Gastrointestinal Symptoms In American Football Athletes Are Higher In Protein Supplement Users Than In Non-users

PURPOSE: Up to 50% of competitive athletes suffer from gastrointestinal(GI) distress, which may impair performance and/or subsequent recovery. This study was intended to identify the prevalence of GI symptoms in collegiate, DI American football athletes by using the Gastrointestinal Symptoms Ratings Scale (GSRS). METHODS: The study targeted n = 97 NCAA DI American football athletes to complete a GI questionnaire including simple demographics and the full GSRS. Athletes were recruited in person after practice (April 2022) and given a handwritten questionnaire. The GSRS is a 15-item recall-based Likert scale questionnaire grading the severity of GI symptoms experienced by participants over the previous 7 days. The average score and scores for individual symptoms were analyzed and split for race (Afro-American or Black vs. Other), playing position (skill vs. line), NSAID use, and self-reported use of protein supplements. Non-parametric tests were used to analyze for significant differences, with significance set for P ≤ 0.05. RESULTS: A total of n = 44 athletes (age: 20.7 ± 1.7 years, 50% Afro-American or Black, 42% skill position, 18% NSAID use, and 41% reporting protein supplement use) completed the questionnaire (45% of the current roster) with a median GSRS of 17.0 and interquartile range 15.0-23.5. Roughly half of the athletes (52%) reported experiencing GI complaints during exercise. Twenty-seven athletes (61%) reported at least one or more GI symptoms. Seven athletes (16%) reported at least two severe symptoms, and each reported at least four symptoms as moderate or worse. The most reported symptom was pain in the pit of the stomach (39%, n = 17), followed by hunger pain (36%, n = 16). Athletes reporting the use of protein supplements reported a higher GSRS (22.0 and17.0-31.8) vs. athletes not reporting protein use (15.0 and 15.0-19.3), P = 0.001. When stratifying for protein supplement use, more NSAIDs were used by athletes supplementing protein (75%, χ2 (1) = 4.701, P = 0.030), but no difference was seen in the distribution of race or playing position (χ2 (1) ≤ 1.504,P ≥ 0.220). CONCLUSION: Nearly two-thirds of football players reported some form of GI symptoms like other competitive athletes. Interestingly, protein supplement use, but none of the other demographics, was associated with a higher average GSRS outcome.