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. 2025 Jul 23:12:1589344.
doi: 10.3389/fnut.2025.1589344. eCollection 2025.

Gastrointestinal symptoms among recreational long distance runners in China: prevalence, severity, and contributing factors

Xueyuan Zhao  1 , Yan Chen  2 , Xiangxin Li  2 , Wei Wen  2 , Jingyi Zhang  1 , Junqiang Qiu  2   3
Affiliations

Gastrointestinal symptoms among recreational long distance runners in China: prevalence, severity, and contributing factors

Xueyuan Zhao et al. Front Nutr. .

Abstract

Purpose: Gastrointestinal (GI) symptoms are prevalent among endurance athletes, especially marathon runners, and can negatively affect performance and wellbeing. However, data on the prevalence and nutritional contributors to GI symptoms in Chinese recreational long distance runners remain limited. This study aimed to investigate the prevalence, severity, and dietary influences of GI symptoms in this population.

Methodology: A total of 805 valid responses were collected through an online and offline questionnaire conducted in China between January and December 2024. Participants were recreational long distance runners recruited via running clubs, community organizations, sports associations, and online platforms. The questionnaire covered six areas: demographics, exercise habits, dietary strategies, GI symptom severity and frequency, influencing factors, and knowledge and attitudes. GI symptoms during races were assessed using the Gastrointestinal Symptom Rating Scale (GSRS), which includes 11 symptoms rated on a 7-point Likert scale.

Results: Notably, 26.1% of participants reported GI symptoms during races, with bloating (18.6%), urge to defecate (17.8%), and stomach pain (16.5%) being the most frequent. Symptoms peaked in prevalence and severity during the middle phase of the race. GI symptoms were more common in males (27.9%) than females (20.8%), and runners aged 34 years and younger had a higher symptom rates. Nutritional factors, particularly pre- and mid-race dietary strategies, significantly influenced symptom occurrence. Foods high in fat, protein, fiber, or fermentable carbohydrates were commonly associated with GI distress. Eating within 30 min before a race increased the risk of bloating and urge to defecate. The use of energy gels, sports drinks, and hydration strategies also correlated with higher GI symptom risk. Other contributing factors included a history of GI issues and high monthly running volume.

Discussion: The findings underscore the importance of individualized dietary planning to reduce GI symptoms among recreational long distance runners. Adjusting pre-race meal timing and avoiding certain food types may mitigate discomfort. In addition to nutrition, variables such as sex, age, training load, and medical history should be considered in preventive strategies. Future research should explore tailored nutrition and training approaches to improve athlete health and performance during endurance events.

Keywords: gastrointestinal symptoms; marathon; nutrition strategies; prevalence; running.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Bar and line graph showing frequency and severity across four stages: Beginning, Middle, Final, and Post-Race. Frequency is highest at the Middle stage and lowest Post-Race. Severity is represented by a line with slight variations among stages. Asterisks and crosses indicate significance.
FIGURE 1
Frequency and severity on a scale of 0 (“none”) to 1 (“very severe”) by segment for finishers who reported that GI symptoms affected race performance. Severity data represent mean scores calculated only from participants who reported symptoms of at least mild intensity in any race segment. *Frequency was significantly greater than the Post-Race Stage (p < 0.05). † Frequency significantly greater than that in the Middle Stage (p < 0.05).
Bar charts display pre-race restricted food types and symptom prevalence. The left chart shows seafood, red meat, and legumes most restricted, with percentages 47.5%, 26.2%, and 25.3%, respectively. The right chart highlights abdominal pain/side stitch, stomach pain, and bloating as prevalent symptoms, with percentages 26.2%, 25.2%, and 22.2%, respectively.
FIGURE 2
Food restrictions before races and associated GI symptoms in Chinese recreational long distance runners. (A) Types of foods typically restricted before races (n = 805). (B) Symptoms during the race without pre-race food restrictions (n = 761).
Stacked bar chart showing in-race food consumption frequency for various items such as water, sports drinks, energy drinks, and bars. Consumption levels range from “Always” to “Never” and are marked with colors blue to beige. Each item shows a different distribution across consumption frequencies.
FIGURE 3
Types and frequency of food consumption during races in Chinese recreational long distance runners (n = 805).
See this image and copyright information in PMC

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