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9 Ways to Reduce Injury Risk and Run Strong in 2021

Injury prevention is one of those topics I get asked about all the time. Runners know that consistency is key when it comes to achieving goals, and getting injured can throw a wrench into your weekly mileage goal, your long term training plans, or your goal race preparation - so it makes sense that everyone wants to stay healthy and avoid getting sidelined. Plus, sitting on the couch while your friends go for a run is no fun!

While diet is far from the only variable impacting your injury risk, it certainly plays a part. Here are my top tips for fueling to keep yourself healthy and strong all year round.

1. Load up on calcium & Vitamin D

Calcium and Vitamin D are crucial nutrients for bone health. Given that bone mass peaks in your early 20's, adult athletes need to be mindful about eating enough to meet their needs and maintain strong bones.

Calcium can be found in leafy green vegetables, dairy (milk, cheese, and yogurt), tofu made with calcium sulfate, and sardines. Some beverages like juice and soy milk are fortified with calcium - check the label of your preferred brand to see how much it contains. Men and women ages 19-50 need 1000 mg of calcium daily. If you are supplementing, you typically have a choice between calcium carbonate or calcium citrate. Calcium citrate is a little bit more expensive, but better absorbed and doesn't have to be taken with food, as compared to the more common calcium carbonate (also the ingredient in Tums).

Vitamin D is one of the most commonly seen nutrient deficiencies in the US. That's because there aren't very many quality food sources, and many of us don't get a lot of sunlight (which is the other main way we absorb Vitamin D). The RDA for Vitamin D in the US is 15 mcg (600 IU) for adults and adolescents ages 14-18. Fatty fish like tuna and salmon is the best dietary source. Mushrooms treated with UV light also contain some Vitamin D, as do fortified milk, dairy substitutes (like soy milk), and juice. You can absorb some from the sun if you are outside for 5-30 minutes in the middle of the day, but unfortunately your SPF sunscreen is probably blocking absorption.

I often recommend athletes get a Vitamin D level checked and supplement if needed. I typically recommend the active form of the vitamin, Vitamin D3 or cholecalciferol, as it tends to raise serum levels more effectively. However, you should always check with a healthcare provider before supplementing, as too much Vitamin D can have adverse health effects and interacts with certain medications.

2. Have carbs at every meal

I always say everyone should have carbs at every meal, but that's especially true for athletes! Endurance athletes need carbs to provide the energy for good performance, but carbs do more than that. Carbs help with muscle repair after a workout or run, and they prevent the loss of lean muscle during exercise. The typical recommendation is for 45-65% of your intake to come from carbohydrate.

Sometimes people get stuck in the trap of thinking "carbs" just means sugar, or bread and pasta. But many nutritious foods are high in carbohydrates - think potatoes and sweet potatoes, beans and lentils, peas, brown rice, barley, quinoa, milk, yogurt, and fruit. The type of carbs in high-fiber foods like whole grains will give you longer-lasting energy, not a quick spike followed by a drop like simple sugars do.

3. Consume moderate amounts of protein, 20-40 gm/meal

Protein is key for maintaining muscle mass and carrying out many bodily functions. Without adequate protein, your muscles can't recover properly from your workouts. However, protein is best absorbed when consumed in moderate quantities, so aim for 20-40 gm with your meals and snacks. That's roughly the amount in a 3-6 oz piece of meat or fish.

4. Eat the Rainbow

Colorful fruits and vegetables are so important to maintaining good health and preventing injury. They are key sources of vitamins and minerals, and those colors indicate the presence of antioxidants. Antioxidants are compounds that destroy free radicals - unstable molecules that can cause cellular damage. Consuming fruits and veggies can help reduce systemic inflammation, which in turn helps you recover more quickly from training!

Include a variety of colors on your plates when possible. You can use fresh, frozen, or even canned veggies (just rinse them off first). I like to add spinach or beets to my smoothies (make sure you add fruit along with the beets to avoid too much beet-y flavor!), throw greens and mushrooms into my tomato sauce or top my pizza with a mix of veggies, caramelized onions and fruit (peaches and pomegranate are the bomb!).

