Daily needs for CHO for an ultra-runner are 6-12g/kg body weight. The lower end for athletes running an average of an hour a day and the higher end for athletes averaging 4+ hours of running a day. Protein (PRO) while not used as a primary energy source is essential to maintain muscle mass and cellular function and repair. Daily needs for PRO for ultra-runners are 1.2-2.0g/kg body weight per day. Again, the lower end is for athletes exercising less and the high end is for athletes exercising more and creating more weekly muscle damage. Most ultra-runners would be safe to consume 1.6-1.8g PRO/kg body weight.
It is a good idea to avoid eating a gel or any high-glycemic food in the hour before a race because research has shown that can lead to the release of insulin which can lead to hypoglycemia early in the race. If you want to eat something in the hour before your race, it’s best to eat a low-glycemic CHO, like fructose and avoid high-glycemic CHO like glucose. As soon as you’re running you can start consuming high-glycemic foods and not have those negative side effects.
While running, it’s a lot easier on your stomach to digest small amounts of food continuously rather than large amounts infrequently. This means focusing on getting in calories constantly in small amounts. You can eat your calories, drink your calories, or do a combination of both to meet your calorie needs. Getting some food in at least every 20 minutes is ideal. Definitely avoid letting an hour or more go by without eating because then it’s a lot more likely your digestive system will shut down and cause you gastrointestinal (GI) distress and you’ll be much more likely to bonk. Those scenarios are best to avoid.
There’s a term called Multiple Transportable Carbohydrates (MTC) that describes how glucose and fructose (two types of sugars) are absorbed in the body differently and when we consume both types, we can absorb more calories of CHO per hour than if we only ingest one type of CHO. Glucose is absorbed in the intestine by the sodium-dependent glucose transporter SGLT1, and fructose is absorbed in the intestine by the intestinal transporter GLUT 5 (or recently renamed SLC2A5). Research has shown people on average can absorb 60g glycose and 30g fructose per hour (360 calories from CHO), so it has been standard practice to recommend ingesting food to meet those numbers. Recent research however has shown that another glucose transporter GLUT2 (or SLC2A2) shows up almost instantly in the gut in response to the presence of glucose and allows athletes to absorb more than previously thought. Research has also shown that the gut is highly trainable in as little as two weeks. I’d recommend experimenting with increasing CHO intakes during training in the weeks prior to your race to figure out what amount your body can tolerate.
Some sports nutrition products will list glucose or fructose on the label, but many will instead list other names for sugar. To understand what these ingredients mean, here’s a breakdown of the most common carbohydrates in sports nutrition products:
Dextrose: another name for glucose
Sucrose: 50% glucose 50% fructose
Maltodextrin: a chain of glucose molecules
Cane Sugar/table sugar: same as sucrose – 50% glucose 50% fructose
Maltose: two molecules of glucose hooked together
Honey: about 50% glucose and 50% fructose
High Fructose Corn Syrup: about 50% glucose and 50% fructose
Brown Rice Syrup: 52% malotriose, 45% maltose, 3% glucose. But maltotriose is three glucose molecules and maltose is two glucose molecules, so it is 100% glucose.
Real foods like rice and wheat are mainly starches which break down into glucose. A potato is about 55% glucose and 45% fructose. A banana is about 50% glucose and 50% fructose, as are most fruits. Oreo cookies, gummy bears, Sour Patch Kids, and most candies are made with sugar, dextrose, corn syrup, and/or high fructose corn syrup and will have between a 50/50 to 60/40 glucose/fructose ratio.
As you can see, most foods trail runners consume while running will give you a mix of glucose and fructose. The shorter the race is (2-5 hours) the easier most athletes find it to eat just CHO, but as races get longer (6-24+ hours) most athletes find their palate demands things other than sugar, and often a little more protein and fat. At higher intensities it is difficult to digest fat and protein. As intensity decreases, which will naturally happen in longer races (6-24+ hours), it becomes easier for your gut to digest fat and protein.
One very promising ingredient in sports nutrition is Highly-Branched Cyclic Dextrin (HBCD) or Cyclic Cluster Dextrin (CCD). HBCD is made by fermenting corn starch to make a molecule of linked glucose units similar to glycogen. HBCD has been shown to decrease gastrointestinal upset, decrease gastric emptying time, decrease rating of perceived exertion, and improve endurance performance compared to typical glucose/fructose mixtures. Many athletes are finding that consuming a portion of their hourly glucose in the form of HBCD decreases GI distress and allows them to consume more CHO/hour.
