The Athlete's Gut - Overcoming Stomach Distress

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1. Are in most cases GI complaints a part of the natural selection, despite there are some examples as you mentioned? It seems to be the real GI distress is more often seen in recreational athletes?
   1. Experience is correlated with a lower rate of GI issues. There may be some natural selection there or if someone has some really bad GI issues it would be hard to be an elite performer. The more likely explanation is as people train they gain more experience, their gut may adapt to the training, the blood flow to the gut is preserved as you train for longer and accumulate mileage, and then you get more experience with your fueling of what works and what does not. So it is hard to disentangle cause and effect there. We do know from multiple studies that athletes that are more experienced have less severe issues. Overall, recreational athletes are more likely to experience issues. 
2. Can you please give examples of GI friendly during activity sports foods such as gels, powders, gummies etc.
   1. Individualized. There are 100s of products. Cannot say much from studies as compared to the number that are out there, only a handful of products have been more extensively studied. What I will say is that, if you are going to be aggressive about your CHO intake such as more than 50 g per hour than you want a multiple transportable CHO source. So essentially you want something that contains glucose and fructose. Most sports nutrition products include both of these sugars, but verify and double check this. Essentially, this is a trial and error process to learn what works best for you. 
3. What about peppermint gums, candies in worsening heartburn or reflux?  any evidence on that?
   1. Not in athletes that he is aware of; Something you could try but it’s not been studied much, even in non-athletes; Been interested in ginger with good evidence (not in athletes) helping with nausea, vomiting for pregnant women, cancer patients and motion sickness. Would like to do studies on ginger and athletes. Good theoretical rationale but no solid evidence.
4. Do you have recommendations for Body Jostlings?
   1. Recruiting for a study to confirm whether the jostling is correlated with body jostling; Vertical oscillations correlation with those issues; Speculated as a problem but nothing confirmed. How much you are oscillating while you run. You could track that with a monitor, the difficulty though is there are no “normals” to compare too. Possibly use yourself as a measure and increase or decrease according to how you feel.
5. Are the "food sensitive"  tests like with everlywell valid or worth doing? Do you have concerns with these?
   1. Hesitates to give specific answer; Debate about how well those correlate with subjective symptoms; Does not do it clinically but his perception is they are not 100% accurate in diagnostic capabilities; Better to go back to basics of removing food and reintroducing it, etc; Elite Specialized dietitians may be better versed.
6. Any difference in consuming 50gs of CHO at once, or 25g every 30 min, for example?
   1. Thought would be that spreading out over two dosages would less likely lead to GI issues; More likely to have stomach upset with one quick dosage but it really depends on individual because if they practice with one dose vs. two doses could give different reactions depending on the person and how they normally eat CHO around training.
7. If consuming 25g of CHO every 30min. Is it better to mix in both times fructose and glucose, or is it better to be 25g of fructose and 25g of glucose separately.
   1. Both at the same time; Fructose can be malabsorbed but it is dramatically reduced when consumed with glucose. People who malabsorp fructose, when given glucose, have shown significantly more absorption of fructose compared to when not consuming glucose. Ultimately they will get mixed up in the small intestine anyways but to be on the safe side,consume at the same time.
8. Do you think that professional genetic testing can help identify risk of athletes who may have food intolerances that may affect/influence their athletic performance?
   1. A little ways away from food intolerance genetic testing's being reliable; Caffeine genetic testing may be the closest to being somewhat accurate due to more research-confirmed for him from doing a test himself for caffeine; Beyond that, gut issue genetics, not research based and would be a “home-run”
9. Can you comment on the validity and usage of portable breath test devices such as Lumen and Foodmarble?
   1. There is debate about how valid they are due to differences in protocols; Can use it but would not just rely on the result of the test and the appearances of the gases in the breath as in and of itself a diagnosis of specific malabsorption. Would need to go along with subjective measures as well. Good use, but there are debates on how to run the test and reading of the results.
10. How do you suggest managing pain without using NSAIDs for athletes during a competition?
    1. There is some evidence with non-athletes such as mindfulness and deep breathing that activate the parasympathetic nervous system can reduce visceral hypersensitivity and perceptions of pain. This has not been shown with runners yet, but currently doing research. Low risk to try. Working with a sport psychologist may be helpful to address specific techniques. Another issue to address is sleep. If athletes are chronically not getting enough sleeping well, then recovering isn’t optimal. So, address sleep issues.
11. Related to NSAIDs do you find that females have taken more frequently than males....I'm thinking in regards to cramps and then possibly leading to GI distress because of not only NSAIDs, but also hormone fluctuations and cycle issues
    1. At this time there is no research to support that females take NSAID’s anymore than males, but based on the hypothesis/question females do deal with bloating, cramping, and headaches during their menstrual cycle. Therefore, it would make sense that NSAID use could go up. Again, no no research at this time. In general part of the issue is differences in gastrointestinal transit times. Women on average have slower transit times, particularly in the colon. Therefore, that means more time for bacteria to act causing gas and bloating. Constipation is more common in women than men also.  
       
12. What do you think about the difference between self-reported GI complaints during competition vs reported complaints afterwards using questionnaires? 
    1. Challenge when doing studies. Pretty strong correlations from the immediately after and when asked a month later; During the race you could get significantly different responses depending on where they are in the race and how they feel after. Pain relies on memory so it's possible that collecting after vs. during would be different in results
    2. We found very large differences within the same event using these two different ways of collecting GI distress data. We found that self-reported GI complaints were much lower during the race vs afterwards.
13. Can you speak on drinking a large volume of water or eating a meal before a run to help increase transporters in the gut and improve gut training?
    1. Should do this chronically. This is not practical to do with exercise all the time. It is possible to try doing this at rest and then mix in to do during some of the training runs. It’s just not practical or realistic to always expect an athlete to do gut training. 
       

Be sure to check out Dr. Wilson's book The Athlete's Gut at www.theathletesgut.com

any recommendations on how to approach a blanket diagnosis of IBS?