Fueling the ULTRA- Distance Athlete

By Nancy Clark, MS RD CSSD

If you are an endurance athlete who is training for an Ironman triathlon, century bike ride, or a swim across the English Channel, you need a food plan. Don’t be the fool  who comments, “My training program is good, but my eating is bad.” Performance starts with fueling, not training! This article provides nutrition tips for ultra-endurance athletes as well as ordinary exercisers who want ultra-energy.

Tip #1. Acknowledge the power of being well fueled. I counsel many already-lean athletes who are convinced they will perform better if they lose just a few more pounds. They fail to realize they will perform better by eating, not dieting, and by being properly fueled. Despite popular belief, the lightest athlete may not be the best athlete. The best athlete tends to be well fueled, well trained, and genetically gifted.

If your hours of exercise have not resulted in loss of those last few pounds, listen to what your training buddies and loved ones are saying about your body. If they agree you have fat to lose, perhaps you do. But if your mother or spouse complains you are too thin, listen up! It’s time to stop dieting and focus more on fueling better to perform better.

Tip #2. Optimize your daily training diet. Your goals are to constantly be fueling-up before workouts and then re-fueling afterwards by eating on a regular schedule carbohydrate-based meals and snacks (that also include some protein). By feeding your body evenly throughout the day (as opposed to skimping on wholesome breakfasts and lunches, then overindulging in “junk” at night), you’ll have steady energy all day with no lags. The trick is to make your breakfast and morning snacks bigger and your evening food intake smaller.

When I counsel athletes, I sketch out a sample meals that fulfill their energy needs. One ultrarunner needed at least 4,000 calories a day to fuel his 15-mile daily runs. I divided his calories into four 1,000-calorie meals/food buckets. The first bucket (6:00-10:00 a.m.) was to fuel-up and refuel from his morning run; the second bucket (10:00-2:00 pm) was for an early hearty lunch; the third bucket (2:00-6:00 pm) was for a second smaller lunch plus energy bar and sports drinks to energize his 5:00 pm workout; and the fourth bucket (6:00-10:00 pm) refueled his muscles after the second workout of the day. Knowing his calorie goals for each 4-hour block helped him maintain high energy so he could train hard yet still enjoy the training sessions.

As a hungry athlete, you need to develop a similar eating strategy to fit your training schedule. One triathlete devised this routine: he drank 16 oz. of juice (i.e., carbs) before his morning swim, refueled afterwards while commuting to work with breakfast in his car (big bagel with peanut butter, a banana, milk in a travel mug). He ate a hot dinner-type meal at lunchtime (from the worksite cafeteria). He also bought at lunchtime a yogurt to add to his second lunch (granola and raisins, stocked in his desk drawer) and his evening meal (turkey sub, chocolate milk). He kept those items in the office refrigerator. This program ensured healthful food would be conveniently waiting for him and prevented him from overeating fatty take-out food at night.

Tip #3. Create a feeding plan for during exercise. Knowing your hourly calorie targets can help you maintain high energy during exercise. A sports nutritionist can help you estimate your energy needs per hour. You should try to replace at least one-third or more of the calories burned during the ultra-distance event. A good target is about 240 to 360 calories of carbohydrate per hour (60-90 g carb/h). For example, during an extended ride a cyclist could stay well fueled by consuming 1 quart sports drink (200 cals/50 g carb) + 3 fig newtons (165 cals/33 g carb) per hour, or a Clif Bar (240 cals; 45 g carb) + a gel (100 cals, 25 g carb). The goals are to maintain a normal blood glucose; if you feel dizzy or lightheaded, you are failing to consume enough calories!

Tip #4. Practice your event-day fueling. An essential part of your training is to train your intestinal tract so you can minimize undesired pit stops. During long training sessions, you want to determine which food and fluids you prefer for fuel during exercise. That is, you need to know which settles better: Gatorade or PowerAde? energy bars or  gels? liquids or solids? By developing a list of several tried-and-true foods, you need not worry about making the wrong food choice on race day.

Also think about “taste-bud burn-out.” That is, how many gels per hour can you endure in a triathlon? When hiking, how many days in a row will you enjoy oatmeal for breakfast? Will you get “sugared-out” on sports drink during the century bike ride? Plan to have a variety of options available.

Tip #5. Good nutrition starts in the grocery store. All too often, in the midst of juggling work, family, friends, sleep plus training, endurance athletes have little time left to plan, shop for, and prepare balanced sports meals. By having the right foods ready and waiting for you, you’ll eat better.

Tip #6. Plan rest days. Because ultra-distance athletes commonly feel overwhelmed by their impending task, they tend to fill every possible minute with exercise. Bad idea. Rest days are essential to reduce the risk of injury and provide muscles with time to refuel. (Remember: The bad things happen when you train; the good things happen when you rest.) Rest days also allow time for you to—tah dah—food shop!!!

Tip #7. Drink enough fluids. Ideally, you should learn your sweat rate by weighing yourself naked before and after an hour of race-pace exercise with no fluid intake. One pound lost = 16 ounces of sweat. You can then target the right amount to drink/hour so you don’t get into a hole.

On a daily basis, monitor your urine. You should be voiding a light-colored urine every 2 to 4 hours. Morning urine that is dark and smelly signals dehydration. Drink more!

Tip #8. Be flexible. Although you will have a well-planned fueling program that ensures adequate calorie and fluid intake, you also need to be flexible. Tastes change during extended exercise! Your initial approach to consume   “healthy foods” may deteriorate into gummy bears and Pepsi. Worry more about survival than good nutrition during events. Any fuel is better than none, and sugar can help delay fatigue.

Eat wisely and have fun!

Image from: listverse.com/2010/04/13/10-grueling-endurance-events/

Nancy Clark, MS, RD offers personal consultations to athletes of all abilities at her office in Newton MA (617-795-1875). Her Sports Nutrition Guidebook is filled with great tips. See www.nancyclark.com for more info. Also see sportsnutritionworkshop.com for online education.





How Many Calories Do You Need Each Day?

By Barbara Day, M.S., R.D., C.N.

There’s an App for this!

Knowing how many calories you need each day will help keep you energized while you are training for your event and doing all the things you need to do each day: work, manage a family, take care our your home or lose weight.  There are some FREE apps that you can use to help to determine how many calories you need each day.

A FREE app, My Fitness Pal, for your smart phone or online at can help to determine how many calories you need each day: www.myfitnesspal.com/tools/bmr-calculator and how many calories you burn when playing soccer or lifting weights: www.myfitnesspal.com/exercise/lookup. Add the calories plus the calories you burned practicing to get how many calories you need on most days.

