Gastrointestinal distress is common during a 161-km ultramarathon
Abstract
This study examined the incidence, severity, and timing of gastrointestinal (GI) symptoms in finishers and non-finishers of the 161-km Western States Endurance Run. A total of 272 runners (71.0% of starters) completed a post-race questionnaire that assessed the incidence and severity (none = 0, mild = 1, moderate = 2, severe = 3, very severe = 4) of 12 upper (reflux/heartburn, belching, stomach bloating, stomach cramps/pain, nausea, vomiting) and lower (intestinal cramps/pain, flatulence, side ache/stitch, urge to defecate, loose stool/diarrhoea, intestinal bleeding/bloody faeces) GI symptoms experienced during each of four race segments. GI symptoms were experienced by most runners (96.0%). Flatulence (65.9% frequency, mean value 1.0, s = 0.6 severity), belching (61.3% frequency, mean value 1.0, s = 0.6 severity), and nausea (60.3% frequency, mean value 1.0, s = 0.7 severity) were the most common symptoms. Among race finishers, 43.9% reported that GI symptoms affected their race performance, with nausea being the most common symptom (86.0%). Among race non-finishers, 35.6% reported that GI symptoms were a reason for dropping out of the race, with nausea being the most common symptom (90.5%). For both finishers and non-finishers, nausea was greatest during the most challenging and hottest part of the race. GI symptoms are very common during ultramarathon running, and in particular, nausea is the most common complaint for finishers and non-finishers.
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Diarrhea is the GI disease that affects the highest number of endurance athletes, representing 16.4-59% of the total number of registered cases of GI problems.
“The results found highlight diarrhea as the GI disease that affects the highest number of endurance athletes, representing 16.4–59% of the total number of registered cases of GI problems [24,25,30,37,57].”
From Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations (2020) · cites this paper as [30]
A high incidence of GI disorders during physical exercise can be observed among long-distance runners, duathletes and triathletes, cyclists, and athletes who participate in other sports modalities of long duration.
“A high incidence of GI disorders during physical exercise can be observed among long-distance runners [30], duathletes and triathletes [24], cyclists [33,37], and athletes who participate in other sports modalities of long duration [5,25].”
From Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations (2020) · cites this paper as [30]
In that cohort, 44% indicated that GI issues negatively impacted race performance.
“In a large cohort of males and females (n = 272) competing in the Western States Endurance Run (100 mile; 161 km), the majority of athletes (96%) experienced GI symptoms at some point during the race, particularly at the hottest and likely most challenging part of the course, with 44% indicating that GI issues negatively impacted race performance.”
From International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing (2019) · cites this paper as [130]
Nausea was cited as the most common symptom likely to affect race strategy, reported in 60% of athletes.
“Nausea was cited as the most common symptom likely to affect race strategy (reported in 60% of athletes) [130], perhaps due to the subsequent impact on the ability to ingest food and fluid.”
From International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing (2019) · cites this paper as [130]
Values of 70-80% of athletes experiencing GI-related issues during ultra-marathon have been reported.
“A conservative estimate is that 30–50% of athletes experience GI-related issues during ultra-marathon [128], although values of 70–80% have been reported [129, 130].”
From International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing (2019) · cites this paper as [130]
In a cohort of 272 runners in the Western States Endurance Run, 96% experienced GI symptoms at some point during the race.
“In a large cohort of males and females (n = 272) competing in the Western States Endurance Run (100 mile; 161 km), the majority of athletes (96%) experienced GI symptoms at some point during the race, particularly at the hottest and likely most challenging part of the course, with 44% indicating that GI issues negatively impacted race performance.”
