Food and Fluid Intake and Disturbances in Gastrointestinal and Mental Function during an Ultramarathon
Abstract
The purpose of this study was to document eating strategies employed by runners during a 160-km race, and to identify eating patterns that predispose the runner to disturbed mental or gastrointestinal functioning. We monitored intake in 19 volunteers during the 12 hours pre-race. Intake was determined by interview with runners approximately every 12 km throughout the race. The mean finish time was 24.3 hours, with 4 runners not completing the race. Body mass decreased during the race, 75.9 ± 2.3 kg to 74.4 ± 2.2 kg (p < .001). Runners ingested 2643 kcals during the 12 hours prerace (68% carbohydrate) and 3.8 L of fluid. During the race 6047 kcal, 18 L of fluid, and 12 g of sodium were consumed. Gastrointestinal distress (GI) was experienced by half of the participants, but was unrelated to food or fluid intake. Upper GI symptoms were more prevalent than lower and occurred mainly after 88 km. Runners with GI distress tended to complete fewer training miles (p = .10) and to do shorter training runs (p = .08). Half of the volunteers reported mental status changes (MSC), such as confusion or dizziness. Runners with MSC had greater intake of total calories, carbohydrate, and fluid (p < .05) than runners without MSC. They also completed shorter training runs (p = .03). Caloric and moisture intake for all runners far exceeded intakes described previously. Although intake did not match energy expenditure, it may represent the upper limit for absorption during exercise, and very high food and/or fluid intake appears to lead to perturbed mental status.
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There are several reports of runners complaining of the unpalatability of sweet foods, particularly energy gels and sports drinks, both in the heat and in ultra-marathons >60 miles contested in thermoneutral environments.
“There are several reports of runners complaining of the unpalatability of sweet foods, particularly energy gels and sports drinks, both in the heat [114] and in ultra-marathons > 60 miles contested in thermoneutral environments [115, 116].”
From International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing (2019) · cites this paper as [115]
Runners experiencing upper-GI discomfort were reported to have a greater energy and CHO intake than runners not experiencing symptoms.
“Runners experiencing upper-GI discomfort were reported to have a greater energy and CHO intake than runners not experiencing symptoms [115].”
From International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing (2019) · cites this paper as [115]
Upper GI-tract related issues are more common in longer races compared with lower GI-tract complaints.
“The type, duration, and severity of symptoms vary on an individual basis, with upper GI-tract related issues (e.g., nausea, vomiting, heartburn) more common in longer races compared with complaints relating to the lower GI-tract (e.g., bloating, diarrhea) [115].”
From International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing (2019) · cites this paper as [115]
The type, duration, and severity of GI symptoms vary on an individual basis.
“The type, duration, and severity of symptoms vary on an individual basis, with upper GI-tract related issues (e.g., nausea, vomiting, heartburn) more common in longer races compared with complaints relating to the lower GI-tract (e.g., bloating, diarrhea) [115].”
From International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing (2019) · cites this paper as [115]
Cites
(2014) · Medical Entomology and Zoology · Cited by 9,400 · see citing works
Generalized equations for predicting body density of men
Jackson, A. S., & Pollock, M. L. (1978) · British Journal Of Nutrition · doi:10.1079/bjn19780152 · Cited by 3,205 · see citing works
Generalized equations for predicting body density of women
Jackson, A. S., Pollock, M. L., & Ward, A. (1980) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-198023000-00009 · Cited by 1,853 · see citing works
Muscle glycogen utilization during prolonged strenuous exercise when fed carbohydrate
Coyle, E. F., Coggan, A. R., Hemmert, M. K., & Ivy, J. L. (1986) · Journal of Applied Physiology · doi:10.1152/jappl.1986.61.1.165 · Cited by 1,022 · see citing works
Hyponatremia in ultradistance triathletes
Speedy, D. B., Noakes, T. D., Rogers, I. R., Thompson, J., Campbell, R. G., Kuttner, J. A., Boswell, D. R., Wright, S. P., & HAMLIN, M. (1999) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199906000-00008 · Cited by 283 · see citing works
Endotoxaemia in exhausted runners after a long-distance race.