Once you determine how many calories you need each day, the timing of your food intake is also important. Eating 5 – 6 times per day will help give you bullets of energy but keeping the calories in line with your overall calorie needs will maximize your performance. Never skip breakfast.

Other excellent apps and websites to determine calories are: LOSE IT! (www.loseit.com), SPARK PEOPLE (www.sparkpeople.com).

The Old Fashion Way to Determine Your Calories

To determine how many calories you need each day, you can calculate the calories the OLD FASHION WAY by using the HARRIS BENEDICT EQUATION to determine your resting metabolic rate (RMR) then choosing an activity factor to estimate the total calories per day.

Harris Benedict Equation


RMR = 88.362 + [1.889 X HT (in)] + [6.089 X WT (lbs)] – (5.677 X Age)


RMR = 447.593 + [(1.219 X HT (in)] + [(4.20 X WT (lbs)] – (4.7 X Age)

HT = height in inches   WT = weight in pounds   age = age in years

Activity Levels

Very Light-seating and standing activities, driving, no regular exercise.

Light – child care, walking on a level surface 2.5 – 3 miles per hour, some regular exercise.

Moderate – walking/running 3.5 to 4 mph, cycling, regular exercise 3 to 4 times/week -30 to 40 minutes duration.

Heavy – walking uphill with a load, basketball, soccer, regular exercise 4 times/week 40 minutes or more in duration.

Very Heavy – distance running, hiking with backpack up and down hills, regular exercise 5 times/week for at least 1 hour in duration.

TABLE 1.  Activity Factors. Choose your activity level from the table below. Then do the math.



Little to no exercise

RMR X 1.2

Light (1 – 3 days per week)

RMR X 1.375

Moderate exercise (3 -5 days/week)

RMR X 1.55

Heavy exercise (6-7 days/week)

RMR X 1.725

Very heavy (twice/day heavy workouts)

RMR X 1.9

Example, 1300 X 1.55 (moderate) = 2015 calories/day

You can also determine how many calories you burned by wearing a heart rate monitor that determines calories burned during exercise. (Not all heart rate monitors calculate calories). Then you can add those calories to your resting metabolic rate calories to get an estimate of active calories burned while exercising.  Example, 1300 X 500 calories = 1800 calories.  So, you could safely eat at least 1800 calories without gaining weight.

Again, it’s just an estimate. Weigh only once a week about the same time.  I suggest weigh after the first void in the morning before drinking anything with as few clothes as possible.

 Using Oxygen Consumption to Calculate your Personal RMR

The BodyGem Resting Metabolic Rate device is the handheld, portable and an effective tool that gives you an accurate RMR measurement result in 10 minutes or less. To perform a measurement, you simply breathe into the indirect calorimeter, which measures their oxygen consumption (VO2), the resulting RMR number is clearly displayed on the device’s LCD screen. It has been validated against the gold standard Douglas Bag, and other commonly used metabolic carts. The test costs anywhere from $75 to $150 per test. For the best results, you should take the test when you are fasted. But you still need to estimate the active calories you burn.

Body Media FIT™ On-Body Wellness Core Armband Monitor

The BodyMedia FIT CORE which is promoted by Biggest Loser is another way to determine how many calories you burn each day. The CORE’s biggest plus is that it track calories burned for 24/7. It cost about $119.  Unlike other fitness trackers, which estimate calories burned using an algorithm of steps and weight, the CORE uses special sensors to track not just your activity but also your body’s reaction to that activity. This makes it much more accurate as a calorie tracker, so you can realistically see how many calories you’re burning. But you have to buy subscription-based Activity Tracker in order to find out how many calories you have burned in the 24 hours.  The CORE Armband does not display any information on the device itself.  That will cost you  $6.95/month or you can opt to purchase a $69 optional display, which syncs with the CORE and lets you see a quick view of progress toward your daily goals. If you want to track your progress, you’ll still need to purchase the Activity Tracker.

What’s the Take Home Message?

I think it’s helpful to know how many calories you need each day so you can manage your health. In today’s world, lifestyle is the major contributor to increasing your risk of many diseases like heart disease, stroke, diabetes, and cancer.  Lifestyle includes your diet and also your daily activity.

Image from: www.greatist.com

Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition, www.DayByDayNutrition.com, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, www.KentuckianaHealthWellness.com. Barbara writes nutrition and health columns for www.LiveStrong.com as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 13 grandchildren.    


6 Tips to Keep Your Bike Rolling Along

By Jesse Roberson

Springtime is coming, the cold air will soon disappear, snow will be replaced with rain, and the green grass will reach up from the ground to meet the warm sunshine. A warm breeze will fill the air and I can almost hear the faint noise of a lawn mower running.  Every year when this time comes I dart to my garage to get my bike and go for a ride.

When I get there, I find my bike dirty, and rusty. I try to go for a ride, but the tires are flat.  So I dig up my pump and air the tires with plans of riding anyway.  Not far from the house I find my brakes make an awful squealing sound.  A sound so terrifying it brings the neighbors kids to tears.  Not to mention I have to walk up the first hill I come to due to the chain falling off.  After fighting the chain back on I decide to head back to the house.  I am disappointed, disgusted, and bleeding.  There is no way I can go wheel around until I get a tune up, so I load up the bike and run down to the bike shop to get the bike ready for the season.

There 6 areas of attention to consider when getting your bike ready for the season:

  1. Tubes – tubes lose air over time, a good tire pump is a must have to get those flat tires rolling again.  If inflating the tires doesn’t fix the problem, get new tubes.
  2. Tires – Tires are made of rubber, and over winter the rubber can get hard and crack.  If your tires show cracks it is time to replace them.  Inspect them closely.
  3. Chain & gears – A bicycle’s chain and gears is the hardest thing to keep from getting dirty and rusty.  But no fear, just get some Teflon based lubricant at your local bike shop and spray on the chain.  Any excess lube should be wiped off with a clean rag.  Some rusty chains will call for a degreaser to be used to clean the rust away before applying any lubricant.
  4. Cables, Cables, Cables, Cables – Check your brake and shifter cables for any corrosion or fraying.  A corroded cable will not move smoothly causing your brakes or shifters to not work properly.  A frayed cable can break, or cut the rider during use.  Also inspect the housing around the cables for any kinks or cracks, as this will lead to corrosion inside the housing where you can not see.
  5. Brakes – Most brake pads are made of rubber and can get very hard after sitting for the winter, causing loud squeaks and squeals. Squeaks and squeals can also be from misalignment of the brake pads.  After a season of wear, make sure to get your brakes adjusted at least every season.
  6. Shocks – Shocks may need attention after sitting for the cold months.  If the bike is hung upside down, or vertically, your shocks will need some maintenance.  Check the shock slider tubes for wear, or excessive oil.  Shocks require professional service to maintain, see you local shop for repair.