From International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing (2019) · cites this paper as [130]
Cites
Noakes, T. D., Sharwood, K. A., Speedy, D. B., Hew, T. D., Reid, S., Dugas, J. P., Almond, C. S. D., WHARAM, P. C., & Weschler, L. B. (2005) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0509096102 · Cited by 330 · see citing works
Nutritional Intake and Gastrointestinal Problems during Competitive Endurance Events
PFEIFFER, B., STELLINGWERFF, T., HODGSON, A. B., RANDELL, R., PÖTTGEN, K., RES, P., & JEUKENDRUP, A. E. (2012) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31822dc809 · Cited by 287 · see citing works
The impact of physical exercise on the gastrointestinal tract
de Oliveira, E. P., & Burini, R. C. (2009) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0b013e32832e6776 · Cited by 225 · see citing works
Factors Related to Successful Completion of a 161-km Ultramarathon
Hoffman, M. D., & Fogard, K. (2011) · International Journal of Sports Physiology and Performance · doi:10.1123/ijspp.6.1.25 · Cited by 208 · see citing works
Self-citationPeters, H. P. F., Bos, M., Seebregts, L., Akkermans, L. M. A., van Berge Henegouwen, G. P., Bol, E., Mosterd, W. L., & de Vries, W. R. (1999) · American Journal of Gastroenterology · doi:10.1111/j.1572-0241.1999.01147.x · Cited by 188 · see citing works
The Western States 100-Mile Endurance Run
Hoffman, M. D., & Wegelin, J. A. (2009) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181a8d553 · Cited by 176 · see citing works
Self-citationGastrointestinal Complaints in Relation to Dietary Intake in Triathletes
Rehrer, N. J., van Kemenade, M., Meester, W., Brouns, F., & Saris, W. H. M. (1992) · International Journal of Sport Nutrition · doi:10.1123/ijsn.2.1.48 · Cited by 153 · see citing works
ter Steege, R. W. F., & Kolkman, J. J. (2012) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2011.04980.x · Cited by 145 · see citing works
Gastrointestinal disturbances in marathon runners.
Riddoch, C., & Trinick, T. (1988) · British Journal of Sports Medicine · doi:10.1136/bjsm.22.2.71 · Cited by 124 · see citing works
Effects of dehydration on gastric emptying and gastrointestinal distress while running
REHRER, N. J., BECKERS, E. J., BROUNS, F., HOOR, F. T., & SARIS, W. H. M. (1990) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-199012000-00010 · Cited by 117 · see citing works
Ter Steege, R. W. F., Van Der Palen, J., & Kolkman, J. J. (2008) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365520802321170 · Cited by 111 · see citing works
Oral salt supplementation during ultradistance exercise
Speedy, D. B., Thompson, J. M. D., Rodgers, I., Collins, M., & Sharwood, K. (2002) · Clinical Journal of Sport Medicine · doi:10.1097/00042752-200209000-00004 · Cited by 104 · see citing works
Physiological changes and gastro-intestinal symptoms as a result of ultra-endurance running
Rehrer, N. J., Brouns, F., Beckers, E. J., Frey, W. O., Villiger, B., Riddoch, C. J., Menheere, P. P. C. A., & Saris, W. H. M. (1992) · European Journal of Applied Physiology and Occupational Physiology · doi:10.1007/bf00376431 · Cited by 101 · see citing works
Fluid Intake and Gastrointestinal Problems in Runners Competing in a 25-km Race and a Marathon*
Rehrer, N. J., Janssen, G., Brouns, F. J. P. H., & Saris, W. H. M. (1989) · International Journal of Sports Medicine · doi:10.1055/s-2007-1024950 · Cited by 100 · see citing works
Food-dependent, exercise-induced gastrointestinal distress
de Oliveira, E. P., & Burini, R. C. (2011) · Journal of the International Society of Sports Nutrition · doi:10.1186/1550-2783-8-12 · Cited by 100 · see citing works
Gastrointestinal symptoms of marathon runners.
Keeffe, E. B., Dk, L., Goss, J. R., & Wayne, R. F. (1984) · PubMed Central · Cited by 98 · see citing works
Glace, B., Murphy, C., & McHugh, M. (2002) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.12.4.414 · Cited by 84 · cited 9× · see citing works
“0% of the runners in this study, which is higher than the 37–85% incidence previously reported at other 161-km ultramarathons (Baska et al., 1990; Glace et al., 2002; Hoffman & Fogard, 2011; Stuempfle et al., 2013).”
BackgroundResultInfluentialGastrointestinal bleeding during an ultramarathon
Baska, R. S., Moses, F. M., Graeber, G., & Kearney, G. (1990) · Digestive Diseases and Sciences · doi:10.1007/bf01536777 · Cited by 81 · see citing works
Association of Gastrointestinal Distress in Ultramarathoners With Race Diet
Stuempfle, K. J., Hoffman, M. D., & Hew-Butler, T. (2013) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.23.2.103 · Cited by 78 · see citing works
Self-citationGastrointestinal Problems in Runners
Simons, S. M., & Kennedy, R. G. (2004) · Current Sports Medicine Reports · doi:10.1249/00149619-200404000-00011 · Cited by 73 · see citing works
Gastroesophageal Reflux in Runners
Kraus, B. B., Sinclair, J. W., & Castell, D. O. (1990) · Annals of Internal Medicine · doi:10.7326/0003-4819-76-3-112-6-429 · Cited by 72 · see citing works
Aetiology of Running-Related Gastrointestinal Dysfunction
Gil, S. M., Yazaki, E. T., & Evans, D. F. (1998) · Sports Medicine · doi:10.2165/00007256-199826060-00001 · Cited by 71 · see citing works
Gastrointestinal disturbances in marathon runners.
