I also think there is a fifth R – Rest. We will look at this in the context of overtraining later in this chapter.
The human body is extremely efficient and clever, but it’s not perfect. Although participating in sport is important for good health, sport itself is not always beneficial for our bodies. Indeed, rates of injury are usually high in athletes. Whether it is a twisted joint, a pulled muscle/ligament or something more serious, training puts a huge strain on the body and, inevitably, can lead to overuse and injury.
Nutrition is a continually evolving science, with new studies and research being published on a daily basis. An area that is of real interest to researchers is how nutrition can impact on injury prevention and how it can improve recovery rates from injury. As with all studies, there are mixed results and, although further research is required, overall there do seem to be some key nutritional strategies that may be beneficial.
In this chapter we will look at some common issues associated with triathlon, the stresses they can potentially cause your body and how nutrition can help to restore balance.
Training is a time-consuming business. Whether you are an elite athlete who needs to commit to double days of training or a recreational athlete who is trying to fit a lunchtime run around work and family commitments, it is inevitable that sometimes you might take shortcuts. Some examples are:
>>> Not warming up or cooling down sufficiently before training, which can lead to poor technique. For example, by not engaging your glutes, a key muscle in triathlon performance, you will be more dependent on your hamstrings and this may ultimately cause an overuse injury
>>> Being disorganized and so having poor nutritional options available either side of your training
These shortcuts may leave your body feeling unbalanced and vulnerable. You may also choose to ignore early symptoms, which can potentially become something more serious further down the line. These symptoms might include:
>>> Pain
>>> Fatigue
>>> Poor sleep patterns
>>> Dizziness
>>> Shortness of breath
>>> Skipping menstruation
>>> A change in heart rate at rest, but also during running
In all these cases, addressing the issue early can help to prevent longer-term problems and, in most cases, the problem is usually quite easy to fix!
There are many things you can do to help prevent injury and many triathletes are familiar with the four Rs:
1 > Rehydrate – sweating causes a loss of water and electrolytes, so make sure you drink water before, during and after exercise to avoid dehydration.
2 > Replenish – stored carbohydrate (glycogen) is the primary fuel for muscles during exercise. It is important to consume carbohydrate after exercise to replace depleted stores, but be guided by the intensity of your training session (see Chapter 2).
3 > Repair – muscle is broken down during exercise so you need to eat high-quality protein after exercise to rebuild muscle tissue.
4 > Reinforce – during exercise your immune system becomes compromised as a result of cell damage and inflammation. To keep a strong immune system, you should refuel with nutritious, fresh foods.
You can see, then, that nutrition plays a huge part in injury prevention. It is also useful to help your body to stay in alignment by strengthening potential weak areas within it.
I also think there is a fifth R – Rest. We will look at this in the context of overtraining later in this chapter.
One way to help avoid injury is to organize your nutrition either side of your training so that you are meeting your requirements. Hopefully by now, having read through this book so far, you will have a good understanding of how to do that, but there are some further nutritional strategies you may find useful. An area of huge interest and research is how specific nutrients, such as those in beetroot or tart cherries (see page 102), have a role to play in recovery, helping to return the body to an optimal state prior to the next training session.
A common phenomenon in athletes is DOMS, or delayed onset muscle soreness, especially in those who have taken on a new form of training, such as adding strength to weekly training in the three disciplines, or those who have trained or competed particularly hard. The soreness is most commonly felt 24–72 hours after the exercise. This is the result of micro-trauma, which is mechanical damage at a very small scale to the exercised muscles, leading to inflammation and oxidative stress. Oxidative stress is the term used to describe free-radical damage to proteins, membranes and genes. Studies have shown that although exercise is good for us, it does also increase the levels of free radicals in our body.
Usually if you repeat a certain exercise pattern sufficiently, your body will get used to it and the soreness will stop. However, we also know that to improve performance, muscles need to be ‘overloaded’ continually and so DOMS is a training inevitability from time to time.
There has been a lot of research into ways in which we can reduce inflammation and oxidative stress on the body, with the best findings coming from the use of powerful antioxidants. Some examples include:
>>> Curcumin – found in cumin
>>> Isoflavanoids – found in soya beans
>>> Vitamin C
With the most evidence stacking up in the use of:
>>> Polyphenols – most of the data has come from studies using tart cherry juice, which did seem to show a significant reduction in inflammatory markers in endurance athletes after strenuous sessions; I recommend tart cherry juice/ capsules or shots after all high-intensity training or races as a way to reduce oxidative stress on the body. You can buy these at health food stores or online.
