The Impact of Performance Supplements on Irritable Bowel Syndrome-like Gastrointestinal Distress in Athletes
DOI:
https://doi.org/10.12775/QS.2026.53.69931Keywords
irritable bowel syndrome, exercise-induced gastrointestinal syndrome, sports nutrition supplements, probiotics, prebiotics, FODMAP, endurance athletes, sodium bicarbonate, protein supplements, carbohydrate gelsAbstract
Background. Athletes frequently experience gastrointestinal (GI)
disturbances overlapping with Irritable Bowel Syndrome (IBS).
Performance supplements—including carbohydrate gels and beverages, protein powders, creatine, caffeine-based pre-workouts, probiotics, prebiotics, and buffering agents—can mechanistically exacerbate or attenuate these symptoms.
Aim. To summarize human data (2021–2026) regarding the effects of performance and recovery supplements on IBS-like symptoms in athletes, identifying mechanistic themes and research gaps.
Material and methods. This narrative review synthesized evidence from
PubMed and Scopus, including observational studies and clinical trials.
Results. No identified trials recruited athletes with Rome-defined IBS, though a high prevalence of IBS-like symptoms was documented. Multi-strain Lactobacillus or Bifidobacterium probiotics showed small-to-moderate reductions in symptom severity in several randomized trials. Conversely, prebiotics and high-FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) sports products were linked to increased lower-GI burden. Experimental data indicated higher symptom rates with solid carbohydrates compared to gels or beverages at equivalent dosages. Sodium bicarbonate remains strongly associated with GI discomfort, despite novel hydrogel delivery systems. Emerging "gut-supportive" supplements (e.g., collagen peptides, multi-ingredient fermented whey) showed neutral acute effects or preliminary, uncontrolled chronic improvements.
Conclusions. Supplement effects are highly dependent on FODMAP content, osmolality, and underlying GI vulnerability. Multi-strain probiotics and low-FODMAP carbohydrate strategies demonstrate the most consistent potential for symptom reduction. High-priority research should focus on rigorously phenotyped athletes with confirmed IBS and head-to-head trials of low- vs. high-FODMAP formulations.
References
1. Ryan, T., E. Daly, and L. Ryan. 2023. "Exploring the Nutrition Strategies Employed by Ultra-Endurance Athletes to Alleviate Exercise-Induced Gastrointestinal Symptoms—A Systematic Review." Nutrients 15. https://doi.org/10.3390/nu15204330
2. Wardenaar, F. C., K. D. Schott, A. Mohr, C. P. Ortega-Santos, and J. E. Connolly. 2023. "An Exploratory Study Investigating the Prevalence of Gastrointestinal Symptoms in Collegiate Division I American Football Athletes." International Journal of Environmental Research and Public Health 20. https://doi.org/10.3390/ijerph20156453
3. Martinez, I. G., J. Biesiekierski, C. Rauch, and R. J. S. Costa. 2024. "Feeding Tolerance to a Running Gut-Challenge Protocol: a Cross-Sectional Exploration." International Journal of Sports Medicine 46: 510 - 524. https://doi.org/10.1055/a-2541-2821
4. Scrivin, R., R. J. S. Costa, F. Pelly, D. Lis, and G. Slater. 2022. "An exploratory study of the management strategies reported by endurance athletes with exercise-associated gastrointestinal symptoms." Frontiers in Nutrition 9. https://doi.org/10.3389/fnut.2022.1003445
