Osmolarity does not affect the gastric emptying rate of oral rehydration solutions.

BACKGROUND: The objective of this study was to determine the effect of either carbohydrate content or osmolarity on gastric emptying rate in normal healthy subjects. METHODS: In total 12 test drinks were ingested as a single 8 mL/kg per body weight bolus on an empty stomach. Six of these drinks had a different carbohydrate content, increasing stepwise from 45 to 90 g/L, but all with the same osmolarity (330 mOsm/kg). The other six drinks all contained 60 g carbohydrate/L but differed stepwise in osmolarity because of the use of maltodextrins with a difference in chain length (243 to 374 mOsm/kg). RESULTS: The results show a significant negative relation between carbohydrate content and gastric emptying in the six drinks with a uniform osmolarity but progressively increasing carbohydrate content. The six drinks, which had the same carbohydrate-energy content but different osmolarities, emptied all at the same rate from the stomach. The delivery of carbohydrate-energy per minute from the stomach to the small intestine was the same for all drinks. CONCLUSIONS: From these data we conclude that the rate of gastric emptying of carbohydrate-containing solutions is triggered by the carbohydrate-energy drink content or by the delivery rate of carbohydrate-energy to the gut. Osmolarity in the range studied here had no effect.

Effects of electrolytes in carbohydrate beverages on gastric emptying and secretion.

Two experiments were done at rest to examine gastric residue and secretion volume and electrolyte composition after ingestion of beverages of varying composition. In the first experiment the effects of two different sport drinks, one isotonic (7% carbohydrate, primarily sucrose) (I) and one hypertonic (18% carbohydrate, primarily maltodextrin) (H), and a control beverage (0.08 g.l-1 aspartame in water) (C) on titratable acid, pH, osmolality, gastric emptying and secretion volume, and Na+, K+, and Cl- content were measured. In a second experiment five solutions were tested all containing 150 g.l-1 maltodextrin, with 28 meq.l-1 Na+ (low Na), 140 meq.l-1 Na+(high Na), 28 meq.l-1 K+(K), or 140 meq.l-1 Na+ and 28 meq.l-1 K+(high NaK). Beverages H and C, and distilled water (W) were also tested. Samples were taken via a nasogastric tube. A dye dilution technique for serial sampling was employed to determine beverage and secretion volumes. After receiving a bolus of 8 ml.kg-1 body weight, samples of gastric residue were taken at 0, 10, 20, 30, 40, 60, and 80 min. Gastric secretion of Na+, K+, and Cl- was fairly constant despite large differences in beverage composition. Changes in gastric residue pH, titratable acid, osmolality, and electrolyte composition reflected the increasing proportion of the residue that was from gastric secretions. The effects of varying concentrations of Na+ and K+ (in a 150 g.l-1 maltodextrin solution) on gastric emptying were not significant. The high carbohydrate concentration and/or the large volume ingested may have overridden any effect of sodium or potassium. No differences were observed between W and C. Secretion was decreased in these two solutions versus all the others. Although nonsignificant, there was a trend for greater secretion in H versus the other carbohydrate containing solutions in experiment 2. This may be a result of the higher pH maintained after ingestion of this beverage.

[The effect of beverage composition and gastrointestinal function on fluid and nutrient availability during physical exertion: e review]. / Der Einfluss der Getränkezusammensetzung und der gastrointestinalen Funktion auf die Flüssigkeits- und Nährstoffverfügbarkeit während körperlicher Belastung: ein Uberblick.

Intensive exercise affects digestion and absorption. Nevertheless, athletes involved in intensive endurance exercise are advised to ingest fluid and energy supplying nutrients, to compensate for the losses and to delay fatigue. The present review describes the effects of exercise on the gastrointestinal tract and the aspects which determine optimal fluid and nutrient delivery during exercise in different climatological and exercise conditions.

Gastric emptying of carbohydrate--medium chain triglyceride suspensions at rest.

Nine male volunteers participated in 4 gastric emptying (GE) tests of liquid equicaloric mixtures of CHO (maltodextrins) and MCT of the following composition (% CHO-% MCT): Drink (Dr) 1:70%-30%, Dr2: 80%-20%, Dr3: 90%-10%, Dr4: 100%-0%. GE was measured at rest for 90 min according to the modified double sampling technique. GE rate, expressed as t1/2 (SEM), was 23 (2.3), 24 (1.6), 27 (2.2) and 36 (2.9) min, respectively, from drink 1 to drink 4. Statistical analysis showed that all MCT containing drinks emptied faster than the 100% CHO drink. Two mechanisms may explain this observation: 1) the CHO content and osmolality increases from Dr 1 to Dr 4 (both are regulators of GE); 2) MCT may not inhibit GE as common fat does, due to a better water solubility and absorption in the small intestine, resulting in a decreased duodenal-gastric feedback.

