Krupali Shah

Sports Nutritionist, Weight Management Counselor and Health Blogger

IMPACT OF EXERCISE ON GASTROINTESTINAL TRACT

http://sportsnutritionist.seotogrow.in

INTRODUCTION

Exercise is beneficial :

HOW????

strengthens muscles and

keeps cardiovascular system

healthy.

But can also turn

FATAL !!!!

BECAUSE:While exercising

1) 80 percent of blood

2) Physical exercise

leads to gastrointestinal distress

mainly when it is vigorous a

and practiced in a hot environment

without adequate training and/

or proper hydration.

PATHOPHYSIOLOGY

The major pathophysiological mechanisms are related to:

PATHOPHYSIOLOGY

Ischemic Factors

Mechanic Factors

Neuro-Endocrine Factors

STRENOUS EXERCISES

ENDURANCE EXERCISES

Reduce GI blood flow,

making it susceptible to

ischemic injury.

Increased mucosa

permeability, hence greater

blood loss.

Translocation of micro biota

and generation of

endotoxins

Higher water loss by

sweating

Pre-competition release of

catecholamine's suppresses

thirst.

ISCHEMIC FACTORS

MECHANIC FACTORS

The enhanced intra-abdominal pressure as seen in sports such as American football, weightlifting and cycling increases the pressure gradient between the stomach and oesophagus.

The increased vibration of the abdominal wall and bouncing of the organs are common causes of gastrointestinal distress in runners.

NEURO-ENDOCRINE FACTORS

The stress hormones secretion by vigorous exercise stimulus leads to negative energy balance

Vigorous exercise has been found to suppress hunger acutely, a phenomenon described as ‘exercise-induced anorexia’.

Exercise stress stimulates hypothalamus–pituitary–adrenal axis leading to an increased secretion of immunosuppressive hormones. One of these hormones, cortisol, is consistent with the increased susceptibility to URTI by athletes

SIGNS AND SYMPTOMS

SIGNS AND SYMPTOMS

HEARTBURN

VOMITTING CHEST PAIN

CONSTIPATION ABDOMINAL

CRAMPSDIARRHOEA

GERD IMMUNE DEFICIENCY

GASTROINTESTINAL BLEEDING

REDUCED APPETITE

MOST COMMON !!

COMPLICATIONS

GERD

IRRITABLE BOWEL DISEASE

DIARRHOEA

GASTROINTESTINAL BLEEDING

EXERCISE INDUCED ANOREXIA

DIAGNOSIS FOR GERD Barium swallow radiograph: uses X-rays to

help spot abnormalities such as a hiatal hernia and other structural or anatomical problems of the oesophagus

Upper endoscopy: flexible plastic tube with a light and lens on the end called an endoscope would be put down the athlete’s throat. Acting as a tiny camera, the endoscope allows the doctor to see the surface of the oesophagus and search for abnormalities

Manometry : determines how well the oesophagus contracts.

DIAGNOSIS FOR IRRITABLE BOWEL SYNDROME physical exam and complete medical history blood test stool test, lower GI series, and flexible

sigmoidoscopy or colonoscopy.

DIAGNOSIS FOR DIARRHOEA Blood test Stool test Endoscopy Radiography

DIAGNOSIS FOR GI BLEEDING Endoscopy

NUTRITION CARE PROCESS

NUTRITION ASSESSMENT

1) HOW MUCH IS THE FOOD INTAKE THROUGHOUT THE DAY/ NUMBER OF MEALS HELP IN FINDING CALORIES CONSUMED. HELP IN FINDING OUT IF THERE IS AVAILABILITY OF FOOD HELP IN FINDING OUT THE NUTRITIONAL DEFICIENCIES HELP IN FINDING OUT IF PRE AND POST EVENT MEALS ARE

APPROPRIATE FOR HIS/HER KIND OF SPORT AND IS MEETING THE NEEDS OF THE BODY OR NOT.

2) PHYSICAL APPEARANCEHELP IN FINDING OUT DEFICIENCIES AND GENERAL WEAKNESSES.

