THE CLINIC

Alternatives to Performance Gels

I have run five marathons with a personal record of 4:15. During my long training runs, I would like to use some form of carb replacement. Yet I find the mere thought of eating something sweet, like a power bar, nauseating. I’ve tried everything, including sports drinks, sports bars, gels, and candy. Any suggestions?

Carry Foiste
Oregon City, OR

You are not alone with this problem and my hunch is that it has something to do with the change in your body chemistry during endurance exercise that creates an aversion to food in general, or specifically to sweets.

As you know, carbohydrate replacement improves the average time to fatigue during endurance exercise.

Research has shown that taking carbs before exercise helps, but having some during exercise is at least as important. However, you don’t need specific sports products to accomplish this. Use what works for you. Choose foods that provide a lower glycemic index prior to exercise (such as a whole-wheat bagel or oatmeal and skim milk). Low glycemic foods make your blood sugar rise more slowly than sugar, and as a result, they tend to be less sweet.

During exercise, choose foods that are higher in the glycemic index, but still, not too sweet. Some suggestions include crackers (saltines or grahams), bananas, potatoes, or white bread. The key with these dry foods is that you will also need to take in plenty of water during your workout, but it does not need to be a carbohydrate beverage. Choosing salty snacks will be an advantage for you since you are a
four-hour marathoner and you will need to replace sodium.

You may also find that salty foods will be more palatable. Try taking your carbs after the first 60 to 90 minutes, then every 30 minutes or so. Consume about 0.5 grams per pound of body weight every hour.
If you weigh 130 pounds, that is about 65 grams per hour or about 30 every half-hour.

To increase the palatability of sports drinks you might try freezing a bottle (remove a little before you freeze it, since it will expand) and carry it in a waist pack. By the time you drink it, it will be partially thawed, very cold and slushy, and you may find it easier to take.

You can also experiment with homemade drinks. Dilute fruit juice, one for one, and add one teaspoon of salt or light salt (for the electrolytes). Or try one tablespoon of sugar, a pinch of salt, one tablespoon of orange or lemon juice, and 7.5 ounces of ice water. That’s from Nancy Clark’s New York City Marathon Cookbook, which is an excellentresource if you want more ideas and great recipes.

The key is to find what works for you. There is no hard and fast rule that you must use the commercial carbohydrate replacements. Plan ahead and try different foods and timing of food intake during your training runs. Have a high-carb meal two to three hours prior to the event (one hour if you can tolerate it), drink plenty of water before beginning and then begin your carbohydrate replacement about 20 minutes before you think your body will need it.

Sarah Harding Laidlaw, MS, RD
Littleton, CO

How Feet React to Warm Climates

I recently moved from Idaho to Nevada. I’m getting used to the change in climate; however, with the warmer weather in Las Vegas, I am finding my feet get hotter and wetter and sorer. It’s bound to get worse during the extreme heat of summer.

I run about 25 miles per week, with a weekly long run on a combination of road and fairly rocky trails with quite of bit of elevation gain and loss. Since moving, I have not changed shoe or sock brands and I haven’t made any drastic changes in my training. I am planning gradual increases in weekly mileage to prepare for a fall marathon. Any suggestions?

Dave Henley
Las Vegas, NV

Your feet will actually expand and get larger as you age. They often expand or swell even more while running in a warm environment. First, check the fit of your shoes—with the warm weather they may now be too small for your foot. Find a good running shoe store to have your feet properly measured and fitted.

Second, use an acrylic-based sock material (such as Cool Max, Drifit, etc.) that actually wicks away moisture and helps keep your feet dry. The socks you wear greatly affect the temperature regulation of your feet.

Pure cotton socks retain moisture and should NOT be worn when running. Also, alternate running shoes every day to allow your shoes to dry fully. If you pack wet running shoes with dry newspaper it will absorb moisture rapidly. You may even want to consider changing your running shoes and socks after an hour of running. Running early in the morning, when the temperatures are cooler and the sun is low, always helps.

If none of these tips keeps you dry enough, follow up with a sports-oriented physician who can prescribe a topical medication that reduces excessive perspiration (called hyperhydrosis).

Matt Werd, DPM
Lakeland, FL

Water Running for OA

I am 49 years old and have been running, biking, and swimming for the past two years, training for and participating in triathlons, and I really love it. Recently, my doctor has diagnosed osteoarthritis in my right hip and advised me to stop running. He said that continuing to run would make my problem worse and lead to hip replacement surgery. Is there any way around this? Do I really have to give up running and, therefore, competing in triathlons?

Kyle Campanelli
Easton, PA

This is a frequently asked, heartbreaking question. Most running injuries respond to correction of training errors, and rest and rehabilitation. However, degenerative osteoarthritis in weight-bearing joints is a different situation. Continuing to run with an arthritic hip will cause it to further deteriorate and speed the progression of the arthritis.

Ordinary walking loads the hip joint with three times your body weight at each step. Running increases that amount even more. It is fortunate that you already cross-train with cycling and swimming thanks to your triathlon training. These two activities will help you to preserve fitness and prevent increasing pain and disability.

Melvin M. Brothman, MD
Amherst, NY

Consider aqua-jogging to replace running on land for training. Aquajogging has been shown to have significant carryover to land running. While minimizing land running with aquajogging won’t eliminate the risk of progressive osteoarthiritis, it may help prolong your triathlon career.

Francis G. O’Connor, MD
Fairfax Station, VA

Easing Back Into Running After Injury

I’ve run numerous 10Ks without trouble but recently increased mileage in preparation for a half marathon. After the race I developed pain in my ankle. I rested for a couple of weeks without improvement and then saw my doctor who diagnosed a stress fracture. It’s been six weeks since the original injury, during which time I’ve cross-trained on the bike and in the pool. I’m ready (according to my doctor) to begin to run again but don’t quite know how to start without worry of hurting myself again. Any suggestions?

Kathrina Gillis
Oceanside, NY

Your objective is to exercise at a level that will not be painful to you either during activity or by the next morning. It might be that the appropriate schedule for you would be to run one mile at a relatively slow pace two or three days a week and gradually working up from there, as if you were a new runner. While you are gradually returning to your former running program, you can maintain fitness with cross-training. Make sure you don’t repeat your previous training error of adding mileage too aggressively.

Small increases in training stress with adequate recovery time scheduled in will allow you to progress to higher mileage without injury. Concentrate on stretching and range of motion exercises. You can set the stage for chronic injury if you are unable to regain your normal range of motion, especially dorsiflexion
of the ankle (raising the toes upwards).

Develop a habit of thorough stretching after a warm up and again after a cool-down. Maintaining flexibility becomes progressively more important for adult runners.

John W. Lamb, MD
Nashville, TN

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