Running a Marathon

You can do it!  It is true, ANYONE can run a marathon with the proper training and preparation.   This section will describe a basic strategy to help you run a strong 26.2 miles.

You need to read this section if you are preparing for your first marathon or if you have ever:

 

Eating and Drinking Before the Race

The marathon unofficially begins when you wake-up the morning of the race and start eating, drinking, and preparing for your run.  For starters, I recommend consuming your pre-race meal approximately 3 HOURS before the start of the race.  This may seem to be an inconvenience, especially given that most marathons begin before most of the general population would even think about waking up (especially on a weekend), however this is important.  First off, it allows for adequate time for digestion decreasing the risk of developing gastrointestinal problems during the race.  Additionally, after you consume food, especially carbohydrates, your body will release insulin.  This increase in insulin can do two things that will affect your performance: (1) Insulin inhibits growth hormone (GH) release.  Because GH improves your performance, you want to minimize the GH inhibition by insulin.  (2) Studies have shown that elevated levels of insulin before activities results in a faster rate of carbohydrate utilization.  Since carbohydrates are a critical component of the energy needed to complete a marathon, you do not want to use them up too quickly.  Typically it takes 2 to 3 hours after a meal for the insulin levels to return to normal, therefore I recommend eating a small carbohydrate meal about 3 hours before the start of the race. 

A good pre-race meal consists mainly of about 100 to 200 grams (400 to 800 kcal) of carbohydrates.  Fruits, whole-grain breads or bagels, and energy bars make great meals, although your ability to digest whatever you consume is the most important issue.  Individuals who have problems with digestion should probably consume a liquid meal, such as an energy drink and a gel pack.  My traditional morning meal before a marathon is a banana (average of 25 gm carbohydrates or 100 kcal) and a drink made with 4 scoops of Perpetuem mixed with 20 ounces of water (this contains approx 125 gm carbohydrate or 500 kcal).  Perpetuem is a high carbohydrate energy powder made by Hammer Nutrition.  Hammer Nutrition products are unique because they are VERY low in simple sugars and consist mostly of complex carbohydrates (maltodextrin) making them a more prolonged energy source that is easier to digest. 

As for fluids, the American College of Sports Medicine recommends drinking 400 to 600 ml (12 to 20 ounces) approximately 2 hours before exercise.  This offsets any deficit that accrued during the night's sleep.  An additional 200 to 300 ml (6 to 10 ounces) should be consumed between 10 and 20 minutes before the start of the event.  This allows for water to be entering the circulation as the race begins and improves the ability of the stomach to digest fluids (aka. gastric emptying); fluids leave the stomach faster when gastric volume is high compared to when the volume is low.

 

Prepare Yourself

The two most common skin problems affecting marathon runners are blisters and chafing.  Just about anyone who runs on a regular basis has experienced these problems, some more often than others.  The best product available to prevent these conditions is petroleum jelly or petrolatum (Vaseline, Aquaphor, or any generic brand).  Additionally, the proper clothing can prevent these conditions well; wicking material such as Coolmax wicks moisture off the skin as opposed to cotton which soaks up the sweat and then the wet material rubs against the skin. 

The most common locations for blisters are the sides of the heel, the sides or bottoms of the toes, and the arch of the foot.  "Hot Spots" are areas on your foot that become warm and painful during or after long runs and may or may not develop into blisters.  Knowing where you typically develop hot spots is helpful, but some people will develop blisters for the first time during the marathon.  This occurs because as you get farther into the marathon, your gait and stride change to adapt to the fatigue and stress in your leg muscles.  This change in your stride alters the stresses on your feet which can lead to blisters in areas that have not had blisters in the past.  Pre-lubing these hot spots with Vaseline will significantly decrease the incidence of blister formation.  Vaseline is not water-based, so the sweat will not wash it off.  It is an excellent lubricant that prevents socks or other clothing from repetitive rubbing against the skin which is what leads to blister formation.  Another blister prevention method is to pre-lube your heels, arches, and toes with a generous amount of Vaseline before putting on your socks.  Additionally, socks that are made with cool-max, nylon, spandex, and polyester (without any cotton) are much better at wicking moisture off the skin than cotton socks, and therefore decrease the incidence of blisters.

Chafing occurs, much like blisters, in areas where clothing (especially wet clothing) rubs against the skin.  Common chafing locations include the groin area, arm pits, and nipples.  Females generally have less nipple chafing than males because the sports bra does not repetitively rub the skin like a loose fitting running shirt does, however females do experience this problem.  Similar to blisters, chafing can be prevented by applying generous amounts of Vaseline to the groin, arm-pits, and nipples before beginning the race.  Some runners place band-aids or similar bandages over the nipples to protect them from chafing.  Wearing shirts made of cool-max, etc and nylon running shorts with liners made of these materials will reduce chafing as well.