Whether you eat or drink your CHO depends on many factors including ease of consumption, availability, personal preference, gut tolerance, sweat rate, and weather conditions. It is important to have a good estimate of individual sweat rates for different conditions and to make sure you match your water and electrolyte consumption accordingly. In cold and dry weather, you are going to need less water and in hot and humid conditions, more water. I’ll discuss hydration in detail in a future article.
In summary, to help set yourself up for a great race, make sure you are consuming adequate carbohydrates in your daily diet, pre-race meal, and during your race. Most athletes find they do well by consuming 75+ grams (300+ calories) of CHO per hour, from a mix of glucose and fructose and possibly in the form of Highly-Branched Cyclic Dextrin. As with everything, experiment and practice your nutrition plan well in advance of your race to find what works for you.
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Let’s talk about recovery. Ultramarathon runners run big miles, lots of vert, and tough races and they quickly learn that hard training and racing requires good recovery. Without recovery we can’t reap the benefits of a great training plan with hard workouts. At best our fitness will suffer and at worst we’ll get injured or sick. When athletes think about recovery, often what comes to mind are products marketed as helping recovery like supplements, recovery drinks, pneumatic compression boots, cryotherapy chambers, percussion massagers, etc. But do these really help recovery and boost fitness? What about old school recovery tools like sleep and whole food nutrition? What role do recovery runs play and how and when are they best used?
Every training session creates stress on the body (either muscular, cardiovascular or both) and require a period of recovery for the body to respond in a positive way and super compensate. An easy way to think about this is to imagine going to the gym for the first time in months and doing heavy weighted back squats. You might feel good doing them but the next day your leg muscles are super sore, and you cannot walk up or down stairs without help from your arms. And this soreness might last up to a week. If you were to go back to the gym the next day and do heavy squats again, you wouldn’t be able to lift as much weight and do as many reps as the first day because you haven’t allowed your muscles to properly recover. If you keep going back each day that week and do squats, you’re going to feel weaker each day and might end up getting injured.
While not as obvious, the same thing can happen with endurance workouts. When you do a running workout, your cardiovascular system gets stressed and needs time to recover. If you don’t allow yourself the appropriate time to recover, you will get weaker (slower) and often sick.
How much recovery time do you need after each workout? It depends on the type of workout and your fitness and physical makeup (athletes with more type 2 fast twitch muscle fibers will need longer to recover). In general, the more intense the training session and the more it requires type 2 muscle fibers, the longer recovery period is needed. Here are some guidelines for the average recovery times for well-trained endurance athletes:
That’s why ultra-runners should space strength and zone 4 and 5 workouts 2-3 days apart to allow optimal recovery. Zone 1 and 2 runs can be done daily for almost every runner and for some runners twice a day.
What’s the best way to gauge whether you are taking enough time between runs? There are tools like checking morning resting heart rate (RHR) and heart rate variability (HRV), but the best way is still by feel. If your muscles are sore at all or you’re tired and don’t feel the spring in your step during your warmup run, it’s best to not do a hard workout that day. Yes, sometimes coaches and training plans have back-to-back hard days or long runs, and these can play important roles in a training block, but most of the time to get the training benefit from a strength workout, hill workout, or Zone 3, 4, or 5 run you want to be fully rested. If you’re not fully rested, you are going to end up doing these workouts at a lower intensity than planned and not gaining the desired performance gains or might even get injured or sick. Some athletes will only be able to do 1 quality workout a week, most athletes can do 2, and some athletes can do 3. Zone 1 and 2 runs can be done daily by many ultra-runners either during an endurance training block or between hard zone 3, 4, 5, and strength workouts.
Every workout produces a physiological stress response in your body of inflammatory fluid containing neutrophils, macrophages, satellite cells, and cytokines. This inflammatory response helps trigger the positive adaptation to the training stress. Anything we do to reduce this inflammatory response will blunt your body’s adaptation – meaning less fitness gains. We also see an increase in testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulphate, estradiol, growth hormone, and cortisol to endurance exercise which all help the body adapt and get stronger in response to the demands put on it. This is important to think about in terms of what “recovery tools” are going to help and which are going to hinder your body’s adaptation to exercise. It’s been shown in studies that ice, cold water immersion, and cryotherapy decrease inflammation which you now understand is counterproductive. Compression clothing and pneumatic compression boots also decrease inflammation which will have negative effects on your performance gains from a workout.
