Nutrition Essentials | Marathon Training: How to Use Nutrition as Running Fuel with Tamanna Singh, MD

Podcast Transcript

John Horton:

Hello, and welcome to another episode of Nutrition Essentials, an offshoot of our popular Health Essentials Podcast. I'm John Horton, your host.

More than a million people plan to run a marathon this year. Given that you're listening to this, you might be among that sweaty crowd. If so, odds are you've put together a detailed training plan with weekly mileage goals and targeted paces to get you race-ready. But if nutrition isn't a big part of your preparation, you're in danger of tripping up and falling flat long before you reach the starting line.

Today, we're going to take a closer look at how to fuel your body so it can handle the demands of marathon training. We'll break down the process from the start until you take the final triumphant steps of your 26.2-mile journey. As usual, we have registered dietitian Julia Zumpano with us to help set up a training menu. To connect the dots between running, nutrition and our health, we're joined by the co-director of Cleveland Clinic's Sports Cardiology Center. Julia, can you introduce our guest?

Julia Zumpano:

Sure thing, John. We're joined today by Dr. Tamanna Singh, a cardiologist and marathon runner — two passions that give her a unique perspective on getting a body ready to run some serious mileage. She knows from experience that what you eat can have an incredible impact on running performance. I'm looking forward to talking with her about how diet can help runners put their best foot forward.

John Horton:

That sounds like a winning formula, Julia. On your marks, get set, let's go.

Welcome to the Nutrition Essentials Podcast, Dr. Singh. Thanks for slowing down long enough from your job here at Cleveland Clinic and your marathon training to sit down and chat with us.

Dr. Tamanna Singh:

Thanks so much for having me. It's always a pleasure.

John Horton:

Whenever I talk with another runner, a question that always comes up is the next race. What's on your calendar, Dr. Singh? I'm guessing that there's a 26.2-mile target in your future.

Dr. Tamanna Singh:

I have a couple of things. My 2025 is already planned. I'm going to kick it off with a half-marathon in Houston. Then I'm going to set sail to Tokyo and run a marathon over there.

John Horton:

Wow!

Dr. Tamanna Singh:

Then, we'll end 2025 with a bang, yeah, we'll go back to Chicago. We'll keep it domestic at the end of the year. I'm very excited to travel.

John Horton:

That is quite the year!

Julia Zumpano:

For fun, yeah.

John Horton:

If you don't mind my asking, how many marathons have you done?

Dr. Tamanna Singh:

I have done nine.

John Horton:

Wow.

Julia Zumpano:

Wow, yeah.

John Horton:

Well, that is why you're ... we were talking earlier, I know Julia's done one. I have none on my thing — I have 35 halves.

Dr. Tamanna Singh:

Wow.

John Horton:

But I've never finished a half and thought I needed to do it again right away.

Dr. Tamanna Singh:

If you put all those halves together, those are a bunch of marathons.

John Horton:

I like it.

Dr. Tamanna Singh:

Yeah.

John Horton:

I have 17-and-a-half fulls then, I guess if you look at it that way.

Dr. Tamanna Singh:

Yeah.

Julia Zumpano:

Dr. Singh, any reason you specifically chose Tokyo?

Dr. Tamanna Singh:

I'm trying to do all of the world majors through Abbott, and Tokyo is one of them. That's probably the farthest one out. Then, after Tokyo, I'll just have one more left.

Julia Zumpano:

Very cool.

John Horton:

Well, Dr. Singh, with all the running you're doing, obviously, we have the perfect person in here today to talk about nutrition and marathon training. Let's jump right in. From your experience, how important is nutrition in marathon preparation?

Dr. Tamanna Singh:

Oh, it's incredibly important. It's the foundation of your fuel, of your energy. Training for a marathon is not something that you could really do in a day or in a week. It really requires a lot of preparation. It's basically a training cycle that's built upon having some sense of base running or base training to begin with.

You want to set yourself up for success by making sure that you have the right fuel, the right nutrition. Not just for before your runs or during your runs, but really, after your runs, and generally eating on a day-to-day basis. Thinking about all of your macronutrients, making sure you understand the purpose behind each macronutrient, when it comes due, supporting recovery, supporting that quick fuel, or just basic cellular health. If you can really do that and understand the importance of nutrition, your marathon should, hopefully, from a fueling perspective, go quite smoothly.

John Horton:

If you are training for a marathon, you're going to be putting in some serious miles to get ready. I know from experience that that effort tends to make you very, very hungry. Should marathon trainees expect that they'll need to up their calorie consumption to meet all these increased demands?

Dr. Tamanna Singh:

Usually, a lot of people tend to feel hungry, or hungrier, I should say, the more they're training, which is a natural sensation that is a human response to, "Whoa, I'm actually utilizing and metabolizing so much more now. I actually need to intuitively take in more to support just basic body health, cellular health, and provide energy for the day."

There is a small number of industries that, at least, that I've encountered in my practice, who sometimes find that their appetite might be a little suppressed. I think it's really important to get a sense of how you're responding to the training — if you're noticing whether you're eating enough to support your training as it progresses, as those miles per week slowly increase steadily.

If you're noticing that you're appropriately increasing your nutrition and your core consumption appropriately with that increase in training, I think you're doing just fine. But if you are finding that you're noticing a little bit of appetite suppression, or perhaps there might be some nervousness or anxiety about having the urge to eat more, but then, maybe psychologically being a little fearful to eat more, I think working with a nutritionist — someone like Julia — would be quite helpful to just help you understand how much you really need to support your training.