Brock‐Utne, J. G., Gaffin, S. L., Mt, W., Gathiram, P., SOHAR, E., Mf, J., Df, M., & Norman, R. J. (1988) · PubMed · Cited by 175 · see citing works
SYMPTOMS OF HYPOGLYCEMIA, THRESHOLDS FOR THEIR OCCURRENCE, AND HYPOGLYCEMIA UNAWARENESS
Cryer, P. E. (1999) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(05)70084-0 · Cited by 159 · see citing works
Is the Gut an Athletic Organ?: Digestion, Absorption and Exercise
Brouns, F., & Beckers, E. (1993) · Sports Medicine · doi:10.2165/00007256-199315040-00003 · Cited by 156 · see citing works
Gastrointestinal 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
Irving, R. A., Noakes, T. D., Buck, R., van Zyl-Smit, R. N., Raine, E., Godlonton, J. D., & Norman, R. J. (1991) · Journal of Applied Physiology · doi:10.1152/jappl.1991.70.1.342 · Cited by 150 · see citing works
Hyponatremia and Ultramarathon Running
Frizzell, R. T. (1986) · JAMA · doi:10.1001/jama.1986.03370060086025 · Cited by 149 · see citing works
Changes in the Gastrointestinal Mucosa after Long-Distance Running
Øktedalen, O., Lunde, O. C., Opstad, P. K., Aabakken, L., & Kvernebo, K. (1992) · Scandinavian Journal of Gastroenterology · doi:10.3109/00365529209000073 · Cited by 124 · see citing works
Medical and physiological considerations in triathlons
Hiller, W. D. B., OʼToole, M. L., Fortess, E. E., Laird, R. H., Imbert, P. C., & Sisk, T. D. (1987) · The American Journal of Sports Medicine · doi:10.1177/036354658701500212 · Cited by 119 · see citing works
Physiological responses to prolonged exercise in ultramarathon athletes
Davies, C. T. M., & Thompson, M. W. (1986) · Journal of Applied Physiology · doi:10.1152/jappl.1986.61.2.611 · Cited by 112 · see citing works
Endurance improved by ingestion of a glucose polymer supplement
Ivy, J. L., MILLER, W., Dover, V., GOODYEAR, L. G., Sherman, W. M., Farrell, S. W., & Williams, H. G. (1983) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-198315060-00005 · Cited by 106 · 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
Dehydration and hyponatremia during triathlons.
Wd, H. (1989) · PubMed · Cited by 96 · see citing works
Hyponatremia Associated with Overhydration in U.S. Army Trainees
O'Brien, K. K., Montain, S. J., Corr, W. P., Sawka, M. N., Knapik, J. J., & Craig, S. C. (2001) · Military Medicine · doi:10.1093/milmed/166.5.405 · Cited by 93 · see citing works
Shaw, S. T. (1985) · JAMA · doi:10.1001/jama.1985.03350350090028 · Cited by 88 · see citing works
Gastrointestinal problems as a function of carbohydrate supplements and mode of exercise
Peters, H. P. F., SCHELVEN, F. W. V., Verstappen, P. A., de Boer, R. W., Bol, E., Erich, W. B. M., TOGT, C. R. V. D., & de Vries, W. R. (1993) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-199311000-00003 · Cited by 79 · see citing works
Fluid and Electrolyte Status in Athletes Receiving Medical Care at an Ultradistance Triathlon
OʼToole, M. L., Douglas, P. S., Laird, R. H., & Hiller, W. D. B. (1995) · Clinical Journal of Sport Medicine · doi:10.1097/00042752-199504000-00008 · Cited by 71 · see citing works
Nutritional and Fluid Intake in a 100-km Ultramarathon
Fallon, K. E., Broad, E., Thompson, M. W., & Reull, P. A. (1998) · International Journal of Sport Nutrition · doi:10.1123/ijsn.8.1.24 · Cited by 69 · see citing works
An endoscopic study of gastroduodenal lesions induced by nonsteroidal anti-inflammatory drugs
