How To Eat If You Are Training for a Marathon

July 22, 2024July 11, 2023 by amystephens

How To Eat If You Are Training for a Marathon

The way you nourish your body is equally important as your training and strength exercises. As a sports nutritionist based in NYC, I frequently encounter questions regarding dietary recommendations for individuals preparing for a marathon. In collaboration with my intern, Sara Fischer, we have developed this guide specifically tailored to individuals participating in the NYC marathon or any fall marathon, providing valuable insights on how to fuel your body leading up to the 26.2-mile journey.

What to eat

CALORIES:

It is important for runners to eat a well rounded, nutrient rich, balanced diet. First and foremost, runners need to ensure they are eating enough calories. Because running requires a lot of energy, it is extremely important that runners are in an energy balance to prevent underfueling. Underfueling leads to serious health effects.

Energy requirements are not static throughout a marathon training block. As the training volume intensifies, higher levels of nutrients become essential. The energy demands may be less on recovery days, but it is equally important to continue fueling to restock glycogen and repair muscle tissue.

A common mistake is to underfuel on recovery days. Recovery days require an adequate amount of nutrients to help the body recover for the next workout. Energy is required for cross-training, daily activities such as attending work or class, errands, or commuting. It’s possible that you may not require as many snacks during these lower intense periods.

CARBOHYDRATES:

Runners need to focus on a carbohydrate rich diet. If you are training for a marathon, you are spending most of your time either recovering from a run, or preparing for another one. Since running requires glucose from the bloodstream, your body is in need of carbohydrates to replenish those glycogen stores after workouts. Runners should aim for 60-70% of their calories from carbohydrates.

Over time, with adequate carbohydrates, the body gradually increases the amount of glycogen that can be stored in muscles and liver. Proper fueling throughout training can increase your overall glycogen storage capacity. Glycogen is one way to help prevent “hitting the wall”. This occurs when runners have not properly trained, run too fast on race day or under fuel on race day.

In order to maximize glycogen stores, runners should aim to consume 7-10 grams of carbohydrates per kilogram of body weight, daily. The average runner should aim for 475-700 g/day. This can be met by eating carb-rich meals spread into three meals plus two-to-three snacks.

PROTEIN:

Protein is broken down into amino acids which are essential for building and repairing damaged tissue. Eating protein throughout the day is also helpful to maintain the immune system and prevent muscle breakdown. Eating too much protein can displace other important nutrients that are necessary to optimize sports performance. Aim for 1.5-1.7 grams protein/kilogram which is about 20-30 grams with meals and 10-15 grams for snacks.

HEALTHY FATS:

It is crucial that runners include healthy fats in their diet. Healthy fats are necessary to absorb fat soluble vitamins, they help to lower injury risk, and regulate energy levels. Healthy fats are a great source of omega-3’s which have been shown to reduce inflammation. In order to keep the diet balanced, aim for approximately 20-30% of calories from fats.

VITAMINS:

Runners need to make sure they are giving their bodies adequate vitamins. Vitamin D and Calcium are particularly important for bone health, specifically reducing the risk of stress fractures. Iron is important to keep you energized. Iron deficiency can lead to decreases in performance. B vitamins are essential to energy production.

How to eat around your workouts

Before a run, especially if the run is 60 minutes or longer, your body will need fuel beforehand. Your pre-run snack should be rich in carbohydrates, and eaten at least 30 mins to an hour before you head out. Avoid high fiber foods as they are difficult to digest and may lead to discomfort during the workout.

Pre-run snack examples include a banana, toast with peanut butter, homemade energy balls, dates, dried fruit, granola bar or Clif bar.

For runs lasting less than 60 minutes, fueling is optional. If you experience hunger, consuming snacks and fluids can be beneficial for sustaining energy levels.

For a run lasting longer than 90 minutes, your body might need additional carbohydrates. Your body processes approximately 60g carbs per hour of exercise, so during these longer sessions you will need to start fueling within 45 minutes, and continue to consume 30-60g carbs/hour for the duration of the run.