Gastric emptying, absorption, and carbohydrate oxidation during prolonged exercise.

This study was designed to examine aspects of digestive function that may limit assimilation of water and oxidation of orally ingested carbohydrate (CHO) during exercise. Eight males completed a crossover study in which each cycled on four occasions for 80 min at 70% maximal O2 consumption. Beverage was consumed at 0, 20, 40, and 60 min. Beverages were water, 4.5% glucose (4.5G), 17% glucose (17G), and 17% maltodextrin (17MD). CHO beverages contained 20 meq/l NaCl and were 13C enriched to measure exogenous CHO oxidation. Gastric (beverage) volume was measured at 80 min. Water uptake was estimated by including 2H2O in the beverage and measuring 2H accumulation in blood. Jejunal perfusion tests were conducted at rest with the same subjects and beverages. In 60 min, 1,294 +/- 31 (SE) ml were ingested; at 80 min, volumes emptied with H2O (1,257 +/- 32 ml) and 4.5G (1,223 +/- 32 ml) were greater than with 17G (781 +/- 56 ml) and 17MD (864 +/- 71 ml; P less than 0.05). Total CHO oxidized was similar with all beverages, but there was a greater increase in exogenous CHO oxidation over time with 17G and 17MD than with 4.5G; 54, 19, and 18% of the CHO ingested with 4.5G, 17G, and 17MD, respectively, was oxidized. This represents 57, 32, and 27%, respectively, of the CHO emptied from the stomach. 2H accumulation in the blood was more rapid with H2O and 4.5G than with 17G or 17MD. Net jejunal water absorption was greater from 4.5G than from water. Net water absorption was also observed from 17MD, whereas net secretion was observed with 17G.(ABSTRACT TRUNCATED AT 250 WORDS)

Physiological changes and gastro-intestinal symptoms as a result of ultra-endurance running.

One hundred and seventy-two competitors of the Swiss Alpine Marathon, Davos, Switzerland, 1988, volunteered for this research project. Of these volunteers 170 (158 men, 12 women) finished the race (99%). The race length was 67 km with an altitude difference of 1,900 m between the highest and lowest points. Mean age was 39 (SEM 0.8) years. Average finishing times were 8 h 18 min (men) and 8 h 56 min (women). Loss of body mass averaged 3.4% body mass [mean 3.3 (SEM 0.2)%; 4.0 (SEM 0.4)%; men and women, respectively]. Blood samples from a subgroup of 89 subjects (6 women and 83 men) were taken prior to and immediately after completion of the race. Changes in haemoglobin (9.3 mmol.l-1 pre-race, 9.7 mmol.l-1 post-race) and packed cell volume (0.44 pre, 0.48 post-race) were in line with the moderate level of dehydration displayed by changes in body mass. Mean plasma volume decreased by 8.3%. No significant changes in plasma osmolality, sodium, or chloride were observed but plasma potassium did increase by 5% (4.2 mmol.l-1 pre-race, 4.4 mmol.l-1 post-race). Mean fluid consumption was 3290 (SEM 103) ml. Forty-three percent of all subjects, and 33% of those who gave blood samples, complained of gastro-intestinal (GI) distress during the race. No direct relationship was found between the quantity or quality of beverage consumed and the prevalence of GI symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of aspiration and scintigraphic techniques for the measurement of gastric emptying rates of liquids in humans.

A comparison was made of two techniques to measure the rate of gastric emptying. A noninvasive scintigraphic technique using a gammacamera and an invasive aspiration technique based on dye dilution were performed simultaneously. Seven healthy male volunteers each consumed two different liquid meals on two separate occasions. Scintigraphic measurements were performed continuously with aspiration every 10 minutes for a total of one hour. Gastric emptying rates were expressed as slope values after semilog linearisation of the emptying curves. Agreement between the two methods was assessed from the individual differences and mean of the two techniques, as well as from the geometric mean, including 95% limits of agreement. The scintigraphic technique gave a 70% slower emptying rate than the dye dilution technique. However, the 95% limits of agreement are large (1.56 to 0.30), reflecting the small sample size and the large coefficient of variation in the techniques used.

Daily variation in gastric emptying when using the double sampling technique.

The purpose of this study was to establish the intra-individual variation in the rate of gastric emptying (GE) by using the double sampling technique of George. Eight healthy male volunteers, all familiar with gastric intubation and testing, participated in four GE tests, using an isotonic fluid as a test meal. Conditions were kept constant during all four tests, and each test was separated by at least 48 h. The within-subjects coefficient of variation proved to be 29%. The findings demonstrate that, given standard conditions, GE is reproducible from day to day.

Carbohydrate supplementation, glycogen depletion, and amino acid metabolism during exercise.