Cheatum, D. E., Arvanitakis, C., Gumpel, M., Stead, H., & Geis, G. (1999) · Clinical Therapeutics · doi:10.1016/s0149-2918(99)80020-4 · Cited by 51 · see citing works
Circulating Gastrointestinal Hormone Changes in Marathon Running
O'Connor, A. M. C., Johnston, C. F., Buchanan, K. D., Boreham, C. A. G., Trinick, T., & Riddoch, C. (1995) · International Journal of Sports Medicine · doi:10.1055/s-2007-973006 · Cited by 49 · see citing works
Treatment of Suspected Heat Illness
Eichner, E. R. (1998) · International Journal of Sports Medicine · doi:10.1055/s-2007-971983 · Cited by 47 · see citing works
Acute hyponatremia in ultra-endurance athletes
Surgenor, S. D., & Uphold, R. E. (1994) · The American Journal of Emergency Medicine · doi:10.1016/0735-6757(94)90057-4 · Cited by 45 · see citing works
Gastrointestinal Symptoms During Exercise
Peters, H. P. F., Akkermans, L. M. A., Bol, E., & MOSTERD, W. L. (1995) · Sports Medicine · doi:10.2165/00007256-199520020-00002 · Cited by 43 · see citing works
Exercise-Associated Symptoms in Triathletes
Sullivan, S. (1987) · The Physician and Sportsmedicine · doi:10.1080/00913847.1987.11702083 · Cited by 42 · see citing works
Energy balance in ultramarathon running
Rontoyannis, G. P., Skoulis, T., & Pavlou, K. N. (1989) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/49.5.976 · Cited by 42 · see citing works
Dietary carbohydrates and endurance exercise
Evans, W. J., & Hughes, V. (1985) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/41.5.1146 · Cited by 35 · see citing works
Glycemic and Insulinemic Responses to Multiple Preexercise Carbohydrate Feedings
Short, K. R., Sheffield-Moore, M., & Costill, D. L. (1997) · International Journal of Sport Nutrition · doi:10.1123/ijsn.7.2.128 · Cited by 28 · see citing works
LaTulippe--a case study of a one hundred and sixty kilometre runner.
O'Hara, W. J., Allen, C., Shephard, R. J., & Gill, J. W. (1977) · British Journal of Sports Medicine · doi:10.1136/bjsm.11.2.83 · Cited by 19 · see citing works
Dietary intakes of participants in the IditaSport Human Powered Ultra-marathon.
Case, S., Evans, D., Tibbets, G., Case, S., & Miller, D. (1995) · PubMed · Cited by 12 · see citing works
Hyponatremia and Ultramarathons
Anderson, J. V. (1986) · JAMA · doi:10.1001/jama.1986.03380020075016 · Cited by 11 · see citing works
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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
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
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
“Previous studies have shown that hot conditions lead to high voluntary fluid intake rates (13), and our data support this.”
BackgroundResultFactors 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
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
Gastrointestinal distress is common during a 161-km ultramarathon
Stuempfle, K. J., & Hoffman, M. D. (2015) · Journal of Sports Sciences · doi:10.1080/02640414.2015.1012104 · Cited by 137 · 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).”
BackgroundResultInfluentialHoffman, M. D., Pasternak, A. V., Rogers, I. R., Khodaee, M., Hill, J. C., Townes, D. A., Scheer, B. V., Krabak, B. J., Basset, P., & Lipman, G. S. (2014) · Sports Medicine · doi:10.1007/s40279-014-0189-3 · Cited by 112 · see citing works
“The average runner utilizes 500–800 kcal/h during a 161-km race [29, 30], but is generally able to only ingest between 200 and 300 kcal/h, so a caloric deficit cannot be avoided [31–33].”