When these 6 areas are all clear of damage, cleaned and adjusted, the bike will roll along quietly and easily.   With your freshly tuned bicycle you can get out for a ride and enjoy the warmer weather.

Regardless if you use your bike daily, weekly, or for occasional neighborhood rides, a properly working bicycle will make your experience more enjoyable.  Don’t forget to wear your helmet, and enjoy your ride wherever it may lead you.

Image from: vic.edu

Jesse Roberson works at Scheller’s Fitness and Cycling in Middletown. For more information go to www.schellers.com.


All Bikes are Not Created Equal

By Jesse Roberson


Whether it’s when I meet a new customer at Scheller’s or overhear a conversation in a restaurant,  it is always a great moment when I hear someone say “I want to start cycling.”  I always get a quick recall of my own excitement as a new rider in anticipation of the fun and challenging rides ahead. Making an informed decision about the type of bike to purchase is as significant as deciding to ride. With that in mind, let me review 5 different bikes that you might consider as an entry to the sport or an addition to your growing passion of cycling.


The Road Bike

Commonly thought of as a racing bike, road bikes are used for much more than racing.  Fast, light, nimble and smooth are great words to describe a road bike.  Nimble and smooth so that a rider’s handling skills are improved when moving at faster speeds, and light weight so that a rider uses less energy to keep the bike traveling over the rolling hills of the Kentucky countryside.  A rider will have a more forward position on a road bike giving much needed pressure to the front wheel for better handling, at a small cost to comfort.  In comparison to the other models, road bikes are one of the fastest varieties; however you don’t need to be a racer to appreciate the extra speed gained by the skinny, high-pressure tires.  These bikes are not recommended for riding off the paved trail, but are exceptional when on it, just as their name implies.  The price of road bikes start higher than other models at around $600 and require some fitting after a few rides. Fitting services are usually offered at a cost, but a good fit is a must, so make sure this service is offered.  Check out the Trek 4.5 for a great priced, comfortable, light road bike.


The Mountain Bike

Mountain Bikes are fat-tire bikes, usually characterized by wide knobby tires, shock absorbers, and wide flat handlebars.  The wider knobby tires and shocks help gain traction and smooth out the rough terrain found on today’s mountain trails.  These bikes can be ridden on anything, yet todays off road trails can include fallen trees, water crossings, wooden bridges, mud holes and rock gardens. Mountain bikes are made to deal with the rough conditions and keep going.  Such adventurous rides can be done year round, are best with 2-6 riders, and can involve at least one meeting with the ground on each ride, and mud.  Riders sit in a more upright position holding a wider handlebar to increase handling and stability than on a road bike.  Mountain bikes start around $350, but if you’re going toCherokeeParkorWaverlyParkto ride, consider the better trail rated bikes from $700 up.



Hybrid Bikes

A hybrid bicycle is the best all around design to meet the needs of any ride.  Though hybrid bikes tend to have skinnier tires than a mountain bike, their seats are usually more comfortable, and they consider an upright riding position as a high point in their design. These bikes are great for taking a ride along the river atCoxParkand the Great Lawn, or around the local neighborhood, or even doing some shopping downFrankfort Ave.  Hybrid bikes are one of the largest groups of bikes that exist in most shops.  Many bike companies have multiple styles of hybrid bicycles represented in their lines. One example from Trek is the FX series and the Multitrack series of hybrids.  Where the FX series is made as a performance or sport tuned hybrid, the Multitrack series is a luxurious or comfort tuned hybrid, similar to comparing a Lexus IS sedan to a Lexus GS sedan.  Hybrid bikes can range in price from $330 to $2500.  The higher cost is associated with lighter and higher quality parts for a more demanding rider.  Anyone can find a hybrid bike and cruise the neighborhood, or venture further out on one of the many weekend bicycle tours we have here in the surroundingLouisvillearea or beyond.


The Triathlon Bike

A triathlon is the definition of a multisport event.  Participants swim, bike and then run, while competing in a single event.  Triathlon or tri bikes are designed to give a fast position while allowing the competitor to rest certain muscles to attain the best performance in the whole event.  Tri bikes are the most performance-oriented bikes of the five described here.  These bikes are very different in position than the other bikes, but when used, have one common goal in mind, Aerodynamics.  Very fast in a straight line, tri bikes are much like a dragster or a rocket, but at a cost to handling, and comfort.  Not good for use off the pavement, and difficult in tight or twisting corners, as they don’t turn extremely fast, these bikes are made for racing.  If group rides are a consideration, a standard road bike is best as tri bikes can present a safety concern.   Tri bikes are fast and fun. They are great for riding long distance, fast-paced rides with a smaller group of cyclists.


Comfort Bicycles

A comfort bike, or city and path bike, is designed just as named, for comfort.  These bikes can change in design from the style of a mountain, to that of a beach cruiser.  Made for style and short casual rides, these bikes are fun.  They will vary from having many gears to just one, and depending on the make, they can be found in almost any color.  Electra Bike is a company that makes over 100 different color and style comfort bikes.  All of which exist to meet the demands of a fun ride.  Although you can ride these bikes for over 100 miles at a time, most riders enjoy short one to five-mile jaunts around town, to the waterfront, or to the pool in the summer.  Style and comfort can come at a price, but the range you will find most these great-looking, comfortable bikes is from $250 to $700.

Image from: bikeablecommunities.org

Jesse Roberson has worked in the cycling industry for 16 years and is the manager of the Middletown branch of Scheller’s Fitness & Cycling.  He holds an accounting degree from Central Michigan University. An avid cyclist for more than half his life, Jesse rides competitively in regional road, mountain and cyclocross events.


Trek Bikes and Women Specific Design: Bikes Made to FIT Women

By Jesse Roberson

            Women’s Specific Design (WSD) is used to balance a woman’s weight more evenly between hands and hips, to allow a more natural riding position.  This is accomplished in part by adjusting geometry on WSD frames, causing a rider to sit more upright, effectively placing a women’s weight better than on a standard frame.  There are also many components used on a WSD bicycle that are used to make the bike more comfortable and to achieve a better position while riding.  Trek designs WSD bikes to optimally fit a woman by using a WSD steering package, shortening top tubes, improving the seat tube angle, and using better FIT components.