Julia Zumpano:

Yeah. I can't agree more with Dr. Singh. Just really listening to your body, that intuitive eating or intuitive nutrition. Understanding that you are expending quite a few more calories and you will need to slowly increase your caloric intake with nutrient-dense foods in the appropriate macronutrient compositions — we'll discuss in a little bit.

Meeting with a dietitian can really help personalize that. You can really have a back-and-forth on maybe what's causing the anxiety if that's present. Or maybe what's causing the depressed appetite if that's also present. Also, being able to embrace an increased appetite and be able to feed it appropriately when that happens, too.

Dr. Tamanna Singh:

I think, if this is the first marathon you're training for as well, everything is going to be new. The mileage is going to be new. You're going to be hitting a lot of new markers that your body has never encountered before and you mentally have not really been aware of, or understood or absorbed. I think that can also be a little tricky when it comes to understanding how much output you're actually getting. When I say “output,” it's really how much energy are you’re expending. At least in my experience, it has taken a couple of tries, a couple of times at the marathon distance, and building my endurance training to really understand what my body responds to well with respect to fueling, how much I really need, how much more I could actually take to really make sure that I get the most out of race day.

Julia Zumpano:

Yeah.

John Horton:

We had talked earlier, I know you had mentioned it's important if you are training for a marathon not to merge that with a weight loss plan. That you shouldn't necessarily decide you're going to run a marathon in order to lose 20 pounds. Those are two separate things and you should just focus on one or the other.

Dr. Tamanna Singh:

Yeah. I think it's tricky when you're combining goals with body composition with goals for running because at some point, they can be a bit discordant. What do I mean by that? I think if you're someone who maybe, and this is a broad term, but perhaps live a relatively unhealthy lifestyle in the sense that you're going from being a very sedentary human, not really eating the best nutritionally — if you jumpstart your exercise habits and start running, you will naturally notice some weight loss, some shifts in your body composition as a response to this new output, this new energy expenditure that your body is feeling.

Oftentimes, we see that individuals may also change their nutrition habits to be quite similar to their running. There's a lot of people out there who will run to eat. But then, there's another group of individuals who will learn how to eat to run and get excited about eating a little more nutritiously. In that group of individuals, we'll naturally see some weight loss.

But if you're truly going into running and thinking, "I'm going to do this because I only want to lose weight and I expect to get faster, and be the fastest marathoner out there," you will likely notice that, at least this is what I've noticed in my practice, is individuals just don't eat enough. Then, they're running their tails off, trying to do a lot of speed work, doing a lot more mileage, and they essentially break down because you just don't have that energy to support what you want to get out of your body. You really can't get both weight loss and running.

I think as a runner, there are cycles. If you're in a base mileage, just steady-state running, not training for anything, I think those are good periods of time to think about how you might want to focus more on strength training, or maybe be a little more specific about your macronutrient consumption to support perhaps a little bit of fat loss and more muscle mass. But I don't think it's ideal to prioritize both body composition/weight loss and getting the best and the most out of your training running faster, running stronger, running more miles. I think it could be a recipe for disaster.

Julia Zumpano:

I completely agree. If you're new into running and it's something that you wanted to try as a challenge, and you're trying to overall get healthier, I think that increased energy expenditure will most likely lead to some weight loss initially. As Dr. Singh said, if you're following more of an unhealthy lifestyle or eating habits, then you may see some initial weight loss because you'll notice quickly that you need to fuel your body with appropriate nutrition in order to be able to sustain some of these long runs, or just this increased activity that you're engaging in.

I do think that, in some cases, if you're not really looking to train hard for a specific goal, you may see some initial weight loss. But most important is that you fuel your body during this time to reduce injury or fatigue, or actually nutritional deficiencies, or even malnutrition.

John Horton:

Dr. Singh, you brought up a phrase in there that I just loved, and that is “you eat to run.” Really, that's, in a nutshell, what this entire podcast today is about. This is what you need to be putting in in order to run your best.

Let's start focusing on what the right food is for everybody to hit those goals. One that always comes up, that gets the most attention when it comes to endurance sports, are carbohydrates. Let's start there. How important are they for marathon training and why?

Julia Zumpano:

As we know, carbohydrates are our body's main source of energy, so they're essential for all movement and for life. We really do need carbs. Especially though, when we're training and doing heavy marathon training and putting in that many miles, we need to build up our glycogen stores, that's our storage form of energy in our muscles and carbohydrates do that the best. That's the form that we can get the most amount of energy in.

They're essential and we really want various types of carbs. Most people — when they think of carbohydrates, they think of bread or rice or pasta. Those are definitely carbohydrates, but we can also get carbohydrates from fruit and some dairy products and legumes. There are other sources of carbohydrates and other vegetables, of course, starchy vegetables. We want to provide a wide range of types of carbohydrates and include the most vast variety to maximize nutrient intake, too.

Yeah, I completely agree with Julia. I think if you look at dietary trends over the course of the last couple of decades, carbs have just gotten such a bad rap. That has slowly but surely infiltrated the endurance sport. Though, I will say, at least over the last five to seven years, maybe even more three to five years, we're seeing this resurgence of the carb, and just a better understanding and appreciation of this little, tiny molecule that's responsible for everything going from fueling your brain to fueling your body. Your brain can only rely on sugars, on carbohydrates.

If you think about it, when you're at mile 22 or 23 of a marathon, it's not just your body that's tired. It's also mentally fatiguing. You're not just fueling your body with carbs, but you're also fueling your brain. It can really be a game-changer.

