Gastrointestinal symptoms in elite athletes: time to recognise the problem?

Pugh, Jamie N.; Fearn, Robert; Morton, James P.; Close, Graeme L.

doi:10.1136/bjsports-2017-098376

Cited by 29 publications

(34 citation statements)

References 6 publications

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“…We identified three studies that measured changes in muscle strength, none of which reported a significant improvement following protein and/or EAA supplementation despite two of the studies employing a combined resistance exercise and protein/EAA intervention. Similar findings have previously been reported in non-frail elderly individuals [ 40 ], however evidence appears to support the beneficial role of protein and/or EAA supplementation in increasing strength in healthy adults [ 16 ] and undernourished people with a long-term condition [ 17 ].…”

Section: Discussionsupporting

confidence: 85%

“…A review of 49 studies by Morton and colleagues [ 16 ] reported a mean 1 repetition maximum (1RM) strength increase of 27.0 kg (95% CI 22.0–32.0 kg) following combined resistance exercise training and protein supplementation in healthy adults. Dietary protein supplementation resulted in a further modest 1RM increase of 2.5 kg (95% CI 0.6–4.3 kg), indicating that protein supplementation plays a smaller role in improving strength, in comparison to resistance exercise training.…”

Section: Discussionmentioning

confidence: 99%

“…Insufficient dietary protein intake is a strong predictor of developing sarcopenia in patients with heart disease [ 15 ]. Regular dietary supplementation with protein or essential amino acids (EAA) has been shown to augment skeletal muscle strength and mass in healthy adults [ 16 ], and in patients with a long-term condition; defined by the authors as, “including coronary artery disease, chronic heart failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, osteoporosis, the metabolic syndrome and dementia” [ 17 ]. This is most likely due to the capacity of dietary protein and/or EAA supplementation to stimulate the mammalian target of rapamycin (mTOR) pathway and muscle anabolism [ 18 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

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The effect of protein and essential amino acid supplementation on muscle strength and performance in patients with chronic heart failure: a systematic review

et al. 2019

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Purpose Critically low skeletal muscle mass and strength, observed in 20% of people with chronic heart failure (CHF), reduces functional capacity, quality of life (QoL) and survival. Protein and essential amino acid (EAA) supplementation could be a viable treatment strategy to prevent declines in muscle strength and performance, and subsequently improve QoL and survival. This systematic review (PROSPERO: CRD42018103649) aimed to assess the effect of dietary protein and/or EAA supplementation on muscle strength and performance in people with CHF. Methods Searches of PubMed, MEDLINE and Embase identified studies that reported changes in strength or muscle performance following protein and/or EAA supplementation in patients with CHF. Following PRISMA guidelines and using predefined inclusion/exclusion criteria relating to participants, intervention, control, outcome and study design, two reviewers independently screened titles, abstracts and full manuscripts for eligibility. Risk of bias was assessed using Cochrane Risk of Bias Tool (RCTs) or Mixed Methods Appraisal Tool (cohort studies). Data were extracted for analysis using predefined criteria. Results Five randomised controlled trials (RCT) and one cohort study met our inclusion criteria. All RCTs had a high risk of bias. The methodological quality of the cohort study was moderate. Heterogeneity of extracted data prevented metaanalyses, qualitative synthesis was therefore performed. Data from 167 patients with CHF suggest that protein and/or EAA supplementation does not improve strength, but may increase six-minute walk test distance, muscle mass and QoL. Conclusions The limited quality of the studies makes firm conclusions difficult, however protein and/or EAA supplementation may improve important outcome measures related to sarcopenia. High-quality randomised controlled studies are needed.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effect of protein and essential amino acid supplementation on muscle strength and performance in patients with chronic heart failure: a systematic review

et al. 2019

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“…Exercise-induced gastrointestinal syndrome, a recently coined term, describes disturbances of gastrointestinal integrity and function that are common features of strenuous exercise [ 1 ]. Gastrointestinal conditions are recognized as the most commonly reported illnesses at international sporting events [ 2 ]. Prevalence rates range from 30 to 50% of athletes, and up to 90% in ultra-endurance events [ 3 ].…”

Section: Gastrointestinal Symptoms (Gis) In Exercisementioning

confidence: 99%

Exit Gluten-Free and Enter Low FODMAPs: A Novel Dietary Strategy to Reduce Gastrointestinal Symptoms in Athletes

Lis

2019

Sports Med

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Exercise-associated physiological disturbances alter gastrointestinal function and integrity. These alterations may increase susceptibility to dietary triggers, namely gluten and a family of short-chain carbohydrates known as FODMAPs (fermentable oligo-, di-, monosaccharides and polyols). A recent surge in the popularity of gluten-free diets (GFDs) among athletes without celiac disease has been exacerbated by unsubstantiated commercial health claims and high-profile athletes citing this diet to be the secret to their success. Up to 41% of athletes at least partially adhere to a GFD diet, with the belief that gluten avoidance improves exercise performance and parameters influencing performance, particularly gastrointestinal symptoms (GIS). In contrast to these beliefs, seminal work investigating the effects of a GFD in athletes without celiac disease has demonstrated no beneficial effect of a GFD versus a gluten-containing diet on performance, gastrointestinal health, inflammation, or perceptual wellbeing. Interestingly, the subsequent reduction in FODMAPs concurrent with the elimination of gluten-containing grains may actually be the factors affecting GIS improvement, not gluten. Pre-existent in the gastrointestinal tract or ingested during exercise, the osmotic and gas-producing effects of variably absorbed FODMAPs may trigger or increase the magnitude of exercise-associated GIS. Research using FODMAP reduction to address gastrointestinal issues in clinically healthy athletes is emerging as a promising strategy to reduce exercise-associated GIS. Applied research and practitioners merging clinical and sports nutrition methods will be essential for the effective use of a low FODMAP approach to tackle the multifactorial nature of gastrointestinal disturbances in athletes.

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“…Strenuous exercise promotes immunodepression, oxidative stress, increased respiratory illness symptoms (URS) and gastrointestinal (GI) disorders 3,4 . Moreover, especially athletes of long distance sports (marathon, triathlon and ultra-endurance), commonly report health issues and endotoxemia 1,5,6 . Thus, there is a growing scientific body looking for strategies, especially in the nutritional supplementation field, to prevent these conditions from impacting sporting performance 4 .…”

Section: Introductionmentioning

confidence: 99%