BackgroundFood Intake and Electrolyte Status of Ultramarathoners Competing in Extreme Heat
Glace, B. W., Murphy, C. A., & McHugh, M. P. (2002) · Journal of the American College of Nutrition · doi:10.1080/07315724.2002.10719254 · Cited by 97 · see citing works
Self-citationNoakes, T. D. (2007) · Journal of Sports Sciences · doi:10.1080/02640410600875036 · Cited by 90 · 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
Race Diet of Finishers and Non-Finishers in a 100 Mile (161 km) Mountain Footrace
Stuempfle, K. J., Hoffman, M. D., Weschler, L. B., Rogers, I. R., & Hew-Butler, T. (2011) · Journal of the American College of Nutrition · doi:10.1080/07315724.2011.10719999 · Cited by 86 · see citing works
“This race diet composition is similar to previous reports for ultraendurance runners [17,18,21].”
BackgroundResultAssociation 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
“, 1992) and within the range of other 161-km ultramarathons (37–75%; Glace et al., 2002; Hoffman & Fogard, 2011; Stuempfle, Hoffman, Weschler, Rogers, & HewButler, 2011).”
BackgroundResultInfluentialGastrointestinal 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
Nutrition in Ultra-Endurance: State of the Art
Nikolaidis, P. T., Veniamakis, E., Rosemann, T., & Knechtle, B. (2018) · Nutrients · doi:10.3390/nu10121995 · Cited by 70 · see citing works
“Moreover, when fluid consumption is adequate, the body mass can be unchanged [63].”
BackgroundMartinez, S., Aguilo, A., Rodas, L., Lozano, L., Moreno, C., & Tauler, P. (2018) · Journal of Sports Sciences · doi:10.1080/02640414.2017.1306092 · Cited by 60 · see citing works
“These studies have reported energy intakes between 3.3 and 5.3 kcal · kg¯1 · h¯1 for some ultramarathons (Glace et al., 2002b ; Glace, Murphy, & McHugh, 2002a; ClementeSuárez, 2015; Stuempfle et al., 2011).”
BackgroundResultInfluentialLimits 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
Exercise-Associated Hyponatraemia
Weschler, L. B. (2005) · Sports Medicine · doi:10.2165/00007256-200535100-00005 · Cited by 52 · see citing works
Nutritional status of adventure racers
Zimberg, I. Z., Guarita, H. V., Juzwiak, C. R., Crispim, C. A., Antunes, H. K. M., Edwards, B., Tufik, S. B., & de Mello, M. T. (2007) · Nutrition · doi:10.1016/j.nut.2007.01.001 · Cited by 47 · see citing works
Energy turnover during 24 hours and 6 days of adventure racing
Enqvist, J. K., Mattsson, C. M., Johansson, P. H., Brink-Elfegoun, T., Bakkman, L., & Ekblom, B. T. (2010) · Journal of Sports Sciences · doi:10.1080/02640411003734069 · Cited by 45 · see citing works
“There might also have been limits to gastric emptying, and thus gastrointestinal limits to a high energy intake (Glace et al., 2002; Westerterp, 2001).”
BackgroundCharacteristics of 161-km Ultramarathon Finishers Developing Exercise-Associated Hyponatremia
Hoffman, M. D., Fogard, K., Winger, J. M., Hew‐Butler, T., & Stuempfle, K. J. (2013) · Research in Sports Medicine · doi:10.1080/15438627.2012.757230 · Cited by 43 · see citing works
“Gastrointestinal symptoms are known to be common complaints in ultramarathons (Baska, Moses, Graeber, & Kearney, 1990; Glace, Murphy, & McHugh, 2002a; Glace et al., 2002b; Hoffman & Fogard, 2011; Rehrer et al., 1992).”
BackgroundPugh, 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
“If euhydration is maintained, GIS may be less prevalent, as has been found in events lasting even up to and beyond 24 h [24].”
