Functional GI functions and exercise

Question 1

GI symptoms in endurance athletes - 4

Answer 1

30-90%
vomiting, nausea, abdominal angina, bloody diarrhea
musosal erosions and ischemic colitis
similar to IBS

Question 2

triggers of GI symptoms in athletes - 4

Answer 2

mechanical- jostling 
splanchnic hypoperfusion (blood shunting, dehydration) - reduced nutrient absorption, impaired intestinal permeability 
nutritional - fibre, fat, protein, fructose

Question 3

strategies to improve GI symptoms - 4

Answer 3

lower fibre/residue or fat intake
reduced fructose load
minimize dehydration
consume multiple transporter carbs

Question 4

Fodmaps - 6

Answer 4

short chained carbs
Monosaccharide (fructose)
Disaccharides (lactose),
Oligosaccharides (FOS and GOS) - beans and lentils
Polyols (sorbitol and mannitol- sugar alcohols)
rapidly fermented and osmotically active with additive effects
proximal colonic gas production
supply of SCFA to mucosa

Question 5

low FODMAP diet

Answer 5

clinical practices as potentially efficacious treatment for irritable bowel syndrome

Question 6

IBS and FODMAP

Answer 6

malabsorption - increase colonic fluid and gas - trigger/amplify GI symptoms including bloating, flatulence, abdominal pain, loose stool or diarrhea, abdominal distension,
- hypersensitive bowl - luminal distension mediated by osmotic effects/rapid fermentation

Question 7

Athletes believe _ can improve exercise induced GI issues

Answer 7

low residue/GFD

Question 8

GFD

Answer 8

naturally low in fructan and GOS - may be modulating factor in symptom improvement instead of gluten but one had no improvement

Question 9

2 objectives of FODMAP diet

Answer 9

nutritional adequacy and long term effect

strategic reintroduction of foods to figure out what specific high FODMAP triggers symptoms

Question 10

suggestion of low FODMAP diet

Answer 10

2-3 days before events/critical training to alleviate bloating, intestinal cramps, flatulence, urge to defecate

Question 11

symptoms of IBS as output from gut brain axis

Answer 11

how they relate to known pathophysiological abnormalities and their functional consequences.

Question 12

ingestion of food can theoretically influence the gut brain axis in 3 ways

Answer 12

responses of the gut NS and ascending pathways in 3 ways
food volume - non specific changes in motility and gut distention (cephalic phase) - gastrocolic reflex
afferent input through stimulation of sensory receptors in the gut which compromises the mechano/stretch receptors, and the chemosensory receptors
food components may induce/modualte visceral hypersensitivity through inflammatory responses/modify receptor expression

Question 13

indigestable carbs and poorly absorbed sugars and sugar alcohols (polyols such as sorbitol(gum)/mannitol(mushrooms)) most influence

Answer 13

intestinal sensory input and function through their delivery to the colon and subsequent lisation by bacteria

Question 14

indigestable carbs can be functionally classified

Answer 14

with relevance to intestinal effects into 3 overlapping gps - fibre, fermentable oligo-, di-, and mono-saccharides and polyols (FODMAP) and prebiotics

Question 15

oligosaccharides

Answer 15

cannot be hydrolyzed so >90% delivered to colon

Question 16

why doesnt lactose get absorbed

Answer 16

lack of lactase

Question 17

risks of low FODMAP - 4

Answer 17

low fibre - short term constipation, long term bowel cancer
reduced prebiotic - reduction of bifido 4 weeks after low FODMAP diet
psychological component
vitamins

Question 18

gluten and IBS

Answer 18

poor evidence - anecdotal evidence

rechallenge RCT negative for specific gluten effect but may worsen symptoms

Question 19

risk of low gluten diet

Answer 19

nutritional inadequacy

low fibre

Question 20

fermentilibity of fibre from very rapid to none

Answer 20

FOS, GOS, innulin
guar gum 
resistant starch 
psyllium 
wheat bran 
fruit and veggies fibre 
cellulose, sterculia

Question 21

gluten -2

Answer 21

group of proteins found predominantly in wheat, barley and rye - cause of celiac disease - symptoms that match IBS
trigger for symptoms

Question 22

is gluten responsible for IBS beyond celiac disease?

Answer 22

non celiac gluten sensitivity - controversial

Question 23

gluten free also reduces

Answer 23

FODMAP

Question 24

4 pathophysiological abnormalities for IBS

Answer 24

central processing, preception
visceral hypersensitivity
impaired motility responses
abnormal viscero-abdominal reflexes

Question 25

3 functional manifestations of IBS

Answer 25

exaggerated responses
abnormal gas clearance in small bowel
abdominal wall and diaphragmatic dyssyergia

Question 26

IBS

Answer 26

irritable bowel syndrome

recurrent abdominal pain as well as abnormal bowel motility which can include diarrhea and constipation

Question 27

celiac disease - pop
symptoms
diagnosis - 3

Answer 27

1% of pop. 
abdominal distension, failure to thrive, diarrhea 
human leukocyte antigen (HLA) DQ2 /8 
increased lymphocyte density 
celiac specific antibodies

Question 28

non-celiac gluten sensitivity - pop

Answer 28

0.6-6%

no serological markers available to prove diagnosis, - diagnosis of exclusion

Question 29

self identified gluten sensitivity and IBS - 2 week low FODMAP prior to high, low gluten or placebo diet for 7 days - 3

Answer 29

no one had gluten sensitivity
all diets caused GI symptoms
low FODMAP- reduced symptoms

Question 30

double blind with self reported gluten sensitivity with placebo, fructan or gluten with a 7 day wash out - 3

Answer 30

13 had highest symptoms with gluten, 24 with fructan and 22 with placebo

Question 31

fructan

Answer 31

fermentable gluten

Question 32

wheat belly - 3

Answer 32

losing wheat will be magical
wheat and gluten make us overeat
exaggeration of findings

Question 33

male athletes on low FODMAP

Answer 33

improved GI symptoms during exercise and throughout the day

Question 34

nonceliac athletes and gluten free diet

Answer 34

GI, weight, health and performance benefits

- no difference in anything

Question 35

psyllium

Answer 35

water soluable

Question 36

fibre RDA

Answer 36

25g f, 38g m

Question 37

gluten free food is often very

Answer 37

processed

Question 38

grains

Answer 38

not really fit for humans

Question 39

what makes a leaky gut

Answer 39

indigestible foods