Background Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating multisystem disorder marked by profound fatigue, cognitive impairment, and post-exertional symptom exacerbation. Because therapeutic strategies for ME/CFS are limited, self-management through dietary supplements may provide affected individuals with a sense of control in managing this chronic illness. Methods A structured questionnaire was distributed to women diagnosed with ME/CFS. Data on illness duration, symptoms, functional capacity, supplement use, and dietary restrictions were collected. Secondary analyses focused on participants' access to supplements, sources of information, and communication with physicians. Supplements were categorized based on established classification systems. Results There were 268 valid responses (Age, 43 ± 14y; ME/CFS duration, 8.8 ± 9.5y). Participants were highly impaired, with 28% classified as functionally housebound. Supplement use was highly prevalent (91%), and supplement users reported a mean of 8±7 different supplements. Perceived symptom improvement (P < 0.001) and higher participant education (P = 0.02) were associated with greater supplement use. Supplement-related concerns, including cost ($106 USD/month) and access, represented significant sources of participant stress. Only half of participants reported disclosing all supplements to their physician. Dietary restrictions were reported by 30% of respondents, with gluten-free, lactose-restricted, and high-protein diets being the most common. Conclusions Supplement use is highly prevalent in ME/CFS, but current scientific evidence supporting their widespread therapeutic use remains limited. As a result, many participants resort to a trial-and-error approach and may engage in excessive supplementation. Continued research assessing the effectiveness of dietary interventions and supplements will enable healthcare professionals to offer evidence-based guidance to improve symptom management and reduce patient burden.

BACKGROUND:Exercise induced gastrointestinal (GI) symptoms affect a significant portion of endurance runners, resulting in discomfort and suboptimal performance. Protein intakes pre-exercise may have benefits; however, research investigating dietary intake prior to exercise suggests that many runners avoid foods high in protein before running to manage their GI symptoms. Unfortunately, clinical trials evaluating the effectiveness of this strategy are lacking. This study aimed to quantify exercise-induced GI symptoms, gut fullness, blood glucose response, and ratings of perceived exertion in response to low-protein (LP) and moderate-protein (MP) pre-exercise shake. METHODS:This single-blind crossover study involved 13 recreational runners (eight females, five males) who completed a 10 km treadmill run at 85% of their 10 km race pace after consuming a shake with carbohydrate and whey protein at either a low-protein (0.15 g/kg body mass) or moderate-protein (0.4 g/kg body mass) dose 60 minutes prior to exercise. Due to increased whey protein and standardized carbohydrate, the shakes had differing energy contents. GI symptoms were assessed pre-shake, 60 minutes post-shake, and post-run using a questionnaire and gut fullness was assessed pre-shake, 15-, 30-, and 60 minutes post-shake, and post-run using a visual analog scale. Blood glucose was measured pre-shake, 30- and 60 minutes post-shake, and post-run using a capillary blood sample and rating of perceived exertion was assessed following the 10 km run. RESULTS:Total symptoms experienced increased over time (p < 0.01) and were greater during the run than at fasting (p < 0.01) or post-shake (p = 0.01) but were not affected by protein content (p = 0.85). A significant increase in bloating severity was observed following the moderate-protein shake as compared to the low-protein shake during the run (0.54 vs 1.23; p = 0.03), but no other symptoms assessed were significantly impacted by the shake composition. Blood glucose was significantly higher at 30 minutes post-shake than at any other time; however, there was no difference between the shakes (p = 0.20). Gut fullness increased post-shake (p < 0.01) but did not differ significantly between the two conditions at any time point; however, remained above fasting at all time points only in the MP group. Rating of perceived exertion was not significantly different between the two conditions (low-protein = 14.9 ± 1.0; moderate-protein = 14.9 ± 0.7; p = 1.00). CONCLUSIONS:Easily digestible protein sources up to 0.4 g/kg body mass consumed one hour before exercise are advised and generally well tolerated, though 0.4 g/kg body mass of protein was associated with increased bloating. However, protein intakes before exercise should be trialed prior to competition due to variations in individual tolerance.