I think Julia brought up a great point about just the types of carbohydrates when we think about simple versus complex carbohydrates. I usually like to think of simple carbohydrates … so the things like the breads or the pasta or the bagel or the banana a little bit. But those simple carbohydrates are really helpful for when you just need a quick little snack before a run. Simple carbohydrates are what are found in running fuels. Whether they be natural forms of running fuel — meaning more food-based — or whether they be the running gel that most people are familiar with, which is really a quick suck of sugar and basically, just an active easy way to metabolize and utilize that sugar source.

But complex carbohydrates, when we think about what really benefits us from a cardiovascular perspective, just an overall health perspective, are really going to be the best source of just giving you healthy micro and macro nutritional density. That's where you really want to lean into the fruits and the vegetables and the leafy greens, and the complex carbohydrates or complex grains like quinoa or bulgur or brown rice, and stuff like that.

I think placement of the carbohydrate is important. All carbs are really important, but understanding that the main reasoning behind the carbohydrate when it comes to endurance training, particularly when you're timing it to before or during a run, and even to some perspective, after, is the simple carbohydrate, the easy to digest. But those complex carbohydrates are what are going to keep your body strong, allow for it to absorb the training, and overall cardiovascularly, and really from a physiological perspective, give you a great nutritional benefit.

Julia Zumpano:

Yeah, I absolutely agree. Timing is really important when you look at the type of carbs you're going to be consuming.

John Horton:

Neither of you mentioned one of my favorite carbs, which is an ice-cold beer. Can that be on the training table or no?

Julia Zumpano:

It certainly can be. It's a form of carbohydrate. I think that runners definitely have a stereotype of liking some alcohol in some cases. I think you can build that in, of course. We certainly don't want our primary source of carbohydrates to be alcohol because there's no nutritional benefit to that. As long as we're consuming a very nutrient-dense mix of complex and simple carbs in the appropriate amount, we can certainly build something like that in.

Dr. Tamanna Singh:

I will say, as we're building your training, when the miles add up and the fatigue adds up, and you're thinking about recovery and getting good quality sleep, those may be times when you may want to drift a little bit away from the alcohol if that's something that you really enjoy, just because it does interrupt sleep, it can interrupt recovery and muscle regeneration and growth. It also can dehydrate you. Those are just a couple of things to think about when you're trying to figure out how you may or may not want to somehow include alcohol as part of your marathon build.

Julia Zumpano:

I do agree, too. It can also sometimes make you feel more bloated or fluid-retentive, which is not very comfortable if you're trying to run. Just keep that in mind, too.

Timing, it's really important to look at the timing, like Dr. Singh said, if you're early in your training versus later on, where you're really trying to support your body to withstand these long mile runs.

John Horton:

Dr. Singh, I have to say, I know one of the last times we talked, we had talked about alcohol a little bit and beer. You mentioned nonalcoholic brews have gotten a lot better. I've tried them, and I got to say, you're right. That is also a good way to at least cut the alcohol out and maybe scratch that itch a little bit.

Julia Zumpano:

A lot of those NA beers do have a lot less overall calories, too. They're more fluid-based. Not that we're looking at calories, but we're trying to avoid calories that aren't necessarily providing us good nutrition, to save those calories for maximizing nutrient intake. But you won't feel as heavy or as bloated or those side effects from regular beer, too, so that helps.

John Horton:

Well, I think we've covered carbs pretty well. But as we know, runners cannot live on carbs alone. Let's turn our attention to another macronutrient, and that's protein. Why is it important to make sure that we're all still checking that dietary box as we're getting our miles in?

Julia Zumpano:

Sure. When you are running and doing any form of activity, what you're actually doing is breaking down muscle and rebuilding it. When we rebuild muscle, we need protein to rebuild those muscle fibers. Protein is the building blocks of muscles, tissues, organs. It's essential for so many processes in the body. Protein-rich foods provide a lot of vitamins and minerals that are rich that may not be found in plant-based foods. That's also another key component there, like B12 and some more usable sources of iron. Protein is essential, but mixing within plant-based versus animal protein, or depending on your style of eating.

Protein is really essential, too, for the foundation of a meal composition. It's important to include all three macronutrients, carbs, proteins and fats. The fat and protein help slow down the absorption of carbohydrates, which give us more sustained energy as well.

Dr. Tamanna Singh:

Yeah. Julia hit the nail on the head. I think any bit of exercise is a breakdown of our body, so why not rebuild it when we can? I think timing the protein consumption really within the first 30 minutes after a run is really key so you can really jumpstart that regeneration and muscle recovery — excuse me … I think really not ignoring protein.

When we think about a marathon-build and the training cycle, most typically, it can extend anywhere as short as 12 weeks to maybe as long as 20 weeks. The actual component of protein on your plate really doesn't need to shift much. When I think about it, it's probably going to be about a quarter of your plate, whether it be plant-based or animal-based. It's really the carbohydrates that are going to ebb and flow as your training fluctuates.

That's actually really easy, just in terms of trying to “dumb it down” and remember how much protein you actually need. Protein consumption really depends a lot on — and Julia can attest to this — on your body size, predominantly your body weight. I would say, and I usually tell my athletes this, the most important thing to remember is that the more you're training, the more protein you'll likely need. As we age, as we get older, muscle breakdown and muscle mass loss, particularly in women, can be as early as their late 20s, early 30s. We've noticed, particularly as we start to get into our third, fourth, fifth decade, and definitely getting through menopause, we need increased amounts of protein to just even maintain the muscle that we have.