3) BIOCHEMICAL PARAMETERS BLOOD, URINE, STOOL ARE ACCURATE PARAMETERS IN

ORDER TO DETERMINE THE SEVERITY OF THE DISEASE.

4) ANTHROPOMETRIC DATA HELP IN DETERMINING BODY FAT LEVELS, MUSCLE MASS,

HYDRATION LEVELS, BONE MASS, HEIGHT, WEIGHT, BMI WHICH PLAY AN IMPORTANT ROLE IN DETERMINING THE FITNESS OF AN ATHLETE FOR THAT PARTICULAR SPORT.

5) CLIENT/ ATHLETE HISTORY MEDICAL HISTORY PERSONAL HISTORY DRUG HISTORY SUPPLEMENT HISTORY

TREATMENT

IRRITABLE BOWEL SYNDROME

• AVOIDING POST PRANDIAL EXERCISE AND EXCESSIVE

CONSUMPTION OF FOODS THAT RELAX LOWER OESOPHAGEAL

SPHINCTER, INCLUDING CHOCOLATE, PEPPERMINT, ONIONS,

HIGH-FAT FOODS, ALCOHOL, TOBACCO, COFFEE AND CITRUS

PRODUCTS

• CHANGING POST-MEAL BEHAVIOUR

• CONSUMPTION OF SMALL MEALS DURING THE DAY

• STRESS REDUCTION

• AVOIDING FOODS CONTAINING LACTOSE AND CANDIES

CONTAINING SORBITOL.

GERD

TREATMENT

DIARRHOEA

• ELECTROLYTE SOLUTION TO REPLACE LOST FLUIDS.

• USE OF BULKING AGENTS.

• OPIODS THAT ACT ON INTESTINAL OPIOD RECPTORS, WHICH WHEN

ACTIVATED CAUSES CONSTIPATION.

• PROBIOTIC USE CAN ENHANCE THE SPECIFIC MUCOSAL IMMUNE

IMMUNOGLOBULIN.

• DIET : BARLEY, BANANA, CURD, RICE, POTATOES MAY LESSEN

DIARRHOEA WHEREAS CAFFEINE CONTAINING BEVERAGES, FRIED

FOODS AND FOOD RICH IN FIBRE MAY WORSEN DIARRHOEA.

TREATMENT cont.…..

TREATMENT contd..

DRUGS

LAXATIVES

BULKING AGENTS

ANTISPASMODICS

ANTI-DIARRHOEAL

PROTON PUMP INHIBITORS

OMEPRAZOLE

VERY ESSENTIAL IS TO MAINTAIN APPROPRIATE HYDRATION LEVELS !!!!

RECOMMENDED???

150-250 ml every 15-20 minutes during event.Approximately 400-500 ml two-three hours before EVENT to prevent gastric problems.

INVESTIGATIONSExercise and gastrointestinal function and disease: an evidence-based review of risks and benefits (Bi L, Triadafilopoulos G, 2003)

Light and moderate exercise is well tolerated and can benefit patients

with inflammatory bowel disease and liver disease.

Physical activity can also improve gastric emptying and lower the

relative risk of colon cancer in most populations.

Severe, exhaustive exercise, however, inhibits gastric emptying,

interferes with gastrointestinal absorption, and causes many

gastrointestinal symptoms, most notably gastrointestinal bleeding.

Gastrointestinal symptoms in long-distance runners, cyclists, and triathletes: prevalence, medication, and etiology (Peters HP et al, 1999)

Runners experienced more lower than upper GI symptoms during

exercise.

Cyclists experienced both upper and lower GI symptoms.

Triathletes experienced during cycling both upper and lower symptoms,

and during running more lower than upper symptoms. Bloating,

diarrhoea, and flatulence occurred more at rest than during exercise

among all subjects.

In general, exercise-related GI symptoms were significantly related to

the occurrence of GI symptoms during non-exercise periods, age,

gender, diet, and years of training.

The prevalence of medication for exercise-related GI symptoms was 5%,

6%, and 3% for runners, cyclists, and triathletes, respectively.