 

Pace Yourself!!!

Bang!  The race begins and you feel good, really good.  Your feet feel light and your legs feel real fresh after your 2 to 3 week taper.  This is a HUGE set-up for taking off way too fast.  You start running significantly faster than your training pace, and after the first few miles you still feel really good, so you keep it up.  Then somewhere between miles 17 and 20 you have used up all the glycogen (energy) stored in your muscles and you now have nothing left.  You end up walking or very slowly jogging the remaining miles while hundreds of people pass you.  Many athletes who have done a few marathons know this experience (myself included on several occasions), it is not pleasant...  Keep in mind, A MARATHON IS MUCH LONGER THAN TWO HALF-MARATHONS.  If you try to run your half-marathon pace you will suffer later in the race.

So, how do you avoid this and become one of the runners doing the passing instead of being passed at miles 22 through 26?  The solution is to PACE YOURSELF.  This is best accomplished by using a heart rate monitor, and I strongly recommend using one to train for and run a marathon.  However, if you do not have one you will just have to focus closely on your perceived level of exertion.  Your ability to maintain enough energy to run steadily for 26.2 miles depends on the rate at which you use up your glycogen.  You will use a lot more glycogen when you are running in an anaerobic zone compared to an aerobic zone (a quick review:  anaerobic training requires a lot more glycogen to produce energy compared to aerobic training which utilizes oxygen and fat for energy and small amounts of glycogen).  Aerobic training occurs when you are running at 65 to 75% of your maximum heart rate (MHR).  Your glycogen stores can last approximately 3 or more hours when exercising in this zone.  Comparatively, when exercising anaerobically at 80% of your MHR you will use up almost all of your glycogen stores in less than two hours, a BIG difference.  A simple and proven method to calculate a good race heart-rate is use 185 - your age as the maximum heart rate for the race.  For example, a 30 year-old would aim to keep their heart rate under 155 for the duration of the marathon (roughly 75% of MHR).  However, this can vary significantly from individual to individual, so during your training you should try to determine a HR zone that corresponds to roughly 75% of MHR.

For those without a heart rate monitor, you can use your Rating of Perceived Exertion (RPE).  The RPE is a number between 6 and 20 that you use to rate how hard you are exerting yourself during activities.  A rating of 6 corresponds to rest or no activity and 20 corresponds to a maximal effort that could only be sustained for a very brief period.  A marathon should be run at an RPE of 15.  Even for experienced runners this method is difficult to use to pace yourself for an entire marathon, so I highly recommend investing in a heart rate monitor.

 

Hydration

On a warm day the average runner can lose over 4 liters (128 ounces) of sweat during a marathon.  If you do not hydrate appropriately during the race your performance will be affected due to dehydration, and your chances of needing medical attention after the race increase.  It is difficult to replace all of the fluids lost as sweat and attempting to do so will cause problems.  Partial fluid replacement is the goal.  Many medical studies have shown that small quantities of fluids at short intervals during prolonged exercise significantly improves performance.  Consuming 120 to 180 ml (4 to 6 ounces) every 10 to 15 minutes during the race is recommended.  Most marathons have water stations every 1 to 1.5 miles, which for most runners is roughly every 10 to 15 minutes.  You can drink water or sports drink, whatever is more palatable for you.  However, if the sports drink seems rather sweet, it may be overly concentrated which could lead to gastric distress.  If this is the case you should drink a mix of water and sports drink (2 to 3 ounces of each) at each water station.  If you have problems with digestion or a history of gastric distress, stick with water and you can get your carbohydrates and sodium through gels and salt tabs (more on this below).  Runners should practice drinking during their training in order to help improve the efficiency and comfort of drinking water during the race.  Be careful not to overdo it at the water stops; overhydration can cause problems.  Hyponatremia is a condition that can occur when an endurance athlete consumes excessive amounts of water and causes a dilution of their electrolytes, more specifically the sodium.  Hyponatremia causes cramping, nausea, vomiting, and disorientation.  If hyponatremia becomes severe, it can require hospitalization; there are numerous reports of marathoners who have died because of hyponatremia.