BackgroundCompetition Nutrition Practices of Elite Ultramarathon Runners
Stellingwerff, T. (2016) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2015-0030 · Cited by 42 · see citing works
“Of the nine studies measuring nonelite or amateur ultramarathon finisher dietary intakes (n = 82 subjects), the average CHO intake rate was only 41 g/hr (Eden & Abernethy, 1994; Glace et al., 2002a, 2002b; Moran et al., 2011; Noakes et al., 1988; Stuempfle et al., 2011, 2013).”
BackgroundNausea 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
“Two studies (Glace et al., 2002; Rehrer et al., 1992) of ultramarathon runners revealed no association between food or fluid consumption and gastrointestinal symptoms.”
BackgroundResultInfluentialAnalysis 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
Hyponatraemic encephalopathy despite a modest rate of fluid intake during a 109 km cycle race
Dugas, J. P., & Noakes, T. D. (2005) · British Journal of Sports Medicine · doi:10.1136/bjsm.2005.018820 · Cited by 36 · see citing works
Energy Intakes of Ultraendurance Cyclists During Competition, an Observational Study
Black, K. E., Skidmore, P. M. L., & Brown, R. C. (2012) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.22.1.19 · Cited by 34 · see citing works
“A relationship between carbohydrate intake and race performance was also seen by Havemann and Goedecke (2008) and Kimber et al.”
BackgroundCharacterization of Medical Care at the 161-km Western States Endurance Run
McGowan, V., & Hoffman, M. D. (2014) · Wilderness and Environmental Medicine · doi:10.1016/j.wem.2014.06.015 · Cited by 33 · 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
Managing Collapsed or Seriously Ill Participants of Ultra-Endurance Events in Remote Environments
Hoffman, M. D., Rogers, I. R., Joslin, J., Asplund, C. A., Roberts, W. O., & Levine, B. D. (2014) · Sports Medicine · doi:10.1007/s40279-014-0270-y · Cited by 28 · see citing works
Wilson, P. B. (2015) · European Journal of Sport Science · doi:10.1080/17461391.2015.1046191 · Cited by 28 · see citing works
“Two additional studies had sample sizes of less than 20 (Glace et al., 2002; Stuempfle et al., 2013), limiting statistical power to detect smallto-moderate effects.”
BackgroundFeeding Strategies of a Female Athlete During an Ultraendurance Running Event
Moran, S. T., Dziedzic, C. E., & Cox, G. R. (2011) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.21.4.347 · Cited by 25 · see citing works
Hoogervorst, D., van der Burg, N., Versteegen, J. J., Lambrechtse, K. J., Redegeld, M. I., Cornelissen, L. A. J., & Wardenaar, F. C. (2019) · Sports · doi:10.3390/sports7060140 · Cited by 24 · see citing works
“By comparison, previous studies reported only a 50% prevalence of GI complaints in 160 km runners [31] and a 82.”
BackgroundResultHoffman, 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
“There is also a conventional perception that fluid or electrolyte imbalances are a cause of nausea, a common symptom during ultramarathons [2–7], and that sodium intake may prevent such symptoms [8].”
Arribalzaga, S., Viribay, A., Calleja-González, J., Fernández‐Lázaro, D., Castañeda-Babarro, A., & Mielgo‐Ayuso, J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18115737 · Cited by 24 · see citing works
“Between 30% and 90% of these athletes have experienced some types of GI problem while competing [6,8,20,32,35,36].”