Our aim was to examine the effects of combined prebiotic fiber supplementation and weight loss counseling on liver fat, body composition, subjective appetite, serum metabolomics, and intestinal microbiota in adults with MASLD. In a double blind, placebo-controlled trial, adult participants aged 18–70 years old with MASLD were randomized to receive prebiotic (oligofructose-enriched inulin, 16 g/day; n = 22) or isocaloric placebo (maltodextrin; n = 20) for 24 weeks alongside weight loss counseling from a registered dietitian. Primary outcomes were change in intrahepatic fat

Iron deficiency is prevalent among female athletes, often leading to fatigue, impaired recovery, and decreased performance. Conventional oral iron supplements are associated with poor absorption and negative gastrointestinal side effects, resulting in low adherence. This feasibility trial investigated the tolerability and gastrointestinal effects of an iron-yeast complex (FeSC) supplement in physically active females to assess its potential for further study. This single-arm, mixed-methods feasibility trial recruited 14 active females (18–25 years) who consumed FeSC-fortified cookies (40 mg elemental iron) every other day for 14 days. Gastrointestinal symptoms, stress, and recovery were assessed through daily and weekly questionnaires (daily questionnaires: Gastrointestinal Symptoms Questionnaire and Short Recovery and Stress Scale; weekly questionnaires: Patient-Reported Outcomes Measurement Information System (PROMIS) Gastrointestinal Symptom Scale; RESTQ Basic-24). Qualitative data on supplement acceptability were collected post-intervention. Feasibility was evaluated based on recruitment, retention, adherence, and safety criteria. Out of 52 participants who completed our screening questionnaire, 14 (age = 22 SD 2 years; weekly physical activity = 420 SD 140 min/week) met all criteria and completed the intervention. All feasibility criteria were met, including 100

There are no known curative treatments for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and current therapeutic regimens often yield inconsistent results. Despite the profound physical and mental burden experienced by those living with ME/CFS, patients often face a trial-and-error process in finding medications that offer some relief. The current study surveyed 135 North American women diagnosed with ME/CFS to characterize medication use in relation to disease features, symptomology, and function. Medications were classified into 9 categories according to their primary mechanism of action and therapeutic use. Participants were primarily middle-aged (47.1 ± 15.3 years) and were diagnosed for a mean duration of 8.4 ± 9.5 years (mean ± SD). Responses showed 68.6% of participants reported taking medications specifically for ME/CFS. Of those taking ME/CFS-related symptom medications, the average use was 3.0 medications per patient, with higher use in US compared to Canadian participants. Analgesic medications (31.7%) were the most frequently used, followed by psychotropic (26.4%), and immune-related medications (10.6%). These trends persisted across different symptom profiles, apart from gastrointestinal associated medication use replacing immune-related medications in those with gastrointestinal, neurological, and psychiatric symptoms. There was no significant correlation found between the number of medications used with disease duration, age, or age at diagnosis. However, a U-shaped relationship between ME/CFS-related symptom medication use and functional capacity as assessed by self-reported physical movement (hours/week) was evident. Our study highlights the diverse and complex patterns in pharmacological treatment regimens for ME/CFS in women, while also underscoring the need for more tailored and evidence-based therapeutic strategies to address the varied symptom profiles.

Background & aims Mitochondrial diseases (MITO) are a large group of rare genetic conditions that manifest in high-energy organ systems and impair mitochondrial oxidative phosphorylation. Therapeutic management often involves the use of dietary supplements and special dietary patterns. Methods A questionnaire assessing dietary patterns and supplement use was administered to diagnosed patients or their surrogate caregivers through various MITO-related patient and advocacy organizations and social media internationally from March to September 2021. Secondary outcomes assessed information available to participants regarding supplements, and factors influencing use, knowledge, and adherence to dietary supplements. Supplements were classified using standard criteria. A total of 236 responses were used for the analysis. Results The average number of supplements taken among patients was 7.0 (±5.0 SD) with over 70% reporting taking more than 4 supplements. Sixty percent of respondents reported dietary restrictions, while 14% were tube fed or parenterally fed. Uncertainty regarding supplement cost, use, and availability were a significant source of stress for most participants with 61% of patients reporting no financial coverage for supplementation and 45% reporting no coverage for special dietary needs. Conclusions Adequate scientific evidence for the widespread use of dietary supplements in MITO is lacking. As a result, there is excessive supplementation in MITO that imposes significant stress on patients. Future studies are needed to evaluate the efficacy of specific supplements as well as special dietary patterns to enable physicians and pharmacists to provide evidence-based recommendations to patients to reduce symptoms, as well as the emotional and financial strain associated with supplement use.