Steering packages include the stem and the handlebars on a bicycle.  When looking a handlebar width for a rider, the width of the handlebars should generally be similar to the width of their shoulders.  Many women riders ride a stock bar that can cause increased shoulder pain while riding.  Adjustments to handlebars help to eliminate hand soreness and numbness felt while riding. Correctly matched stem and bars also aid a rider with better control when riding.  To fit a women’s body, Trek WSD bikes use a narrower handlebar to keep hands in a more natural position to decrease shoulder pain and fatigue.

Shorter top tube lengths are used to sit a rider more upright.  Many bikes are fit to riders by using the length of the rider’s legs and not the length of a rider’s torso.  Sizing a bicycle by using a rider’s torso length positions the body more evenly over the bicycle frame.  Better riding position decreases pain and fatigue in the hips, lower back, shoulders, neck, and even hands.  A Trek WSD bike has a shorter top tube to redistribute a women’s weight between her hands and her hips to eliminate lower back pain and reduce neck and shoulder stress.

Seat position and seat tube angle attribute to pedal efficiency and power.  Riders generally position seats too high and too far back from the pedals.  A seat that is high will cause too much action in the hips and lead to pain and numbness.  A seat that is positioned too far back will cause a rider to slide forward on the seat, which results in hip pain and numbness.  Sitting too far back from the pedals will also cause a weak pedal stroke.  Balancing rider weight over the pedals increases pedaling efficiency.  Trek WSD bikes use a steeper seat tube to position a women’s body forward, resulting in an exceptionally powerful pedal stroke.

Steering design, frame adjustments, and seat position on WSD bikes aren’t all that is used by Trek to make a women’s bicycle fit so well.  Components like shorter reach levers and smaller-diameter grip size fit a women’s hand better.  WSD saddles position women’s sit bones upon the padding of the seat better, and provide more clearance for riders when standing and climbing.  Comfortable hands and butts lead to longer more enjoyable rides.  One the most important, yet overlooked features on a bicycle is color, Trek WSD bikes have some of the best paint offered.

Women’s Specific Design is not just found on performance bikes either, Trek bikes use WSD technology on almost all bikes they make.  WSD is on Hybrid and Fitness bicycles for commuting, touring, or riding paved trails.  Mountain bikes, both full suspension and hard tails, use WSD for off road trails, single-track, or racing.  Comfort bikes for short commutes, bike paths, or around town riding as well as cruisers for the boardwalk and other flat terrain use WSD.  Trek also has WSD riding shorts, jerseys, pumps, helmets, and many other accessories that help to make riding both casual and religious better.  Trek uses WSD on almost every bike they make so any women on any type of ride can feel great, ride happy, and look outstanding.

Image from: www.bicyclehabitat.com.

Jesse Roberson works at Scheller’s Fitness & Cycling in Middletown. For more information go to www.schellers.com.


The Effects of Vitamin D Deficiency in Athletes

By Stacie L. Grossfeld, M.D.

It is estimated that over 1 billion people are vitamin d deficient or insufficient. This is not just found in patients with medical problems but otherwise healthy elite athletes. Dr. Angeline et al from the Hospital for Special Surgery, in New York City, New York, published an outstanding article in the American Journal of Sports Medicine in Feb, 2013 regarding the effects of vitamin D deficiency in athletes.

Listed below are bullet points from their article.
1. Vitamin D deficiency is defined as serum levels of less than 20 ng/ml and insufficiency is defined as a level of 20 to 31 ng/ml. Vitamin D intoxication is defined as greater than 150 ng/ml.
2. Medical studies have found vitamin D deficiencies ranging from 40 to 50 % in dancers, patients undergoing ACL reconstruction or meniscal surgery. A recent study conducted by the Hospital for Special Surgery in New York found that out of 89 NFL players from a single team 51% were vitamin D insufficient and 30 % were deficient.
3. Sources of dietary vitamin D and intestine absorption of vitamin D a minor part of the total vitamin D requirements. The MAJOR source is from the interaction of the skin with UV light.
4. Vitamin D regulates the intracellular accumulation of phosphate within the muscles cells and this helps to maintain muscle function and metabolism.
5. Vitamin D receptor expression within muscle tissues decreases with age, which may provide a partial explanation as to why athletic performance declines with age.
6. Vitamin D’s active metabolite 1, 25(OH) D3 binds to the muscle nuclear hormone receptor, vitamin D receptor (VDR). Its pathway promotes gene transcription leading to increased cell protein synthesis and growth.
7. Studies in vitamin D deficient rats have shown that supplementation increases protein synthesis and muscle mass. There was also a decrease in the rate of exercise induced muscle apoptosis.
8. Muscle biopsy specimens from adults with low vitamin D levels have revealed atrophic changes of type 2 muscle fibers which are reversed with vitamin D and calcium supplementation.
9. Vitamin D deficiency is associated with limited sun exposure: sunblock use, region in the world, indoor training and dark skinned athletes.
10. Vitamin D supplementation may help improve athletic performance if the athlete is deficient. Unfortunately there are NO studies that determine the best level for the highest performance.
11. There are some studies that suggest that high level of vitamin D may be linked to other health problems such as tissue or kidney damage.
12. Vitamin D supplementation is best if 25(OH) D3 is used. D2 is only 30 % as effective as D3.
13. RDA recommendation for Vitamin D is 600 IU/day for children older than one year in age, adolescence and adults up to 70 years of age

14. RDA serum concentrations of 25(OH) D3 is between 30 to 50 ng/ml.
15. For the body to optimally absorb calcium the blood level of vitamin D must be at least 30 ng/ml.
16. If the body’s level of vitamin D falls below 30 ng/ ml it causes calcium to be mobilized from bone via parathyroid hormone and RANK-L. This can cause stress fractures and osteoporosis.
17. Calcium and vitamin D supplementation has been shown to decrease the incidence of stress fractures in female military recruits.
18. A link between vitamin D deficiency and decreased athletic performance has been known for years. Seasonal variability of athletic performance in the northern hemisphere was reported in the 1950’s. Peak performance occurred during late summer months and declined in the winter. Studies have revealed peak performance in the summer and lowest performance in the winter even with consistent training throughout the year. It’s maybe related to vitamin D levels.

19. UV radiation has been used in the past to improve physical performance: Russian researcher found in 1938 improvements in sprinters treated with UV radiation as compared to their non irradiated controls. The Germans in 1952 found increases in cardio fitness in children when exposed to UV radiation. The control group of children improved, to match the UV exposed group fitness levels, when given vitamin D supplementation. More recent studies have revealed an increase in muscle power, force, velocity and jump height in girls age 12 to 14 when vitamin D levels were optimized. Another more recent study found an increase in grip strength in teenage girls with normal levels of Vit D compared to the control group that was deficient.
20. Recommendation from the authors are to assess total serum 25(OH) D3 levels in high risk athletes and treating those that are deficient or insufficient.

