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Stephanie K. Gaskell, Rhiannon M.J. Snipe, and Ricardo J.S. Costa

Gastrointestinal symptoms (GIS) are a common feature of exercise, with prevalence data suggesting intensity and duration of exercise as major influential factors in the magnitude of GIS incidence and severity ( Costa et al., 2017c ). Consistently, >60% of ultraendurance athletes report GIS during

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Alan J. McCubbin, Anyi Zhu, Stephanie K. Gaskell, and Ricardo J.S. Costa

-associated gastrointestinal symptoms (GIS; Jeukendrup, 2014 ). More recently, there has been a focus on additional ingredients in CES to further improve gastric emptying, minimize GIS, and enhance carbohydrate absorption and oxidation during exercise ( Sutehall et al., 2018 ). Through the addition of alginate and pectin

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Charles S. Urwin, Dan B. Dwyer, and Amelia J. Carr

Sodium citrate induces alkalosis and can provide a performance benefit in high-intensity exercise. Previous investigations have been inconsistent in the ingestion protocols used, in particular the dose and timing of ingestion before the onset of exercise. The primary aim of the current study was to quantify blood pH, blood bicarbonate concentration and gastrointestinal symptoms after ingestion of three doses of sodium citrate (500 mg⋅kg-1, 700 mg⋅kg-1 and 900 mg⋅kg-1). Thirteen participants completed four experimental sessions, each consisting of a different dose of sodium citrate or a taste-matched placebo solution. Blood pH and blood bicarbonate concentration were measured at 30-min intervals via analysis of capillary blood samples. Gastrointestinal symptoms were also monitored at 30-min intervals. Statistical significance was accepted at a level of p < .05. Both measures of alkalosis were significantly greater after ingestion of sodium citrate compared with placebo (p < .001). No significant differences in alkalosis were found between the three sodium citrate doses (p > .05). Peak alkalosis following sodium citrate ingestion ranged from 180 to 212 min after ingestion. Gastrointestinal symptoms were significantly higher after sodium citrate ingestion compared with placebo (p < .001), while the 900 mg.kg-1 dose elicited significantly greater gastrointestinal distress than 500 mg⋅kg-1 (p = .004). It is recommended that a dose of 500 mg⋅kg-1 of sodium citrate should be ingested at least 3 hr before exercise, to achieve peak alkalosis and to minimize gastrointestinal symptoms before and during exercise.

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Ricardo J.S. Costa, Vera Camões-Costa, Rhiannon M.J. Snipe, David Dixon, Isabella Russo, and Zoya Huschtscha

-debilitating gastrointestinal symptoms (GIS; Costa et al., 2017a ). With this in mind, it has previously been shown that consuming a CHO (1.2 g CHO/kg body mass [BM]) recovery beverage, with or without protein (PRO; 0.4 g PRO/kg BM), from supplement-based ingredients (i.e., maltodextrin and soya PRO) immediately after 2 hr of

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Stephanie K. Gaskell and Ricardo J.S. Costa

population ( Lovell & Ford, 2012 ). IBS has also been reported among exercising populations; including in endurance athletes ( Diduch, 2017 ; Heiman et al., 2008 ). Gastrointestinal symptoms (GIS) experienced by individuals with IBS mimic those commonly reported by non-IBS athletes during and after

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Ricardo J.S. Costa, Pascale Young, Samantha K. Gill, Rhiannon M.J. Snipe, Stephanie Gaskell, Isabella Russo, and Louise M. Burke

Exercise-associated gastrointestinal symptoms (Ex-GIS), such as abdominal pain and nausea, have been reported in the scientific literature for almost a century ( Burgess et al., 1924 ). However, awareness of disturbances to the gastrointestinal tract, and subsequent instigation of Ex-GIS, as a

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Charles S. Urwin, Rodney J. Snow, Dominique Condo, Rhiannon Snipe, Glenn D. Wadley, and Amelia J. Carr

.J. ( 2016 ). Induced alkalosis and gastrointestinal symptoms after sodium citrate ingestion: A dose–response investigation . International Journal of Sport Nutrition and Exercise Metabolism, 26 ( 6 ), 542 – 548 . PubMed ID: 27098485 doi:10.1123/ijsnem.2015-0336 10.1123/ijsnem.2015-0336 Urwin , C

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Riina A. Kekkonen, Tommi J. Vasankari, Timo Vuorimaa, Tari Haahtela, Ilkka Julkunen, and Riitta Korpela