As is always the case when it comes to research, we need further studies to help us decide on dosages and timings for optimal benefits. Triathletes can also benefit from increasing their intake of food-derived antioxidants – quite simply, you can eat more fruit, vegetables, herbs and spices (see the Nepalese Chicken recipe on page 161 for one of many spicy recipes).
The most important thing to remember when you are injured is that you need to rest. Depending on the severity of your injury, you may need as little as a few days to over 6 months. Being injured is very frustrating, especially when training has been going well. However, it is also a good time to reflect and work out how you can reduce your risk of the same injury occuring again:
>>> Did you ignore signs of pain and so keep going when you should have rested?
>>> Did you fuel and recover appropriately after each training session?
>>> Did you take sufficient rest between your training sessions?
Nutrition can also be instrumental in your recovery and return to exercise. A lot of athletes understandably worry about weight gain when they become injured. Research has demonstrated that decreasing your overall energy intake, but increasing your protein intake (to as high as 2.3g/kg BW daily) is a useful way to recover without gaining weight.
Protein has a high satiety factor, so it helps you to feel full while limiting your overall energy intake. Additionally, protein has demonstrated a role in repair of the damaged area. With bone injuries, such as a stress fracture, supplementing with vitamin D (see page 107) has been shown to be effective; and new research emerging is also looking at the role of vitamin C and collagen as supplements.
When you are training hard, you are bound to feel some residual fatigue. However, if tiredness does not disappear after a few days’ rest, it is important to take note and consider what else could be contributing. Ask yourself:
>>> Have I increased or changed my training significantly recently?
>>> Am I taking enough rest or active recovery time between hard or long sessions?
>>> Am I recovering appropriately nutritionally?
>>> Am I hydrated?
>>> Am I eating enough before I train?
>>> Is it possible I am coming down with a virus or other illness?
If your answers to these questions don’t seem to reveal what might be contributing to your fatigue, consider whether there are other medical or nutritional reasons that could be at the root. We have already seen that a vitamin-D deficiency is linked to chronic fatigue and poor muscle recovery. Similarly deficiencies in other micro-nutrients can pose problems.
Don’t imagine that the prefix ‘micro’ means these nutrients have only small effects and are therefore less significant for your wellbeing than macronutrients. Micro means that we need to consume them in ‘micro’ amounts, but they are no less essential to good health. Examples are:
>>> Vitamins – A, B, C, D, E and K
>>> Minerals – calcium, iron and phosphorus
>>> Electrolytes – sodium and potassium
>>> Trace elements – iodine, zinc and magnesium
Micronutrients are essential for many metabolic processes within the body, and although we can manufacture a few of them within the body, most have to come from the diet. Most function as co-enzymes or co-factors within the body – that is, they aid enzymes and proteins in their function. For example, the B-vitamins are very important for carbohydrate and fat metabolism, while vitamin C, along with zinc, is important for a healthy immune system; you need magnesium and calcium for good muscle contraction. Each and every micronutrient has a significant part to play in your training success.
This begs the question, do you need to supplement your intake to make sure you meet your requirements? The bottom line is that if you eat a wellbalanced diet that includes whole grains, vegetables, meat, fish and dairy you will have no problem in getting everything you need.
And, do athletes have higher requirements of micronutrients? The jury is out on this one. Some studies show that there are enhanced requirements in athletes as a result of an increase in free-radical damage in frequently trained muscles. However, no study has shown an absolute link between improved sporting performance and a diet high in antioxidants. Overall, though, if you are a very physically active person (such as an athlete), you will naturally be taking in more food, because you need the fuel. As long as this fuel is well-balanced and nutrient-rich and not made up of empty calories, you will naturally meet your increased antioxidant requirements without needing to resort to supplements.
That said, in some individuals, exercise, particularly at increased volumes and intensities, leads to elevated requirements of iron (see below) and a deficiency in important micronutrients such as vitamin D. This is linked to chronic fatigue and poor muscle recovery.
IRON
Your body needs iron to make haemoglobin, which is the protein that transfers oxygen around the body. If iron levels become low, either because your diet is providing too little or because you are losing iron excessively, you may develop iron-deficiency anaemia.