Halvorsen, F.-A., Lyng, J., Glomsaker, T. B., & Ritland, S. (1990) · British Journal of Sports Medicine · doi:10.1136/bjsm.24.4.266 · Cited by 44 · see citing works
Deibert, P., Koenig, D., Dickhuth, H., & Berg, A. (2005) · International sportmed journal for FIMS · Cited by 3 · see citing works
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Cited by
Sorted by citations
Costa, R. J. S., Snipe, R. M. J., Kitic, C. M., & Gibson, P. R. (2017) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.14157 · Cited by 426 · see citing works
Physiology and Pathophysiology in Ultra-Marathon Running
Knechtle, B., & Nikolaidis, P. Τ. (2018) · Frontiers in Physiology · doi:10.3389/fphys.2018.00634 · Cited by 329 · see citing works
Tiller, N. B., Roberts, J. D., Beasley, L., Chapman, S., Pinto, J. M., Smith, L., Wiffin, M., Russell, M., Sparks, S. A., Duckworth, L., et al. (2019) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-019-0312-9 · Cited by 164 · see citing works
Costa, R. J. S., Miall, A., Khoo, A., Rauch, C., Snipe, R., Camões-Costa, V., & Gibson, P. (2017) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2016-0453 · Cited by 162 · see citing works
Snipe, R. M. J., Khoo, A., Kitic, C. M., Gibson, P. R., & Costa, R. J. S. (2017) · European Journal of Applied Physiology · doi:10.1007/s00421-017-3781-z · Cited by 144 · see citing works
Snipe, R. M. J., Khoo, A., Kitic, C. M., Gibson, P. R., & Costa, R. J. S. (2017) · Applied Physiology Nutrition and Metabolism · doi:10.1139/apnm-2017-0361 · Cited by 117 · see citing works
Do Sex Differences in Physiology Confer a Female Advantage in Ultra-Endurance Sport?
Tiller, N. B., Elliott-Sale, K. J., Knechtle, B., Wilson, P. B., Roberts, J., & Millet, G. Y. (2021) · Sports Medicine · doi:10.1007/s40279-020-01417-2 · Cited by 114 · see citing works
Costa, R. J. S., Snipe, R. M. J., Camões‐Costa, V., Scheer, V., & Murray, A. M. (2016) · Sports Medicine - Open · doi:10.1186/s40798-015-0041-9 · Cited by 114 · see citing works
Potential Long-Term Health Problems Associated with Ultra-Endurance Running: A Narrative Review
Scheer, V., Tiller, N. B., Doutreleau, S., Khodaee, M., Knechtle, B., Pasternak, A. V., & Rojas‐Valverde, D. (2021) · Sports Medicine · doi:10.1007/s40279-021-01561-3 · Cited by 118 · see citing works
Costa, R. J. S., Gaskell, S. K., McCubbin, A. J., & Snipe, R. M. J. (2019) · Temperature · doi:10.1080/23328940.2019.1597676 · Cited by 101 · see citing works
Roberts, J., Suckling, C., Peedle, G., Murphy, J., Dawkins, T., & Roberts, M. (2016) · Nutrients · doi:10.3390/nu8110733 · Cited by 99 · see citing works
Gaskell, S., Snipe, R., & Costa, R. (2019) · International Journal of Sport Nutrition & Exercise Metabolism · doi:10.1123/ijsnem.2018-0215 · Cited by 99 · see citing works
The psychology of ultra-marathon runners: A systematic review
Roebuck, G. S., Fitzgerald, P. B., Urquhart, D. M., Ng, S. K., Cicuttini, F., & Fitzgibbon, B. M. (2018) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2018.04.004 · Cited by 88 · see citing works
Costa, R. J. S., Camões‐Costa, V., Snipe, R. M. J., Dixon, D. J., Russo, I., & Huschtscha, Z. (2019) · Journal of Applied Physiology · doi:10.1152/japplphysiol.01032.2018 · Cited by 85 · see citing works
Snipe, R. M. J., Khoo, A., Kitic, C. M., Gibson, P., & Costa, R. J. S. (2018) · International Journal of Sports Medicine · doi:10.1055/s-0043-122742 · Cited by 84 · see citing works
Considerations for ultra-endurance activities: part 1- nutrition
Costa, R. J. S., Hoffman, M. D., & Stellingwerff, T. (2019) · Research in Sports Medicine · doi:10.1080/15438627.2018.1502188 · Cited by 83 · see citing works
Self-citationConsiderations for ultra-endurance activities: part 2 – hydration