Use what you got so you don't lose it and make sure you take in that protein. However you eat and get your nutritional sources, understanding that that need will increase independent of what you're doing from a running perspective.

Julia Zumpano:

Yeah. One more important note about protein is that protein is absorbed and used most efficiently when it's spaced out. Making sure you're not saving all your protein needs and having them at one meal, so spacing them evenly throughout the day and consuming small amounts of protein with each meal and snack is ideal. From an absorption standpoint and an efficiency standpoint.

John Horton:

Now, Dr. Singh, you had mentioned having a little protein after a run. Do you ever recommend having a little bit ahead of it?

Dr. Tamanna Singh:

I don't necessarily. Let me actually maybe give you a couple of answers.

I think for shorter runs, and I'm going to use time as the basis for this, if you're doing anything really less than 60 to 90 minutes, your predominant fuel source is going to be, depending again, how fast you're running, the intensity of your session that day, is going to be probably some little bit of fat but predominantly carbohydrates. Having protein beforehand, it doesn't provide you with really any energy and it can actually — because it's broken down a bit more slow in your GI tract — can just maybe cause a little more GI distress.

Now, on days where you have longer runs, where your carbohydrate consumption should be much higher because you're anticipating that your runs are going to be much longer than 90 minutes to two hours, even getting to the three-hour threshold depending upon what your time is expected to be for the marathon, what I'll do to fill my belly a little bit so that I don't feel necessarily hungry is have a little bit of protein in my pre-run breakfast. What does that look like? If I do, let's say, waffles with a banana and maple syrup, the waffles that I eat have about 10 grams of protein in them. I usually keep it to maybe about 10 to 12. That's just my style. It doesn't bother my belly but it also gives me a little bit of sensation that I'm full.

What else could you do? You could do a bagel. A bagel is going to be about 50 grams of carbs in itself. You could do a little bit of jam and a little bit of peanut butter. That nut butter in itself could be just enough protein, again, to give you that sensation of a little bit of fullness. But it's not so much protein that it's going to cause you to feel bloated, to feel like you can't run or feel heavy, nor will it interrupt the ability for you to use your carbohydrates.

John Horton:

Now, that's a good tip, especially as people start getting to those longer runs at the tail end of their training, when you're out there and you're doing the 20-plus mile runs, maybe to get a little bit in.

Now, people usually associate protein intake with meat consumption. But if you follow a vegetarian or a vegan diet, that's not exactly on the menu. Dr. Singh, I know you have some experience related to this. Can you share how athletes can make it work and still perform at a high level?

Dr. Tamanna Singh:

Yeah. I'm a plant-based runner. I've been plant-based now for probably seven or eight years, and vegetarian for many, many years prior to that. When I started to run, I really didn't notice the importance of protein until I started to break down a bit, get an injury, after an injury, after an injury.

Then, once I started to realize how much protein I was actually eating through a day as someone who was plant-based trying to get protein from things like lentils and beans and tofu intermittently, I realized my protein consumption was probably only maybe 20 to 30 grams a day. I really needed something like 90 to 110 or 120 grams. While we'd love to get all protein sources from whole foods, nutritionally dense foods like tofu or tempeh or soy or lentils and legumes and nut butters or seeds, it's just not really feasible when you're plant-based.

What do I do? I do a lot of supplemental protein. Today, I had speed work, so after my run, I have my little protein shake here, which has about 25 grams of protein. I also have a protein shake, another supplemental source, that has about 32 grams for my afternoon snack, along with a 13-gram protein bar. That gives me about 45 grams. Now, we're already up to, if I can do the math, 70 grams. Then, for lunch, we made a lentil Bolognese pasta. We put two cans of lentils with my husband's homemade pasta sauce, plopped that all in with spaghetti, so I'm getting at least some, I don't really know how much, but probably at least maybe half-a-cup of lentils with my spaghetti this afternoon for lunch.

Already, before dinner, I'm probably now somewhere maybe in the 70- to 85-gram protein consumption. Then, my dinner, with our dinners and lunches typically being very whole food-oriented, I anticipate we'll probably have, because we love tofu, some kind of tofu mumbo-jumbo that my husband will make. Usually, we love to do Taco Thursdays. We'll scramble up some tofu, put it in the oven, get it all crispy, have it in a little bit of a marinade. Plop that into a tortilla with some good healthy vegetables, make our own guacamole, and that's usually our dinner.

That's how I think you can feasibly get the appropriate amount of protein. I think if you're a little hesitant to lean into those supplemental proteins, I would look at the quality. A lot of the products that I use are going to be sport-certified, meaning that they've actually been vetted, there's no added ingredients in them. I prioritize my protein powders in making sure they have a good amount of leucine because that tends to be something that we just don't see in plant-based forms of protein and it's really important for recovery. The other thing, too, is a lot of plant-based "bars" tend to have things like coconut oil or palm oil, which are heavy in saturated fat. I really try to avoid those when I'm looking for some of these supplemental bars. I'm not a bar person, but hey, when a girl needs protein, she's got to lean somewhere. The brand that I like doesn't have either one of those, and it's pretty clean in terms of their ingredients.

It requires a little bit of legwork, but we make it a bit easier by really, honestly, just having a list of foods that we know have a certain amount of protein so we don't need to make decisions about it, we know what's going to be in our lunch bag for our snacks for the day. Everything is set up for success.