An inadequate intake of iron is possible if you are following a restricted diet for weight loss, or because you are a vegan or vegetarian (see page 36); excessive losses can happen during menstruation in female athletes, but have also been linked to an increased breakdown in red blood cells in some athletes, particularly those where running is involved.
Why is iron deficiency such a big deal? It becomes an issue because if there is not enough iron in the body, the body struggles to make haemoglobin, which in turn means that lower levels of oxygen can be transported around the body. This will not only make you feel pretty lousy, but also have an impact on your overall performance. Common symptoms of iron deficiency include:
>>> Feeling tired all the time
>>> Being short of breath, even just going up the stairs
>>> Poor performance in training
>>> Dizziness
>>> Looking pale
>>> Loss of appetite
>>> Bluish tinted dark circles around the eyes
>>> Increased prevalence of infections
If you have any of these symptoms, talk them through with your GP, who can do a simple blood test to check your iron levels. It is important that your doctor checks both haemoglobin (HB) levels in the blood and ferritin levels in the stores. In runners, HB levels should be 12ng/ml or above and ferritin levels should ideally be 30ng/ml or above.
Make sure that you get an adequate intake of iron from your diet. Red meat is the best source of iron and I always encourage athletes to aim for one portion of lean red meat a week. For vegetarians and vegans, the main tip to remember is to combine vitamin C with plant-based iron-rich foods as vitamin C helps your body to absorb iron. Iron-rich plant foods include:
>>> Dark leafy vegetables, such as spinach, kale and broccoli
>>> Lentils and other pulses
Vegetarians can also eat egg yolks for a source of iron.
Don’t drink tea with your iron-rich foods, or within 30 minutes of eating them, as the phytates in black tea block iron absorption.
VITAMIN D
Vitamin D is a fat-soluble vitamin that functions as a hormone. Its structure is similar to steroid hormones, such as oestrogen and testosterone. There has been a lot of interest in vitamin D over the last few years. It has always been known for its role in preserving bone health, but it has now also been linked to many other aspects of health, including optimal muscle function.
We make vitamin D in our bodies from sunlight. However, those who live in countries where sunlight might be limited, those who spend little time outdoors, those who cover up with high-factor sunscreen and those who are darker-skinned may actually be at risk of a vitamin-D deficiency. A vitamin-D deficiency can lead to several health issues such as:
>>> Chronic fatigue
>>> Depression
>>> Increased risk of bone injury
>>> Chronic musculoskeletal pain
>>> Viral respiratory tract infections
There also seems to be emerging strong evidence that supplementing an athlete who has sub-optimal levels of vitamin D has real benefits for performance, particularly in strength, power, reaction time, and balance.
There is no universally accepted definition for vitamin-D deficiency, but practitioners use the following guidelines for analyzing blood levels of vitamin D:
>>> Blood levels below 50nmol/l – vitamin-D deficiency
>>> Blood levels below 75nmol/l – insufficient levels of vitamin D
>>> Blood levels between 75 and 120nmol/l – ideal levels of vitamin D
Vitamin-D supplements are readily available, but always make sure that you buy your supplements from a reputable source.
Although you will not be able to meet your requirements through food alone, there are small amounts of vitamin D in certain foods:
>>> Oily fish
>>> Egg yolks
>>> Fortified foods such as milk, margarine and cereals
We know that good nutrition and regular exercise are essential components of a healthy lifestyle. However, what about when we lose sight of why we started training in the first place? Perhaps it was to drop a few kilos or improve cardiovascular health, or maybe it was a bet that you definitely were not going to lose face over? Regardless of why you started, the fact that you have continued means that you gained something from it: a sense of achievement, a better body composition, or maybe more energy. However, perhaps turning up for the weekly triathlon club swim or taking your place at a sprint or Olympic distance triathlon a few times a year just doesn’t feel like enough of a challenge. So you set your sights on something new – getting faster, going further, competing in more extreme places. But what does this mean for your body?
In recent years I have had many an athlete, both recreational and elite, walk into my clinic and tell me that they’ve just lost their ‘mojo’. They keep going out to train but motivation is poor, energy levels are low and if they try to attack a speed session, the engine, the power that was always present, has just disappeared. They come looking for a magic potion, but what they get instead is a prescription for rest and recovery, and ideas on how to boost their immune system.