Sports nutrition for athletes with a spinal cord injury (SCI) is complex, making it challenging for athletes to stay informed. The aim of this study was to assess sports nutrition knowledge in athletes with an SCI and coaches of para sports. The secondary aim was to report sources of sports nutrition information. Eighty athletes and 26 coaches across various adapted sports were recruited. The Nutrition for Sport Knowledge Questionnaire was used to assess nutrition knowledge for both groups. Athletes achieved their highest score among the alcohol (65 +/- 19%) category and the lowest in sports nutrition (43 +/- 17%). Coaches demonstrated the most knowledge in the alcohol (73 +/- 17%) category and lowest knowledge in the supplementation (45 +/- 19%) category. Both groups relied on the internet, dietitians, and coaches for sports nutrition information. Future studies should explore the effects of nutrition education on nutrition knowledge and dietary intakes among these populations.

Individuals with inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and reflux frequently experience gastrointestinal symptoms (GIS), potentially enhanced by high-intensity running. Food avoidances, food choices, and GIS in runners with IBS/IBD (n = 53) and reflux (n = 37) were evaluated using a reliability and validity tested questionnaire. Comparisons to a control group of runners (n = 375) were made using a Fisher's Exact test. Runners with IBS/IBD experienced the greatest amount of exercise-induced GIS followed by those with reflux. Commonly reported GIS were stomach pain/cramps (77%; 53%), bloating (52%; 50%), intestinal pain/cramps (58%; 33%), and diarrhea (58%; 39%) in IBS/IBD and reflux groups respectively. In the pre-race meal, those with IBS/IBD frequently avoided milk products (53%), legumes (37%), and meat (31%); whereas, runners with reflux avoided milk (38%), meat (36%), and high-fibre foods (33%). When considering food choices pre-race, runners with IBS/IBD chose grains containing gluten (40%), high fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) fruits (38%), and water (38%). Runners with reflux chose water (51%), grains containing gluten (37%), and eggs (31%). In conclusion, while many runners with IBS/IBD and reflux are avoiding trigger foods in their pre-race meals, they are also consuming potentially aggravating foods, suggesting nutrition advice may be warranted.

The Paralympic movement is growing in popularity, resulting in increased numbers of athletes with a spinal cord injury (SCI) competing in various sport disciplines. Athletes with an SCI require specialized recommendations to promote health and to maximize performance, as evidenced by their metabolic and physiological adaptations. Nutrition is a key factor for optimal performance; however, scientifically supported nutritional recommendations are limited. This review summarizes the current knowledge regarding the importance of carbohydrates (CHO) for health and performance in athletes with an SCI. Factors possibly affecting CHO needs, such as muscle atrophy, reduced energy expenditure, and secondary complications are analyzed comprehensively. Furthermore, a model calculation for CHO requirements during an endurance event is provided. Along with assessing the effectiveness of CHO supplementation in the athletic population with SCI, the evaluation of their CHO intake from the available research supplies background to current practices. Finally, future directions are identified. In conclusion, the direct transfer of CHO guidelines from able-bodied (AB) athletes to athletes with an SCI does not seem to be reasonable. Based on the critical role of CHOs in exercise performance, establishing recommendations for athletes with an SCI should be the overall objective for prospective research.

