013e32832e6776 de Oliveira , E.P. , & Burini , R.C . ( 2014 ). Carbohydrate-dependent, exercise-induced gastrointestinal distress . Nutrients, 6 ( 10 ), 4191 – 4199 . doi:10.3390/nu6104191 10.3390/nu6104191 Flood , T.R. , Montanari , S. , Wicks , M. , Blanchard , J

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Iñigo Mujika

fat oxidation and gastrointestinal distress without changing performance . Nutrients, 8 ( 7 ), 392 . PubMed ID: 27347999 doi:10.3390/nu8070392 10.3390/nu8070392 Braakhuis , A.J. , Meredith , K. , Cox , G.R. , Hopkins , W.G. , & Burke , L.M. ( 2003 ). Variability in estimation of self

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Kristin J. Stuempfle, Martin D. Hoffman and Tamara Hew-Butler


Gastrointestinal (GI) distress is common during ultrarunning.


To determine if race diet is related to GI distress in a 161-km ultramarathon.


Fifteen (10 male, 5 female) consenting runners in the Javelina Jundred (6.5 loops on a desert trail) participated. Body mass was measured immediately prerace and after each loop. Runners reported if they had nausea, vomiting, abdominal cramps, and/or diarrhea after each loop. Subjects were interviewed after each loop to record food, fluid, and electrolyte consumption. Race diets were analyzed using Nutritionist Pro.


Nine (8 male, 1 female) of 15 runners experienced GI distress including nausea (89%), abdominal cramps (44%), diarrhea (44%), and vomiting (22%). Fluid consumption rate was higher (p = .001) in runners without GI distress (10.9 ± 3.2 ml · kg−1 · hr−1) than in those with GI distress (5.9 ± 1.6 ml · kg−1 · hr−1). Runners without GI distress consumed a higher percentage fat (p = .03) than runners with GI distress (16.5 ± 2.6 vs. 11.1 ± 5.0). In addition, fat intake rate was higher (p = .01) in runners without GI distress (0.06 ± 0.03 g · kg−1 · hr−1) than in runners with GI distress (0.03 ± 0.01 g · kg−1 · hr−1). Lower fluid and fat intake rates were evident in those developing GI distress before the onset of symptoms.


A race diet with higher percentage fat and higher intake rates of fat and fluid may protect ultramarathoners from GI distress. However, these associations do not indicate cause and effect, and factors other than race diet may have contributed to GI distress.

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Jeffrey J. Zachwieja, David L. Costill, Glenn C. Beard, Robert A. Robergs, David D. Pascoe and Dawn E. Anderson

To determine the effect of a carbonated carbohydrate (CHO) drink on gastric function and exercise performance, eight male cyclists completed four 120- min bouts of cycling. Each bout consisted of a 105-min ride at 70% VO2max followed by a 15-min self-paced performance ride. During each trial, one of four test solutions was ingested: carbonated CHO (C-10%), noncarbonated CHO (NC-10%), carbonated non-CHO (C), and noncarbonated non-CHO (NC). Following the performance ride, the subjects had their stomach contents removed by aspiration. There were no significant differences in gastric emptying (GE) except for Trial C-10%, which averaged 13.3% less than NC. However, there was no difference in the perception of gastrointestinal comfort between this trial and any other. Average power output during the performance ride was not significantly different between carbonated and noncarbonated trials, or between CHO-fed and no-CHO trials; however, the subjects worked at a greater intensity when fed CHO. Finally, acid base status did not change when a carbonated drink was ingested. This indicates that adding carbonation to a sport drink does not significantly alter gastric function, the perception of GI comfort, or exercise performance.

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Patrick B. Wilson

Gastrointestinal (GI) symptoms may affect up to 90% of competitors during endurance races. Studies have typically assessed GI symptoms retrospectively or only over an acute timeframe, and information on the validity and reliability of the questionnaires employed is lacking. This investigation aimed to estimate the frequency of GI distress experienced by runners over 30 days and to establish the validity and reliability of a retrospective GI symptom questionnaire. Runners (70 men, 75 women) recorded GI symptoms with a prospective journal for 30 days. Retrospective GI symptom data were then collected after the 30-day period on two occasions within one week. GI symptoms were rated on a 0–10 scale. Descriptive statistics for GI symptoms are reported as medians (interquartile ranges) because of nonnormal distributions. Men and women experienced at least one GI symptom on 84.0% (59.8–95.1%) and 78.3% (50.0–95.2%) of runs, respectively. Moderate-to-severe GI symptoms (score of ≥5) were experienced on 13.8% (6.7–37.3%) and 21.7% (5.3–41.2%) of runs for men and women. Spearman’s rho correlations between journal ratings and retrospective questionnaire ratings ranged from 0.47 to 0.82 (all p < .001), although they were highest when journal ratings were quantified as mean 30-day values (all rho ≥ 0.59). Reliability of the retrospective questionnaire ratings was high (rho = 0.78–0.92; p < .001). In comparison with tracking GI symptoms with a daily journal, retrospective questionnaires seem to offer a convenient and reasonably valid and reliable method of quantifying GI symptoms over 30 days.