Image from: www.drdavidgeier.com

Stacie L. Grossfeld, M.D. is an orthopedic surgeon with Orthopaedic Specialists. She is
Board certified in Orthopaedic Surgery and Sports Medicine. For more information go to
louisvillebones.com or call 502-212-BONE (2663). Fb: Orthopaedic Specialists PLLC
YouTube: Louisville Bones. 

Do Compression Stockings Prevent Athletic Injuries and Increase Performance?

By Stephen Karam PT, DPT

This is a great question and makes for great conversation with Physicians, Physical Therapists, Athletic Trainers and Personal Trainers. The answer is…”maybe and probably not”.

 Let’s first establish some necessary uses of compression stockings.  The post-surgical patient may be required and need a compression stocking or TED Hose Brand stocking to serve as a fluid pump for blood and lymph in prevention of a deep vein thrombosis (DVT) which could be life threatening.  Another necessary use is for the individual with a significant lymphatic drainage pathology.  They need the compression to help pump the lymph/edema back to the heart and into the circulatory system from the limbs.

Compression stocking manufacturers for athletes have a litany of claims:

  • Enhanced blood circulation to limbs
  • Reducing blood lactate concentration
  • Increased vertical jump (what!?!)
  • Reducing the effects of delayed onset muscle soreness (DOMS)
  • Enhancing warm-up through increased skin temperature
  • Prevention of both acute and chronic injuries

What we know is that there is numerous research examining the physiological effects of compression stockings with athletes and performance.  There are a few studies that consistently demonstrate that compression stockings help to reduce blood lactate concentration during tests on both treadmill and bicycle ergometers.  This would potentially result in improved performance with short-medium distance high intensity sprints and bike rides by allowing the athlete to perform at a higher intensity slightly longer.  There is also research that states there may be improved vertical jump height and improved repetitive jump performance by reducing muscle oscillation at landing impact.   This research regarding the improvements in vertical jump needs to be approached with caution as most of the studies have a limited number of participants.

Most of the research strongly suggests that the results they found need to be studied further which is a very fair statement.  They also suggest that there may be no performance improvement in elite or well trained athletes.  It appears wearing compression stockings in colder environments may help keep your skin temperature increased, which may improve some of your joint awareness, but does not provide joint stability.

There does not appear to be any negative performance attributes to wearing compression stockings other than maybe a hit to your wallet, but for me personally it is still a hard sell.

Image from: mypypeline-triathlon.blogspot.com/2009/06/low-down-of-compression-socks.html

KORT Physical Therapy Clinic Director Stephen Karam PT, DPT earned his doctorate in physical therapy from the University of Kentucky after completing a bachelor’s degree in exercise science. He is a member of the American Physical Therapy Association (APTA). He specializes in manual therapy with a strong emphasis in orthopedics and sports medicine. In his spare time, he enjoys tennis, working out, music and football. www.kort.com





Four Critical Periods for Training for an Endurance Event

By Barbara Day, M.S., R.D., C.N.


There are four critical periods when you are training for an endurance event like a half marathon, marathon, or an ultramarathon.

These include:

1. Your daily training diet.

2. What you eat and drink before daily exercise and before the event.

3. What you eat and drink during long training bouts and the event.

4. What you eat and drink after your daily training and after the endurance event.

Your Daily Training Diet

  1. Calories

Knowing how many calories you need each day will help keep you energized while you are training for your event and doing all the things you need to do each day: work, manage a family, take care our your home.  There are some FREE apps that you can use to help to determine how many calories you need each day. If you eat too few calories and continue to up your miles, you may find you are losing weight which might be your goal but you may also battle with fatigue and then ultimately an injury or an immune related illness.

The Lose It! FREE App for I-Phone or Droid or www.loseit.com,  www.Sparkpeople.com  or My Fitness Pal app will help you to determine how many calories you need each day.  In addition, these apps can help you determine how many calories you are burning during the time you are being very active as well.

An Alternative Method of Determining How Many Calories You Burn During Activity

The other method of determining your activity is just to look at a particular definition and pick what activity category that you think you belong in and multiply your resting metabolic rate.  Some people tend to over estimate or under estimate their activity.  See the categories below.

Activity Category

Very Light which consists of: seated and standing activities, painting trades, driving, laboratory work, typing, sewing, ironing, cooking, playing cards, playing a musical instrument, and no regular exercise.

Light which includes walking on a level surface at 2.5 to 3 mph, garage work, electrical trades, carpentry, restaurant trades, house-cleaning, child care, golf, sailing, table tennis and some regular exercise.

Moderate which includes walking/running 3.5 to 4 mph, weeding and hoeing, carrying a load, cycling, skiing, tennis, dancing and regular exercise 3 to 4 times per week — 30 to 40 minutes in duration.

Heavy which includes walking with a load uphill, tree  felling, heavy manual digging, basketball, climbing, football, soccer, wrestling and  regular exercise 4 times per week 40 minutes or more in duration.

Very heavy activity includes training for athletic competition, distance running or regular exercise 5 times per week for at least I hour in duration.

Then, multiply your ACTIVITY CATEGORY times your RMR to get your daily energy needs.

Women                            Men

Very Light Activity =      1.3 X RMR             1.3 X RMR

Light Activity       =        1.5 X RMR             1.6 X RMR

Moderate Activity   =      1.6 X RMR             1.7 X RMR

Heavy Activity      =        1.9 X RMR             2.1 X RMR

Very Heavy Activity =     2.2 X RMR             2.4 X RMR

RMR X ACTIVITY CATEGORY = caloric expenditure per day                                


EXAMPLE:   1300 X 1.6 (moderate activity)  = 2080  calories per day for the a women who weighs 130 pounds. The women works out at least 4 days a week for at least 105 minutes running, weight training and doing yoga.  As you can see there’s a  difference in the caloric expenditures if you use an app based on the exact exercise rather than using the formula mentioned above.  ( 1978 calories vs. 2080 calories with a difference of  102 calories).

 Once you determine how many calories you need each day, the timing of  your food intake is also important. Eating  5 – 6 times per day will help give you bullets of energy but keeping the calories in line with your overall calorie needs is required. Never skip breakfast. Eat or drink something  before early morning workouts to get the most effective workout.

  1. How Much Fluid do you Need to Consume Daily?

Once you determine how many calories you need each day, you can determine how much fluid you need each day.

Fluid Needs = Total calories/30 = how many approximate ounces you need per day.  Example of your goal: 2000 calories/30 = 66.6 ounces of fluid each day.