Athletes and their support personnel are constantly seeking evidence-informed recommendations to enhance athletic performance during competition and to optimize training-induced adaptations. Accordingly, nutritional and supplementation strategies are commonplace when seeking to achieve these aims, with such practices being implemented before, during, or after competition and/or training in a periodized manner. Performance nutrition is becoming increasingly specialized and needs to consider the diversity of athletes and the nature of the competitions. This Special Issue, Nutrition Support for Athletic Performance, describes recent advances in these areas.

Caffeine is the most commonly consumed central nervous system stimulant worldwide resulting in increased alertness, mood, arousal, vigilance, and attention. Caffeine is also one of the few permitted ergogenic aids with well-established performance benefits and therefore is used extensively by athletes. Research supports its effectiveness in a broad range of exercise modalities, including sprint, power, intermittent, and endurance activities. For this reason, there has been intense interest in understanding the timing, dose response, biochemistry, and mechanisms of caffeine's action related to sports performance. This chapter will provide an overview of the pharmacokinetics of caffeine, including metabolism and excretion. Caffeine's role in exercise performance encompassing both aerobic and anaerobic activities will be covered in the context of physiological impacts and performance measures. Current recommendations regarding effective dose, timing, and alternative modes of administration are provided. Mechanisms of action, including adenosine receptor antagonism, skeletal muscle function, and carbohydrate and fat oxidation, are reviewed. Concerns regarding caffeine ingestion and potential negative side effects are highlighted, as well as the need for individualized recommendations. Factors that could affect an athlete's response to caffeine, including biological sex, habituation, and genetics, are discussed. Finally, unanswered questions and future directions are included to show limitations in our knowledge.

PURPOSE: Gastrointestinal (GI) symptoms often hinder running performance and are responsive to nutrient intakes. Currently, the recommendation is to “limit” protein intakes to minimize symptoms, but a threshold has not been established. The purpose of this study was to examine the effect of a highprotein (HP) vs a low protein (LP) shake on running induced GI symptoms. METHODS: Five (n=2 male) endurance trained runners were administered a HP (0.4 g/kg body weight) or LP (0.15 g/kg/ body weight) shake one hour prior to a 10 km run at 85% of their race pace in a single-blind, randomizedcross-over design. Carbohydrate and water intakes remained consistent across trials. Exercise induced GI symptoms were measured pre-shake, 60 minutes post-shake, and post-run. Symptoms were rated on a 10 point scale and included six upper abdominal problems, seven lower abdominal problems, and five systemic problems. RESULTS: Symptoms experienced during the LP run included belching (2), stomach cramps (2), intestinal cramps (3), flatulence (1), urge to defecate (1), stitch (1), dizziness (1), muscle cramp (1), urge to urinate (2), and fullness (1). Severity was consistently low with only urge to urinate rated as a 4. Symptoms experienced during the HP run included re-flux (1), belching (2), bloating (1),stomach cramps (2), intestinal cramps (1), flatulence (1), stitch (1), and fullness (1). Severity was consistently low with a maximum of 3. There was no significant difference in the severity of symptoms experienced between the two trials and no difference in the number of symptoms. CONCLUSIONS: A pilot trial indicates no difference in exercise-induced GI symptoms with a HP or LP shake pre-run and suggests intakes up to 0.4g/kg body weight can be well tolerated. Supported by a Mount Royal UniversityInnovation Grant.

Background Endurance runners frequently experience exercise-induced gastrointestinal (GI) symptoms, negatively impacting their performance. Food choices pre-exercise have a significant impact on the gut's tolerance to running, yet little information is available as to which foods runners restrict prior to exercise. Methods A questionnaire designed to assess dietary restrictions pre-racing and gastrointestinal symptoms was administered to 388 runners. Fisher's exact tests determined differences in gender, age, performance level, and distance with follow-up multivariable logistic regression modeling. Results Runners regularly avoided meat (32%), milk products (31%), fish/seafood (28%), poultry (24%), and high-fiber foods (23%). Caffeinated beverages were commonly avoided in events 10 km or less (p < .001); whereas in females, increased running distance was a predictor of avoiding high-fiber foods (OR = 6.7; 95% CI = 1.6-28.5). Rates of food avoidance were elevated in younger and more competitive runners. Common GI symptoms included stomach pain/cramps (42%), intestinal pain/discomfort (23%), side ache/stitch (22%), urge to defecate (22%), and bloating (20%). The prevalence of GI symptoms was higher in younger athletes, especially females, which may explain their propensity to avoid foods. Lower recreational athletes were the least likely to report GI symptoms. Diarrhea incidence increased with running distance.Conclusions:Identification of voluntary food restrictions in the pre-running meal highlights trends that can direct further research.