Hoffman, M. D., Stellingwerff, T., & Costa, R. J. S. (2018) · Research in Sports Medicine · doi:10.1080/15438627.2018.1502189 · Cited by 83 · see citing works
Self-citationThe Athlete Gut Microbiome and its Relevance to Health and Performance: A Review
O’Brien, M., O’Sullivan, Ó., Claesson, M. J., & Cotter, P. D. (2022) · Sports Medicine · doi:10.1007/s40279-022-01785-x · Cited by 82 · see citing works
Miall, A., Khoo, A., Rauch, C., Snipe, R. M. J., Camões‐Costa, V., Gibson, P. R., & Costa, R. J. S. (2017) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.12912 · Cited by 78 · see citing works
Pugh, J. N., Impey, S. G., Doran, D. A., Fleming, S. C., Morton, J. P., & Close, G. L. (2017) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2016-0646 · Cited by 70 · see citing works
Gaskell, S. K., Taylor, B., Muir, J. G., & Costa, R. J. S. (2019) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2019-0187 · Cited by 70 · see citing works
Epidemiology of Injury and Illness Among Trail Runners: A Systematic Review
Viljoen, C. T., van Rensburg, D. C. J., Verhagen, E. A. L. M., van Mechelen, W., Tomás, R., Schoeman, M., Scheepers, S., & Korkie, E. (2021) · Sports Medicine · doi:10.1007/s40279-020-01418-1 · Cited by 58 · see citing works
Costa, R. J. S., Young, P., Gill, S. K., Snipe, R. M. J., Gaskell, S. K., Russo, I., & Burke, L. M. (2022) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2022-0048 · Cited by 56 · see citing works
Limits of Ultra: Towards an Interdisciplinary Understanding of Ultra-Endurance Running Performance
BERGER, N. J. A., Best, R., Best, A. W., Lane, A. M., Millet, G. Y., Barwood, M. J., Marcora, S., Wilson, P. B., & Bearden, S. E. (2023) · Sports Medicine · doi:10.1007/s40279-023-01936-8 · Cited by 59 · see citing works
Nutritional implications for ultra-endurance walking and running events
Williamson, E. (2016) · Extreme Physiology & Medicine · doi:10.1186/s13728-016-0054-0 · Cited by 53 · see citing works
“Endeavoring to prevent GIS is important as it is one of the most common cited reasons for inadequate intake during events [176, 177] and is positively correlated with increasing duration [178].”
BackgroundSnipe, R. M. J., & Costa, R. J. S. (2018) · Journal of Sports Sciences · doi:10.1080/02640414.2018.1478612 · Cited by 46 · see citing works
Lis, D. M. (2019) · Sports Medicine · doi:10.1007/s40279-018-01034-0 · Cited by 45 · see citing works
Pugh, J. N., Kirk, B., Fearn, R. I., Morton, J. P., & Close, G. L. (2018) · Nutrients · doi:10.3390/nu10070811 · Cited by 43 · see citing works
Dietary restrictions in endurance runners to mitigate exercise-induced gastrointestinal symptoms
Parnell, J. A., Wagner–Jones, K., Madden, R. F., & Erdman, K. A. (2020) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-020-00361-w · Cited by 42 · see citing works
Nausea is associated with endotoxemia during a 161-km ultramarathon
Stuempfle, K. J., Valentino, T., Hew-Butler, T., Hecht, F. M., & Hoffman, M. D. (2016) · Journal of Sports Sciences · doi:10.1080/02640414.2015.1130238 · Cited by 41 · see citing works
Self-citationSmith, K. A., Pugh, J. N., Duca, F. A., Close, G. L., & Ormsbee, M. J. (2021) · European Journal of Applied Physiology · doi:10.1007/s00421-021-04737-x · Cited by 41 · see citing works
Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons
Krabak, B. J., Lipman, G. S., Waite, B. L., & Rundell, S. D. (2017) · Wilderness and Environmental Medicine · doi:10.1016/j.wem.2017.05.008 · Cited by 38 · see citing works
Perceived life stress and anxiety correlate with chronic gastrointestinal symptoms in runners
Wilson, P. B. (2017) · Journal of Sports Sciences · doi:10.1080/02640414.2017.1411175 · Cited by 39 · see citing works
