An exploratory study of the management strategies reported by endurance athletes with exercise-associated gastrointestinal symptoms

Rachel Scrivin; Ricardo J S Costa; Fiona Pelly; Dana Lis; Gary Slater

doi:10.3389/fnut.2022.1003445

An exploratory study of the management strategies reported by endurance athletes with exercise-associated gastrointestinal symptoms

Front Nutr. 2022 Nov 9:9:1003445. doi: 10.3389/fnut.2022.1003445. eCollection 2022.

Authors

Rachel Scrivin^{1

2}, Ricardo J S Costa³, Fiona Pelly¹, Dana Lis⁴, Gary Slater¹

Affiliations

¹ School of Health and Behavioral Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia.
² Faculty of Health, Education and Environment, Toi Ohomai Institute of Technology, Tauranga, New Zealand.
³ Department of Nutrition Dietetics and Food, Monash University, Melbourne, VIC, Australia.
⁴ Department of Neurobiology, Physiology and Behavior, University of California, Los Angeles, Los Angeles, CA, United States.

Abstract

This exploratory study investigated endurance athletes self-reported exercise-associated gastrointestinal symptoms (Ex-GIS) and associated strategies to manage symptomology. Adult endurance athletes with a history of Ex-GIS (n = 137) participating in events ≥ 60 min completed an online validated questionnaire. Respondents included runners (55%, n = 75), triathletes (22%, n = 30), and non-running sports (23%, n = 32), participating at a recreationally competitive (37%, n = 51), recreationally non-competitive (32%, n = 44), and competitive regional/national/international (31%, n = 42) levels. Athletes identified when Ex-GIS developed most frequently either around training (AT), around competitions (AC), or equally around both training (ET) and competitions (EC). Athletes reported the severity of each symptom before, during, and after exercise. Athletes predominantly categorized Ex-GIS severity as mild (< 5/10) on a 0 (no symptoms) to 10 (extremely severe symptoms) visual analog symptomology scale. The Friedman test and post hoc analysis with Wilcoxon signed rank test was conducted with a Bonferroni correction applied to determine differences between repeated measures. The only severe symptom of significance was the urge to defecate during training in the ET group (Z = -0.536, p = 0.01). Ex-GIS incidence was significantly higher during training and competitions in all categories. A content review of self-reported strategies (n = 277) to reduce Ex-GIS indicated popular dietary strategies were dietary fiber reduction (15.2%, n = 42), dairy avoidance (5.8%, n = 16), and a low fermentable oligosaccharides, monosaccharides, and polyols (FODMAP) diet (5.4%, n = 15). In contrast, non-dietary strategies included the use of medications (4.7%, n = 13) and relaxation/meditation (4.0%, n = 11). On a Likert scale of 1-5, the most successful dietary strategies implemented were dietary fiber reduction (median = 4, IQR = 4, 5), low FODMAP diets (median = 4, IQR = 4, 5), dairy-free diets (median = 4, IQR = 4, 5), and increasing carbohydrates (median = 4, IQR = 3, 4). Accredited practicing dietitians were rated as the most important sources of information for Ex-GIS management (n = 29). Endurance athletes use a variety of strategies to manage their Ex-GIS, with dietary manipulation being the most common.

Keywords: Ex-GIS; athletes; dietary fiber; dietary strategies; exercise; gastrointestinal symptoms; low FODMAP; questionnaire.