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The Gastrointestinal Exertional Heat Stroke Paradigm: Pathophysiology, Assessment, Severity, Aetiology and Nutritional Countermeasures

1
Faculty of Sport, Health and Wellbeing, Plymouth MARJON University, Derriford Rd, Plymouth PL6 8BH, UK
2
School of Chemical Engineering, University of Birmingham, Birmingham B15 2QU, UK
3
Institute of Naval Medicine, Alverstoke PO12 2DW, UK
*
Author to whom correspondence should be addressed.
Nutrients 2020, 12(2), 537; https://doi.org/10.3390/nu12020537
Received: 1 February 2020 / Revised: 14 February 2020 / Accepted: 15 February 2020 / Published: 19 February 2020
(This article belongs to the Section Sports Nutrition)
Exertional heat stroke (EHS) is a life-threatening medical condition involving thermoregulatory failure and is the most severe condition along a continuum of heat-related illnesses. Current EHS policy guidance principally advocates a thermoregulatory management approach, despite growing recognition that gastrointestinal (GI) microbial translocation contributes to disease pathophysiology. Contemporary research has focused to understand the relevance of GI barrier integrity and strategies to maintain it during periods of exertional-heat stress. GI barrier integrity can be assessed non-invasively using a variety of in vivo techniques, including active inert mixed-weight molecular probe recovery tests and passive biomarkers indicative of GI structural integrity loss or microbial translocation. Strenuous exercise is strongly characterised to disrupt GI barrier integrity, and aspects of this response correlate with the corresponding magnitude of thermal strain. The aetiology of GI barrier integrity loss following exertional-heat stress is poorly understood, though may directly relate to localised hyperthermia, splanchnic hypoperfusion-mediated ischemic injury, and neuroendocrine-immune alterations. Nutritional countermeasures to maintain GI barrier integrity following exertional-heat stress provide a promising approach to mitigate EHS. The focus of this review is to evaluate: (1) the GI paradigm of exertional heat stroke; (2) techniques to assess GI barrier integrity; (3) typical GI barrier integrity responses to exertional-heat stress; (4) the aetiology of GI barrier integrity loss following exertional-heat stress; and (5) nutritional countermeasures to maintain GI barrier integrity in response to exertional-heat stress. View Full-Text
Keywords: exercise; sport; nutrition; supplement; gut exercise; sport; nutrition; supplement; gut
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MDPI and ACS Style

Ogden, H.B.; Child, R.B.; Fallowfield, J.L.; Delves, S.K.; Westwood, C.S.; Layden, J.D. The Gastrointestinal Exertional Heat Stroke Paradigm: Pathophysiology, Assessment, Severity, Aetiology and Nutritional Countermeasures. Nutrients 2020, 12, 537. https://doi.org/10.3390/nu12020537

AMA Style

Ogden HB, Child RB, Fallowfield JL, Delves SK, Westwood CS, Layden JD. The Gastrointestinal Exertional Heat Stroke Paradigm: Pathophysiology, Assessment, Severity, Aetiology and Nutritional Countermeasures. Nutrients. 2020; 12(2):537. https://doi.org/10.3390/nu12020537

Chicago/Turabian Style

Ogden, Henry B.; Child, Robert B.; Fallowfield, Joanne L.; Delves, Simon K.; Westwood, Caroline S.; Layden, Joseph D. 2020. "The Gastrointestinal Exertional Heat Stroke Paradigm: Pathophysiology, Assessment, Severity, Aetiology and Nutritional Countermeasures" Nutrients 12, no. 2: 537. https://doi.org/10.3390/nu12020537

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