PURPOSE: Protein recommendations pre-running have yet to be established and will need to consider performance responses as well as the potential for exercise-induced gastrointestinal symptoms. The purpose of this study was to examine the impact of a high protein (HP) shake consisting of 0.4 g/kg body weight (BW) protein vs. a low protein shake (LP) 0.15 g/kg BW protein pre-run on glucose, gut fullness, and perceived exertion. METHODS: Five (n=2 male) endurance trained runners were administered a HP or LP shake one hour prior to a 10 km run in a randomized cross-over design. Carbohydrate and water intakes remained consistent across trials. Blood glucose was measured at fasting, 30, and 60 minutes post-shake and post-run using a glucose meter. Perceived exertion was measured using Borg’s scale. Exercise induced gastrointestinal symptoms were measured at fasting, pre-run and post-run using a 10-point questionnaire. Gut fullness was measured using a visual analogue scale at fasting, 15, 30, 60 minutes post-shake and post-run. RESULTS: Blood glucose peaked at 30 minutes post-shake and there was no difference between the HP and LP shakes. There was a significant interaction between time and shake (p=0.044), however no main effect of time or shake. There was no difference in perceived exertion between the two interventions. Gut fullness changed over time (p=0.005), however, was not affected by the composition of the shake. There was no difference in the number of exercise-induced gastrointestinal symptoms experienced on the HP and LP shakes. CONCLUSION: The results from this pilot study suggest that the inclusion protein in the pre-run meal is feasible and provides support for a fully powered trial. Supported by Mount Royal University Innovation Grant

Previous literature has shown that complementary and alternative medicine (CAM) is steadily increasing in autism spectrum disorder (ASD). However, little data is currently available regarding its use, safety, and efficacy in children with ASD. Thus, the purpose of this study is to describe the use of supplement-based CAM therapies in children between the ages of 4 to 17 years with ASD. This population-based, cross-sectional study evaluated children with ASD regarding supplement use. A total of 210 participants were recruited from a variety of sources including educational and physical activity programs, and social media to complete a questionnaire. Primary caregivers provided information on current supplement based CAM use. Data evaluated the proportion of children that used supplement therapies, the types of supplements used, reasons for use, perceived safety, and demographic factors associated with use (e.g., income, parental education, severity of disorder). Seventy-five percent of children with ASD consumed supplements with multivitamins (77.8%), vitamin D (44.9%), omega 3 (42.5%), probiotics (36.5%), and magnesium (28.1%) as the most prevalent. Several supplements, such as adrenal cortex extract, where product safety has not yet been demonstrated, were also reported. A gluten free diet was the most common specialty diet followed amongst those with restrictions (14.8%). Health care professionals were the most frequent information source regarding supplements; however, 33% of parents reported not disclosing all their child’s supplements to their physician. In conclusion, the use of supplement therapies in children with ASD is endemic and highlights the need for further research concerning public health education surrounding safety and efficacy.

