Gastrointestinal cell injury and perceived symptoms after running the Boston Marathon

Melani R Kelly; Dawn M Emerson; Brendon P McDermott; Whitley C Atkins; Cory L Butts; R Mark Laursen; Christopher Troyanos; Andrew Duckett; Jacob Siedlik

doi:10.3389/fphys.2023.1268306

Gastrointestinal cell injury and perceived symptoms after running the Boston Marathon

Front Physiol. 2023 Oct 16:14:1268306. doi: 10.3389/fphys.2023.1268306. eCollection 2023.

Authors

Melani R Kelly^{1

2}, Dawn M Emerson^{1

3}, Brendon P McDermott⁴, Whitley C Atkins⁴, Cory L Butts⁵, R Mark Laursen⁶, Christopher Troyanos⁷, Andrew Duckett⁸, Jacob Siedlik⁹

Affiliations

¹ Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS, United States.
² Department of Exercise Science and Outdoor Recreation, Utah Valley University, Orem, UT, United States.
³ Department of Exercise Science, University of South Carolina, Columbia, SC, United States.
⁴ Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, United States.
⁵ Department of Exercise and Nutrition Sciences, Weber State University, Ogden, UT, United States.
⁶ Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States.
⁷ Boston Athletic Association, Boston, MA, United States.
⁸ Department of Athletics, Boston University, Boston, MA, United States.
⁹ Department of Exercise Science and Pre-Health Professions, Creighton University, Omaha, NE, United States.

Abstract

Gastrointestinal (GI) disturbances are a prevalent cause of marathon related complaints, and in extreme cases can promote life-threatening conditions such as exertional heat stroke. Our aim was to study intestinal cell injury [via intestinal fatty acid binding protein (I-FABP)] and perceived GI distress symptoms among marathon runners. We also examined potential risk factors (e.g., inadequate sleep) that could exacerbate GI disturbances in healthy, trained endurance runners. This was a parallel mixed-methods study design. 2019 Boston Marathon participants were recruited via email and subjects completed surveys before the race describing demographics and training history. Participants completed a GI questionnaire to assess presence and severity of symptoms, a survey regarding risk factors (e.g., recent illness, medications) that could promote GI disturbances, and provided a urine sample at three time points (immediately pre-race, post-race, and 24-h post-race). Due to weather, blood samples were only collected immediately and 24-h post-race. A total of 40 runners (males: n = 19, age = 44.9 ± 10.8 years; females: n = 21, age = 44.8 ± 10.6 years) completed this study. I-FABP significantly decreased from post-race (3367.5 ± 2633.5 pg/mL) to 24-h post-race (1657.3 ± 950.7 pg/mL, t (39) = -4.228, p < .001, d = -.669). There was a significant difference in overall GI symptom scores across the three time points (F (2, 39) = 41.37, p < .001). The highest average score occurred post-race (.84 ± .68), compared to pre-race (.09 ± .12) and 24-h post-race (.44 ± .28). Post-race I-FABP (r = .31, p = .048) and post-race urine specific gravity (r = .33, p = .041) were significantly correlated with post-race GI symptom scores. Our study provides further support to the individualized nature of GI disturbances, with participants experiencing a wide range of risk factors that can influence the extent of GI damage and perceived symptoms during and after exercise.

Keywords: endurance exercise; hydration; intestinal epithelium; intestinal fatty acid binding protein; race medicine.

Grants and funding

The authors declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by internal funding from the New Faculty Research Grant awarded to DE by the University of Kansas School of Education and Human Sciences and by external funding from the Mid-America Athletic Trainers Association awarded to DE and MK.