We seem to be living in a society where no matter what you succeed in, it is never good enough; there is always more you can achieve. We seem to be losing sight of what is actually humanly possible. With the increase in popularity of ultra-endurance events such as Ironman and the rise in the number of events you can take part in all over the world, over a range of distances, we are spoilt for choice. However, this also means we seem to have lost the ability to pace ourselves. I’m lucky enough that I get to work with elite athletes and, in most cases, they choose one or two races a year – these are the ones they focus on. Anything else will be seen as training. Now let’s compare this with the recreational athlete. No longer is training for one event a year enough; some individuals are doing them back to back. It never fails to surprise me, when working with someone new, what they have previously completed and what they plan to do next. A typical example is:
>>> End of Feb – 100-mile bike sportive
>>> 2 weeks later – marathon
>>> 3 weeks later – 70.3 Half Ironman
>>> 2 weeks later – Ironman
What surprises me the most, though, is the lack of recovery after each race. It’s bad enough that the races are so close together, but many competitors take only one day off before returning to normal training. The elite athletes I work with generally take a minimum of between one and two weeks off post-race and then build back slowly so as not to over-reach the body.
So what does happen when we think the body is invincible and we cause it to over-reach? And how can we overcome this? Over-reaching can have a huge impact on your immune system and it is often this that leads to the loss of your ‘mojo’. In order to prevent your body from reaching this point, there are several things I recommend.
Always make sure you tailor your nutrition to your training. If you are going to increase your intensity, distance or number of races, you also need to adjust your intake of carbohydrate and protein so that your body has sufficient fuel to train and recover. I have seen many athletes who cut back on carbs significantly at the same time as they increase their training; they report feeling amazing to start with – and then 6–12 months down the line, their bodies fight back. Carbohydrate, although feared by many, is an essential nutrient for the exercising body. Whilst you should be mindful of portion sizes and the types of carb you’re eating, I never advocate a completely ketogenic diet.
Although I always prefer individuals to get their nutrition from their diets, there are a few nutrients that can be difficult to obtain. Both vitamin D (see page 107) and probiotics have a really important function to play in immune health. I recommend a high-dose supplement of vitamin D and probiotic to all my athletes, especially through the winter months.
Hydration is also key for immune function. Saliva is our first line of defence, as it contains IgA. If we are dehydrated, we produce less saliva and in turn this can make us more susceptible to infections and illness.
If you start to notice that you are lacking energy during training and at rest, it is always worth asking your GP to take some blood tests. I usually recommend an athlete is tested for blood levels of iron and ferritin, vitamin D, CRP and thyroid function, as these can indicate if the body is under stress.
The relationship between sleep and sports performance is a huge area of research. What we know already is that it is necessary to have enough good-quality sleep for training recovery and for immune health. Many individuals I have worked with complain about poor sleep and then admit that the last thing they do before they go to bed is check their phone! Increasingly, we are being told how the blue light in phones can disrupt sleep. Switch off your phone at least half an hour before you go to bed – try reading or listening to music instead! Also, be aware that training late in the evening can affect your ability to sleep.
I’m a big believer in monitoring well-being and performance, and I regularly get athletes to keep a log of the following:
>>> Resting heart rate (although get nocturnal HR data if you can – it’s more accurate as there is less room for error with more control over the environment and external factors; less deviation owing to changes in temperature, noise, activity and light)
>>> Sleep quantity and quality
>>> Motivation to train
>>> Energy levels
These measures tell us a lot about how we are feeling. Most sports watches have the ability to monitor heart rate, at rest, during exercise and at night. HR data informs us about what is going on in the body. A resting (nocturnal) HR reading elevated by even just 10 percent from basal levels could indicate illness, fatigue and not sufficient recovery. Take a rest day and ideally wait until HR levels return to normal before training at a high intensity again. Low motivation to train could indicate that you are tired.
As triathletes we often push ourselves to improve our performance and meet specific goals. This is not a problem as long as you listen to your body, rest when you need to and fuel appropriately. However, sometimes things can get out of balance; we choose not to rest or recover adequately, which can present itself in many ways, but always ends with poor performance outcomes.