Low dietary fiber intake is associated with higher rates of microbiota-associated chronic diseases such as obesity. Low-fiber diets alter not only microbial composition but also the availability of metabolic end products derived from fermentation of fiber. Our objective was to examine the effects of dietary fiber supplementation on gut microbiota and associated fecal and serum metabolites in relation to metabolic markers of obesity. We conducted a 12-week, single-center, double-blind, placebo-controlled trial with 53 adults with overweight or obesity. They were randomly assigned to a pea fiber (PF, 15 g/d in wafer form; n=29) or control (CO, isocaloric amount of wafers; n=24) group. Blood and fecal samples were collected at baseline and 12 weeks. Serum metabolomics, gut microbiota and fecal short-chain fatty acids (SCFAs) and bile acids (BAs) were examined. Within-group but not between-group analysis showed a significant effect of treatment on serum metabolites at 12 weeks compared to baseline. Fiber significantly altered fecal SCFAs and BAs with higher acetate and reduced isovalerate, cholate, deoxycholate and total BAs content in the PF group compared to baseline. Microbiota was differentially modulated in the two groups, including an increase in the SCFA producer Lachnospira in the PF group and decrease in the CO group. The change in body weight of participants showed a negative correlation with their change in Lachnospira (r=−0.463, P=.006) abundance. The current study provides insight into the actions of pea fiber and its impact on modulating microbiota–host–metabolic axes in obesity.

Exercise induced gastrointestinal (GI) symptoms can plague athletes, especially runners. Sport nutrition recommendations are nutrient rather than foods focused and do not adequately address strategies to reduce GI symptoms. The objective was to develop a valid and reliable questionnaire to evaluate pre-training and pre-racing voluntary food restrictions/choices, reasons for avoiding foods, and gastrointestinal symptoms in endurance runners. Validity testing occurred through four Registered Dietitians, three of whom possess Master’s degrees, and a dietetic trainee who provided initial feedback. Additionally, one Registered Dietitian is a Board Certified Specialist in Sports Dietetics (CSSD), and another has an International Olympic Committee Diploma in Sports Nutrition. The second version was sent out to nine different experts who rated each question using a Likert scale and provided additional comments. For reliability testing, the questionnaire was administered to 39 participants in a test re-test format. Kappa statistics and the prevalence-adjusted bias-adjusted kappa (PABAK) were used to assess the reliability. All questions had an average Likert scale rating of 4/5 or greater. All test re-test results falling under basic information exhibited substantial agreement (kappa ≥0.61). All medical questions including food allergies and intolerances had moderate (kappa ≥0.41) or higher agreement. Responses were less consistent for food avoidances while training (5/28 outcomes) versus racing (0/28 outcomes) with a kappa below 0.41. All reasons for avoiding foods were deemed reliable. Regarding symptoms, side stitch while training and gas while racing were the only flagged categories. Overall, the questionnaire is a valid and reliable tool to evaluate voluntary dietary restrictions among endurance runners. Future studies can use the questionnaire to assess dietary strategies runners employ to reduce GI distress and optimize performance.

Wheelchair rugby is a rapidly growing Paralympic sport; however, research remains predominantly in the realms of physiology and biomechanics. Currently, there is little investigation into nutrition and dietary supplement use among wheelchair rugby athletes (WRA). The aim of this study was to assess the types of dietary supplements (DS) used, the prevalence of usage, and the reasons for use among WRA. The secondary aim was to report utilized and preferred sources of nutritional information among this population. A valid, reliable Dietary Supplement Questionnaire was used to report supplement use and reasons for use. Male (n = 33) and female (n = 9) WRA were recruited at a national tournament and through emailing coaches of various Canadian teams. Dietary supplement usage was prevalent as 90.9% of males and 77.8% of females reported usage within the past three months with the most regularly used supplements being vitamin D (26.2%), electrolytes (19.5%), and protein powder (19.5%). The most common reason for usage was performance. The top sources of nutrition information were dietitian/nutritionist and the internet. Further investigation into DS use is needed to help create nutritional guidelines that are accessible to WRA and athletes with disabilities in general.

In obesity and diabetes the liver is highly susceptible to abnormal uptake and storage of fat. In certain individuals hepatic steatosis predisposes to the development of non-alcoholic steatohepatitis (NASH), a disease marked by hepatic inflammation and fibrosis. Although the precise pathophysiology of NASH is unknown, it is believed that the gut microbiota-liver axis influences the development of this disease. With few treatment strategies available for NASH, exploration of gut microbiota-targeted interventions is warranted. We investigated the therapeutic potential of a prebiotic supplement to improve histological parameters of NASH.