Gastrointestinal Issues In Athletes

Just as athletes train for their sport, they must also “train their guts.” Athletes who are not used to drinking or eating during exercise are more likely to develop GI symptoms in training and competition.

The sports dietitian is the nutrition coach for an athlete. Athletes affected by digestive concerns are often referred to a sports dietitian to develop a meal plan that addresses and corrects the gastrointestinal (GI) symptoms. Sports dietitians who work with athletes who have GI concerns need to be knowledgeable about sports nutrition recommendations, the effect of exercise on the GI tract, and how to adjust the diet accordingly. In addition, the sports dietitian has to be familiar with GI disorders and medical nutrition therapy recommendations for treating those disorders, as there are athletes who have lactose intolerance, inflammatory bowel disease, and functional bowel disorders. The Nutrition Care Process can provide a plan of action for athletes to help them manage symptoms and optimize performance. Collegiate, professional, and private practice sports dietitians are not with their athletes 24/7. In professional sports, many athletes seek out the advice of “trainers,” who may recommend particular eating plans or supplements that may cause digestive distress. Some athletes follow elimination diets at the request of their trainers, where the focus is more on what not to eat; but the potential food “offenders” may not be added back to the diet gradually, and that may cause GI distress. The sports dietitian needs to communicate and collaborate with the trainer and the athlete to ensure that nutrition recommendations do not compromise the athlete’s gut or performance.

The sports dietitian can and should work with the university food service, hotels, and airlines for travel to make sure there are acceptable, appropriate foods available for all athletes, including those with preexisting GI concerns. It is also important to educate athletes on the importance of food safety. In some cases, GI symptoms may be traced to a foodborne illness, not to the exercise. It is important to ask athletes about food preparation and storage and to make sure that proper food handling and storage procedures are in place in your facilities. The sports dietitian should also ask about supplement use as some may have deleterious effects on the GI tract. Questions about quantity, quality, frequency, and timing of supplements can help prevent the unintended consequence of GI distress.

Just as athletes train for their sport, they must also “train their guts.” Athletes who are not used to drinking or eating during exercise are more likely to develop GI symptoms in training and competition (ter Steege, 2008). The sports dietitian is best equipped to help the athlete with nutrition management of GI symptoms. Although athletes may not be forthcoming in talking about symptoms, it is the sports dietitian’s job as the nutrition coach to advise the athlete on food choices, quantity, and timing to alleviate any potential GI distress. Use time with athletes efficiently and effectively by providing education on:

How to eat and drink during training
How to alter fueling and hydration for competition
When to eat and drink during exercise; in general, GI complaints are more common after consumption of a meal within 2 to 3 hours of exercising
How much to eat and drink during exercise
What to eat and drink during exercise

Helping athletes with their food and fluid choices around the time of training not only optimizes performance but may minimize GI distress by ensuring rapid emptying and absorption of water and nutrients to maintain adequate perfusion of splanchnic vasculature. Gastrointestinal issues are likely to occur when athletes consume the wrong concentration of glucose to fructose to fluid, which can occur in athletes that use both sports drinks and other sports products such as gels as fuel during an event. Digestive distress may also occur in the athlete who consumes carbohydrate in excess of the recommended amount during exercise. Training can improve food and beverage tolerance and decrease stomach upset during exercise (Lambert, 2008a). Counseling athletes on fluid choices—for instance, sports beverages vs water—may positively impact gut function (Wittbrodt, 2003).

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