Over-training syndrome, or OTS, can best be defined as the state in which training has repeatedly stressed an athlete’s body to the point at which rest is no longer adequate to allow for recovery. It is the name given to a collection of emotional, behavioural and physical symptoms that occur as a result of over-training and have persisted for weeks to months. This is different from the day-to-day variation in performance and post-exercise tiredness that is common in conditioned athletes. Over-training is marked by cumulative exhaustion that persists even after recovery periods and often precedes over-reaching symptoms.
It’s not always easy to identify OTS: although the list of symptoms below can guide you, you may not exhibit them all. That said, there are several ways in which you can objectively measure it. One such method includes documenting your heart rate at specific training intensities and speeds over a period of time. If your pace at a given intensity starts to slow, but your heart rate is increased or your resting heart rate increases, or the perceived effort of doing an easy session is consistently higher than it should be, you may be heading into over-reaching. If you ignore the signs of over-reaching, eventually you’ll develop full-blown OTS. Some signs and symptoms are:
>>> Lack of energy
>>> Mild leg soreness, general aches and pains
>>> Pain in muscles and joints
>>> Sudden drop in performance
>>> Insomnia
>>> Headaches
>>> Decrease in immunity, leading to more colds and sore throats
>>> Decrease in training capacity/intensity
>>> Moodiness and irritability
>>> Depression/low mood
>>> Lack of motivation to train
>>> Decreased appetite
>>> Increased incidence of injuries
>>> A compulsive need to exercise
>>> An increase in resting heart rate by 10 percent or more
Research into OTS shows that getting adequate rest is the most important thing to overcoming it. Total recovery can take several months, or even years; and some athletes may never fully recover their original athletic form.
Identifying and acting on over-reaching symptoms has a much more positive outcome. Encouraging rest and recovery, reducing stress (both physical and emotional), adopting a nutritious diet of complex carbohydrates, lean protein, and fruits and vegetables, and staying hydrated, will help a runner return to physical form. Try the delicious smoothies and salads in the recipe section to help boost your immune system and provide your body with a nutrient-dense diet.
Take your pulse each morning before getting out of bed. If there is a marked increase, 10 beats per minute higher than normal, this may indicate that you aren’t fully recovered and should take an extra day or more to recover. The amount of time you need to recover will depend on the length of time you have been over-training.
Sometimes training and nutrition can become imbalanced. OTS is one example of how the body responds to this imbalance, but there are other potential problems that can occur if good nutrition and good rest do not make up an integral part of your training programme.
When we are training hard, sometimes it is difficult to detect if we are getting sufficient amounts of energy to meet our day-to-day needs, as well as our increased exercise demands. In general terms if you listen to your body, and fuel as required for your chosen activity and intensity, you can maintain your body’s equilibrium. However, in some cases, the energy demands of training can be a challenge to meet. For some this will result in weight loss (which may or may not be wanted and which needs to be addressed accordingly). Sometimes, it is not so clear-cut. There are occasions when weight stays stable, but available energy is low; energy intake is not sufficient to meet daily requirements, whether this is owing to a conscious decision to restrict nutritional intake (disequilibrium is sometimes because of an eating disorder) or simply an inability to meet the demands of training. When energy availability is low the body preserves energy by deeming the reproductive system as not essential, therefore lowering the level of sex hormones in the body. This is easy to detect in females as it usually represents itself as a missed period; it is much harder to detect in males. In both genders this situation needs urgent addressing.
Vitamin D and calcium are important for bone health. However, low energy availability can also lead to significant decreases in bone density and overall bone health. In the female athlete, missing three periods consecutively can have potentially negative effects on bone health.
Similarly, body-fat levels that are too low also have a negative effect on bone density. In female athletes, dropping to a body fat of 12 percent or below will once again suppress sex hormones and cause menstruation to cease. In male athletes, a level of 6 percent or below will have a negative effect on bone health, in particular bone density. DEXA scans can be used to measure bone density. A low level is used to diagnose osteoporosis, which is a potentially serious condition that compromises bone strength and may predispose someone to an increased risk of fractures.