John Horton:

If you ever get tired of this cardiology thing, I'm pretty sure you could go into meal prep, too. I'm ready to sign up for your service right now.

Julia Zumpano:

Absolutely.

Dr. Tamanna Singh:

Well, I'm the eater. The husband is the chef.

Julia Zumpano:

Those were phenomenal recommendations. I completely agree that if you are plant-based, you will definitely need supplemental protein. If you struggle with the bars or buying them and you like to cook, there are a lot of great ways you can make bars on your own at home. They're very simple to make. I've made a ton of them before. Energy balls, where you use that protein powder that you've already checked out, it's third-party tested, it's clean and your gut can handle it, and you make very simple energy balls or number bars. Then, you can consume those throughout the day, too. They're great for anybody, too, the whole family. I make them for my kids for breakfast, et cetera.

There's a lot of great ways you can be very creative. And also, at the same time, minimize some unnecessary supplemental protein or take a little more ownership in meal prep and food prep to decrease some of that intake, too.

John Horton:

Julia, you make those energy balls sound really, really easy to eat. Is it that simple? Is it just a quick thing you can share with us?

Julia Zumpano:

Yeah. My base, the one I use the most, is just peanut butter, oats, honey, and then I use two scoops of protein powder in it, ground flaxseeds and chocolate chips. I usually use a little bit more dark chocolate chocolate chips. You can sub up the chocolate chips for dried fruit. You just put them in a bowl and mix it all together and roll them into balls and put them in the fridge. Then, that's it, super easy.

John Horton:

It sounds incredibly easy and it also sounds delicious. You got chocolate chips and honey in it.

Julia Zumpano:

Yeah.

John Horton:

How can you go wrong?

Julia Zumpano:

And peanut butter which is-

John Horton:

…And peanut butter, yeah.

Julia Zumpano:

...amazing. I've also made one that you put out on a pan, but I'll use a blender and I'll mix up dates. I'll mix up some dates, and then oats or almond flour, cocoa powder and peanut butter. Then, you can flatten it and cut them. There's a lot of great options. They're on our website, Health Essentials. The recipes are on there. Check them out.

John Horton:

Well, look, we'll put the link in at the bottom.

Julia Zumpano:

OK.

John Horton:

We've covered carbs, we've covered proteins. One more macronutrient that I know we need to talk about is fats. I'm guessing when you hear that, you have certain things that come to mind, but I'm guessing neither one of you is going to recommend that we suddenly start eating donuts.

Julia Zumpano:

Absolutely not. Donuts are more of a carb than they are a fat, anyway. Right?

John Horton:

A guy can try. That would be more the run to eat than eat to run.

Julia Zumpano:

There's nothing wrong with a donut here and there. They can be included. But certainly, wouldn't classify that as a fat.

Fats are essential. They're very important. I think all macronutrients are equally important. Fats are our preferred fuel source for resting conditions. Fats support hormone production, healthy cell membranes. They're necessary for the absorption of our essential vitamins A, D, E and K, the fat-soluble vitamins. Really important to get good quality sources of fats. If you are following more plant-based, nuts are a fat but they also have protein. I encourage nuts and seeds often. Nut butters, extra virgin olive oil, fatty fish, avocados. Those are really what we're encouraging, more plant-based fats, or fat from fish.

Fat is something you want to be very cautious with because it does take the longest to digest and can lead to some gastrointestinal distress if you're consuming too much fat. You just want to space fat out evenly throughout the day and, again, be very mindful of how much fat you're consuming before a run if any at all.

Dr. Tamanna Singh:

Yeah, I completely agree. If you think about eating a big cheesy burger before an hour or an hour-and-a-half long run, my tummy, granted I'm plant-based, already feels really heavy thinking about that.

John Horton:

Yeah, that's not going to sit well.

Dr. Tamanna Singh:

It's just a massive load of fat.

John Horton:

Yeah.

Dr. Tamanna Singh:

You'll probably vomit before you get to the 10-minute mark.

Julia mentioned it's really important to distinguish the type of fat that you're having. When we categorize fats, you think about saturated versus unsaturated fats. From a cardiovascular perspective, we really try to minimize saturated fats as much as we can because that is what contributes to the cholesterol plaque accumulation in your blood vessels, AKA heart disease. The last thing you want to do is have people start to develop plaque, progressive heart disease, and then, suddenly develop an impairment in blood flow and oxygen delivery to the heart that then culminates as symptoms of chest pain and take you out of the running game.

We really heavily want to focus on those plant-based sources, which are unsaturated fats. All plants — except for what I had mentioned, coconut and palm oil — all plant-based sources of fats are going to be unsaturated naturally. I love avocados. We use a lot of avocado oil and olive oil in our household. Nuts and seeds — we got nuts galore everywhere. Pepitas are our jam.

If you lean into those very natural foods sources, I think it also just helps you get into the eating nutritiously game, and being able to identify some really cool, some really fun plant-based foods that you can add to your perhaps a little more carnivorous plate.

Then again, when we bring back that plate … last I mentioned that your protein is typically about a quarter of the plate, the carbs ebb and flow. The fats really don't change in terms of the amount that you need through the marathon cycle. Again, that can be less than a quarter or maybe a little quarter, it really doesn't need to be much of the plate. Just remember, the oils that you add to your food count. You may be envisioning, "Oh, wow! A quarter of my plate can be this big hunk of cheese." It could also include spinach salad with a dousing of olive oil.

