Effect of a starch-based oral rehydration solution in dehydration following training in Australian Rules footballers.

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1.Background: Dehydration, or the loss of fluid and salt from the body can sometimes be a life-threatening disorder. Intense exercise can cause the loss of 1-3L of fluid/h and may be aggravated by warm climates (Ramakrishna, 2004). The fluid deficit typically ranges from 2-4% of body weight and can result in thermal stress, impaired cognition and cardiovascular function, accelerated fatigue and impaired exercise function (Rodriguez et al., 2009). During an Australian Rules football game or intensive training session AFL players lose between 1.15-3.45% of their body weight. As outlined above this degree of fluid loss will result in physiological changes that impact on player performance. The current sports drinks consumed by players during and after the game have a high glucose content much higher than in proven rehydration solutions. Because of the high glucose content (hyperosmolar to body fluids) it is inefficient for hydration, leads to a slower than achievable water absorption and only utilises the absorptive capacity of the small intestine and not the large intestine. It has been shown that hypo-osmolar solutions achieve faster and more effective rehydration in children and adults with acute diarrhoea and as a consequence, hypo-osmolar solutions are the WHO/UNICEF policy for rehydration [WHO/UNICEF, 2009] Oral rehydration solutions which utilise the absorptive capacity of both the large and small intestine have been developed and proven effective in the treatment of cholera. Water and salt absorption through the large intestine requires the presence of short chain fatty acids (SCFAs) which are fermented by colonic bacteria from carbohydrates This study aims to build on this foundation work and test a formulation that is designed for healthy guts taking advantage of absorption of fluids and salts from the large and small intestine. 2.Rationale: The current sports (“hydration”) drinks are really energy drinks because they have a high glucose content are designed less for rehydration than they are for delivering glucose. As such they seem to be less than ideal for rehydration when dehydration is evident Provision of “resistant starch” will do this while at the same time providing glucose in the small intestine. It is thus conceived as a dual-action solution providing glucose to stimulate small intestinal uptake and RS for fermentation to SCFA to drive large intestine uptake. This principle has been tested now in four randomised controlled trials in India in severe acute diarrhoea and in all studies it reduces severity of diarrhoea significantly. This study will test whether the use of RS and an oral rehydration solution (Sports-FS-ORS or SpORS), which contains a balance of salts, glucose, and starches which optimise water absorption by also utilising the absorptive capacity of the large intestine, can improve hydration in elite athletes during and after strenuous exercise.

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