You can accomplish this by eating things like energy gels, easy-to-eat dried fruit, go-go squeeze applesauce, or even gummy bears. You can also put a spoonful of honey mixed with something like coconut water into your water bottle to make a carb and electrolyte rich sports drink.

After a run, your body needs to replenish its glycogen stores. Refuel after runs by eating a balanced meal or snack high in protein and carbs. It is best to eat this within 30 minutes to an hour of finishing a run, so that you can kick start the recovery process and be ready to go for your next session. Prioritize recovery food especially on tough workout days or if you are planning a double workout session.

How to hydrate

Hydration requirements are individualized. Sweat rates depend on many factors such as: genetics, gender, heat acclimation, exercise intensity, humidity, etc. A sweat test is a great way to determine individual sweat rates.
Easy runs: 1-2 hours before your run, drink 10-20oz of water. During your run, it is your choice whether you want to sip on water throughout. After your run, replenish the lost fluids with 35-70 oz of water with electrolyte. Take note of your hydration level prior to running. If you begin your workout in a dehydrated state, you will need to consume fluids regardless of the duration. Additional fluids will aid in replenishing lost fluids from previous workouts and prevent further dehydration.
Long runs/tempos: 1-2 hours before your workout, drink 10-20oz of water. During your run, drink 4-8oz of water every 20 minutes, with electrolytes. After your workout, replenish the fluids with 35-70 oz of water with electrolytes.

References

Burke L, Hawley J, Wong S & Jeukendrup A. Carbohydrates for training and competition, J Sp Sc, 2011. 29:sup1, S17-S27.

Coyle, E. F. Fluid and fuel intake during exercise. J Sp Sc 2004. 22: 39–55.

Jeukendrup, A. E. and Chambers. Oral carbohydrate sensing and exercise performance. Current Opinion in Clinical Nutrition and Metabolic Care, 2010. 13: 447–451.

Sawka MN, et al. American College of Sports Medicine position stand. Exercise and fluid replacement. Med Sci Sports Exerc. 2007. 39(2):377-90.

Eating Disorders in Athletes: Impact on Performance

June 22, 2023October 25, 2022 by amystephens

Eating Disorders in Athletes: Impact on Performance

Eating disorders affect an athlete both mentally and physically and have significant impacts on performance. This blog will discuss the prevalence of eating disorders, identify warning signs in athletes, distinguish the differences and similarities to relative energy deficiency syndrome (REDS), and provide resources for those struggling to seek help. Eating Disorders are a serious issue for everyone, but especially for athletes. Nutrition requirements are high and the inability to fuel an athlete’s body will lead to worsening of disordered eating, injuries, and overall decline in performance.

The most common forms of eating disorders are anorexia, bulimia and binge eating disorder. Anorexia refers to restriction of food and refusal to meet nutritional needs, typically resulting in extreme weight loss. Bulimia is defined by consuming a large quantity of food in a short period of time, followed by a desire to “get rid” of the food through vomiting, exercise, or medications. Often, athletes can have a combination of both. Binge eating disorder is another type of eating disorder characterized by consuming a large quantity of calories in a short period of time. In one study, up to 84% of athletes were found to have subclinical disordered eating, and engaging in maladaptive eating and weight control behaviors, such as binge eating, excessive exercise, strict dieting, fasting, self-induced vomiting, and the use of weight loss supplements (Chatterton, Clifford). Evaluation by a physician or therapist can determine the severity and best form of treatment.

Eating disorders do not discriminate as they affect all races, genders, and socioeconomic classes. Some populations have higher rates of eating disorders. Eating disorders are most commonly screened and diagnosed between the ages 12-19, but can occur at any age. The earlier an athlete is diagnosed, the more likely they are to recover and reverse any damage to their bodies. The longer an eating disorder behavior is untreated, the more difficult the treatment and full recovery become.

Prevalence

13.5% of athletes struggle with an eating disorder (Ghoch).
Up to 45% of female athletes and 19% of male athletes struggle with an eating disorder (Bratland-Sanda)
In a study by Petrie, 19.2% of athletes surveyed had maladaptive eating behaviors such as restricting food intake, limiting food choices, excluding large groups of foods, and purging behavior.