 

Nutrition

The average runner burns approximately 3,000 calories during a marathon.  With good carbo-loading your body can store about 1,200 to 1,500 calories in the muscles and liver.  This stored energy (in the form of glycogen) is typically completely utilized in approximately 2 hours.  Unless you can finish the marathon in around 2 hours, you are going to need some extra energy.  So where are the extra calories going to come from?  A large portion of the energy expended during a marathon will come from utilization of free fatty acids, however caloric supplementation is a must.  Runners use a wide variety of products including energy gels, energy bars, energy drinks, and fruits such as oranges or bananas.  Although what you eat is important, when you eat and how much you eat is even more important.  As a general rule, during a marathon you should aim to consume between 25 to 50 grams of carbohydrates (100 to 200 calories) per hour.  This is an individualized quality, and you must experiment in training to find what works best for you. Some individuals can tolerate more than this, but that is generally the exception, not the rule.  It is difficult to digest while running, so I recommend staying on the lower sides of calorie consumption.  If you have problems with digestion during longer events, stick to gels and liquid nutrition and try to keep the intake around 25 to 35 grams of carbs per hour.  Obviously this does not equally replace what you are using during a marathon, but (1) your body can only digest and utilize this quantity while running, and (2) while running aerobically you will utilize a significant amount of fat for energy. 

A good and simple nourishment strategy is to consume 25 to 30 grams of carbohydrates (100 to 120 calories) every 30 to 60 minutes.  The typical energy gel contains approximately 100 calories, so consuming 1 to 2 energy gels and a few cups of sports drinks will provide one with adequate calories. 

Another nutritional aspect to consider is SALT.  The benefits of salt supplementation are controversial, however there are no large studies investigating whether salt decreases cramping and dehydration.  Physiologically, you lose A LOT of salt in your sweat.  The concentration of salt in your sweat is generally more than the concentration of salt in energy drinks.  Excessive loss of salt leads to cramping, dehydration, and hyponatremia.  If you are a heavy sweater, if you get quite dehydrated during marathons, if you have white salt stains on your body or clothes after a marathon, or if you experience significant cramping during a marathon you probably could benefit from some form of salt supplementation.  Salt has several benefits in endurance events: the average athlete loses a lot of salt in their sweat, much more than can be replaced by the typical sports drink, therefore salt supplementation may help to maintain adequate sodium (salt) levels.  The average athlete will lose approximately 1000 milligrams of sodium per liter (33 fluid ounces) of sweat.  Most sports drinks have between 200 to 450 milligrams of sodium per liter; thus the need for salt supplementation.  Salt helps your body retain water which leads to less dehydration.  Additionally, if you have digestive problems, sodium helps move fluids out of the stomach enhancing digestion.  Calcium, magnesium, and potassium are other electrolytes that are lost in sweat; replacing these electrolytes may enhance performance as well.  A good salt or electrolyte supplementation strategy is to consume 2 to 4 salt or electrolyte capsules or tablets per hour during endurance events.  There are a variety of different brands of electrolyte supplements available; I prefer endurolytes by e-caps, which provide sodium, potassium, calcium, and magnesium.

 

Recovery

Congratulations, you completed the marathon.  Now comes the fun part, recovery.  This is fun because this part involves EATING, DRINKING, and SLEEPING.  Most athletes will be somewhat dehydrated after finishing the marathon; a rough way to gauge your dehydration is how long it takes you to urinate after finishing a marathon.  If it takes you several hours to urinate, you are finishing the marathon quite dehydrated.  On the other hand, if you are urinating several times during the race and several times shortly after the race you are probably overhydrated and at risk for having hyponatremia.  I recommend consuming sports drinks or other sodium-containing beverages instead of water to help replace some of the sodium you lost during the event. 

As for food, you should aim to consume 500-1000 calories within an hour after finishing the race.  During the race you will exhaust your glycogen stores.  Because insulin is somewhat elevated during prolonged exercise, your body more efficiently stores glycogen during the hour after your run.  Effectively replenishing your glycogen leads to a faster recovery.  If possible, consume a mix of 70% carbohydrates, 15% protein, and 15% fat as this will further improve glycogen storage. 

Growth hormone is the major chemical that your body produces that is responsible for building muscles and recovery.  Since the majority of your growth hormone secretion occurs while you are sleeping, sleep is therefore an essential part of the recovery process.  I strongly recommend trying to get AT LEAST 8 hours of sleep per night for at least a week after the marathon.  If you are feeling worn down or sleepy during the days after a marathon, you are not getting enough sleep.  Upper respiratory tract infections are extremely common after completing a marathon.  The best way to avoid getting ill is plenty of sleep, fluids, and healthy eating.

This is a basic guide designed to help all runners with the finer details of running marathons.  I was inspired to write this after talking with MANY runners about their trials and tribulations (of which I have suffered from many myself!) during marathons as well as their questions and concerns about running marathons.  The contents of this section should address most problems and questions that you might have, however if you would like to discuss something more in depth please feel free to email me at endurancedoc@gmail.com