BackgroundNutrition Update for the Ultraendurance Athlete
Getzin, A. R., Milner, C., & LaFace, K. M. (2011) · Current Sports Medicine Reports · doi:10.1249/jsr.0b013e318237fcdf · Cited by 21 · see citing works
“(35)/IJSNEM 1992 V 19 finishers Ultramarathon V 741 43 248 500 45”
Nutrition, hydration and ergogenic aids strategies in ultraendurance mountain events
Belinchón-deMiguel, P., & Clemente‐Suárez, V. J. (2019) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.18.08920-x · Cited by 19 · see citing works
Physiological and Pathophysiological Consequences of a 25-Day Ultra-Endurance Exercise Challenge
Tiller, N. B., Chiesa, S. T., Roberts, J., Turner, L. A., Jones, S. H., & Romer, L. M. (2019) · Frontiers in Physiology · doi:10.3389/fphys.2019.00589 · Cited by 16 · see citing works
Changes in Pain and Nutritional Intake Modulate Ultra-Running Performance: A Case Report
Best, R., Barwick, B., Best, A., BERGER, N. J. A., Harrison, C., Wright, M., & Sparrow, J. (2018) · Sports · doi:10.3390/sports6040111 · Cited by 16 · see citing works
“Ad-libitum drinking is favoured throughout ultra-endurance events, and these recommendations are supported by high reported fluid and sodium [8,15] intakes during ultra-marathon running [45] and low incidence of hyponatraemia [19].”
BackgroundKienast, C., Biere, K., Coker, R. H., Genov, N. N., Jörres, M., Maggioni, M. A., Mascarell-Maricic, L., Schalt, A., Genov, M., Gunga, H., et al. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2022.970016 · Cited by 13 · see citing works
“Dehydration and gastrointestinal problems can lead to confusion or dizziness (Glace et al., 2002).”
BackgroundSodium ingestion and the prevention of hyponatraemia during exercise: Table 1
Noakes, T. D. (2004) · British Journal of Sports Medicine · doi:10.1136/bjsm.2004.014191 · Cited by 13 · see citing works
Cardiopulmonary Physiology and Responses of Ultramarathon Athletes to Prolonged Exercise
Blaber, A. P., Walsh, M. L., Carter, J. B., Seedhouse, E., & Walker, V. E. (2004) · Canadian Journal of Applied Physiology · doi:10.1139/h04-035 · Cited by 12 · see citing works
“Of the research performed with ultramarathon athletes, the majority have focused on nutritional and hematological factors (Fallon et al., 1998; Glace et al., 2002; Neumayr et al., 2002).”
BackgroundNutritional Intake during a Simulated Adventure Race
Zimberg, I. Z., Crispim, C. A., Juzwiak, C. R., Antunes, H. K. M., Edwards, B., Waterhouse, J. M., Tufik, S. B., & de Mello, M. T. (2008) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.18.2.152 · Cited by 12 · see citing works
“…be a result of the inability to eat and drink sufficient food and fluid, which might result from gastrointestinal discomfort, difficulty in carrying food and fluid, and lack of storage points en route (Applegate; Colombani et al.; Glace et al., 2002a; Hawley, Dennis, & Noakes, 1992; Kimber et al.).”
BackgroundResultInfluentialDoes 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
Alterations in spontaneous electrical brain activity after an extreme mountain ultramarathon
Spring, J., Sallard, E., Trabucchi, P., Millet, G. P., & Barral, J. (2022) · Biological Psychology · doi:10.1016/j.biopsycho.2022.108348 · Cited by 9 · 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
“Studies using food records reported slightly higher mean intakes for carbohydrate (44–50 g/h) and fluid (415–765 mL/h) than the current study [13,14].”
BackgroundLong distance running – Can bioprofiling predict success in endurance athletes?