Heavy exercise is associated with an increased risk of upper respiratory tract infections. Strenuous exercise also causes gastrointestinal (GI) symptoms. In previous studies probiotics have reduced respiratory tract infections and GI symptoms in general populations including children, adults, and the elderly. These questions have not been studied in athletes before. The purpose of this study was to investigate the effect of probiotics on the number of healthy days, respiratory infections, and GI-symptom episodes in marathon runners in the summer. Marathon runners (N = 141) were recruited for a randomized, double-blind intervention study during which they received Lactobacillus rhamnosus GG (LGG) or placebo for a 3-mo training period. At the end of the training period the subjects took part in a marathon race, after which they were followed up for 2 wk. The mean number of healthy days was 79.0 in the LGG group and 73.4 in the placebo group (P = 0.82). There were no differences in the number of respiratory infections or GI-symptom episodes. The duration of GI-symptom episodes in the LGG group was 2.9 vs. 4.3 d in the placebo group during the training period (P = 0.35) and 1.0 vs. 2.3 d, respectively, during the 2 wk after the marathon (P = 0.046). LGG had no effect on the incidence of respiratory infections or GI-symptom episodes in marathon runners, but it seemed to shorten the duration of GI-symptom episodes.

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Dana Lis, Kiran D.K. Ahuja, Trent Stellingwerff, Cecilia M. Kitic, and James Fell

Athletes employ various dietary strategies in attempts to attenuate exercise-induced gastrointestinal (GI) symptoms to ensure optimal performance. This case-study outlines one of these GI-targeted approaches via the implementation of a short-term low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) diet, with the aim to attenuate persistent running specific GI symptoms in a recreationally competitive multisport athlete (male, 86 kg, 57.9 ml·kg·min-1 V02max, 10–15 hr/week training, with no diagnosed GI disorder). Using a single-blinded approach a habitual diet was compared with a 6-day low FODMAP intervention diet (81 ± 5g vs 7.2 ± 5.7g FODMAP s/day) for their effect on GI symptoms and perceptual wellbeing. Training was similar during the habitual and dietary intervention periods. Postexercise (During) GI symptom ratings were recorded immediately following training. Daily GI symptoms and the Daily Analysis of Life Demands for Athletes (DALDA) were recorded at the end of each day. Daily and During GI symptom scores (scale 0–9) ranged from 0–4 during the habitual dietary period while during the low FODMAP dietary period all scores were 0 (no symptoms at all). DALDA scores for worse than normal ranged from 3–10 vs 0–8 in the habitual and low FODMAP dietary periods, respectively, indicating improvement. This intervention was effective for this GI symptom prone athlete; however, randomized-controlled trials are required to assess the suitability of low FODMAP diets for reducing GI distress in other symptomatic athletes.

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Amelia J. Carr, Gary J. Slater, Christopher J. Gore, Brian Dawson, and Louise M. Burke

Context:

Sodium bicarbonate (NaHCO3) is often ingested at a dose of 0.3 g/kg body mass (BM), but ingestion protocols are inconsistent in terms of using solution or capsules, ingestion period, combining NaHCO3 with sodium citrate (Na3C6H5O7), and coingested food and fluid.

Purpose:

To quantify the effect of ingesting 0.3 g/kg NaHCO3 on blood pH, [HCO3−], and gastrointestinal (GI) symptoms over the subsequent 3 hr using a range of ingestion protocols and, thus, to determine an optimal protocol.

Methods:

In a crossover design, 13 physically active subjects undertook 8 NaHCO3 experimental ingestion protocols and 1 placebo protocol. Capillary blood was taken every 30 min and analyzed for pH and [HCO3−]. GI symptoms were quantified every 30 min via questionnaire. Statistics used were pairwise comparisons between protocols; differences were interpreted in relation to smallest worthwhile changes for each variable. A likelihood of >75% was a substantial change.

Results:

[HCO3−] and pH were substantially greater than in placebo for all other ingestion protocols at almost all time points. When NaHCO3 was coingested with food, the greatest [HCO3−] (30.9 mmol/kg) and pH (7.49) and lowest incidence of GI symptoms were observed. The greatest incidence of GI side effects was observed 90 min after ingestion of 0.3 g/kg NaHCO3 solution.

Conclusions:

The changes in pH and [HCO3−] for the 8 NaHCO3-ingestion protocols were similar, so an optimal protocol cannot be recommended. However, the results suggest that NaHCO3 coingested with a high-carbohydrate meal should be taken 120–150 min before exercise to induce substantial blood alkalosis and reduce GI symptoms.