Eight highly trained cyclists were studied during exercise after glycogen depletion (test A) and during carbohydrate (CHO) loading (test B). In test B subjects were able to complete 2 h of exercise at 70-75% maximal workload (Wmax), whereas the initial intensity of 70% Wmax had to be reduced to 50% in test A. Plasma ammonia increased more rapidly, and plasma alanine, glutamate, and glutamine were lower in test A. Exercise caused a 3.6-fold increase in the proportion of active branched-chain 2-oxoacid dehydrogenase (BC) complex in muscle in test A. No activation occurred in test B. There was an inverse correlation between the activity of the BC complex and the glycogen content of the postexercise biopsies. Exercise did not cause changes in the muscle content of ATP, ADP, AMP, IMP, hypoxanthine, and lactate. It is concluded that CHO loading abolishes increases in branched-chain amino acid (BCAA) oxidation during exercise and that part of the ammonia production during prolonged exercise originates from deamination of amino acids. The data appear to confirm the hypothesis (A.J. M. Wagenmakers, J.H. Coakley, and R.H.T. Edwards. Int. J. Sports Med. 11: S101-S113, 1990) that acceleration of the BCAA aminotransferase reaction may drain the tricarboxylic acid cycle and that glycogen is a carbon chain precursor of tricarboxylic acid cycle intermediates and glutamine.

Effects of dehydration on gastric emptying and gastrointestinal distress while running.

Gastrointestinal distress is commonly reported by athletes after ingestion of a beverage. We speculate that ingestion may be occurring after dehydration has taken place. The high prevalence of GI disorders in marathon runners who have lost greater than or equal to 4% body weight supports this theory. To test this theory, the effects of dehydration, and dehydration in combination with endurance running, on gastric emptying (GE) and frequency of gastrointestinal (GI) complaints were tested in this experiment. A complete cross-over study was designed. Sixteen subjects ingested 8 ml.kg BW-1 of a 7% carbohydrate (296 mOsm.kg-1), solution after a euhydration or dehydration regime. Dehydration (4% BW loss) was produced by 60% maximal speed running at 30 degrees C or by intermittent sauna exposure at 100 degrees C. Euhydration experiments were conducted with a 2 h rest period with water administered at 20 and 40 min. Gastric drink volumes were measured every 10 min for 40 min. Emptying curves were compared using semi-log transformation of the percentage emptying data and simple linear regression. The slope of each line was used as a measure of average GE rate. Dehydration-exercise resulted in slower GE than in all other treatments (P less than 0.05). ANOVA revealed significant effects of dehydration (P less than 0.05) and exercise (P less than 0.05), these two effects being additive in delaying GE. GI complaints were reported by 37.5% of the subjects during dehydration-exercise experiments. No GI disturbance was reported in other tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Gastric emptying with repeated drinking during running and bicycling.

The high prevalence of gastrointestinal complaints in long-distance runners makes the movements specific to this type of exercise suspected of causing a disruption of normal gastrointestinal function. Gastric emptying rate is one indicator thereof. In the present study trained volunteers performed similar repeated fluid ingestion tests while running and while bicycling for 80 min at 70% VO2max. Control tests at rest were also conducted. Two drinks containing carbohydrate were tested, one hypertonic, and one isotonic. Artificially sweetened water was used as a control. Gastric emptying rate of the isotonic drink, expressed as a percentage of the volume in the stomach at the beginning of each measurement period, did not differ between cycling and running during the first 40 min and was faster during cycling than during running between 40 and 80 min. With the hypertonic drink no differences between cycling and running were observed. In comparing gastric emptying rates after each sequential bolus, at rest, the isotonic drink was observed to maintain a high emptying rate, equal to that of water, whereas the hypertonic drink emptied more slowly after the first 20-min period. A similar pattern was observed during both running and cycling. The isotonic drink continued to empty quickly after the initial 20 min, whereas GE rate of the hypertonic drink decreased after the initial 20 min.

Determination of total gastric volume, gastric secretion and residual meal using the double sampling technique of George.

In literature several techniques are described for the measurement of gastric emptying. One of these is the double sampling technique of George which has the advantage that it enables multiple measurements of total gastric volume in one experiment. In order to estimate net gastric emptying, however, it is important to differentiate between the test meal volume present in the stomach and gastric secretion. In the present study George's technique was extended with a calculation procedure to estimate gastric secretion and net test meal outflow. An in vitro experiment was carried out which showed an accuracy of 5-10% for this method. An in vivo comparison was made with Hunt's chloride technique, which is used for estimating gastric secretion. Sixteen subjects participated in a 60 minute test with water as a test meal. Regression analysis showed a high degree of correlation (R2 = 0.99) between Hunt's method and the proposed method. The data obtained indicate that the proposed method gives a reliable estimation of net gastric emptying and is simple to do as no further measurements have to be carried out other than those needed for George's method.