But you should drink until your urine is pale to clear, if not drink more fluids. You first void of the morning will be yellow but as the day goes your urine should be pale to clear. When exercising in the heat, weight yourself before you workout, then weigh yourself after and drink 16 to 24 ounces of fluid for every pound you have lost.

  1. 3.  Carbohydrates: the Athletes Nutrient

Carbohydrate (CHO) has three main functions in the body.  It provides fuel for the body, dietary fiber, plus a source vitamins and minerals.  CHO is the body’s preferred source of energy and is used to replenish muscle glycogen.  The CHO you eat has two fates:  it will be either burned for energy or it will be stored for future use in the form of muscle glycogen or liver glycogen. CHOs contain only 4 calories per gram.  CHOs are not fattening unless eaten in excessive amounts but can be filling (particularly the complex CHOs that contain a lot of dietary fiber). Recommended CHOs are whole grains like oatmeal, brown rice, quinoa, fruits, vegetables, etc. Read the food label to determine how many grams of carbohydrate is included in each food.

How much and where Dietary CHO is stored

During exercise, [blood] glucose and [muscle and liver] glycogen supply energy to the working muscles. A diet rich in complex carbohydrates will increase glycogen stores and endurance.  Carbohydrates get stored in your blood, muscles and liver in varying amounts.

One of the limiting factors in your performance will be the amount of muscle energy available.  The best way to load up your muscles with energy is by what you put in your mouth!  A proper performance diet can prevent the cumulative effects of muscle glycogen depletion occurs as you increase your mileage. Complex carbohydrates are preferable to simple carbohydrates because they are easily digested, providing a slow, steady supply of glucose to your body.  At the same time, complex carbohydrates contribute other essential nutrients such as vitamins and minerals needed for energy metabolism.

Daily Carbohydrate Recommendations for Athletes

●        2.27 – 3.18 g of CHO/lb/day: athletes engaging in moderate-intensity exercise for 60 to 90 minutes per day.

●        3.18 – 5.45 g of CHO/lb/day: athletes engaging in moderate-to-high intensity endurance for one to three hours.

●        4.55 – 5.45 g of CHO/lb/day: athletes participating in extreme endurance exercise for four to six hours per day (e.g. Tour de France, IronMan)


  1. 4.  Protein:  Builds and Repairs Muscles for Tip Top Performance


Protein is important for growth and development, required for healing injuries, and necessary for the maintenance of body tissues. As our body grows, it uses protein to manufacture cells.  For example, the protein, collagen, serves as both building and mending material in tissues such as ligaments and tendons.  Enzymes, hormones, and antibodies are synthesized from protein.   Proteins within each cell are also constantly turning over – being made and being broken down. Protein is composed of individual amino acids strung together in chains. The constant synthesis and breaking down of protein is known as protein turnover. When protein breaks down, they free amino acids to join the general circulation.  Some are recycled into other proteins; others may be stripped of their nitrogen and used for energy.  Protein provides 4 calories per gram. Although protein is not a major source of energy, an active person needs for protein may be slightly higher than the needs of a sedentary person.


So how much protein do you need each day? 


You do need to consume an adequate amount of protein for good health. Use Table 1 to determine your daily protein needs. Unlike fat and carbohydrate, protein contains nitrogen.  The body strives for a perfect nitrogen balance and when too much nitrogen is available in the body, it needs to be excreted. When you eat too much protein, your kidneys need more water to eliminate the extra nitrogen from the excess protein consumed in order to maintain nitrogen balance. Therefore, weight loss from a high protein diet tends to be due to a water loss rather than a decrease in body fat.

Table 1. Determining Your Protein Needs


Grams of Protein per pound of body weight


Sedentary Adult                                                 0.4

Recreational exerciser, adult                               0.5 – 0.7

Endurance adult                                                  0.6 – 0.7

Growing Athlete, teen age – 24 years                    0.7 – 0.9

Adult Building Muscle Mass                                  0.7 – 0.8

(weight/strength training)

Adult restricting calories                                                0.8 – 0.9

Estimated upper requirement for adults                0.9

SOURCE: Combination from American College of Sports Medicine, American Dietetic Association, Dietitians of Canada Joint Position Paper Statement Nutrition and Athletic Performance, Medicine and Sciences in Sports & Exercise 32 (12): 2130 – 2145, 2000.  R. Maughan & L. Burke, editors.  Sports Nutrition (part of the Handbook of Sports Medicine & Science series, an IOC Medical Commission Publication).  Malden, MA: Blackwell Publishing, 2002; Institute of Medicine.  Dietary Reference for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids.  Food and Nutrition Board, Washington, DC: National Academy Press, 2002.


Example 1:         * 120 pound athletic woman who is an “active adult”

120 lb X 0.6 g/lb = 72 grams of protein needed/day


Example 2:         * 170-pound sedentary adult

170 lb X 0.4 g/lb = 68 grams of protein needed/day

The best way to find out how many grams of protein a food contains is to read the NUTRITION FACTS on the food label. Remember to look at the serving size on the label and compare it to the amount in your actual serving.

  • A small 3-ounce piece of meat  about the size of a deck of cards after cooking has about 21 grams of protein. A typical 8-ounce piece of meat could have over 50 grams of protein.
  • One 8-ounce container of yogurt has about 11 grams of protein.
  • One cup of milk has 8 grams of protein.
  • One cup of dry beans has about 16 grams of protein.

3 Days Before Endurance Event – ½ Marathon

CHO         3.86 grams per pound per day

Fluids       at least 3 grams of water/gram of CHO to ensure adequate hydration during loading phase.  You will gain weight but it is a transient weight gain. Poor hydration may increase muscle damage.

              Example, 3.86 X 150# = 579 grams of CHO.  579 X 3 = 1737/30 = 57.9 oz.   at least 57.9 ounces per day but drink until urine is clear.


Calories     200 – 600 calories depending on how long you eat before event.

CHO         .5 – 1.8 grams per pound 1 to 4 hours before event.  CHO amount depends on when you eat your pre-event meal.

Timing              1 to 4 hours before event.

Fluids       2 – 3 cups (16 – 24 oz) 2 – 3 hours before exercise, then another 8 – 10 oz 30 minutes before exercise, make sure to reserve time before the event for a bathroom stop.

During Events lasting longer than 60 minutes

CHO         30 – 60 grams of CHO per hour; sports drinks, gels, sport jelly beans, bananas, etc. (.45 – .68 grams of CHO/pound)

Fluids       8 – 10 oz every 15 – 30 minutes . One gulp is about 1 oz. Use planned water stops or use a fanny pack that carries a water bottle. A 20-oz water bottle if filled with a sports drink can supply 35 – 50 grams of CHO and 140 – 200 calories. 6 – 8% CHO optimal sports drink; 14 – 19 g CHO/8 oz.