John Horton:

Dr. Singh, you mentioned your fat needs don't change at all during the cycle. Do your carb and protein needs change as your training advances? It's a long time, like you said, 12 to 20 weeks. Do those dietary needs change through those different stages?

Dr. Tamanna Singh:

It's really the carbohydrates that will ebb and flow. As your miles increase, your carbohydrate needs will likely also increase. You will probably feel it, too. If you're really not getting enough carbohydrates, you're like going to be feeling fatigued during your runs, after your runs. You may not sleep so well. You may not feel adequately recovered in the morning.

When we are hitting six to eight weeks out, we're getting those 18-, 20-milers, even maybe your 20-20-miler if you're a more advanced marathon runner. You really will want to make sure that your carbohydrates are really increasing. They don't need to go crazy. You don't need to have a whole plate of carbohydrates. But again, it's really going to go from maybe being about a third of your plate to maybe even half of the plate if it's the night before a 20-miler.

I can't really quantify, and this is I think where working with a dietitian or a nutritionist can be really helpful, if you're someone who needs guidance about how much to eat as you train. But just generally speaking, fats and proteins don't really change. It's really going to be the carbohydrates as you start to get into higher intensity, higher mileage.

Julia Zumpano:

Great point, Dr. Singh. We do need more calories as we increase our runs. Our caloric need increases, so therefore, as a dietitian, I look at your macronutrient needs, are a percentage of total calories. You may start, when you're running a four-mile, early in your running stages, you might need 1,800 calories. We're looking at 50% of your calories from carbohydrates, 25 from fat, 25 from protein, let's just say for easy math. But then, when you're training, you might need more like 22 or 23 or 2,400 calories, so your percentage of total calories from carbs, proteins and fat will also increase.

In that sense, you will need more protein, you will need a little more fat, you will need more carb. You'll need a little bit of all three, but we do increase the percentage of carbohydrate needs as you continue to train and increase mileage. In the end, that percentage starts to go up in terms of carbohydrate, but obviously, will go down a little bit in protein and fat.

Dr. Tamanna Singh:

It sounds like maybe the plate gets a little bigger as the mileage increases, but perhaps the actual general amount of each macro maybe stays comparable in a ratio perspective. This is why you need a dietitian.

John Horton:

There's been a lot of math in this podcast so far. We've got ratios going, we've got everything.

We talked about eating throughout. I know if you're a runner, you really tend to worry and fixate on what you should eat in those couple days before the race. Do you guys have any advice on how people should tackle that?

Julia Zumpano:

Well, I think one thing that's really important is that you practice throughout your training on how foods specifically react, how you react to certain carbohydrates and food. It's super important to practice. We want to combine and do some simple carbohydrates and some complex. But again, complex carbohydrates contain fiber, and sometimes, too much fiber can be very difficult on the gut, especially if you're running. Really important to try how your body reacts to complex or simple carbs. Then, of course, we want to carb load at least about three days before the run, and start to significantly increase carbohydrate intake.

Dr. Tamanna Singh:

Yeah. I can't emphasize what Julia said even more. The best way to practice, particularly because the marathon is 26 miles, the closest thing to that distance is really going to be your long run of the week. Use the night before dinner as a way to practice what your body likes, what you feel good on. Early in a marathon cycle, again as someone who's more plant-based, I really don't have too much trouble taking in a little bit of fiber. But as my miles start to add up and once I'm hitting 16, 18, 20, I actually tend to focus a little more on some of those simple carbohydrate sources for my dinner. I eat more before that run because I know that having a big bowl of pasta for me really sits well before my run the following day.

Then, in terms of the carbohydrate load, typically, at least with the dietitian that I work with, we've done three-day carb loads. You could if you wanted to, if you have trouble taking in a whopping dose of carbohydrates each day, you could do it over the five days before your race. Most people will typically do three days before a marathon distance, maybe about a day before a half-marathon distance. Again, utilize foods that you are familiar with. This is where leaning into simple carbohydrates, as much as you might get sick of them by the end of the carb load, will sit better with your belly.

The night before a marathon is really not the night to have 10 sweet potatoes, they may not sit well in your belly, or have a bunch of asparagus. It's really the best opportunity for you to, again, maybe lean into some of those pastas, those rice plates, just easily digestible things.

Then, one thing to remember is that, oftentimes, because carbohydrates are absorbed along with water, you're going to feel bloated. That's natural. My dietitian always says, "If you feel bloated after a carb load, you've probably done it right." The way I think about it is that not only are you getting your carbs, but you're getting some extra hydration alongside of it, which is really important when you're running marathons, particularly in the heat.

Find foods that you like. Find foods that you've practiced with. If you're going out to a race that's not going to have grocery stores around, travel with your food. We've packed bagels in our bags before. Just so that way, again, you don't have to think about what you are going to tolerate, you don't have to think about what you want to eat. Everything is right there for you, the decisions have already been made.

John Horton:

It's nice to know that the bloating is just normal. You should just look at that as energy that's stored up inside you, right?

Dr. Tamanna Singh:

Exactly.

John Horton:

One thing that we mentioned briefly earlier but I want to go back to is the use of energy gels, electrolyte drinks and other endurance products during training and actually on race day. How can folks get the most out of those products?

Dr. Tamanna Singh:

There's a bunch of products. One, as Julia had mentioned earlier, practice your fuel. Race day is not the day to pick the gels on the course if you've never tried them, or take gels from a buddy if you've never tried them because you just don't know how your gut's going to respond. A lot of these gels are based upon very simple sugars, like fructose and glucose and dextrose and maltodextrin. Everybody responds differently.

