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.