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Mahdi Sareban, David Zügel, Karsten Koehler, Paul Hartveg, Martina Zügel, Uwe Schumann, Jürgen Michael Steinacker and Gunnar Treff

The ingestion of exogenous carbohydrates (CHO) during prolonged endurance exercise, such as long-distance triathlon, is considered beneficial with regard to performance. However, little is known about whether this performance benefit differs among different forms of CHO administration. To this end, the purpose of our study was to determine the impact of CHO ingestion from a semisolid source (GEL) on measures of performance and gastrointestinal (GI) comfort compared with CHO ingestion from a liquid source (LIQ). Nine well-trained triathletes participated in this randomized crossover study. Each participant completed a 60-min swim, 180-min bike exercise, and a 60-min all-out run in a laboratory environment under 2 conditions, once while receiving 67.2 ± 7.2 g · h−1 (M ± SD) of CHO from GEL and once while receiving 67.8 ± 4.2 g · h−1 of CHO from LIQ. The amount of fluid provided was matched among conditions. Respiratory exchange ratio (RER), blood glucose, and lactate as well as GI discomfort were assessed at regular intervals during the experiment. The distance covered during the final all-out run was not significantly different among participants ingesting GEL (11.81 ± 1.38 km) and LIQ (11.91 ± 1.53 km; p = .89). RER, blood glucose, and lactate did not differ significantly at any time during the experiment. Seven participants reported GI discomfort with GEL, and no athlete reported GI discomfort with LIQ (p = .016). This study suggests that administration of GEL does not alter long-distance triathlon performance when compared with LIQ, but GEL seems to be associated with reduced GI tolerance. Athletes should consider this a potential disadvantage of GEL administration during long-distance triathlon.

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Ernst Albin Hansen, Anders Emanuelsen, Robert Mørkegaard Gertsen and Simon Schøler Raadahl Sørensen

It was tested whether a marathon was completed faster by applying a scientifically based rather than a freely chosen nutritional strategy. Furthermore, gastrointestinal symptoms were evaluated. Nonelite runners performed a 10 km time trial 7 weeks before Copenhagen Marathon 2013 for estimation of running ability. Based on the time, runners were divided into two similar groups that eventually should perform the marathon by applying the two nutritional strategies. Matched pairs design was applied. Before the marathon, runners were paired based on their prerace running ability. Runners applying the freely chosen nutritional strategy (n = 14; 33.6 ± 9.6 years; 1.83 ± 0.09 m; 77.4 ± 10.6 kg; 45:40 ± 4:32 min for 10 km) could freely choose their in-race intake. Runners applying the scientifically based nutritional strategy (n = 14; 41.9 ± 7.6 years; 1.79 ± 0.11 m; 74.6 ± 14.5 kg; 45:44 ± 4:37 min) were targeting a combined in-race intake of energy gels and water, where the total intake amounted to approximately 0.750 L water, 60 g maltodextrin and glucose, 0.06 g sodium, and 0.09 g caffeine per hr. Gastrointestinal symptoms were assessed by a self-administered postrace questionnaire. Marathon time was 3:49:26 ± 0:25:05 and 3:38:31 ± 0:24:54 hr for runners applying the freely chosen and the scientifically based strategy, respectively (p = .010, effect size=-0.43). Certain runners experienced diverse serious gastrointestinal symptoms, but overall, symptoms were low and not different between groups (p > .05). In conclusion, nonelite runners completed a marathon on average 10:55 min, corresponding to 4.7%, faster by applying a scientifically based rather than a freely chosen nutritional strategy. Furthermore, average values of gastrointestinal symptoms were low and not different between groups.