But the cool thing is that, while there's a lot of gels, there are a couple of common ones that are really of high value I think and that are made pretty well. Just go online — you can easily buy one or two gels of a specific brand and use those on your long runs. Definitely incorporate a gel on speed days or days of higher intensity. Then, you can figure out what your body likes, what you respond to.

Then also, I think it's important to recognize that it's not that you need one gel for an entire marathon. You will need to learn how to fuel with these gels. Typically, we try to, at least I do, I built my belly up to tolerate a gel every 25 to 30 minutes. I emphasize when I say “I built my belly up” that the tummy is trainable. Focus on taking those gels in. If you're someone who's like, "Man, I just get nauseous thinking about eating while I run." Start by taking a gel an hour. Then, start taking a gel every 45 minutes. Then, every 40, 35, 30. You'll realize that you can actually tolerate a lot more carbohydrates than you thought that you could in the beginning.

If you're someone who … you want whole foods as your source of carbohydrate, we see this a lot more in the ultra-distance space. When we're thinking about beyond the marathon distance, 50Ks, 50-milers. But even in the marathon distance, there's a number of brands out there who have more natural whole food-oriented gels. You can lean into those.

Then, if you're thinking about eating other natural foods, again, it just depends upon what your belly likes. I've seen some ultra-runners will eat mashed potatoes in a Ziploc bag as they're running because that's a whole food source and it's easily digestible for them. I think the key here is to practice your fuel, find out what works well for you, and don't be afraid to dabble and get a little creative.

Julia Zumpano:

I completely agree. Really, the trial is the biggest thing, trial and error. There's a lot of different types of quick, easy-use carbohydrates in these gels and goos. You may be able to tolerate one but not another, so it's really important to try a lot of different kinds with all the different types of simple carbohydrates included. Just being able to read the label, looking at the form of carbohydrate it has.

Using it more than once I think is important, too. You may have not tolerated it on that run, but maybe you took it too fast or the wrong mileage or too early. I think it's a lot of trial, a lot of trial and error.

Dr. Tamanna Singh:

But if you don't like gels, there's chews. You could even just get an electrolyte mixed with carbohydrate drink mixes or drink powders if you're someone who wants to drink your energy. There's so many modalities to take fuel. The key is to just actually take it.

John Horton:

Well, Dr. Singh, I know you had mentioned they hand out gels a lot during marathons, and I know, half-marathons. Most races will tell you what they're handing out. I think it's probably a good idea to experiment with those ahead of time, just to make sure they hit your belly right.

Dr. Tamanna Singh:

Yeah. Especially if you're someone who plans on not carrying fuel with you, which is not something I recommend. But if you're someone who plans on taking fuel on the course, please practice taking that fuel during your long runs because the last thing you want is to surprise yourself and take a gel and say, "Oh my gosh, I feel awful." That can make it or break it for race day.

John Horton:

Yeah. I'm always amazed at what some people carry. There are people, they look like they have the Batman utility belt on. They are ready to go. They've got so much fuel on them.

Dr. Tamanna Singh:

Yeah. I carry a lot of gels. I probably carry somewhere between eight or nine gels for a marathon. My hips look like they've got big balls attached to them because they're filled with gels. I take pride in emptying out my pockets as the marathon goes.

It also breaks up the miles a bit because it's easier for me to say, "I only have three more gels I need to take," versus, "Oh no, I still have an hour-and-a-half left to run."

John Horton:

It does segment it up very, very nicely.

As we all know, the inspirational figure behind marathons, Pheidippides, famously dropped dead after completing his run. I know, Dr. Singh, you said that for a lot of people, that's a very real worry as they look at tackling a marathon. How can proper diet and nutrition help ensure that your ticker's going to keep going so you can celebrate your achievement afterward and drive around with that well-earned 26.2-mile sticker on the back of your car?

Dr. Tamanna Singh:

Yeah. Cardiac arrest and sudden death during, and even immediately after, a marathon, is actually something that we see a lot. It's part of what I do as a sports cardiologist. My job is to try to identify those individuals who are at highest risk.

Even looking at the demographic of people who run marathons, most people who are getting into running tend to get into it at a later stage in life, like in their 40s or their 50s or 60s. Now, if we take the age range for when people start to have cardiovascular disease or have their cardiac events, in men, we see them around the 50s, and in women, we see them postmenopausal, more so around the 60s. Those two demographics have a decent amount of overlap.

When we think about the cardiovascular impacts from fueling, as well as from an increase in intensity, energy expenditure and a style of training, we really want to make sure that we understand and communicate with our body in terms of how it's responding to training. Are we feeling different? Are we developing red flag symptoms like chest pain, difficulty breathing, lightheadedness, dizziness, heart-racing sensations? If we're feeling them, are they truly related to cardiac cause or could they actually also be tied into our nutrition? What do I mean by that? From a cardiovascular perspective, we've given examples of an abundance of foods that are really healthy that support good cardiovascular health, blood vessel health, cellular health. Leaning into whole food nutrition, really minimizing saturated fat consumption. It still that holds for individuals who want to run marathons to minimize cardiovascular risk. But when you're not eating enough, you're not drinking enough, you can easily get lightheaded, get heart-racing sensations, develop metabolic abnormalities that can set you up for a little bit of disaster, particularly if we create a marathon day of a very hot day, you're sweating a lot, dehydrated, not appropriately fueled. Your potassium levels maybe go in the wrong direction and then, your heart gets all wonky, goes into an arrhythmia, and you can arrest.