Why are these devices so popular and is there ever a time and place to use them? They are popular because they make money. The people promoting these ideas are making money from selling products or books or from ads on websites, YouTube videos, or social media. People are always looking for a magic bullet or elixir and it’s easy to fall prey to things that sound so promising. There is a time and place where these anti-inflammation tools can be beneficial (but only in the short term, they are always negative in the long term) and that is when you are doing a race like the Golden Trail World Series stage race or riding the Tour de France. When you are racing hard day after day after day you don’t have time to fully recover naturally, and reducing inflammation after each stage and before the next might help your body perform better. I would not recommend doing this on a regular basis however, as your chance of injury greatly increases as your body is depleted and muscles are repeatedly stressed. There is no advantage to doing this during normal training.
Supplements marketed to help recovery are for the most part not effective and a waste of money. It pays to read the actual scientific studies rather than flashy headlines of marketing campaigns. An example is curcumin, a polyphenol extracted from turmeric, which has been marketed for its antioxidant and anti-inflammatory affects. Supplement companies will claim curcumin decreases exercise induced muscle damage (EIMD) as shown in decreased delayed onset muscle soreness (DOMS) and decreased creatine kinase (CK) in the blood. CK is a sign of muscle damage. What they don’t say is that it does not actually decrease muscle damage, only the signs of muscle damage. Curcumin interferes with the release of CK from the muscle cell membranes so there is less CK in the blood but not less actual EIMD. The same is true for DOMS as curcumin decreases the feeling of muscle damage but not actual muscle damage.
The best supplements to boost recovery? Whole foods. Eating a large variety of fruits, vegetables, legumes, pulses, whole grains, lean proteins, and other whole unprocessed foods are the most essential part of an athlete’s diet. No supplement will make as big an impact on your performance (and health) as a balanced whole food diet. Making sure to eat sufficient calories including sufficient carbohydrates before, during, and after training will have big impacts on your performance. Getting sufficient protein during your day is also important to help your body rebuild stronger after each workout.
Sleep is also essential for recovery and performance. Track your sleep for a week and then try to increase your nightly sleep the following week and notice how you feel. You might notice yourself recovering faster and running better. Studies have shown that athletes who get less than 8 hours of sleep a night are 1.7 times more likely to get injured than athletes who get more than 8 hours of sleep a night!
Lastly, let’s discuss the recovery run and what it really is and what purpose it plays in ultramarathon training. After a hard training session (intervals, tempo, long run etc.) the following day you want to allow your body to recover and get stronger from the previous days’ workout. Resting and taking a day off from training is one way to do that and for any new runner that is what I’d recommend. More experienced runners can help speed up their recovery by doing a recovery run. The purpose of a recovery run is not to boost cardiovascular fitness but to help your body recover. Increasing blood flow to your muscles, warming up your muscles, and helping increase lymphatic flow are all major benefits of a recovery run. The key is running very slow and very easy. Recovery runs should be zone 1 and after a recovery run you should feel looser, less sore, less tired, and have more spring in your step. If you don’t feel these positive changes, you are either running too fast or would be better off using cross training for recovery. Great options for cross training are cycling, swimming, cross-country skiing, hiking, walking, yoga, or Egoscue. Again, with all of these activities you want to go very easy and should feel much better after the exercise than before. Most ultrarunners would do good with a 30-minute recovery run and high mileage experienced runners might do well with a 45–60-minute recovery run.
A great example of how easy and slow recovery runs should be is to look at what previous men’s marathon world record holder Eliud Kipchoge does. His race pace for a marathon is 4:35/mile and he runs his recovery runs at 8:30-10:30/mile pace. Twice as slow as his race pace! For the average ultrarunner who’s race pace is 12min/mile, it’s not necessary to run a 24min/mile pace, but a recovery run should be much slower than marathon race pace.
In summary, ultramarathon runners should be doing 1 to 3 harder workouts a week with very slow easy recovery runs the day after, focusing on eating enough calories and lots of carbohydrates and protein from whole food sources, getting 8+ hours of sleep a night, and not worrying about spending money on expensive recovery tools or supplements.
Matt Whitehead coaches ultramarathon runners at Ultra Run Coaching and helps athletes and non-athletes become pain free at Oregon Exercise Therapy. When not coaching athletes or doing posture alignment therapy, Matt can be found trail running and mountain biking around the Pacific NW with friends and his dog Lucky.