Risk factors for developing eating disorders in athletes

Certain sports that are weight dependent and focus on leanness pose a bigger risk for eating disorders. Both male and female athletes are at risk.

In addition, athletes who have recently undergone stressful events such as an injury are at a greater risk for developing an eating disorder. Athletes who have been struggling with poor performance might want to restrict food and blame the body.

There are additional societal contributions that can lead to eating disorders. It’s important to be aware of these factors so proper education for athletes and coaching staff can help prevent disordered eating among athletes.

Societal contributions include:

A fixation on thinness and the need to have a certain appearance in order to be happy or successful
Social media’s tendency to reinforce negative body image by giving attention to overly thin athletes
Restrictive diet plans promoted by ill-trained professionals
Society’s fixation on toxic positivity and the need to seek perfectionism to achieve one’s goals

All of these practices promote unhealthy relationships with the body and eating patterns. Athletes are no exception. Weight dependent sports not only encourage unhealthy dietary practices, but reward them. The thinner athletes promote themselves as having reached their performance levels due to their thin body type. Misinformation from friends, coaches, and media can cause an athlete to try and achieve an inappropriate level of thinness that causes physical and mental harm to their body. Eating disorders are often overlooked if the athlete is performing well.

Difference between eating disorders and Relative Energy Deficiency Syndrome (RED-S)

Relative Energy Deficiency Syndrome (REDS) is a new classification of symptoms identified in 2014 by International Olympic Committee Mountjoy. REDS is characterized by low calorie intake in relation to energy exerted during exercise. REDS was formerly named “The Female Athlete Triad Syndrome because it affected three key systems in the female body:low calorie intake, menstrual irregularities, and lowered bone density. The term REDS is new but the condition has been in existence for a long time. Simply put, exercising too much and not eating enough causes an imbalance in which the body cannot function at optimal levels. What’s most interesting to me is that someone with REDS can be any body weight. The difference between REDS and an ED is that REDS is an unintentional mismatch of calories. Once an athlete with REDS is evaluated and educated about an appropriate amount of calories to sustain daily exercise and body functions, the deficit is corrected and the body can function properly. ED is further explored if the athlete is unable to willingly consume calories to support energy expenditure.

Sometimes it may not be obvious or easy to diagnose REDS or eating disorders. Someone can be a normal weight but is exercising too much and refueling inadequately. In this instance, athletes may feel that they are eating well, but in truth, are not eating enough calories to support exercise.

Signs of chronic underfueling that warrant further screening to determine if disordered eating is present

Females – change in menstrual cycle, can be longer or lighter periods, it is NOT normal for a female athlete to miss a period
Males – low testosterone and growth hormone. Both are natural performance enhancing hormones made by the body. Low levels can negatively affect sport performances, muscle growth, and energy production. Also important for serotonin uptake for the brain, it can lift mood. (Skolnick)
Hormonal changes can lead to stress fractures and ultimately osteoporosis
Frequent injuries to bones and soft tissues
Isolated, eats alone
Withdrawn behavior
Sudden changes with diet or food choices
Noticeable fluctuations in weight, both up and down
Irritability
Lethargy, difficulty finishing a workout
Digestive issues such as bloating (often mistaken for IBS), gas, diarrhea (this is often worsened by further restricting suspected nutrients)
Decrease in sports performance
Difficulty sleeping
Not seeing improvements in performance despite increasing workouts
Depressed immune system
Decreased cognitive functioning (lower blood sugar supplied to brain)

Treatment

Treatment often begins with an evaluation by a physician, eating disorder dietitian, and therapist. Once the patient is evaluated, they are recommended to the best form of treatment depending on their situation. The dietitian will create a plan that provides adequate calories to support daily expenditure. It can be challenging to find the right physician to help especially since there are differing opinions among professionals. In my experience, missing a period leads to complications related to menstrual cycle and bone growth. It is important to let your doctor know if you’ve lost your period for more than three months as this can be related to underfueling or the result of underlying medical conditions. Your doctor can help guide you to the best treatment approach.