Those are situations in which your nutrition and hydration are directly impacting the ability for you to cardiovascularly withstand the intensity and the magnitude of a marathon. Most people are not running marathons in their training leading up to a marathon. For most people who are first-time marathon runners will have never run the 26 miles. That last six-mile journey is completely foreign to them, as well as their heart. It's really important, again, to practice that nutrition, eat healthily when you're thinking about just your day-to-day nutritional consumption outside of what you're doing between or during runs and after runs to make sure you're not increasing cardiovascular risk.

There's a lot of runners out there who run to eat and are training for marathons. Meaning they're running, they're eating their Big Macs. They're running, they're getting their shake, they're eating their donuts — a lot of foods that are really high in saturated fat. Perhaps they don't realize they have undiagnosed blood pressure or undiagnosed high cholesterol, perhaps they've ignored their family history of heart attacks, and now they're setting to run this marathon that's of a high intensity and they're planning on going crazy with it. In those situations, your nutrition completely could derail your marathon, and perhaps, maybe just your capacity to endure sport as you're getting older because your cardiovascular risk is also increased from what you've eaten.

There's so many tie-ins, not just directly to the race, but there's so many tie-ins on how your nutrition is directly impacting your physiological well-being. If you want any longevity in sport and longevity to begin with, I think you really have to have intention behind what you're putting into your body. That will translate into just healthy outcomes and healthy running.

John Horton:

Dr. Singh, I could listen to you talk all day on that because I always feel like I get so much out of it whenever I have you on or whenever we meet on these things.

Dr. Tamanna Singh:

Yeah.

John Horton:

Thank you for all of that.

Dr. Tamanna Singh:

Of course. I will say one thing. We're talking a lot about running. We love running, we love activity. In the grand scheme of one's lifespan, running is probably still going to be a smaller number of hours than the vast number of hours that you're living and breathing. But nutrition is the basis and the fundamental behind all of it. If you're really eating quality nutrition, focusing and leaning into whole foods, being plant-forward, minimizing that saturated fat, you will feel better, you will live better. You will be able to have more capacity to do more with your body, which includes long endurance efforts like marathons or triathlons, or whatever you want to do. I think completely ignoring nutrition when you're expecting a lot out of your body, you're really just missing the mark.

John Horton:

Well, I feel like we're approaching the finish line here. But before we say goodbye, for both of you, what would be your No. 1 recommendation for people looking to build an eating plan that will help fuel them to run a marathon?

Julia Zumpano:

I think Dr. Singh just said it and summarized it absolutely beautiful. Eating a whole foods heart-healthy diet all the time is essential, but when you're trying to put so much strain and have this phenomenal goal of running a marathon, your body needs nutrition more now than ever. It always does. But really, fueling your body appropriately as much as possible is the key, and looking toward those, as we talked about, those heart-healthy foods and minimizing the unhealthy fats. That's really the key here, is looking at it on a holistic approach.

Sometimes, taking the step of running a marathon, or whatever your health goal or physical activity goal might be, could easily get you into a better eating habit. Take the opportunity to fuel your body with good nutrition. Take the opportunity to say, "Well, I'm making this positive change from a physical activity standpoint. Let's extend that into how I'm fueling my body and how my body will react in every way, head to toe, internally and externally."

Dr. Tamanna Singh:

I completely agree. When you're already motivated and seeing the benefits, and all those wins in your marathon training, it's completely natural to say, "How else can I feel healthy and be healthy?" That's when we see a lot of people start to lean into eating more nutritiously.

I think for me personally, I did not know whatever I know about nutrition and what works for me from day one of starting my journey on long-distance running. I am fortunate enough to have a team of support individuals, one of whom is a sports dietitian, whom I've worked with for a number of years. For me, and I think for anyone who's really looking for guidance and does well with coaching and support, and leaning into someone helping them understand the purpose behind food, and also encouraging them to be creative about it, I think working with a sports dietitian or a nutritionist is key. It's not only that you're just going to get gains from your running. I've changed how I've eaten even more so than I anticipated. I think I've changed my personal relationship with food. I've addressed fears, anxieties behind certain foods or certain food groups, and I think I'm much better for it.

Don't be afraid to ask for help. Two heads oftentimes work better than one. Not all of us are meant to know everything about everything. I bet even if you just meet with a dietitian or nutritionist once or twice, you're going to leave those sessions really empowered and better fueled mentally and physically.

John Horton:

Perfect way to end things. I think anybody listening here today has got to feel really, really good as they start to take that first step in entering a marathon and getting to the finish line, which I know is everybody's goal. Thank you both for coming and sharing so much fabulous information. Can't wait until our next talk.

Julia Zumpano:

Thank you, Dr. Singh, for all your support of dietitians and really seeing the value of nutrition.

Dr. Tamanna Singh:

My pleasure. Thank you, Julia. And thanks, John, for having us. This is a blast here. Happy to join anytime to talk about food, to talk about running, two things that are very important to all of us.

John Horton:

Well, we'll have to go running. You can carry all the energy gels.

Dr. Tamanna Singh:

Sure. No prob.

John Horton:

There's more to running a marathon than just running. Proper nutrition is essential during training to help your body meet the challenge of running farther than many folks drive in a day. Pay attention to what you eat just as much as your weekly mileage. Now, go and get that marathon medal because you've got this.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, eat well.

Speaker 4:

Thank you for listening to Health Essentials brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.