5. Killian, L., J. Muir, J. Barrett, N. Burd, and S. Lee. 2021. "High Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAP) Consumption Among Endurance Athletes and Relationship to Gastrointestinal Symptoms." Frontiers in Nutrition 8. https://doi.org/10.3389/fnut.2021.637160
6. Zhao, X., Y. Chen, X. Li, W. Wen, J. Zhang, and J. Qiu. 2025. "Gastrointestinal symptoms among recreational long distance runners in China: prevalence, severity, and contributing factors." Frontiers in Nutrition 12. https://doi.org/10.3389/fnut.2025.1589344
7. Ribichini, E., G. Scalese, A. Cesarini, C. Mocci, N. Pallotta, C. Severi, and E. Corazziari. 2023. "Exercise-Induced Gastrointestinal Symptoms in Endurance Sports: A Review of Pathophysiology, Symptoms, and Nutritional Management." Dietetics. https://doi.org/10.3390/dietetics2030021
8. Kołodziejczyk, A., W. Staśkiewicz-Bartecka, and M. Kardas. 2026. "The Role of FODMAPs in Sports Nutrition: A Narrative Review and Clinical Implications." Nutrients 18. https://doi.org/10.3390/nu18020239
9. Costa, R. J. S., S. Gaskell, K. Henningsen, N. A. Jeacocke, I. G. Martinez, A. Mika, V. Scheer, et al. 2025. "Sports Dietitians Australia and Ultra Sports Science Foundation Joint Position Statement: A Practitioner Guide to the Prevention and Management of Exercise-Associated Gastrointestinal Perturbations and Symptoms." Sports Medicine (Auckland, N.z.) 55: 1097 - 1134. https://doi.org/10.1007/s40279-025-02186-6
10. Gaskell, S., C. Rauch, and R. Costa. 2021. "Gastrointestinal Assessment and Therapeutic Intervention for the Management of Exercise-Associated Gastrointestinal Symptoms: A Case Series Translational and Professional Practice Approach." Frontiers in Physiology 12. https://doi.org/10.3389/fphys.2021.719142
11. Wilson, P. B. 2021. "Sport supplements and the athlete’s gut: a review." International Journal of Sports Medicine. https://doi.org/10.1055/a-1704-3086
12. Chantler, S., A. Griffiths, J. Matu, G. Davison, A. Holliday, and B. Jones. 2022. "A systematic review: Role of dietary supplements on markers of exercise-associated gut damage and permeability." PLoS ONE 17. https://doi.org/10.1371/journal.pone.0266379
13. Bazarewicz, J., G. Adaśko, M. Świda, C. Kubuj, U. Mazur, P. Ogonowska, D. Dmowski, A. Michalska, J. Waszak, and M. Siwik. 2025. "Functional Supplements for Managing Exercise-Induced Gastrointestinal Distress: A Focused Review for Athletes." Quality in Sport. https://doi.org/10.12775/qs.2025.45.66517
14. Gough, L. A., and S. A. Sparks. 2024. "The Effects of a Carbohydrate Hydrogel System for the Delivery of Bicarbonate Mini-Tablets on Acid–Base Buffering and Gastrointestinal Symptoms in Resting Well-trained Male Cyclists." Sports Medicine - Open 10. https://doi.org/10.1186/s40798-024-00684-x
15. Schreiber, C., S. Tamir, R. Golan, A. Weinstein, and Y. Weinstein. 2021. "The effect of probiotic supplementation on performance, inflammatory markers and gastro‐intestinal symptoms in elite road cyclists." Journal of the International Society of Sports Nutrition 18. https://doi.org/10.1186/s12970-021-00432-6
16. Smarkusz-Zarzecka, J., L. Ostrowska, J. Leszczyńska, and U. Cwalina. 2022. "Effect of a Multi-Strain Probiotic Supplement on Gastrointestinal Symptoms and Serum Biochemical Parameters of Long-Distance Runners: A Randomized Controlled Trial." International Journal of Environmental Research and Public Health 19. https://doi.org/10.3390/ijerph19159363