              Examples – Gatorade, Powerade. Accelerade, Endura, etc.


CHO         .5 to .75 grams per pound within 15 to 30 minutes post exercise

Protein      For every 4 grams of CHO eat 1 gram of protein. (chocolate milk)

              (3:1 ratio CHO to PRO = replenishment of glycogen & rebuild muscles)

Timing       Eat and drink 15 minutes to 30 minutes post exercise.

Fluids       Drink at least 20 – 24 oz for every pound of weight loss to rehydrate.  Weigh before and after exercise to estimate water loss.  Drink until urine is clear.


  • Energy bars, gels and drinks can boost calorie intake.
  • Find an energy gel, beans or bloks that you like to eat, and try it during training before the competition. Never try anything new during a competition.
  • If you use gels, beans or bloks, remember they are concentrated CHOs and should be washed down with at least 8 oz of water (DO NOT sports drink – sport drinks immediately following a gel may cause nausea).
  • For running events like a ½ marathon or longer, take alternate water and sports drink at beverage stations to prevent hyponatremia (low blood sodium).


Nancy’s Clark’s Food Guide for New Runners.  Nancy Clark, M.S., R.D. $16.95.  ISBN 978-1-84126-262-8. 2009.


Fueling Your Early Morning Workouts

Training for early morning workouts on an empty stomach does not improve performance and the quality of your training may actually suffer. You wouldn’t consider driving your car from Louisville to Jasper on empty, so why train on empty? It can cause you to run out of gas. After an 8-to-10-hour overnight fast, about 80% of your liver glycogen (not muscle glycogen) is depleted, so you would start exercising with depleted carbohydrate stores. In these conditions, your body converts protein to carbohydrate in order to maintain adequate blood sugar levels.

Your early-morning meal should be primarily carbohydrate, with a touch of protein to help you feel a little more full and satisfied. Keep the meal around 300 calories or less.  Use the food label as a guide. Some people might be able to eat more or need to eat less – it’s very individualized. But be wise and eat or drink something.  You body will thank you by helping you to get the most out of your workout.

The meals recommended below will also work to get you through most morning workouts that last for less than 90 minutes, especially if you take some carbohydrate to eat during the training session. If your morning workout is going to be over two hours, wake up early enough to eat a more substantial breakfast between 90 and 120 minutes before training. (I drink carnation instant breakfast with skim milk & run in an hour).

Pre-run Meals 30 – 60 minutes before your morning run; 300 or less calories

* Carnation Instant Breakfast mixed with skim milk

* Low-Fat Yogurt plus 8 oz of water, sport drink or diluted juice.

* Breakfast Bar or Energy Bar that contains 3 to 4 times as many carbs as protein plus 8 oz water.

* 1 slice of Toast with 1 tbsp jam, jelly or honey (skip the butter) plus 8 oz water or sport drink.

* Multi grain bagel with 1 tbsp peanut butter or other nut butter plus 8 oz water or sports drink.

* 1 large banana plus 8 ounces of sport drink or diluted juice.


Recovery Foods & Meals

* Chocolate milk plus a container of yogurt.

* 1 Can of Carnation Instant Breakfast, Boost, or Ensure.

* Cereal with milk.

* Turkey on a baguette.

* Chicken dinner with brown rice and vegetables.

* Spaghetti with meat sauce.

* Pasta with vegetables.

Sunshine Smoothie

8 oz plain or vanilla yogurt, ½ cup skim milk, ½ cup orange juice 8 ice cubes plus 1 tbsp of honey, sugar, or sweetener. Blend until smooth and frothy.

Banana Smoothie

8 oz plain or vanilla yogurt, ½ cup skim milk, 1 banana 8 ice cubes plus 1 tbsp of honey, sugar, or sweetener. (you can also add blueberries, etc for extra fruit) Blend until smooth and frothy. Frozen berries work well. Use less ice cubes if using frozen fruit.

Crunchy Yogurt

1 contain of yogurt with ¼ cup Kashi Mountain Medley Granola (cranberries, raisins, almonds, pecans, and sunflower seeds). Drink 8 oz water or sports drink.

Image from: http://www.brazosrunning.com/

Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition, www.DayByDayNutrition.com, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, www.KentuckianaHealthWellness.com. Barbara writes nutrition and health columns for www.LiveStrong.com as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 12 grandchildren.    

Preventing Injuries While Training for a miniMarathon or Marathon

By Stephen Karam, PT, DPT

Now that New Years has come and gone, many of you are sticking with your resolutions of staying active.  Some of you have begun training for the next marathon or maybe your first marathon coming up this spring or summer.  If you have been running a long time you know that aches and pains throughout your legs and feet are a part of the process, but they do not necessarily have to be if you train smart and listen to your body.

There are a variety of running injuries that may afflict runners.  These include patellofemoral syndrome (runners knee), iliotibial band syndrome, tibialis tendonitis also known as shin splints and may vary location depending on which tendon, achilles tendonitis and plantar fasciitis.  All of these injuries may be caused by a source of either chronic movement dysfunction or an acute event while running such as surface change, ankle rolling/twisting, inappropriate shoewear for your foot, and vast change in mileage or pace.  The good news is that most if not all of these injuries associated with running is preventable.  Most of these injuries can be alleviated by having gait analysis performed and functional strength assessments in order to address any hip and core strength deficits or asymmetries within your mechanics.  Here are some tips for starting and maintaining an injury free running program.

  • Stretch lightly before running using a dynamic warm-up series that helps warm your muscles up in a manner that is similar to the exercise.
  • Do not initiate a program running more than you are capable of, consider your pace, your environment and your surface.  Ten miles on a treadmill feels a lot different than 10 miles on the road.
  • Do not wear old running shoes or shoes that are not made for running.  Contact your local KORT Physical Therapist to make sure that your shoe is appropriate for your foot.  Buying an expensive shoe does not mean it is the best for you, it must be appropriate for the shape of your foot and your individual running mechanics.
  • Do not ignore any running pain.  Please address the pain immediately so that it does not become a chronic pain or a real injury.  You are guaranteed not to finish your marathon training or finish with the PR you were looking for.
  • Strengthening your hips and core can greatly reduce the likelihood of you sustaining a preventable running injury.  A strong center/core allows for improved mechanics down the movement chain into your legs and feet.


If you are interested in beginning a running program or have already started one, feel free to contact your local KORT Physical Therapy Clinic to have your shoes, feet, strength, and mechanics assessed and addressed.  This will ensure that you are running at your best and running happy!

