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What if gastrointestinal complications in endurance athletes were gut injuries in response to a high consumption of ultra-processed foods? Please take care of your bugs if you want to improve endurance performance: a narrative review

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Abstract

To improve performance and recovery faster, athletes are advised to eat more often than usual and consume higher doses of simple carbohydrates, during and after exercise. Sports energetic supplements contain food additives, such as artificial sweeteners, emulsifiers, acidity regulators, preservatives, and salts, which could be harmful to the gut microbiota and impair the intestinal barrier function. The intestinal barrier plays a critical function in bidirectionally regulation of the selective transfer of nutrients, water, and electrolytes, while preventing at the same time, the entrance of harmful substances (selective permeability). The gut microbiota helps to the host to regulate intestinal homeostasis through metabolic, protective, and immune functions. Globally, the gut health is essential to maintain systemic homeostasis in athletes, and to ensure proper digestion, metabolization, and substrate absorption. Gastrointestinal complaints are an important cause of underperformance and dropout during endurance events. These complications are directly related to the loss of gut equilibrium, mainly linked to microbiota dysbiosis and leaky gut. In summary, athletes must be cautious with the elevated intake of ultra-processed foods and specifically those contained on sports nutrition supplements. This review points out the specific nutritional interventions that should be implemented and/or discontinued depending on individual gut functionality.

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Acknowledgements

The authors would like to thank Dr Mikel Berdud and Dr Francisco Corbi for their advice on writing and editing this article. With the support of the National Institute of Physical Education of Catalonia, INEFC.

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The authors did not receive support from any organization for the submitted work.

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All the authors contributed to the study. JÁ-H had the idea for the article and was the writer of the first version of the manuscript. AG and AO wrote specifically about intestinal permeability. FC collaborates supervising the manuscript. All the authors commented on previous versions of the manuscript. Finally, all the authors read and approved the final manuscript.

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Correspondence to Jesús Álvarez-Herms.

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The authors declare that they have no conflict of interest to disclose. All the authors certify that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.

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This article contains no studies on human or animal subjects conducted by the authors.

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Communicated by Michael I Lindinger.

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Álvarez-Herms, J., González-Benito, A., Corbi, F. et al. What if gastrointestinal complications in endurance athletes were gut injuries in response to a high consumption of ultra-processed foods? Please take care of your bugs if you want to improve endurance performance: a narrative review. Eur J Appl Physiol 124, 383–402 (2024). https://doi.org/10.1007/s00421-023-05331-z

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  • DOI: https://doi.org/10.1007/s00421-023-05331-z

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