By restoring energy availability, it is possible to reverse the effects on bone health in the following ways. Adequate energy availability promotes bone health:
>>> Directly by stimulating the production of hormones that promote bone formation
>>> Indirectly by preserving menstruation and oestrogen production that stems bone resorption
Another variable to consider is a low carbohydrate intake; with the rise in ultra-distance events, more and more individuals are turning to a ketogenic diet – a very low carbohydrate diet where intakes of carbohydrate are no more than 50g a day. As discussed previously, the theory is that in a carbohydrate-depleted state, the body has to use fat as its chosen fuel for all demands, including exercise. This then regulates the use of fat as fuel, potentially making you a more efficient athlete in long-distance events such as Half to Full Ironman. However, as yet, there are no studies looking at the long-term effects on health of such extreme diets. My own observations in clinic tell me that this is not a sustainable practice and while it may be useful to a degree, athletes should be cautious. The ketogenic diet is certainly not something I would advocate any athlete follows for long periods of time. Instead, I prefer to encourage a periodized approach, including carbohydrates around high-intensity training. In fact, we know that low carbohydrate diets will affect oestrogen production and this is another reason female athletes, even if they are normal weight and body fat, may still not menstruate.
Many runners also avoid carbohydrate in an attempt to lose weight. This has become a very common practice as a result of claims in the media from celebrity/health and fitness bloggers, many of whom don’t have nutritional qualifications or any scientific understanding of the role of carbohydrate in the body. The only way to lose weight is to take in less energy than you utilize. However, even that requires treading a fine line: increasing the difference between energy in and energy out too much can cause the body to preserve energy reserves and hamper weight loss. Carbohydrates get a bad press as it is so easy to over-consume the wrong types of carbohydrate – think back again to the example of jelly babies versus potatoes (see page 17). If you are a triathlete who wants to lose weight, you do not need to cut out carbohydrates, you just need to reduce them and tailor them to your training.
As mentioned, it is difficult to detect problems in male athletes, but some symptoms to look for in both genders that demonstrate low body-fat levels or poor energy availability include:
>>> Feeling extremes in temperature (hot and cold), owing to low body-fat levels and being unable to regulate heat
>>> Feeling dizzy or disorientated because of low blood glucose
>>> Poor/low libido
>>> Poor concentration
>>> Poor sleep patterns
>>> Recurrent stress fractures
>>> Irritability
>>> Poor recovery between sessions and reduced performance
>>> Withdrawal from social circle and situations
In most cases we can restore equilibrium simply by addressing energy needs and encouraging a minimum of 30Kcals/kg BW of fat-free mass and sufficient carbohydrate. I always encourage individuals who have had an episode of low energy to increase their intake of calcium to 1,600mg a day, which is four servings of dairy, and also take a high-dose vitamin-D supplement (see page 107) to aid the recovery process.
However, sometimes things are not quite this simple. If the individual has developed irregular eating patterns or is suffering from an eating disorder, it can take months to restore equilibrium and involves a multidisciplinary team approach with a registered dietitian/nutritionist, psychologist, coach (if there is one available), and a GP or other doctor.
The menstrual cycle can have a real influence on a female athlete’s energy levels and energy intake. During the follicular phase, day 1 to about day 13, where day 1 is the first day of your period, oestrogen levels are rising and peak just before ovulation (in a 28-day cycle around days 14/15), while progesterone levels are low. During the luteal phase, roughly days 16–28, oestrogen levels decrease, falling to the lowest levels just before your period starts; progesterone is at its highest point midway through this luteal phase. These hormones control what type of fuel you utilize.
It has been well documented that when oestrogen levels are high, that is just before you ovulate, women use a higher percentage of fat for energy. As oestrogen levels drop and progesterone levels rise, our bodies become more dependent on carbohydrate for fuel, which explains the sugar cravings most women experience just before their period. Additionally, high progesterone levels are linked to an increase in protein catabolism, the breakdown of proteins.
These hormone changes also influence temperature change within the body – most women find that a reduction in oestrogen and increase in progesterone during the luteal phase causes a rise in temperature. How many of you that are not near post-menopausal age have woken up with night sweats and wondered what this is about? Now you know! This increase in temperature is also linked to a small increase in overall energy expenditure, which helps to explain the increased hunger and appetite we also tend to feel during this time.