Analysis of food and fluid intake in elite ultra-endurance runners during a 24-h world championship
Lavoué, C., Siracusa, J., Chalchat, É., Bourrilhon, C., & Charlot, K. (2020) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-020-00364-7 · Cited by 39 · see citing works
(2017) · doi:10.1097/mog.0000000000000322 · Cited by 36 · see citing works
Real-Time Observations of Food and Fluid Timing During a 120 km Ultramarathon
Wardenaar, F. C., Hoogervorst, D., Versteegen, J. J., van der Burg, N., Lambrechtse, K. J., & Bongers, C. C. W. G. (2018) · Frontiers in Nutrition · doi:10.3389/fnut.2018.00032 · Cited by 34 · see citing works
Injuries and Health Considerations in Ultramarathon Runners
Hoffman, M. D. (2015) · Physical Medicine and Rehabilitation Clinics of North America · doi:10.1016/j.pmr.2015.08.004 · Cited by 33 · see citing works
Self-citationAlcock, R., McCubbin, A. J., Camões‐Costa, V., & Costa, R. J. S. (2018) · Wilderness and Environmental Medicine · doi:10.1016/j.wem.2018.06.004 · Cited by 33 · see citing works
Heat Stress Challenges in Marathon vs. Ultra-Endurance Running
Bouscaren, N., Millet, G. Y., & Racinais, S. (2019) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2019.00059 · Cited by 33 · see citing works
Nutritional considerations to counteract gastrointestinal permeability during exertional heat stress
King, M. A., Rollo, I., & Baker, L. B. (2021) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00072.2021 · Cited by 32 · see citing works
Ultra-Endurance Participation and Acute Kidney Injury: A Narrative Review
Tidmas, V., Brazier, J., Bottoms, L. M., Muniz‐Pumares, D., Desai, T., Hawkins, J., Sridharan, S., & Farrington, K. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192416887 · Cited by 33 · see citing works
Dietary Strategies to Improve Exercise Performance by Modulating the Gut Microbiota
Zhang, L., Li, H., Song, Z., Liu, Y., & Zhang, X. (2024) · Foods · doi:10.3390/foods13111680 · Cited by 33 · see citing works
Wiffin, M., Smith, L., Antonio, J., Johnstone, J., Beasley, L., & Roberts, J. (2019) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-019-0268-9 · Cited by 27 · see citing works
Costa, R. J. S., Gaskell, S. K., Henningsen, K., JEACOCKE, N. A., Martinez, I. G., Mika, A. S., Scheer, V., Scrivin, R., Snipe, R. M. J., Wallett, A. M., et al. (2025) · Sports Medicine · doi:10.1007/s40279-025-02186-6 · Cited by 31 · see citing works
Current Trends in Ultramarathon Running
Spittler, J., & Oberle, L. (2019) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000654 · Cited by 26 · see citing works
Martínez-Sanz, J. M., Fernández Nuñez, A., Sospedra, I., Martínez-Rodríguez, A., Domínguez, R., González-Jurado, J. A., & Sánchez-Oliver, A. J. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17114082 · Cited by 25 · see citing works
Lhee, S.-H., Jain, R., Sadasivam, M. M., Kim, S., Bae, M., Yu, J., & Lee, D. Y. (2021) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2019-000689 · Cited by 24 · see citing works
Hoffman, M. D., Stuempfle, K. J., & Valentino, T. R. (2015) · Sports Medicine - Open · doi:10.1186/s40798-015-0040-x · Cited by 23 · see citing works
Self-citationMartinez, I. G., Mika, A. S., Biesiekierski, J. R., & Costa, R. J. S. (2023) · Sports Medicine · doi:10.1007/s40279-023-01841-0 · Cited by 29 · see citing works
The influence of exercise intensity and exercise mode on gastrointestinal damage
Edwards, K. H., Ahuja, K., Watson, G., Dowling, C., Musgrave, H., Reyes, J., Cherry, J., & Kitic, C. M. (2021) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2020-0883 · Cited by 23 · see citing works
Factors influencing ultra-endurance athletes food choices: an adapted food choice questionnaire