König, S., Jockenhöfer, C., Billich, C., Beer, M., Machann, J., Schmidt‐Trucksäss, A., & Schütz, U. H. W. (2020) · Medical Hypotheses · doi:10.1016/j.mehy.2020.110474 · Cited by 8 · see citing works
ASUPAN CAIRAN DAN STATUS HIDRASI MEMPENGARUHI PROFIL TEKANAN DARAH PADA ATLET SEPAKBOLA REMAJA
Penggalih, M. H. S. T., Juffrie, M., Sudargo, T., & Sofro, Z. M. (2017) · Gizi Indonesia · doi:10.36457/gizindo.v39i2.212 · Cited by 8 · see citing works
Carbohydrate Ingestion on Exercise Metabolism and Physical Performance
Noakes, T. D., Prins, P., Buga, A., D'Agostino, D. P., Volek, J. S., & Koutnik, A. P. (2025) · Endocrine Reviews · doi:10.1210/endrev/bnaf038 · 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
van Venrooij, N., Wardenaar, F. C., Hoogervorst, D., Senden, J. M., van Dijk, J., & Jonvik, K. L. (2022) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2021-0711 · Cited by 7 · see citing works
Personalized hydratation status in endurance and ultra-endurance: A review
Paternoster, N., Baggio, E., & Pelosi, E. (2020) · Mediterranean Journal of Nutrition and Metabolism · doi:10.3233/mnm-200434 · Cited by 5 · 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
Changes in Urine Components and Characteristics During a 415-km Mountain Ultra-Marathon
Yamagata, T., & Sakuraba, K. (2019) · Juntendō Igaku/Juntendo igaku · doi:10.14789/jmj.2019.65.jmj19-oa03 · Cited by 4 · see citing works
Charlot, K., Lavoué, C., Siracusa, J., Chalchat, É., Hertert, P., & Bourrilhon, C. (2022) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2022.2046443 · Cited by 4 · see citing works
“The etiology and frequency of GIS during ultraendurance races have been extensively described and appear to mainly result from physiological (reduction in splanchnic blood ow) and mechanical factors (pounding and jostling during running) (4, 6, 26, 27), as well as the high intake, during the race (particularly hyperos…”
BackgroundUltramarathon Running: Medical Issues
Knechtle, B. (2016) · Springer eBooks · doi:10.1007/978-3-319-28265-7_13 · Cited by 4 · see citing works
“Runners with gastrointestinal distress tended to complete fewer training miles and to do shorter training runs [52].”
BackgroundBirkenhead, K. L., Barr, S. I., Lovell, G. P., & Solomon, C. (2019) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.18.08882-5 · Cited by 3 · see citing works
Amino Acids Changes and Muscle Damage During the 400 km Ultra Trail Gobi RacePreprint
Li, M., Yao, W., Huang, G., Chen, S., Li, S., Cao, J., Ma, X., & Du, Y. (2018) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/466706 · Cited by 3 · see citing works
Carpenter, M., Brouner, J., & Spendiff, O. (2024) · Kinesiology · doi:10.26582/k.56.1.16 · Cited by 2 · see citing works
Biondich, A. S., & Joslin, J. (2016) · Journal of Sports Medicine · doi:10.1155/2016/1276369 · Cited by 2 · see citing works
Knechtle, B. (2013) · Elsevier eBooks · doi:10.1016/b978-0-12-396454-0.00016-3 · Cited by 2 · see citing works
(2004) · British Journal of Sports Medicine · doi:10.1136/bjsm.2004.010876corr1 · Cited by 2 · see citing works
Совенко, С., & Попов, С. (2023) · Теорія і методика фізичного виховання і спорту · doi:10.32652/tmfvs.2023.3.22-30 · Cited by 1 · see citing works
Convit, L., Rahman, S. S., Jardine, W. T., Urwin, C. S., Roberts, S., Condo, D., Main, L. C., Carr, A. J., Young, C., & Snipe, R. M. J. (2024) · Nutrition & Dietetics · doi:10.1111/1747-0080.12870 · Cited by 1 · see citing works
Coleman, E. (2009) · CRC Press eBooks · doi:10.1201/9781420068160.ch8 · Cited by 1 · see citing works
Effect of nutrients on brain function
Ahire, E. D., Keservani, R. K., Balekundri, A., Rajora, A. K., & Surana, K. R. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-18951-7.00013-x · Cited by 1 · see citing works
