The importance of volume in regulating gastric emptying

There is now substantive evidence that the provision of exogenous carbohydrate at high rates (1-2 g. min-1) can enhance performance during prolonged exercise. This finding has revived research into the factors determining the rate of exogenous carbohydrate delivery during exercise. While the rate of muscle oxidation of exogenous carbohydrate could be determined by the rate of gastric emptying or of intestinal carbohydrate absorption or of muscle glucose uptake and oxidation, most physiologists seem to have assumed that gastric emptying is the factor that limits the rate of exogenous carbohydrate delivery during exercise. Furthermore, studies of gastric emptying have suggested that the carbohydrate content of the ingested solution is an important factor determining its rate of gastric emptying. However, the findings of recent studies employing a repeated drinking design suggest that the gastric volume and therefore the pattern of drinking during exercise will have a significant, possibly major, influence on the rate of both carbohydrate and water delivery from any solution. This review considers this evidence and its practical implications for athletes who wish to ingest carbohydrate during exercise and for exercise physiologists designing studies to optimize carbohydrate delivery to muscle during exercise. It is proposed that, if gastric volume is an important determinant of the rate of gastric emptying, a more standardized method for reporting the rates of gastric emptying of different solutions should be adopted.