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Beate Pfeiffer, Alexandra Cotterill, Dominik Grathwohl, Trent Stellingwerff and Asker E. Jeukendrup

Two studies were conducted to investigate gastrointestinal (GI) tolerance of high carbohydrate (CHO) intakes during intense running. The first study investigated tolerance of a CHO gel delivering glucose plus fructose (GLU+FRC) at different rates. The second study investigated tolerance of high intakes of glucose (GLU) vs. GLU+FRC gel. Both studies used a randomized, 2-treatment, 2-period crossover design: Endurance-trained men and women (Study 1: 26 men, 8 women; 37 ± 11 yr; 73 ± 9 kg; 1.76 ± 0.07 m. Study 2: 34 men, 14 women; 35 ± 10 yr; 70 ± 9 kg; 1.75 ± 0.09 m) completed two 16-km outdoor-runs. In Study 1 gels were administered to provide 1.0 or 1.4 g CHO/min with ad libitum water intake every 3.2 km. In Study 2 GLU or GLU+FRC gels were given in a double-blind manner to provide 1.4 g CHO/min. In both studies a postexercise questionnaire assessed 17 symptoms on a 10-point scale (from 0 to 9). For all treatments, GI complaints were mainly scored at the low end of the scale. In Study 1 mean scores ranged from 0.00 ± 0.00 to 1.12 ± 1.90, and in Study 2, from 0.00 ± 0.0 to 1.27 ± 1.78. GI symptoms were grouped into upper abdominal, lower abdominal, and systemic problems. There were no significant treatment differences in these categories in either study. In conclusion, despite high CHOgel intake, and regardless of the blend (GLU vs. GLU+FRC), average scores for GI symptoms were at the low end of the scale, indicating predominantly good tolerance during a 16-km run. Nevertheless, some runners (~10–20%) experienced serious problems, and individualized feeding strategies might be required.

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Mathilde Guillochon and David S. Rowlands

Carbohydrate sports drinks produce worthwhile benefits to endurance performance compared with noncaloric controls. However, athletes now consume carbohydrate in a range of formats, including gels and bars, but the comparable performance outcomes are unknown. Therefore, the aim of this study was to establish the relative effects of drink, gel, bar, and mixed carbohydrate formats on intense cycling performance. In a treatmentapparent randomized crossover design, 12 well-trained male cyclists completed 4 trials comprising a 140-min race simulation, followed by a double-blind slow-ramp to exhaustion (0.333 W·s-1). Carbohydrate comprising fructose and maltodextrin was ingested every 20 min via commercial drink, gel, bar, or mix of all 3, providing 80 g carbohydrate·h-1. Fluid ingestion was 705 ml·h-1. Exertion, fatigue, and gastrointestinal discomfort were measured with VAS. Performance peak power (SD) was 370 (41), 376 (37), 362 (51) and 368 W (54) for drink, gels, bars, and mix respectively. The reduction in power (-3.9%; 90%CI ±4.3) following bar ingestion vs. gel was likely substantial (likelihood harm 81.2%; benefit 0.8%), but no clear differences between drinks, gels, and the mix were evident. Bars also produced small-moderate standardized increases in nausea, stomach fullness, abdominal cramps, and perceived exertion, relative to gels (likelihood harm 95–99.5%; benefit <0.01%) and drink (75–95%; <0.01%); mix also increased nausea relative to gels (95%; <0.01%). Relative to a gel, carbohydrate bar ingestion reduced peak power, gut comfort, and ease of exertion; furthermore, no clear difference relative to drink suggests bars alone are the less favorable exogenous-carbohydrate energy source for intense endurance performance.

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Darren Peter Morton, Luis Fernando Aragón-Vargas and Robin Callister

The present study investigated the effect of ingested fluid composition on the experience of exercise-related transient abdominal pain (ETAP). Forty subjects, susceptible to ETAP, completed 4 treadmill exercise trials: a no-fluid trial and flavored water (FW, no carbohydrate, osmolality = 48 mosmol/L, pH = 3.3), sports drink (SD, freshly mixed Gatorade®, 6% total carbohydrate, 295 mosmol/L, pH = 3.3), and reconstituted fruit juice (FJ, BERRI® orange, 10.4% total carbohydrate, 489 mosmol/L, pH = 3.2) trials. Measures of the experience of ETAP and gastrointestinal disturbances, particularly bloating, were quantified. The FJ was significantly (p < .01) more provocative of both ETAP and bloating than all other trials. There was no difference among the no-fluid, FW, and SD in the severity of ETAP experienced, although the difference between the no-fluid and SD approached significance at the .05 level (p = .056). There was a significant relationship between both the mean (r = 0.40, p < .01) and peak (r = 0.44, p < .01) levels of ETAP and bloating. When the level of bloating was controlled for, the FJ remained significantly (p < .01) more provocative of ETAP than the other conditions, with no difference between the FW and SD (p = .37). The results indicate that in order to avoid ETAP, susceptible individuals should refrain from consuming reconstituted fruit juices and beverages similarly high in carbohydrate content and osmolality, shortly before and during exercise. Further, the mechanism responsible for the heightened experience of ETAP in the FJ trial extends beyond a gastric mass explanation.