Physiological changes and gastro-intestinal symptoms as a result of ultra-endurance running

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Abstract
One hundred and seventy-two competitors of the Swiss Alpine Marathon, Davos, Switzerland, 1988, volunteered for this research project. of these volunteers 170 (158 men, 12 women) finished the race (99%). The race length was 67 km with an altitude difference of 1,900 m between the highest and lowest points. Mean age was 39 (SEM 0.8) years. Average finishing times were 8 h 18 min (men) and 8 h 56 min (women). Loss of body mass averaged 3.4% body mass [mean 3.3 (SEM 0.2)%; 4.0 (SEM 0.4)%; men and women, respectively]. Blood samples from a subgroup of 89 subjects (6 women and 83 men) were taken prior to and immediately after completion of the race. Changes in haemoglobin (9.3 mmol·l−1 pre-race, 9.7 mmol·l−1 post-race) and packed cell volume (0.44 pre, 0.48 post-race) were in line with the moderate level of dehydration displayed by changes in body mass. Mean plasma volume decreased by 8.3%. No significant changes in plasma osmolality, sodium, or chloride were observed but plasma potassium did increase by 5% (4.2 mmol·l−1 pre-race, 4.4 mmol·l−1 post-race). Mean fluid consumption was 3290 (SEM 103) ml. Forty-three percent of all subjects, and 33% of those who gave blood samples, complained of gastro-intestinal (GI) distress during the race. No direct relationship was found between the quantity or quality of beverage consumed and the prevalence of GI symptoms. The circulating concentration of several GI hormones was measured and several were found to be significantly elevated (P−1; vaso-active intestinal peptide 224.3 (SEM 20.1) ng·l−1; peptide histidine isoleucine 311.1 (SEM 27.5) ng·l−1 ; motilin 214.1 (SEM 15.1) ng·l−1] but larger increases were not found to be significantly correlated with GI symptoms. Plasma cortisol, adrenaline, and noradrenaline concentrations were significantly higher after the race compared to resting values (P−1 increase], whereas no increase was observed in individuals without GI symptoms. An inability of the Na+-K+ pump to keep pace with the needs of skeletal muscle (as well in the intestinal tract) may have accounted for the high plasma potassium values immediately following exercise and may have played a role in the development of GI disorders. However, many other sources of K+ release may have accounted for the elevated plasma K+ (skeletal muscle, liver and red blood cells) in such sufferers and the correlation between the increase in K+ and GI symptoms may be an indirect one.