17. Łagowska, K., J. Bajerska, S. Kamiński, and C. D. Bo’. 2022. "Effects of Probiotics Supplementation on Gastrointestinal Symptoms in Athletes: A Systematic Review of Randomized Controlled Trials." Nutrients 14. https://doi.org/10.3390/nu14132645
18. Heimer, M., M. Teschler, B. Schmitz, and F. Mooren. 2022. "Health Benefits of Probiotics in Sport and Exercise - Non-existent or a Matter of Heterogeneity? A Systematic Review." Frontiers in Nutrition 9. https://doi.org/10.3389/fnut.2022.804046
19. Rauch, C., A. Mika, A. McCubbin, Z. Huschtscha, and R. J. S. Costa. 2022. "Effect of prebiotics, probiotics, and synbiotics on gastrointestinal outcomes in healthy adults and active adults at rest and in response to exercise—A systematic literature review." Frontiers in Nutrition 9. https://doi.org/10.3389/fnut.2022.1003620
20. Wardenaar, F. C., A. E. Mohr, C. P. Ortega-Santos, J. Nyakayiru, C. Kersch-Counet, Y. Chan, A. Clear, J. Kurka, K. D. Schott, and R. G. N. Seltzer. 2024. "Explorative Characterization of GI Complaints, General Physical and Mental Wellbeing, and Gut Microbiota in Trained Recreative and Competitive Athletes with or without Self-Reported Gastrointestinal Symptoms." Nutrients 16. https://doi.org/10.3390/nu16111712
21. Taylor, G. S., A. Leonard, J. C. Y. Tang, R. Dunn, W. Fraser, N. Virgilio, J. Prawitt, E. Stevenson, and T. Clifford. 2022. "The effects of collagen peptides on exercise-induced gastrointestinal stress: a randomized, controlled trial." European Journal of Nutrition 62: 1027 - 1039. https://doi.org/10.1007/s00394-022-03051-2
22. Parker, C., K. Hunter, M. Johnson, G. Sharpe, G. R. Gibson, G. Walton, C. Poveda, B. Cousins, and N. Williams. 2023. "Effects of 24‐week prebiotic intervention on self‐reported upper respiratory symptoms, gastrointestinal symptoms, and markers of immunity in elite rugby union players." European Journal of Sport Science 23. https://doi.org/10.1080/17461391.2023.2216657
23. Gough, L. A., A. Weldon, C. Clark, A. Young, C. J. Roberts, N. D. Clarke, M. Brown, and R. Williams. 2025. "The Effects of 12-Week Prebiotic Supplementation on General Wellness and Exercise-Induced Gastrointestinal Symptoms in Recreationally Trained Endurance Athletes: A Triple-Blind Randomised Controlled Pilot Trial." Nutrients 17. https://doi.org/10.3390/nu17213390
24. Rauch, C., K. Henningsen, I. G. Martinez, P. Young, A. Mika, Z. Huschtscha, A. McCubbin, R. Henry, D. Anderson, and R. J. S. Costa. 2025. "The Effects of Prebiotic Supplementation on Markers of Exercise-Induced Gastrointestinal Syndrome in Response to Exertional Heat Stress." International journal of sport nutrition and exercise metabolism: 1-18. https://doi.org/10.1123/ijsnem.2024-0127
25. Lennon, S., T. Lackie, A. Miltko, Z. C. Kearns, M. Paquette, R. Bloomer, A. Wang, and M. v. d. Merwe. 2024. "Safety and Efficacy of a probiotic cocktail containing P. acidilatici and L. plantarum for gastrointestinal discomfort in endurance runners: Randomized Double-Blinded Crossover Clinical Trial." Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. https://doi.org/10.1139/apnm-2023-0449
26. Aitkenhead, R., M. Waldron, G. E. Conway, K. Horner, and S. M. Heffernan. 2025. "The Influence of Dietary Supplements on Exercise-Induced Gut Damage and Gastrointestinal Symptoms: A Systematic Review and Meta-Analysis." Nutrients 17. https://doi.org/10.3390/nu17030443
