Health Seminar Synopsis: Marathon Injury Prevention and Nutritional Support


Japanese Medical Society of America

M. Adachi, M.D., Sc.D and J. Furuyama, D.D.S: Editors


Marathon Injury Prevention and Nutrition Support                  

Asako Miyashita, MS, RD. Nihon Clinic, New York, N.Y.

A proper diet is essential and significantly influences your marathon training and race-day performance. An adequate diet in terms of quantity and quality, before, during, and after training and competition, will give you optimal results. Eating balanced meals can meet basic nutrition requirements and provide your body with enough nutrients and energy to maintain health and prevent injury.


How to calculate daily caloric intake?

Ideal Energy Intake (kcal) = Ideal Weight (kg) × 25~30 (kcal)

Ideal Weight (kg) = Height (m) × Height (m) × 22

Ex. Person whose height is 165 cm

Ideal Weight = 1.65 × 1.65 × 22 = 59.895 (≒60 kg)

Ideal Energy Intake = 60 × 25~30 = 1500~1800 (kcal)

How many calories do you burn during the marathon?

『Your weight × 42.195 km』

Ex. Person who weighs 60 kg: About 2,500 kcal 

Person weighs 50 kg: About 2,100 kcal

Nutrient and food for body function

The Japanese diet is based on three side dishes with soup and staple food (rice). The three side dishes consist of one main and two lesser dishes. Each dish provides a variety of nutrients and gives health and normal body function.

  • Staple food (rice, bread, noodles, barley, starch): carbohydrate: for energy
  • Main dish (meat, fish, seafood, egg, soy products, legumes): protein, fat, iron, and calcium: for muscle, bone, and the whole body.
  • Side dish (vegetables, seaweed, mushroom): vitamin, minerals, fiber: for balanced energy, to maintain a healthy body
  • Fruit (fruit, 100% fruit juice): vitamins, carbohydrate, fiber: for balanced energy, to maintain a healthy body
  • Daily products (milk, yogurt, cheese): protein, calcium: for building muscle, bone, and whole body.

Nutrition Strategies for Runner

First, eat meals every day. You need to eat more than three meals per day; your body can easily create more energy. Eat meals consisting of carbohydrate, protein and fat. When you eat a low carbohydrate diet and/or skip meals, you will get hypoglycemic and break down muscle. Skipping meals also decreases growth hormone and testosterone. Ideal caloric intake at each meal: after 3 hours, you can get hungry. Each meal should be about 400-1000 kcal. Second, eat breakfast at the same time on the race day to give you good digestion. Third, you need to save a lot of fluids in the body. Fourth, enhance your immune system – preventing colds is very important. Take vitamins, especially A, C and E to enhance immune cell function. Eat protein to build strong muscles, bones and to increase absorption of iron (to prevent anemia, and create burn-fat chains to complete running) and zinc (increase metabolism). Eat scallions, ginger and garlic for stamina, good fats such as omega-3 fatty acids, and probiotics for the GI system.

This ideal nutrition ratio is 60% carbohydrates, 25% fats and 15% protein. Do not eat too much fat. Keeping a low fat intake makes it possible to absorb enough carbohydrates and proteins for mental health, joints, immune system, boosting the immune system, a balanced GI system, weight management and chronic disease prevention. Choose good fats such as fish, fish oil, nuts, seeds, flaxseeds, soybeans, olive oil and avocado. 

An ideal meal to get 60% carbohydrates, you can follow: balanced meal x 3 + fruit + dairy products. Protein is also a very important nutrient for our body.

Daily Protein Intake: ☆Non-active person: weight × 1.0~1.2 g ☆Runner: weight × 1.2~1.7 g

*If you are a vegetarian, you need good fats, whole grains, iron (need 1.8 times more than non-vegetarian), calcium with vitamin D, zinc and vitamin B12.

There are 10 g of protein in the following foods: 28 g of Meat and Legume, 2 eggs, 1 cup of milk and yogurt, 28 g of cheese, 2/3 cup of beans, 1/3 cup of nuts, 2 tablespoons of peanuts

Carbohydrate loading means to increase carbohydrate intake to 70% from 60%, starting 3 days before the competition, and to decrease training. When people do carbo-loading, they will gain some weight, have poor digestion, and become ill because of the unusual diet. I personally recommended that they try carbo-loading for three days a few months before the competition. If they do not get a negative reaction, then they are able to do it 3 days before the race-day.

As for the day before the competition, you need to get enough energy from foods. Eat foods especially carbohydrates, take Vitamin B complex rich food for utilizing carbohydrates and protein, Vitamin B1 rich foods for carbohydrate utilization such as pork, eel, fish egg, soy products, and Vitamin B6 rich foods for protein degradation such as bananas and fish like tuna. Also drink enough fluids, 1.5ℓper day. Choose water, non-caffeinated drinks and refrain from alcohol as it makes you dehydrated. Avoid raw foods to prevent food poisoning, fried food because it takes time to digest, and high fiber food that can create bloating and gas, and avoid foods you don’t routinely eat which might not agree with you.