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Running injury recovery used to be focused on RICE: Rest, Ice, Compression and Elevation. RICE has been shown to actually slow recovery from injury and healing. After a running injury there is a natural and beneficial inflammatory process around the injured tissues that we want to allow to happen. Inflammation around the injured area creates a natural brace that limits movement (think sprained ankle) to allow injured tissues to heal. The inflammatory fluid also contains many substances that help with the pain and healing including neutrophils, macrophages, and satellite cells. If we ice, compress, or elevate the injured area we are decreasing this natural and helpful inflammation which will slow healing.
PRICE is another common acronym where the P which stands for Protect was added to RICE. Protecting the injured area to prevent further injury in a good idea for a limited period of time, but the body will naturally do this with pain messages and natural inflammation. We want to use braces, wraps, tapes, orthotics, etc. as little as possible because they all weaken the body and allow movement before the body is ready which can lead to re-injury.
PEACE is third acronym used for running injuries. PEACE stands for Protect, Elevate, Avoid anti-inflammatories, Compress, and Educate. Protect, Elevation, and Compression I already talked about above. Avoiding anti-inflammatories is a good idea because as I stated above, we want to allow the neutrophils, macrophages, and satellite cells to surround the injured tissues to help it heal faster. We also don't want to take any drugs that decrease the feelings of pain because pain signals are there to tell us whether or not we are ready to start loading the injured tissues. If it hurts, it's not healed and too early to start running again. When the area is naturally pain free, then it's our body telling us we can slowly are carefully start running. Education is always a good thing (you’re educating yourself right now!).
LOVE is the newest acronym used when talking about running injuries and stands for Load, Optimism, Vascularization, and Exercise. The acronym LOVE is great: we want to slowly start Loading the injured joint in most cases (as long as the pain is not increased by loading). Optimism creates both physical and mental/emotional changes associated with faster healing and better health. Pessimism creates physical and mental/emotional changes associated with slower healing and worse health. The choice seems clear. Vascularization means getting pain free cardiovascular exercise because it boosts blood flow, keeps muscles and joints moving, and boosts motivation and mindset. Exercise is referencing specific therapeutic exercises to restore strength, mobility, and proprioception to the injured joint and other affected joints.
Let's summarize what slows recovery from running injuries and what helps healing happen faster:
Bad: Ice, Compression, Elevation, Anti-inflammatories, prolonged external Protection and anything that reduces your body's natural inflammation or numbs your pain.
Good: Load, Optimism, Vascularization, Exercise, limited Protection and anything that allows your body to heal itself naturally and any pain free movement and therapeutic exercise to restore function.
Myth 1: Injuries are the result of bad luck.
Truth: Scientifically there is no such thing as bad luck, thus that can't be the cause of running injuries. All running injuries are caused by something concrete and with enough investigation the underlying cause can be found and fixed or eliminated, which will help that injury heal faster and more completely and help prevent future running injuries.
Myth 2: Injuries are from overuse.
Truth: Most running injuries are not from overuse (running too much etc.) but caused by posture imbalances, especially left to right imbalances in your body. You don’t get right Achilles tendon pain (save the tendonitis vs tendinosis debate for another time) because you are running too many miles, but because your right foot strike is compromised. Why is it compromised? There could be many reasons, but some examples are: your right shoulder blade is locked up and out of position; or your right hip is not flexing and extending from the hip joint correctly; or your left hip is unstable and you’re overloading your right leg; or your right ankle lacks dorsiflexion; or…The point is, it is not an overuse issue like running too many miles, running too fast, running too much vert., it is a posture imbalance issue that needs to be addressed.
Myth 3: Most running injuries are caused by inflammation.
Truth: Most running injuries RESULT in inflammation but are not caused by inflammation. If you sprain your ankle, either straining or tearing ligaments, your body senses the damage and instability created by the sprain and inflames the area for several reasons. The inflammation creates a natural brace to limit movement at the ankle until the ligaments have healed – brilliant! The inflammatory fluid also contains many substances that help with the pain and healing including neutrophils, macrophages, and satellite cells. The last thing we want to do is reduce this inflammation after an acute injury. The inflammation is actually helping us in multiple ways to heal faster. Running injuries are not caused by inflammation but result in inflammation.
Myth 4: Running injuries are caused by a weak core.
Truth: Most running injuries are not caused by a weak core. Most running injuries are caused by posture imbalances. Most running injuries are one sided. Think about it: you injure your right knee, or left ankle, or right foot, or left hip. Most injuries are not to both feet at the same time or both knees - it's either your right or left side. Why? Because you have posture imbalances left to right in your body. Yes most physical therapists will immediately tell you your core is weak and give you exercises to strengthen it, but that is doing nothing to fix the underlying cause of your running injury.
