The Impact of Gastrointestinal Symptoms and Dermatological Injuries on Nutritional Intake and Hydration Status During Ultramarathon Events

Abstract

BackgroundDebilitating gastrointestinal symptoms (GIS) and dermatological injuries (DI) are common during and after endurance events and have been linked to performance decrements, event withdrawal, and issues requiring medical attention. The study aimed to determine whether GIS and DI affect food and fluid intake, and nutritional and hydration status, of ultramarathon runners during multi-stage (MSUM) and 24-h continuous (24 h) ultramarathons.MethodsAd libitum food and fluid intakes of ultramarathon runners (MSUM n = 54; 24 h n = 22) were recorded throughout both events and analysed by dietary analysis software. Body mass and urinary ketones were determined, and blood samples were taken, before and immediately after running. A medical log was used to monitor symptoms and injuries throughout both events.ResultsGIS were reported by 85 and 73 % of ultramarathon runners throughout MSUM and 24 h, respectively. GIS during MSUM were associated with reduced total daily, during, and post-stage energy and macronutrient intakes (p < 0.05), whereas GIS during 24 h did not alter nutritional variables. Throughout the MSUM 89 % of ultramarathon runners reported DI. DI during MSUM were associated with reduced carbohydrate (p < 0.05) intake during running and protein intake post-stage (p < 0.05). DI during 24 h were low; thus, comparative analyses were not possible. Daily, during running, and post-stage energy, macronutrient and water intake variables were observed to be lower with severity of GIS and DI (p < 0.05) throughout the MSUM only.ConclusionsGIS during the MSUM, but not the 24 h, compromised nutritional intake. DI presence and severity also compromised nutrient intake during running and recovery in the MSUM.

Nutritional implications for ultra-endurance walking and running events

“…However, it should be recognized that other non-nutritional strategies to reduce the risk of inadequate energy intake, such as those to reduce gastrointestinal symptoms and injuries, play a role in achieving this. Common GI challenges that hinder intake include nausea, abdominal cramping, bloating, diarrhea, vomiting, flatulence, and belching [26, 36]. These issues are more common as intensity and/or duration increase.…”

“…These issues are more common as intensity and/or duration increase. Common injuries that hinder intake depend largely on the environment and climate and include blisters, subungual haematomas, chafings, abrasions, and plantar fasciitis [26, 37]. Climate and environmental-specific injuries include blisters and sunburns in hot temperatures, [26] and frostnip and frostbite in cold temperatures [37].…”

“…These findings are possible indicators that the difficulty which athletes experience in meeting standard recommendations could be attributed to various factors. Among these are lack of or poor nutrition education, norms of ultra-endurance sports, the development of physical symptoms including injury, gastrointestinal disturbances, suppression of appetite, logistic challenges with implications for both food preparation in terms of time and available resources/facilities to do so and, by extension, total food intake particularly in those periods of increased needs [15, 26, 27]. Additionally, dehydration and fluid overload [14, 26–29] appear to be areas with which have challenges.…”

“…Among these are lack of or poor nutrition education, norms of ultra-endurance sports, the development of physical symptoms including injury, gastrointestinal disturbances, suppression of appetite, logistic challenges with implications for both food preparation in terms of time and available resources/facilities to do so and, by extension, total food intake particularly in those periods of increased needs [15, 26, 27]. Additionally, dehydration and fluid overload [14, 26–29] appear to be areas with which have challenges. The myriad of stressors, such as extreme environmental conditions, intense physical exertion, limited sleep, and rationing of food, which ultra-endurance athletes encounter [14, 26–29], highlights the importance of prior planning where individualized nutrition strategy is concerned.…”

“…Additionally, dehydration and fluid overload [14, 26–29] appear to be areas with which have challenges. The myriad of stressors, such as extreme environmental conditions, intense physical exertion, limited sleep, and rationing of food, which ultra-endurance athletes encounter [14, 26–29], highlights the importance of prior planning where individualized nutrition strategy is concerned. It is clearly demonstrated throughout the literature that there is a need for appropriate education of ultra-endurance athletes, coaches, medical staff and race organizers, based on environmental conditions and course topography.…”