Blennerhassett, C., McNaughton, L. R., & Sparks, S. A. (2019) · Research in Sports Medicine · doi:10.1080/15438627.2018.1530999 · Cited by 21 · see citing works
Exercise Is Medicine? The Cardiorespiratory Implications of Ultra-marathon
Tiller, N. B., Stewart, G. M., Illidi, C. R., & Levine, B. D. (2020) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000738 · Cited by 22 · see citing works
Scrivin, R., Costa, R. J. S., Pelly, F. E., Lis, D. M., & Slater, G. (2021) · Nutrition & Dietetics · doi:10.1111/1747-0080.12674 · Cited by 20 · see citing works
The gut mucin-microbiota interactions: a missing key to optimizing endurance performance
Clark, A. P., & Mach, N. (2023) · Frontiers in Physiology · doi:10.3389/fphys.2023.1284423 · Cited by 20 · see citing works
Scrivin, R., Costa, R. J. S., Pelly, F. E., Lis, D. M., & Slater, G. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.1003445 · Cited by 19 · see citing works
Occurrence and Impacts of Gastrointestinal Symptoms in Team-Sport Athletes: A Preliminary Survey
Wilson, P. B., Fearn, R. I., & Pugh, J. N. (2022) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0000000000001113 · Cited by 17 · see citing works
The Role of the Gut Microbiome and Probiotics in Sports Performance: A Narrative Review Update
Jarrett, H., Medlin, S., & Morehen, J. C. (2025) · Nutrients · doi:10.3390/nu17040690 · Cited by 17 · see citing works
Irritable bowel syndrome is underdiagnosed and ineffectively managed among endurance athletes
Killian, L. A., & Lee, S. (2019) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2019-0261 · Cited by 18 · see citing works
Emotional intelligence and mood states impact on the stress response to a treadmill ultramarathon
Howe, C. C. F., Pummell, E. K. L., Pang, S., Spendiff, O., & Moir, H. J. (2019) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2019.02.008 · Cited by 15 · see citing works
Urwin, C. S., Main, L. C., Mikocka‐Walus, A. A., Skvarc, D., Roberts, S., Condo, D., Carr, A. J., Convit, L., Jardine, W. T., Rahman, S. S., et al. (2021) · Sports Medicine - Open · doi:10.1186/s40798-021-00389-5 · Cited by 18 · see citing works
Rowlatt, G., Bottoms, L. M., Edmonds, C. J., & Buscombe, R. M. (2016) · European Journal of Sport Science · doi:10.1080/17461391.2016.1251497 · Cited by 17 · see citing works
Proper Hydration During Ultra-endurance Activities
Hoffman, M. D. (2018) · Sports Medicine and Arthroscopy Review · doi:10.1097/jsa.0000000000000229 · Cited by 15 · see citing works
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Knechtle, B., Bragazzi, N. L., Rosemann, T. J., & Rüst, C. A. (2015) · SpringerPlus · doi:10.1186/s40064-015-1445-1 · Cited by 13 · see citing works
Nutritional behaviour and beliefs of ski-mountaineers: a semi-quantitative and qualitative study
Praz, C., Granges, M., Burtin, C., & Kayser, B. (2015) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-015-0108-5 · Cited by 13 · see citing works
Four Cases of Acute Kidney Injury Requiring Dialysis in Ultramarathoners
Pasternak, A. V., Newkirk-Thompson, C., Howard, J. H., Onate, J., & Hew‐Butler, T. (2023) · Wilderness and Environmental Medicine · doi:10.1016/j.wem.2022.12.004 · Cited by 12 · see citing works
Eating habits and nutritional knowledge among amateur ultrarunners
Kosendiak, A. A., Król, M., Ligocka, M., & Kepinská, M. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1137412 · Cited by 12 · see citing works
Gao, C., Wei, J., Lu, C., Wang, L., Dong, D. F., & Sun, M. (2024) · Gut Microbes · doi:10.1080/19490976.2024.2404141 · Cited by 10 · see citing works
Does oral buffered sodium supplementation reduce nausea and vomiting during an ultramarathon?