From a nutritional point of view, I suggest that in the 7–10 days prior to your period, so during the luteal phase of your menstrual cycle, you make small dietary changes. Aim to include small frequent snacks of both complex carbohydrate and protein every 2–3 hours to prevent blood-sugar fluctuations. Some good examples include:
>>> Fat-free Greek yogurt with fruit and honey
>>> Hot chocolate made with milk (see Recovery Hot Chocolate, page 197)
>>> Wholegrain toast with Nut Butter (see page 132)
>>> Eggs on toast
>>> Dried fruit and nuts
>>> Oatcakes with cheese
As we have already seen, the levels of hormones during your menstrual cycle can influence the types of fuel you will use for energy. This has a significant impact during ultra-distance events. During such events your body will ultimately run out of glycogen and thus readily available glucose stores within a couple of hours; it will look for other means to provide energy for the working muscles. This could be via fuel you take on during your event – or gluconeogenesis is a further potential pathway for this. Gluconeogenesis is a method by which the body breaks down non-carbohydrate sources of fuel into glucose. The most common of these sources within the body will be fatty acids from fat stores and amino acids from muscle.
However, at certain points of your menstrual cycle – namely just after ovulation and at the start of the luteal phase (that is, when both oestrogen and progesterone levels are equal) – gluconeogenesis is suppressed. This means that in order to continue to meet your fuel requirements for the duration of your ultradistance event, you will need to take on sufficient amounts of carbohydrate; 90g of carbohydrate per hour has been quoted as the optimal amount needed.
A very common and unpleasant side effect most runners will experience at some stage is the phenomenon often known as ‘runners trots’, that is an urgent need to defecate. There are a number of reasons why this can occur:
1 > Leaving little time between eating and training; when you start training, in particular running, the body directs blood flow to the working muscles, and away from the digestive system. This combined with the actual physical movement of running causes the contents of the stomach to be thrown up and down, thus leading to that all-too-familiar immediate need to go to the toilet!
2 > Similarly, in longer endurance events, when you are most likely to be using sports gels and drinks, becoming dehydrated and/or taking on more energy than you need causes the contents of the stomach to become very concentrated and this in turn causes stomach issues.
3 > Caffeine is well known for causing an increase in speed of food through the digestive system. This can be advantageous as you can be sure that your digestive system is ‘empty’ prior to training or competing. Some energy gels and products contain caffeine and while this can have positive effects on your performance, if you are not used to using caffeine with your training, it may cause you some issues, so it best to always practise taking on caffeine in training.
4 > Too much fluid. Some triathletes panic about becoming dehydrated and so aim to take on fluid before and often during their run, even if it is short. Again drinking too much can cause an increase in speed of food through the gut, once again leading to stomach issues.
5 > Change in position; in longer events such as Half to Full Ironman, the change from sitting in a bent over position on the bike for several hours, to suddenly being upright and running can prove problematic. If the change from cycling to running causes you discomfort, I would advise testing different strategies for nutrition and hydration during BRICK sessions.
For most triathletes, addressing these issues can limit problems with having the ‘trots’ to the occasional bout. However, there is a small percentage of athletes who really struggle with stomach issues, no matter what they do. Even after reducing fluid, training in a fasted state and avoiding highfibre foods, they still have problems – in some cases, on every session. This obviously can become very distressing and also debilitating, preventing an individual from going out on training sessions because of concerns about getting caught short.
In these cases, something that has been useful to a lot of the athletes I have worked with is following a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet. FODMAPs are shortchain carbohydrates and polyols found in the foods we eat. In some people, the FODMAP molecules are poorly absorbed in the small intestine of the digestive tract, which means they continue their journey along the digestive tract, arriving at the large intestine, where they act as a food source to the bacteria that live there. The bacteria then digest/ferment these FODMAPs and can cause symptoms of irritable bowel syndrome (IBS), including abdominal bloating and distension, excess wind (flatulence), abdominal pain, nausea, changes in bowel habits (diarrhoea, constipation, or a combination of both), and other gastro-intestinal symptoms.
I recommend that you embark on a low FODMAP diet only under the supervision of a fully trained dietitian. It is not a long-term strategy, lasting for a period of only 4–6 weeks, by which time – if FODMAPs are the cause of your symptoms – your symptoms will be significantly improved. If symptoms have not improved, then it is unlikely that FODMAPs are the trigger.
If they do improve, you will enter a re-introduction phase, to help you work out which specific FODMAP food (or foods) is the culprit for your symptoms – sometimes there may be more than one. Often the results are surprising – I have had many runners who have been on a FODMAP diet, convinced that it is gluten or dairy causing their gastro-intestinal symptoms, only to find that it is actually onion and sweetcorn!
It is worth noting here that once again the hormonal affects of the menstrual cycle can have a huge influence on stomach issues. Most women will find that they are most likely to have problems around ovulation and then immediately before their period is due.