Intestinal barrier dysfunction, endotoxemia, and gastrointestinal symptoms: the 'canary in the coal mine' during exercise-heat stress?

Med Sport Sci. 2008:53:61-73. doi: 10.1159/000151550.


Reduced intestinal blood flow and high intestinal temperatures during exercise-heat stress can lead to intestinal barrier dysfunction. Such dysfunction may increase intestinal permeability to endotoxin. During exercise-heat stress, intestinal barrier dysfunction and endotoxemia can produce gastrointestinal symptoms and increased production of pro-inflammatory cytokines. Such problems may be a warning sign ('canary in the coal mine') for the onset of exertional heat stroke. Failure to heed such a warning may culminate in problems indicative of exertional heat stroke such as circulatory collapse and multiple organ failure. Prior exposure to exercise-heat stress may, however, be a protective mechanism.

Publication types

  • Review

MeSH terms

  • Adaptation, Physiological
  • Cytokines
  • Endotoxemia / physiopathology*
  • Exercise Tolerance*
  • Exercise*
  • Gastrointestinal Tract / physiopathology*
  • Heat Stress Disorders / etiology
  • Heat Stress Disorders / physiopathology*
  • Humans
  • Inflammation / etiology
  • Oxidative Stress
  • Permeability*


  • Cytokines