GASTROENTERIC DIABETES OF THE ATHLETE

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Contrary to what you can imagine, gastrointestinal disorders (nausea, vomiting, diarrhea, etc.) in athletes are particularly common. According to recent literature data, in a particularly intense exercise condition, the prevalence of these disorders is around 70%.

The emergence of gastrointestinal problems leads the athlete to necessarily reduce the intensity of the exercise or, in the most serious cases, to abandon the competition. They are, in fact, among the main causes of withdrawal.

What are the main disturbances? Gastroesophageal reflux, stomach burns, nausea, vomiting, abdominal pain, diarrhea, and blood facial presence are the most common disorders reported by endurance discipline athletes.

Who suffers most? Certainly runners are the athletes most affected by these ailments, with the same stroke as the cause, the vertical truncated oscillations of the trunk with the endodontal organs are continually shaken at each step. This problem is less evident in athletes of other disciplines like cyclists. Women suffer more frequently than men. Training is also important: there is a greater risk to those who are less trained and suddenly increase the intensity and duration of the workouts.

Gastrointestinal disorders are more frequent in races than in workouts, this fact is probably linked to the influence on such psychological stress disorders.

What are the causes? During exercise, there is a redistribution of the blood flow from the gastro-intestinal tract to the muscles and the skin. During the execution of a maximum exercise the intestinal blood flow may be reduced by up to 80% compared to rest.

High temperatures, causing more blood clotting to the skin (for thermoregulation), further reduce blood flow to the endotominal organs.

Drugs, particularly anti-inflammatory drugs, tend to worsen the membrane integrity of the intestinal mucous membranes already partially damaged by the decrease in visceral blood flow.

Another risk factor is inevitably the diet, taking in before the activity of foods rich in fat, protein, and fiber increases the risk of disturbances.

Therefore, it is important to pay attention to the precautionary diet, but also to the foods or drinks taken during training or competition. Among the main causes of the rider's diarrhea there are too much water-soluble solutions of sugars and particularly fructose, this has a rather slow intestinal absorption, in the small intestine it recalls water with increased osmolarity (expression of the concentration of particles in A solution) and consequent mechanical stimulus to diarrhea.

How to avoid these problems: a practical guide

Pre-meal: The meal before the race should be such as to make the right amount of carbohydrates but limit the consumption of high-fiber foods (legumes, pasta and whole bread, fruit, vegetables, etc.). Useful advice, especially in subjects particularly susceptible to these disorders, is to avoid milk or foods with high lactose content (cheeses not seasoned) in the hours prior to the competition. Coffee should also be limited and especially the food caffeinated whose digestion can be particularly difficult. Another important factor is the amount of fat taken in the hours before the race. Fatty, processed foods and especially fried foods put the athlete at risk of disturbances.

Last but not least, the last meal before the race should be taken at least 3 hours after the start of the competition. This period should be increased if you have a particularly slow digestion. The meal should be made up of family foods and welcome by the athlete.

During the race: a high degree of dehydration, especially when over 2% of the body weight, as well as reducing performance and increasing perception of fatigue, slows down gastric emptying and increases the risk of gastrointestinal disturbances.

The osmolarity of the drinks you take is very important, hypertonic drinks decrease the rate of gastric emptying.

Even the temperature of the drinks is a risk factor, too hot drinks slow the gastric emptying, too cold it accelerates.

Therefore, the optimal drink should be a hypo-isotonic drink, with a carbohydrate content of 4-6% (however not higher than 10%) and should have a temperature of about 15 to 18 ° C. The presence in this drink of Glucose and sodium is very important in order to promote the intestinal absorption of liquids.

The amount of liquid to be used should vary from 150 to 200 ml every 15 minutes.

Training to nourish and hydrate you during exercise: Training is not only useful to induce those physical adaptations that are indispensable in order to seek maximum performance. During workouts, if you are over 60 minutes long, drinks and / or food (eg, fingers, gel) should be tested in the race. Each athlete has an individual degree of "sensitivity", and the intestine is also "trained" to welcome food and drink during the effort. Environmental conditions are also to be taken into account, if the outside temperature is low and is thought to have reduced sweating, the need to take water is reduced and the beverage may be more concentrated than the recommended concentration of around 5%.

Think about the health of your intestine:

When it comes to integration in sports it's rare to hear mention of probiotics. These are beneficial bacteria for human health and are especially important for the athlete. First, their integration helps to maintain the proper composition of the intestinal bacterial flora and thus to reduce the risk of gastrointestinal disturbances. Other positive effects include improved digestion and absorption of nutrients and the important immunostimulatory effect. In fact, recent literature data indicate fewer respiratory tract infections in endurance athletes undergoing probiotics.

Guidelines to minimize gastrointestinal disturbances in long-lasting sports and especially in running

1. Athletes suffering from gastroesophageal reflux during exercise should identify the most responsible foods. There is always a minimum of individuality, the general council is to avoid fatty and spicy foods, alcohol, caffeine and chocolate in the hours immediately preceding the competition
2. Athletes suffering from diarrhea during exercise should identify the foods that are most likely to cause problems: usually caffeine, high fiber foods (legumes, whole foods, vegetables, etc.) foods containing high amounts of lactose (milk, ice cream , Etc.), high fructose foods such as fruit and fruit juices. Even high-fat foods and proteins should be avoided. Often, solid foods are not tolerated in hours prior to exercise, in this case you can opt for a liquid meal. The advice is also to reduce fiber intake the night before the race.
3. During exercise the athlete should remain well hydrated: most of the disorders are favored by a dehydration condition (> 2% of the body weight)
4. Those suffering from gastrointestinal disturbances should use sports drinks with concentrations of 2-4% unless gradual concentration increases with exercise.
5. Every athlete should always experience the foods to be consumed before and during the races. These should be the most appreciated and familiar to the athlete.

Bibliographical references

RWF ter Steege and JJ Kolkman, Review article: The pathophysiology and management of gastrointestinal symptoms during physical exercise, and the role of splanchnic blood flow, Aliment Pharmacol Ther 2012; 35: 516-528

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