fact sheet
RUNNER’S GUT
WHAT IS RUNNER’S GUT? GIT symptoms associated with exercise. Note that the factors in
Bowel function is frequently overlooked in the world of sports bold font will be more extensively covered in the scope of this fact
nutrition. In general, exercise is often recommended for sheet.
the protective effect it can exert on bowel health, such as
reducing the incidence of colon cancer, diverticular disease, INTRINIC RISK FACTORS EXTRINSIC RISK FACTORS
and constipation, most likely due to accelerating transit time of Younger Age High intensity exercise
faeces through the gut . However, in certain groups of athletes,
Female Gender Dehydration
particularly runners and triathletes, loose bowels and therefore
Previous abdominal surgery Dietary Factors
a sense of urgency to find a bathroom (also known as “runner’s
trots”) can ruin a perfectly good run. For some it is just a Irritable Bowel Syndrome Poorly conditioned athlete
grumbling sensation, pain in the stomach, or sense of bloating, Lactose Intolerance / Fructose Medication
but for others, toilets must be publicly accessible at regular Malabsorption
intervals. This is not only disruptive in training and competition, Coeliac Disease Vertical impact sport (running)
but is also stressful and can diminish an athlete’s confidence and This table has been adapted from Wright et al. 2009.
performance.
Dehydration
Runners may be twice as likely as other athletes to experience Dehydration of greater than 2% loss of body weight (eg. a 1.4 kg
bowel discomfort. This could be due to altered motility from loss in a 70 kg athlete) increases the risk of nausea, vomiting,
the redistribution of blood away from the gastrointestinal tract diarrhoea and other gastro-intestinal problems during exercise.
(GIT) to working muscles (gut ischaemia), the mechanical factor Always start exercise well hydrated; this will reduce the
of running (i.e. organs jarring in the abdominal cavity) and/ risk of becoming dehydrated during sport. Drinks that have a
or altered neurological and hormonal functions1. In addition, very high carbohydrate concentration can also cause diarrhoea.
females and those with high levels of nervous anxiety are more Therefore, sports drinks, such as Gatorade™, with between 4 –
commonly affected. (A sports psychologist would be useful in 8% carbohydrate are ideal for rehydration, but also are generally
assisting with strategies to manage performance/competition well tolerated. Drinks with higher carbohydrate concentrations
anxiety). Moreover, elite athletes are 1.5 to 3 times more likely to than 10% (i.e. fruit juices, soft drinks, caffeinated ‘energy’ drinks)
suffer from gastrointestinal symptoms than non-elite recreational are likely to cause gut issues in susceptible athletes, when
athletes. Younger athletes may also be more at risk of GIT consumed just before or during training as they draw extra water
symptoms. Possible explanations for this observation are that into the bowel. For more information on dehydration, refer to the
younger athletes perform exercise at higher relative intensity
Fluids in Sport Fact Sheet.
than older athletes, they have a poorly ‘conditioned’ GIT compared
to older athletes, and may be more prone to dehydration due to
lack of experience . High intensity exercise and gut
ischaemia
These problems are more common than may be expected. Gut Ischaemia has been shown to be the main cause of nausea,
Several studies, including a study by Halvorsen and Ritland abdominal pain, vomiting and diarrhoea. Exercising at 70% of
have confirmed speculation that 25% to 50% of elite athletes VO2max can decrease blood flow to the gastrointestinal tract
experience some form of gastrointestinal symptoms including by up to 80%, to allow extra blood flow to the working muscles
one or more of these symptoms: urgent sensations to defecate and heart . In addition, prolonged, high intensity exercise
while running, diarrhoea (sometimes with blood present), upper (e.g. marathon or triathlon endurance events) can cause the
gastrointestinal symptoms including heartburn (reflux), nausea athlete’s body temperature to increase to as high as 41°C. When
and less commonly, vomiting1. These latter symptoms are more accompanied with substantial dehydration, the decreased blood
commonly seen in American football, weightlifting and cycling as volume results in further reducing blood flow to the gut.
these sports involve intra-abdominal pressure .
The table below outlines the intrinsic and extrinsic risk factor for
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fact sheet
RUNNER’S GUT
A prospective cohort study showed an increase of GIT symptoms in exercise, particularly the urge to defecate while running.
from 50% to 80% once dehydration exceeded 4-5% . To put this Symptoms can also be triggered by other poorly absorbed
into context, this would be a 75kg male athlete losing 3kg (or carbohydrates such as fructans (chains of fructose sugars joined
3L of body fluid). Therefore, it is wise to get to know your sweat together), galacto-oligosaccharides and polyols. These are found
rate by weighing yourself before and after training sessions and in everyday foods such as wheat, apples, pears, onions, garlic,
competition, and aim to match your sweat rate with fluid intake as and more importantly for runners, in many drinks, gels and
closely as possible. powders. Athletes need to know exactly what their intolerance is
and plan ahead. Please refer to the SDA fact sheet on Athletes
General dietary factors and Low FODMAPs Diets for further information.
The type of food, the timing of the last meal before exercise
and caffeine intake may be associated with the development of Summary points
GIT symptoms during exercise. In addition, anecdotally, some • Disturbed bowel function is more likely to occur in runners than
athletes report GIT symptoms the night after consuming several other athletes.
drinks of alcohol or with vitamin C supplementation. High fibre, • Elite athletes, younger athletes, those prone to anxiety, and
fat and protein meals pre-exercise have been shown to cause an females are more likely to be affected.
increase in GIT symptoms, as has the timing of the last meal prior • Dietary factors such as dehydration, having a high fibre intake,
to an event. This makes logical sense as fibre, fat and protein are caffeine, the intake of fructose and lactose, gluten (if coeliac),
slow to empty from the stomach, and planning to eat the pre- and possibly vitamin C and alcohol may all impact on normal
event meal well before the whistle provides ample time to allow GIT function.
for almost complete gastric emptying. Athletes should assess • Athletes should enjoy their pre-event meal two to four hours
individual tolerance. See our fact sheet on Eating and Drinking before running, and only a light snack (or fluids) in the hour
Before Exercise for general guidelines for more information. before if prone to runner’s gut.
• Make sure the meal or snack is low in fibre (ie. white bread
rather than wholemeal or wholegrain), low in fat (ie. low fat
Coeliac disease
dairy if consuming this rather than full cream), and contains
Coeliac disease is a genetic medical condition that results in
minimal protein (ie. very little or no meat, chicken or fish).
permanent intestinal intolerance to dietary gluten and can cause
• Athletes should be careful not to self-prescribe anti-diarrhoeal
GIT symptoms if undiagnosed or poorly managed. When gluten
medication as a prophylactic measure. These should only
is ingested, “villi” (finger-like projections in the small bowel)
be taken under advice from a general practitioner or sports
become damaged and this interferes with the absorption of
medicine professional.
nutrients, thus increasing GIT symptoms. Adherence to a well-
• If you are athletes are concerned about adverse gut symptoms,
planned and controlled gluten free diet prevents further damage
they should consult with a sports dietitian. To find a sports
to the villi, promotes comfort through the return of normal gut
dietitian, click here.
function and allows for complete absorption of nutrients. Please
refer to the SDA fact sheet on Athletes with Coeliac Disease for
further information.
May 2011
Irritable bowel syndrome, © This is a sports nutrition publication of Sports Dietitians Aus-
lactose intolerance and fructose tralia.
malabsorption
Irritable Bowel Syndrome (IBS), Lactose Intolerance and Fructose
Malabsorption have been suggested to be associated with
the development of GIT symptoms of a chronic nature in both
athletes and non-athletes. These symptoms can be exacerbated
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