Hoffman, M. D., & Stuempfle, K. J. (2016) · Research in Sports Medicine · doi:10.1080/15438627.2015.1126278 · Cited by 10 · see citing works
Self-citationBoerhaave’s syndrome in an ultra-distance runner
Pasternak, A. V., Ellero, J., Maxwell, S. J., & Cheung, V. (2019) · BMJ Case Reports · doi:10.1136/bcr-2019-230343 · Cited by 9 · see citing works
Carbohydrate intake and ketosis in self-sufficient multi-stage ultramarathon runners
Edwards, K. H., Elliott, B., & Kitic, C. M. (2019) · Journal of Sports Sciences · doi:10.1080/02640414.2019.1702269 · Cited by 9 · see citing works
Medical Coverage of Ultramarathons and Its Unique Challenges
Larson, H. H., Khalili-Borna, D., Uzosike, E., & Sugiyama, D. (2016) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000267 · Cited by 9 · see citing works
Gastrointestinal considerations related to youth sports and the young athlete
Koon, G., Atay, O. K., & Lapsia, S. P. (2017) · Translational Pediatrics · doi:10.21037/tp.2017.03.10 · Cited by 9 · see citing works
Hou, P., Wang, D., Lang, H., Yao, Y., Zhou, J., Zhou, M., Zhu, J., Yi, L., & Mi, M. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms24010221 · Cited by 8 · see citing works
Best, R., Maulder, P. S., & BERGER, N. J. A. (2021) · Beverages · doi:10.3390/beverages7010009 · Cited by 7 · see citing works
Intestinal adaptations to a combination of different diets with and without endurance exercise
Daniels, J., Bloomer, R. J., van der Merwe, M., Davis, S. L., Buddington, K. K., & Buddington, R. K. (2016) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-016-0147-6 · Cited by 8 · see citing works
Optimal pacing and carbohydrate intake strategies for ultramarathons
Pruitt, K. A., & Hill, J. M. (2017) · European Journal of Applied Physiology · doi:10.1007/s00421-017-3741-7 · Cited by 8 · see citing works
Parnell, J. A., Lafave, H. C., Wagner–Jones, K., Madden, R. F., & Erdman, K. A. (2019) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-019-0278-7 · Cited by 8 · see citing works
Wardenaar, F. C., Hoogervorst, D., van der Burg, N., Versteegen, J. J., Yoo, W., & Tasevska, N. (2019) · Nutrients · doi:10.3390/nu11102391 · Cited by 8 · see citing works
Morton, J. P., Fell, J. M., Gonzalez, J. T., Hearris, M. A., Podlogar, T., Pugh, J. N., & Wallis, G. A. (2026) · Journal of Nutrition · doi:10.1016/j.tjnut.2026.101442 · Cited by 9 · see citing works
Sutehall, S., Muñiz-Pardos, B., Bosch, A. N., Galloway, S. D. R., & Pitsiladis, Y. P. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2021.810041 · Cited by 7 · see citing works
Aitkenhead, R., Waldron, M., Conway, G. E., Horner, K. M., & Heffernan, S. M. (2025) · Nutrients · doi:10.3390/nu17030443 · Cited by 7 · see citing works
Jiménez-Alfageme, R., Garrone, F. P., Rodríguez-Sánchez, N., Romero-García, D., Sospedra, I., Giménez-Monzó, D., Ayala-Guzmán, C. I., & Sanz, J. M. M. (2025) · Sports Medicine - Open · doi:10.1186/s40798-024-00801-w · Cited by 10 · see citing works
Buddington, R. K., Wong, T., & Howard, S. C. (2021) · Medical Sciences · doi:10.3390/medsci9010009 · Cited by 6 · see citing works
Pacing in ultra-marathon running: the Western States 100-mile endurance run 2006–2023
Marković, S., Čuk, I., Nikolaidis, P. Τ., Weiss, K., Rosemann, T. J., Scheer, V., Thuany, M., & Knechtle, B. (2025) · Scientific Reports · doi:10.1038/s41598-025-92141-2 · Cited by 5 · see citing works
Zhao, X., Chen, Y., Li, X., Wen, W., Zhang, J., & Qiu, J. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1589344 · Cited by 5 · see citing works
Vargas, A., Mosquera, J. C. G., & Arroyo, J. A. M. (2023) · Nutrients · doi:10.3390/nu15092069 · Cited by 7 · see citing works
Are the Dietary–Nutritional Recommendations Met? Analysis of Intake in Endurance Competitions
Jiménez-Alfageme, R., Álvarez, J., Garbisu-Hualde, A., Romero-García, D., Giménez-Monzó, D., Sospedra, I., Ausó, E., & Sanz, J. M. M. (2024) · Nutrients · doi:10.3390/nu16020189 · Cited by 4 · see citing works
Ehlert, A., & Wilson, P. B. (2021) · British Journal of Pain · doi:10.1177/20494637211028265 · Cited by 4 · see citing works
Incidence of Hyponatremia in Critically Ill Patients in Intensive Care Unit: Observational Study
Patil, S., Mukherji, A., & Shetty, A. (2016) · International Journal of Dental and Medical Specialty · doi:10.5958/2394-4196.2016.00004.2 · Cited by 4 · see citing works
Wie ungesund ist ein Ultramarathon?