Resources for help

There are many resources to help. If you or someone you are close to might have an eating disorder, here are some important resources that can help:

- Visit your doctor and explain why you are concerned. Be sure to ask if your doctor works with eating disorders.
- For college athletes, visit your health center and explain why you are concerned. The health professionals can conduct proper screenings and assessments.
- Seek out a sports dietitian (ask if they have experience with eating disorders)
- See a school psychologist
- If you think you have an eating disorder, speak to a trusted family member or friend and share your concerns. Eating disorders are isolating so speaking out is a step in the right direction.
- Seek out supportive teammates and coaches and share your eating concerns. They can help you locate the best resources for an evaluation and assessment.
- National Eating Disorders Hotline (NEDA) 1-800-931-2237

References

Bratland-Sanda S, Sundgot-Borgen J. (2013). Eating disorders in athletes: overview of prevalence, risk factors and recommendations for prevention and treatment. Eur J Sport Sci, 13(5):499-508.

Chatterton, J. M., & Petrie, T. A. (2013). Prevalence of disordered eating and pathogenic weight control behaviors among male collegiate athletes. Eating Disorders, 21(4), 328-341.

Clifford, T., & Blyth, C. (2018). A pilot study comparing the prevalence of orthorexia nervosa in regular students and those in university sports teams. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 24(3), 473-480.

Conviser, J. H., Schlitzer Tierney, A., Nickols, R. (2018). Essential for best practice: treatment approaches for athletes with eating disorders. J of Clin Sports Psych, 12.

Ghoch, M. E., et al. (2013). Eating disorders, physical fitness, and sport performance: a systematic review. Nutrients, 5:12.

Mehler, P.S., Sabel, A.L., Watson, T. and Andersen, A.E. (2018). High risk of osteoporosis in male patients with eating disorders. Int. J. Eat. Disord, 41: 666-672.

Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. (2018). OC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Brit J of Sports Med, 52:687-697.

Petrie, Trent, Greenleaf, Christy, Reel, Justine, Carter, Jennifer. (2018). Prevalence of Eating Disorders and Disordered Eating Behaviors Among Male Collegiate Athletes. Psych of Men & Masculinity, 9: 267-277.

Scott CL, Plateau CR, Haycraft E. (2020). Teammate influences, psychological well-being, and athletes’ eating and exercise psychopathology: A moderated mediation analysis. Int J Eat Disord, 53(4):564-573.

Shufelt CL, Torbati T, Dutra E. (2017). Hypothalamic Amenorrhea and the Long-Term Health Consequences. Semin Reprod Med, 35(3):256-262.

Skolnick A, Schulman RC, Galindo RJ, Mechanick JI. (2016). The endocrinopathies of male anorexia nervosa: case series. AACE Clin Case Rep, 2(4):e351-e357.

Feature: How to Eat Before Sports Tryouts, According to a Dietitian

June 26, 2023October 4, 2022 by amystephens

FEATURE: How to Eat Before Sports Tryouts, According to a Dietitian

Amy’s recommendations on Foods to eat before sports tryouts featured on Livestrong.

Hydrating in heat and humidity

June 23, 2023August 19, 2021 by amystephens

Hydrating in heat and humidity

Water is the forgotten nutrient

Exercise produces heat and leaves the body as sweat to stay cool. Studies have repeatedly shown that losing more than 2% body weight impacts performance (James). More sweat is produced when the temperatures are higher or when humidity is high. Dehydration results in an increase in one’s core temperature, reduced cardiovascular function and imparied exercise performance.

Essentially, dehydration increases an athlete’s perceived effort and reduces the ability to continue exercising at a high level (Nybo). If you’re overheating, the body will prioritize cooling itself versus rapid energy production (James).