27. Reynolds, K. M., T. Clifford, S. Mears, and L. James. 2022. "A Food First Approach to Carbohydrate Supplementation in Endurance Exercise: A Systematic Review." International journal of sport nutrition and exercise metabolism: 1-15. https://doi.org/10.1123/ijsnem.2021-0261
28. Mlinaric, J., and N. Mohorko. 2025. "Nutritional strategies for minimizing gastrointestinal symptoms during endurance exercise: systematic review of the literature." Journal of the International Society of Sports Nutrition 22. https://doi.org/10.1080/15502783.2025.2529910
29. Ryan, T., E. Daly, and L. Ryan. 2024. "Carbohydrate beliefs and practices of ultra-endurance runners in Ireland for gastrointestinal symptom management." Frontiers in Nutrition 11. https://doi.org/10.3389/fnut.2024.1408101
30. TURJAKA, Arbëresha, AMETI, Vullnet, TURJAKA, Bujar and MEMISHI, Shpresa. Reasons for application of dietary supplements in fitness. Pedagogy and Psychology of Sport. Online. 20 October 2020. Vol. 6, no. 4, pp. 20-28. [Accessed 17 March 2026]. DOI 10.12775/PPS.2020.06.04.002. https://doi.org/10.12775/PPS.2020.06.04.002
31. ZDEBSKI, Paweł, DMOWSKA, Dominika, MIERNICZEK, Mateusz, MIERNICZEK, Maria, BILIŃSKA, Aleksandra, GLOC, Ewa, ZAŁĘSKI, Daniel, RYMSKA, Karolina, LEWANDOWSKI, Mikołaj and KRZESIMIR KUŚWIK, Maciej. High-Intensity vs. Low-Intensity Exercise in the Management of Irritable Bowel Syndrome. Journal of Education, Health and Sport. Online. 11 January 2026. Vol. 86, p. 67698. [Accessed 17 March 2026]. DOI 10.12775/JEHS.2026.87.67698. https://doi.org/10.12775/JEHS.2026.87.67698
32. MĄSIOR, Magdalena Natalia, KAPLER, Marta, KOTUŁA, Jacek and ZINKOW, Karolina. The Impact of physical activity on gastrointestinal health and prevention and treatment of common gastrointestinal diseases: Irritable Bowel Syndrome and Inflammatory Bowel Diseases. Quality in Sport. Online. 23 September 2024. Vol. 22, p. 54667. [Accessed 17 March 2026]. DOI 10.12775/QS.2024.22.54667. https://doi.org/10.12775/QS.2024.22.54667
33. MACHAŁA-ĆWIKŁA, Ewelina, ŁAPIŃSKA, Urszula, ZDZIEBŁO , Piotr, ĆWIKŁA, Piotr, MACHAŁA, Kamila, SZELĄG, Kacper, MACHALA, Dominika, KUJAWSKI, Antoni, ZUZAK, Andrzej Paweł and ZDZIEBŁO, Katarzyna. Effect of physical activity on the severity of irritable bowel syndrome (IBS) symptoms. Quality in Sport. Online. 17 July 2024. Vol. 16, p. 52921. [Accessed 17 March 2026]. DOI 10.12775/QS.2024.16.52921. https://doi.org/10.12775/QS.2024.16.52921
34. KACZYŃSKA, Agnieszka, WIETESKA, Małgorzata, STANICKI, Paweł and SZARPAK, Julita. Irritable bowel syndrome dietary modifications - what to forbid and what to recommend?. Journal of Education, Health and Sport. Online. 1 August 2020. Vol. 10, no. 8, pp. 72-77. [Accessed 17 March 2026]. DOI 10.12775/JEHS.2020.10.08.008. https://doi.org/10.12775/JEHS.2020.10.08.008
35. GĄBKA, Ilona, DALMATA, Weronika, DĄBROWSKI, Jan, SZARPAK, Julita and LIPIEC, Marta. Irritable bowel syndrome - pathophysiology, diagnosis, treatment. The role of low FODMAP diet. Journal of Education, Health and Sport. Online. 5 September 2022. Vol. 12, no. 9, pp. 469-476. [Accessed 17 March 2026]. DOI 10.12775/JEHS.2022.12.09.054. https://doi.org/10.12775/JEHS.2022.12.09.054
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Martyna Utnik, Patrycja Bajur, Wiktor Czereczon, Maksymilian Działowy, Milena Uszko
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 160
Number of citations: 0