For the day of the competition, you can try the following eating plan:


< 2-4 hours >: Rice/pasta + soup with proteins + vegetables + fruit + fluid (more than 2 cups)

< 1~2 hours >: Rice ball, bread with peanut butter, cracker, banana + fluid (more than 2 cups)

< 30 minutes >: Sports drinks, coconut water, fluid (1 cup)

< During the competition >: Intake snacks (100-150 kcal) between 20~30 km. Intake energy twice during the competition, fluids every 15-20 minutes (6-8 oz per drink) and drink 16-24 oz fluid (2-3 cups) within 2 hours.

After your race, it is very important to get enough nutrients and fluid. Especially fluid and sodium intake are very important. Within 2 hours, you need 24 oz for every 1 lb lost during the competition and carbohydrate and protein intake. Carbohydrates restore the glycogen in muscle and liver. You need 0.5-1 g of carbohydrate for every 1 kg (2 lbs) of the weight 0.5~1 g within 30 minutes. A person who weighs 60 kg needs: 60 × 0.5-1 g of CHO = 30-60 g. You can eat 1/2-3/4 of a big bowl of rice, 1-2 bananas, 2-3 oranges and 2 apples. Protein restores energy, builds muscle, and prevents muscle cramps. You need 10-20 g of protein within 30 minutes. You need a lot of anti-oxidant rich foods to prevent oxidation and get vitamins and minerals.

Marathon runners also need to prevent injury. Here are the key nutrients for prevention and healing injury: Protein + Vitamin C + Calcium with Vitamin D. Eat enough protein and vitamin C to make collagen, which makes your joints, muscles and bone strong. If you have joint inflammation, a ligament sprain, tendon damage, a pulled muscle or injury related to muscle, take a lot of protein, vitamin C and vitamin B complex. For injury related to bone, you need protein, vitamin C and calcium with vitamin D.

I believe that good nutrition is key to running a marathon and achieving an end result both safely and rewardingly. Meal plans with food nutrients helps you focus on your competition. As you train, healthy eating habits play a key role. You should know when, what and how much you eat and drink to get your best results.


Marathon Injury Prevention and Increase Fitness

Kenneth Vitale, MD, Nihon Clinic, New York, N.Y.

Running, as a way to increase fitness, as a recreational sport, and as a form of competition in various distance races, has largely grown over the last decade. The technology of running shoes and other gear has advanced too, which has further sparked the interest in the general population. It has even spawned the newest trend of “minimalist” or “barefoot” shoes. However, as we continue to exercise, and as newcomers enter the sport, there are many injuries that limit our running, stop us from running, and even make some of us quit running entirely. These injuries are largely preventable. If one understands the factors leading to injury, and can comprehend the methods of both preventing injury and improving our running performance, then we can continue to enjoy this wonderful sport and improve our health. Presented here are the most common running related injuries, the factors leading to injury, and ways of improving our running.

The most common running injuries are briefly reviewed here. Achilles tendonitis is an inflammation of the Achilles tendon. Factors leading to this condition include a tight achilles tendon and/or calf, and an overpronated foot with running. Stiff and/or poorly fitting shoes may also increase the chances of getting this injury. Runner’s knee is a general term describing pain in the front of the knee at the kneecap, and is due a number of different conditions, all leading to pain while the kneecap is tracking or gliding on the femur. A medical term that basically fits this is patellofemoral pain syndrome. While many medical professionals continue to argue as to which is the primary factor leading to this, various reasons may include weak quadriceps, tight hamstrings or calves, increased Q angle, or overpronated foot. When running, if one does too many hills, too much mileage, running on hard and/or tilted ground, they may develop this pain. If it continues, the cartilage lining the knee may soften, weaken, thin out, and possibly crack, leading to chondromalacia. Iliotibial band syndrome is an inflammation at the lateral knee where the iliotibial band rubs against the femur. If one has “O” shaped legs (bowlegs), tight leg muscles, weak abductor muscles, or do too much hill training and/or running on tilted ground, they may have this condition. Plantar fasciitis manifests as pain in the plantar foot, and results from increased tension on the plantar fascia and its connection to the calcaneus (heel bone). If the arch of the foot is too low, or too high, one can develop tension in the foot with running. If your foot is overpronating, or if your achilles tendon is too tight, or if you shoes are too tight or stiff, you may get plantar fasciitis. The next condition, shin splints, is a very complex topic on which entire books have been written about it alone. The best way to explain this is that there is an overuse stress on the muscles that connect to the shin, resulting in inflammation, and it can actually pull on the lining of the bone (periosteum), leading to further inflammation. There are two locations for this, anteriorly at the tibialis anterior, and medially at the tibialis posterior. Running with fatigued muscles, overstriding or trying to exercise when you are already tired, running on hard ground, or overpronating, may result in this pain. The medial pain is the most well known version of this, and is aptly named medial tibial stress syndrome. Stress fractures are another overuse stress injury, which is occurring in the bone itself. Your bone is naturally breaking down and rebuilding whenever you are running, however if the balance shifts and you break down bone faster than you can remodel new bone, you may have this condition. Common areas to have this are the tibia, fibula, and navicular bone. Lastly, chafing isn’t so much an injury as it is an irritation, figuratively and literally. It occurs when skin rubs on skin (in the thighs), or when skin rubs on fabric (nipples and groin). If you are overweight, have skin folds, or too much moisture, you may get this irritating and painful condition.