Image from: www. thecatholicbeat.sacredheartradio.com/5k-races/

KORT Chevy Chase Clinic Director,  Stephen Karam PT, DPT,  earned his doctorate in physical therapy from the University of Kentucky after completing a bachelor’s degree in exercise science. He is a member of the American Physical Therapy Association (APTA). He specializes in manual therapy with a strong emphasis in orthopedics and sports medicine. In his spare time, he enjoys tennis, working out, music and  football.  For more information go www.kort.com.





Injured Athletes: Nutrition Tips to Hasten Healing

By Nancy Clark MS RD CSSD

Being injured is one of the hardest parts of being an athlete. If you are unable to exercise due to broken bones, knee surgery, stress fracture, or concussion, you may wonder: What can I eat to heal quickly? How can I avoid getting fat while I’m unable to exercise? Should I be taking supplements? This article will address those concerns, plus more.

Don’t treat good nutrition like a fire engine

To start, I offer this motherly reminder: Rather than shaping up your diet when you get injured, strive to maintain a high quality food intake every day. That way, you’ll have a hefty bank account of vitamins and minerals stored in your liver, ready and waiting to be put into action. For example, a well-nourished athlete has enough vitamin C (important for healing) stored in the liver to last for about six weeks. The junk food junkie who gets a serious sports injury (think bike crash, skiing tumble, hockey blow) and ends up in the hospital in a coma has a big disadvantage. Eat smart every day!

Don’t diet

A big barrier to optimal fueling for injured athletes is fear of getting fat. Please remember: even injured athletes need to eat! I’ve had a runner hobble into my office on crutches saying, “I haven’t eaten in three days because I can’t run.” He seemed to think he only deserved to eat if he could burn off calories with purposeful exercise. Wrong! Another athlete lost her appetite post-surgery. While part of her brain thought “what a great way to lose weight”, her healthier self realized that good nutrition would enhance recovery.

Despite popular belief, your organs (brain, liver, lungs, kidneys, heart, etc.)—not exercising muscles—burn the majority of the calories you eat. Organs are metabolically active and require a lot of fuel.  About two-thirds of the calories consumed by the average (lightly active) person support the resting metabolic rate (the energy needed to simply exist). On top of that, your body can require 10% to 20% more calories with trauma or minor surgery; major surgery requires much more. Yes, you may need fewer total calories because you are not training hard, but you definitely need more than your sedentary baseline. Your body is your best calorie counter, so respond appropriately to your hunger cues. Eat when hungry and stop when your stomach feels content.

Here are two other weight myths, debunked:

Muscle turns into fat. Wrong. If you are unable to exercise, your muscles will shrink, but they will not turn into fat. Wayne, a skier who broke his leg, was shocked to see how scrawny his leg muscles looked when the doctor removed the cast six weeks later. Once he started exercising, he rebuilt the muscles to their original size.

Lack of exercise means you’ll get fat. Wrong. If you overeat while you are injured (as can easily happen if you are bored or depressed), you can indeed easily get fat. Joseph, a frustrated football player with a bad concussion, quickly gained 15 pounds post-injury because he continued to eat lumberjack portions. But if you eat mindfully, your body can regulate a proper intake. Before diving into meals and snacks, ask yourself, “How much of this fuel does my body actually need?”

When injured, some underweight athletes gain to their genetic weight. For example, Shana, a 13-year-old gymnast, perceived her body was “getting fat” while she recuperated from a knee injury. She was simply catching up and attaining the physique appropriate for her age and genetics.

Do eat “clean”

To enhance healing, you want to choose a variety of quality foods that supply the plethora of nutrients your body needs to function and heal. Don’t eliminate food groups; they all work together synergistically! Offer your body:

Carbohydrates from grains, fruits, vegetables. By having carbs for fuel, the protein you eat can be used to heal and repair muscles. If you eat too few carbs—and too few calories, your body will burn protein for fuel. That hinders healing.

Protein from lean meats, legumes, nuts and lowfat dairy. Protein digests into the amino acids needed to repair damaged muscles; your body needs a steady stream of amino acids to promote healing (especially after physical therapy). You need extra protein post-injury or surgery, so be sure to include 20 to 30 grams of protein at each meal and snack. A portion with 20 to 30 grams of protein equates to one of these: 3 eggs, 1 cup cottage cheese, 3 to 4 ounces of meat, poultry, or fish, two-thirds of a 14-ounce cake of firm tofu, or 1.25 cups of hummus. While you might see ads for amino acid supplements including arginine, ornithine, and glutamine, you can get those amino acids via food.

Plant and fish oils. The fats in olive and canola oils, peanut butter, nuts and other nut butters, ground flaxseeds, flax oil, and avocado have an anti-inflammatory effect. So do omega-3 fish oils. Eat at least two or three fish meals per week, preferably the oilier fish such as Pacific salmon, barramundi, and albacore tuna. Reduce your intake of the omega-6 fats in packaged foods with “partially hydrogenated oils” listed among the ingredients, and in processed foods containing corn, sunflower, safflower, cottonseed, and soy oils. Too much of these might contribute to inflammation.

Vitamins. By consuming a strong intake of colorful fruits and vegetables, you’ll get more nutrition than in a vitamin pill. Fruits and veggies have powerful anti-oxidants that knock down inflammation. Don’t underestimate the healing powers of blueberries, strawberries, carrots, broccoli, and pineapple. Make smoothies using tart cherry juice, PomWonderful pomegranate juice, and grape juice.

Minerals. Many athletes, particularly those who eat little or no red meat, might need a boost of iron. Blood tests for serum ferritin can determine if your iron stores are low. If they are, your doctor will prescribe an iron supplement. You might also want a little extra zinc (10 to 15 mg) to enhance healing.

Herbs, spices and botanicals. Anti-inflammatory compounds are in turmeric (a spice used in curry), garlic, cocoa, green tea, and most plant foods, including fruits, vegetables, and whole grains. For therapeutic doses of herbs and spices, you likely want to take them in pill-form. Yet, consuming these herbs and spices on a daily basis, in sickness and in health, lays a strong foundation for a quick recovery.

Image from: http://www.active.com/running/Articles/How-to-Prevent-and-Treat-Common-Running-Injuries

 Nancy Clark, MS, RD, CSSD (Board Certified Specialist in Sports Dietetics) counsels both casual and competitive athletes at her office in Newton, MA (617-795-1875). Her Sports Nutrition Guidebook and food guides for new runners, marathoners, and soccer players offer additional information. They are available at www.nancyclarkrd.com. See also sportsnutritionworkshop.com.