Myth 5: Your knee hurts, so it must be a knee problem.
Truth: Knee injuries are almost never caused by a knee problem, just as foot injuries are almost never caused by a foot problem. Knee injuries and foot injuries are related to your ankles, knees, hips, spine, and shoulders because your body is a unit and everything works together. If you injure your right knee it could very well be because your left hip is weak causing you to overload your right knee. If you injure your lower back it is probably because your hips and upper back have lost mobility and function, putting increased stress on your lower back. Again the key is finding and fixing the underlying cause of your injury, not just treating the injury itself.
Myth 6: Once you injure a joint, it will always be prone to re-injury.
Truth: It is true re-injury rates are alarming: ACL up to 60%, disc herniation up to 20%, rotator cuff up to 80%, ankle sprain up to 30%, etc. The reason re-injury rates are so high is because most people treat the injury, but never fix the underlying cause of the injury. It's like this: You spilled a box of nails on your driveway and you drive over them and your car gets a flat tire. You repair your tire and then get another flat the next day as you drive over the nails again. It's no surprise you got another flat tire! You forgot to pick up the spilled nails on your driveway! When we correct or fix the cause of the running injury we can prevent future re-injury.
Myth 7: It’s important to RICE or PRICE after an injury.
Truth: RICE which stands for Rest, Ice, Compression, and Elevation or PRICE which adds Protect to the start, do not help running injuries heal faster and research is showing they most likely slow healing. Why? Post injury inflammation is helpful to healing. We want to allow the body’s natural inflammation to remain to allow faster healing of the damaged tissues. Ice, compression, and elevation were all designed to decrease inflammation, which is what we now know is the opposite of what we want to do. What about Rest? Resting the injured area is a good idea initially but once the initial pain has decreased it’s important to start slowly and carefully moving the injured area. Movement helps improve blood and lymphatic flow which is important to remove waste products from the injured area and to bring more nutrients and healing cells to the injured area. Movement can decrease scar tissue from forming which can lead to future problems. The key is keeping movement gentle, slow, easy, and as pain free as possible.
Myth 8: A stress fracture is caused by RED-S or low energy availability.
Truth: Stress fractures are caused by imbalances in your posture and gait not low energy availability. Why? The stress fracture almost always happens on one side of the body – like one tibia, or one femur, or one side of the pelvis. Pure nutritional issues wouldn’t show up on one side of the body. Posture imbalances left to right in the body have caused increased load and stress on one side of the body and one part of the body causing the stress fracture. Fix the imbalances and the stress fracture wouldn’t happen. (Don’t take this to mean that RED-S and low energy availability isn’t a big problem in sports and especially ultra-endurance running – it is. And I encourage everyone to eat enough and not restrict eating at all. Food is vitally important for health and performance. It’s just not the cause of injuries like this.)
Myth 9: After a running injury we should always take anti-inflammatory drugs (NSAIDS) like Ibuprofen, Aspirin, or Naproxen.
Truth: NSAIDS slow healing because they decrease natural and positive inflammatory cells around the injury site. Those inflammatory cells (like neutrophils, macrophages, and satellite cells) play an important role in tissue healing after injury. It’s also important to remember pain plays an important role after injury – it keeps us from using/loading the injured tissues before they are healed and ready to be loaded. NSAIDS decrease pain which might encourage someone to start using the injured area too soon which could lead to more injury.
Myth 10: Running injuries are genetic.
Truth: Genetics determine our hair color and how tall we are, but not whether we get running injuries or not. Just because your father and two brothers have had plantar fasciitis, it does not mean you are going to get plantar fasciitis.
If you'd like to discuss your injury and learn what's really causing your injury and how you can fix it and get back to running pain free, contact me and let's have a conversation about it.
Many people start running later in life, and what a great thing to discover running in your 40s, after your kids go to college, or after you retire. There's nothing like the joy that comes from trail running in beautiful places, the peace of early morning runs, and the sense of accomplishment that comes from finishing your first ultra or a premier 100 miler like UTMB or Western States. Matt however, discovered running and his love of trail racing quite a bit earlier than that...(cue the flashback music)
Matt's first race was a 4th of July kids fun run in Council Idaho in 1981 at the age of 2. As seen below, Matt was so fast he not only won the race, but had time to be talked into "breaking the tape" before the other runners finished. Matt had learned at an early age not to break things, so he didn't want to "break the tape" at the finish line.
After this race, Matt had a love of running and never stopped running, even though he didn't always win the race.