Stellingwerff, T. (2015) · Cited by 1 · see citing works
Wood, T. (2004) · British Journal of Sports Medicine · doi:10.1136/bjsm.2003.009043 · Cited by 1 · see citing works
Nutrition and the Gastrointestinal Tract for Athletes
Pearce, J., & Hunter, J. O. (2011) · doi:10.1002/9781444344905.ch20
Anthropometric characteristics and changes in skinfold thickness in 415-km ultramountain runners
Takayama, F., Mori, H., Mayuko, A. N. D. O., & Yamamoto, M. (2015) · Taiikugaku kenkyu (Japan Journal of Physical Education Health and Sport Sciences) · doi:10.5432/jjpehss.15032
Carbohydrate intake and metabolism during prolonged endurance exercise
Pfeiffer, B. (2010) · University of Birmingham Institutional Research Archive (University of Birmingham)
Clisby, E. (2004) · British Journal of Sports Medicine · doi:10.1136/bjsm.2003.005843
Wilson, P. B. (2014) · University of Minnesota Digital Conservancy (University of Minnesota)
Blennerhassett, C. (2018) · Edge Hill University
Bagchi, D., Nair, S., & Sen, C. K. (2013) · Elsevier eBooks · doi:10.1016/b978-0-12-396454-0.00060-6
Pugh, J. N. (2019) · Liverpool John Moores University · doi:10.24377/ljmu.t.00010815
Knechtle, B., & Nikolaidis, P. Τ. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-813922-6.00014-x
(2004) · British Journal of Sports Medicine · doi:10.1136/bjsm.2004.003921corr1
(2004) · British Journal of Sports Medicine · doi:10.1136/bjsm.2004.000044corr1
Barriola, I. E., Arocena, R. P., Urcelay, M., Sarriegi, N., Martin, J. I., & Esnal, H. (2022) · Archivos de medicina del deporte: revista de la Federación Española de Medicina del Deporte y de la Confederación Iberoamericana de Medicina del Deporte · doi:10.18176/archmeddeporte.00084
Distúrbios Gastrointestinais em Atletas
Engenheiro, G., Loureiro, N., de Portugal, D. M. E. D. P. D. S. C., Mendes, A. P., de Portugal, D. M. E. D. P. D. S. C., Fortunato, J., de Portugal, D. M. E. D. P. D. S. C., Araújo, J. P., & de Portugal, D. M. E. D. P. D. S. C. (2023) · Revista de Medicina Desportiva informa · doi:10.23911/gastrointestinal_2023_jul
Role of fruit and food components in brain cognition
Ahire, E. D., Keservani, R. K., & Bharti, S. K. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-18951-7.00001-3
Schalt, A., Coker, R. H., Gunga, H., Kienast, C., Mascarell-Maricic, L., & Steinach, M. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1691771
“Athletes strive to match their energy expenditure, yet several previous studies have clearly pointed out that this is rarely achieved (12, 13), which consequently leads to a loss of muscle mass (14).”
- Authors
- Glace, B., Murphy, C., & McHugh, M.
- Affiliations
- Lenox Hill Hospital (US)
- ORCID
- McHugh, Malachy
- Venue
- International Journal of Sport Nutrition and Exercise Metabolism
- Publisher
- Human Kinetics
- Published
- 2002-12
- Volume
- 12
- Issue
- 4
- Pages
- 414-427
- ISSN
- 1526-484X (ISSN-L)
- 1543-2742
- OpenAlex
- W2105883377
- Cited by
- 84
- References
- 35
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 3 · 2022: 5 · 2021: 1 · 2020: 3 · 2019: 8 · 2018: 10 · 2017: 3 · 2016: 3 · 2015: 8 · 2014: 4 · 2013: 4 · 2012: 1
- FWCI
- 2.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Sport Nutrition and Exercise Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Keywords
- ultramarathon, dietary intake, fluid intake, gastrointestinal distress, mental status changes, dehydration, carbohydrate intake, sodium intake, energy expenditure, endurance running
- MeSH terms
- Adult, Mental Disorders, Energy Intake, Dehydration, Drinking, Eating, Feeding Behavior, Female, Gastrointestinal Diseases, Humans, Male, Running, Weight Loss
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