Knechtle, B., & Nikolaidis, P. Τ. (2018) · Praxis · doi:10.1024/1661-8157/a002943 · Cited by 4 · see citing works
Zha, Y., Xiang, M., Zuo, Y., Liu, D.-S., & Wang, Q. (2025) · International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition · doi:10.31083/ijvnr37069 · Cited by 3 · see citing works
John, L., Munk, M., Bizjak, R., Schulz, S. V. W., Witzel, J., Engler, H., Siebers, C., Siebers, M., Kirsten, J., Grau, M., et al. (2025) · Nutrients · doi:10.3390/nu17233801 · Cited by 4 · see citing works
Guertin, P. A. (2025) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk10010033 · Cited by 3 · see citing works
Lin, Z., Hou, P., Jing, J., Zhou, M., Wang, L., Wu, L., Zhu, J., Yi, L., & Mi, M. (2023) · Nutrients · doi:10.3390/nu15092036 · Cited by 3 · see citing works
PILLAY, S., Schwellnus, M. P., GRANT, C., RENSBURG, A. J. V., SWANEVELDER, S., & JORDAAN, E. (2022) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.21.12072-9 · Cited by 3 · see citing works
Moncelon, L., Millet, G. Y., Poletti, L., Féasson, L., & Édouard, P. (2020) · Journal de Traumatologie du Sport · doi:10.1016/j.jts.2020.10.007 · Cited by 3 · see citing works
Menthol mouth swilling and endurance running performance in the heat
Best, R. J. (2020) · Wintec Research Archive (Waikato Institute of Technology) · Cited by 3 · see citing works
Trail Running Safety: A Review of Serious Adverse Events Reported in Online News Articles
Viljoen, C. T., da Cruz, M., Matlala, K., Groves, M., du Toit, K., Fourie, L., Silva, B., Scheer, V., MacMillan, C., & van Rensburg, D. C. J. (2025) · Wilderness and Environmental Medicine · doi:10.1177/10806032251338703 · Cited by 3 · see citing works
Knechtle, B., Scheer, V., Nikolaidis, P. Τ., Thuany, M., Chlíbková, D., Forte, P. M., Leite, L. B., Weiss, K., Rosemann, T. J., & Đurić, S. (2026) · Frontiers in Physiology · doi:10.3389/fphys.2026.1811456 · Cited by 2 · see citing works
Mougin, L., Stennett, R., Ely, B. R., Taylor, L., Adams, W. M., Blagrove, R. C., Longman, D. P., & Mears, S. A. (2026) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2026.05.014 · Cited by 2 · see citing works
- Authors
- Stuempfle, K. J., & Hoffman, M. D.
- Affiliations
- Gettysburg College (US)
- University of California Davis Medical Center (US)
- Corresponding author
- Stuempfle, Kristin Jean
- ORCID
- Hoffman, Martin Dean
- Venue
- Journal of Sports Sciences
- Publisher
- Informa UK Limited
- Published
- 2015-02-26
- Volume
- 33
- Issue
- 17
- Pages
- 1814-1821
- ISSN
- 0264-0414 (ISSN-L)
- 1466-447X
- OpenAlex
- W2036018519
- Cited by
- 137
- References
- 24
- Citations by year
- 2026: 9 · 2025: 18 · 2024: 7 · 2023: 10 · 2022: 13 · 2021: 16 · 2020: 8 · 2019: 17 · 2018: 13 · 2017: 10 · 2016: 11 · 2015: 5
- FWCI
- 9.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Sports Sciences (publishedVersion)
- PubMed (publishedVersion)
- The Cupola: Scholarship at Gettysburg College (Gettysburg College) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Rehabilitation › Exercise and Physiological Responses
- Keywords
- gastrointestinal symptoms, ultramarathon, nausea, flatulence, belching, diarrhea, race performance, heat exposure, endurance running
- MeSH terms
- Adult, Eructation, Female, Flatulence, Gastrointestinal Diseases, Humans, Male, Middle Aged, Nausea, Physical Endurance, Running
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