What do all these conditions have in common? Simply put, training errors. Inconsistency (where one doesn’t train all week, and suddenly does all their week’s worth of training in one day) leads to injury. Building mileage too rapidly, or not following the classic “10% rule” (don’t increase your daily or weekly distance by more than 10%) will lead to injury. Not doing the traditional “hard & easy” running concept (do an easy workout following a hard one, don’t do two hard workouts in a row) further increases your chances of getting an injury. Finally, simply not listening to your body when it hurts isn’t a good idea. Your body is telling you it needs rest. Other factors include doing too heavy a total training load, using running shoes that aren’t appropriate for your foot and running style, going out in poor weather and/or training conditions, not stretching enough (if you are naturally tight), and having weak muscles (by not doing enough strength training).

There are a few important things that you must do to improve your running. High quality running shoes, stretching, strength training, cross-training, utilizing recovery techniques, sports nutrition, and hydration are key areas to work on. Start with high-quality running shoes. Try on shoes later in the day when your feet have swelled to their maximum size. You should have a half-inch between the front of the shoe and your longest toe. Bring the socks you normally run in. Do not base your decision to buy new shoes by observing how much tread remains on your current ones (the mid-sole of many running shoes break down between 250-500 miles of use, where more than 60% shock absorption is lost). Buy new shoes for the marathon approximately 4 to 6 weeks prior, in the same model for your long runs, and break the new pair, at least 60-70 miles, including one long run prior to your race. Stretching has many benefits. It improves mechanics and efficiency, however it hasn’t been shown to reduce injury. Basically, I recommend doing more stretching, if you are naturally tight. Stretching before vs. after the run is a common question. Too much stretching before can actually weaken the muscles during your running. It may be better to jog / walk for 5 minutes to warm the muscle before running, and it seems more effective to stretch after your workout. Strength training is very important. Strong arms maintain running form late in a marathon/long run, and improve your arm drive (after all, your legs won’t move any faster than your arms can swing). Running creates an imbalance; your hamstrings and calf develop at a faster rate than the quadriceps and shin muscles. Therefore having strong quads will improve your running efficiency, running uphill, and running at a fast pace downhill. And finally a strong core improves torso stability when fatigued. Cross-training consists of non-running activities that supplement your running. It should not increase your level of fatigue however, which might possibly lead to injury. These may include biking, swimming, strength training, using various gym machines, or going to gym classes.

In terms of the actual running, make sure you include varying distances and speeds. Long runs should be slower than your goal marathon pace. The distance varies from 10-22 miles. Short runs are at a comfortable pace, faster than long run but slower than goal pace, with a distance from 3-10 miles. Fartlek runs are at or above your goal race pace, in cycles (for example run 4min followed by 1min jog/walk) and vary from 3-5 miles. Interval runs are shorter distances than fartlek, at or above race pace, with 2-3 min slow jog (for example, 800 m fast / 400 m slow, 4-8x). Hill climbs are similar to intervals, with a distance of 3-6 miles. Find a 400 m hill, or use a treadmill. It is useful even if your marathon race doesn’t have hills. One may typically do one short run, one long run, one interval run in their weekly regimen, make sure you include strength training once or twice a week, and finally include a rest day in your weekly program. After long runs, utilize recovery techniques. Don’t stop immediately after your run and rest; take a short walk after long run to cool down. Upon returning home, don’t immediately rest and lay down; ice your legs or take an ice bath. After you do this, then you may rest. The following day, if you feel pain, you can try massage therapy, sauna, or whirlpool. If you are doing cool weather running, you are less likely to get chilled if you run into the wind when you start running and run with the wind at the finish. Check your stride; while a longer stride may be more efficient, too much of one increases impact forces (a shorter stride is less efficient however has less impact forces). Aim to peak your distances 3 to 4 weeks prior to marathon, and then taper. Avoid runs more than 10-12 miles, to allow for recovery from training. Rest, ice, compress, elevate, or RICE; if you feel any pain anywhere, first try this. It really works!

By doing these techniques, your power and stamina will improve. On a scientific level, you will improve your lactate threshold and possibly your VO2 max. These concepts relate to the maximum capacity of an individual’s body to transport and use oxygen during exercise. There are a few other things besides running you can do to increase this. Increase lung capacity (make more room in your lungs by doing yoga to expand chest area). Make your heart stronger (add intensity to your weekly training with intervals, fartlek, hills). Stay hydrated to increase blood volume during exercise, which will increase stroke volume. Increase oxygen in your blood. Consider high altitude conditions, increase your iron intake, possibly ferritin. Increase omega 3 and anti-oxidant intake to improve heart condition, stroke volume and cardiac output.

Your goal should be get to the starting line injury free: once you make it there, you can feel confident that you should reach the finish line happy. Train hard, but train smart, and good luck!