Role of sweat

During exercise, the body produces heat and energy. Sweat is the body’s built-in cooling system that enables the body to make more energy. In warmer temperatures, exercise raises core temperatures at a faster rate which require more water expelled through the skin to keep the body cool. As temperatures increase, our bodies respond by sweating more. However, humidity compounds this problem by preventing evaporation. In situations where humidity levels are high, as we experience on the east coast all summer long, there is more moisture in the air and the sweat does not evaporate. As a result, the body’s core temperature increases, making exercise seem harder.

Dehydration affects performance

Many studies have shown that a 2% loss in body weight will impair performance (Lewis). The body has to work harder to keep the heart pumping to produce energy and muscles firing. Not only does it feel harder when you are dehydrated, but your body is also producing energy at a slower rate.

As core temperatures increase, energy metabolism shifts from aerobic production to anaerobic and this causes a buildup of anaerobic by-products that stimulate fatigue. This process occurs at a faster rate in hot and humid conditions. Fuel source shifts from fatty acids to glucose and amino acids and creates more hydrogen and lactic acid (Burke 2015). The heart receives less blood and therefore, less oxygen is delivered to working muscles. This makes exercising even more difficult in warmer conditions. Muscles have a harder time contracting when they’re overheated and premature fatigue can set in (Nybo).

Cramping

If you lose too much water, the risk of cramping is increased. Humidity increases risk of dehydration which causes an imbalance of electrolytes, especially potassium, magnesium and sodium. These electrolytes are lost at high levels through the skin and have a significant impact on cramping (Jung).

Symptoms of dehydration

feeling thirsty
lightheaded
fatigue
dry mouth
urinating less often
infrequent, dark colored urine

Dietary recommendations in the heat

Fluid requirements are individualized. Establish your sweat rate by using a sweat test to better estimate the amount of sweat you lose in one hour of exercise. Once you know how much fluid your body loses, you can more precisely match your fluid requirements. Estimate fluid losses by using a sweat rate calculator to input your weight and fluids. Calories do not need to be increased when exercising in heat (Burke).

Start drinking fluids when you wake up. Have a glass of water before you drink coffee!
Before exercising, urine should be a pale yellow color.
Exercise in the beginning or end of the day when it’s cooler
Don’t chug water without electrolytes, this can lead to hyponatremia.
You will rehydrate faster when fluids contain electrolytes and carbohydrates. This helps stimulate thirst and retain fluids consumed (Baker & Jeukendrup 2014).

Hyponatremia is caused by drinking too much water and not enough electrolytes. Make sure to have salt or nuun tablets handy. Water follows electrolytes and when you sweat, you lose both!

The color of your urine is the best indicator of hydration. Aim for pale yellow, shade 1 or 2 on the chart is ideal. Clear urine can indicate fluid overload and hyponatremia. If your urine is dark yellow before a run, delay the start until you can drink more fluids.

References

Baker & Jeukendrup. Optimal composition of fluid replacement beverages. Comp Physiol. 2014;4:575-620.

Burke L. Nutritional needs for exercise in the heat. Comp Biochem Physiol Mol Integr Physiol. 2001; 128: 735-48.

Burke L. Clinical Sports Nutrition, 5th edition. 2015.

Cory M, et al. Resistance training in the heat improves strength in professional rugby athletes. Sci Med in Football. 2019;3:198–204.

James LJ, et al. Does Hypohydration Really Impair Endurance Performance? Methodological Considerations for Interpreting Hydration Research. Sports Med. 2019 Dec;49(Suppl 2):103-114.

Jung A, et al. Influence of Hydration and Electrolyte Supplementation on Incidence and Time to Onset of Exercise-Associated Muscle Cramps. J Athl Train. 2005; 40: 71–75.

Lewis J, et al. Does Hypohydration Really Impair Endurance Performance? Methodological Considerations for Interpreting Hydration Research. Sports Med. 2019;49:103-114.

Nybo & Sawka. Performance in the heat physiological factors of importance for hyperthermia-induced fatigue. Compr Physiol 2014;4:657-89.

Lau W, et al. Effect of oral rehydration solution versus spring water intake during exercise in the heat on muscle cramp susceptibility of young men. J of the Intl Soc of Sp Nutr. 2021; 18 (1).

Amy Stephens