5. Think about collagen

If you have a ligament or tendon injury, consuming collagen could help you heal faster while you continue to strengthen your problem areas. A few studies have shown that collagen supplementation can improve function and reduce pain (1, 2), and there's also some evidence that consuming Vitamin C with collegen can help enhance healing (3). However, there's no scientific consensus on the effectiveness of collagen supplementation.

Collagen is a pretty low-risk supplement, since it's naturally-occurring in many foods. If you want to try it, you can use a supplement powder or consume collagen-containing foods like gelatin (hey, an excuse to make jello!). The recommended dose is ~5-15 gm of gelatin or collagen hydrolysate (4). Consider having it with a glass of orange juice for that Vitamin C punch.

6. Eat your Omega 3's

Omega-3 Fatty Acids are known to reduce inflammation, improve blood flow, and can potentially help offset the effects of delayed-onset muscle soreness (DOMS). Fatty fish like salmon, sardines and tuna are the best source. Not a seafood fan (me either!)? You can get Omega-3's from flax, chia seeds, and walnuts. Or, you can take a supplement (fish oil or algal oil for my vegan runners). Krill oil may be easier for your body to absorb than other varieties. As with all supplements, I recommend that you choose one that's NSF or USP-verified to make sure what's on the label is what's actually in the bottle.

7. Treat recovery like your job

To maintain consistency as an athlete, you have to take recovery seriously. I know way too many runners (myself included, sometimes) who are willing to sacrifice a lot of time and effort for the run itself, but blow off their post-run nutrition, hydration, and mobility. That's like shooting yourself in the foot after every workout! Recovery is where the magic happens. Recovery is what helps our muscles repair and rebuild after we break them down with exercise. If you aren't recovering, you won't get stronger. And you need energy to recover!

Tell yourself your workout isn't done until you've refueled. You want a ratio of 3:1 or 4:1 gm carbs to protein in your post-run snack. Chocolate milk is a very popular example, as it contains a perfect ratio of carbs to protein. You can also use something like a turkey sandwich, an egg and potato breakfast taco, or a fruit and yogurt smoothie. Hunger cues are often impacted by intense exercise, but your body needs the energy even if you're not very hungry, so don't skip it!

8. Take the batteries out of your scale

In my opinion, the scale is one of the biggest barriers to success for athletes. Why? Because it takes the focus away from your performance and puts it on your weight. Weight is not a very good indicator of health - a basic bathroom scale doesn't tell you how much muscle you have, or how hydrated you are, how your labs are looking, or how dense your bones are. But because we live in a culture that is very fixated on weight, we tend to assign a value to body weight that just isn't meant to be. A lower weight is not "better", and a higher weight is not "worse". Your body performs to the best of its ability when you're fueling well and recovering smart. If you are cutting calories to try and lose weight, your ability to fuel effectively and recover is compromised.

So when you start a training block, take the batteries out of that scale and stick it in the closet. Use other indicators, like how recovered you're feeling or how well you can execute your workouts, as a better proxy for your fitness than your weight. I promise, nobody will care what you weighed when you ran that PR.

9. Fuel well before and during workouts

Along with recovering after workouts, it's important to start them fueled, too. Fasted training has gained some popularity over the years out of a belief it will promote weight loss, but it actually has the opposite effect. Trained fasted tends to increase bodily stress and preserve fat mass while breaking down more muscle. And while there is some evidence that fat-adapted training can be beneficial for ultra-endurance athletes (6), athletes hoping to pick up speed will be better served by performing their runs with gas in the tank - in the form of carbs (7, 8).

If it's been more than 4 hours since the last time you ate, have at least a snack of 15-30 gm easily digestible carbs before your run. Bananas, toast, crackers, or juice are good choices. If you have more than 30 minutes before you go, you can add in a little protein like peanut butter or nonfat yogurt.

During runs longer than an hour, consuming carbs can delay fatigue and improve your endurance. Consider adding in about 30-60 gm carbs/hour (you can start small and build up if you have a sensitive stomach) in the form of gels, chews, fluids, or real food. One gel usually has about 20 gm carbs, while a packet of most chews has about 50-60 gm. You can also use a small box of raisins (34 gm carbs), 1.5 oz pretzels (35 gm carbs), or a 2 squeezable pouches of applesauce (~32 gm carbs).

On very long runs (such as ultra marathons or marathons longer than ~4-5 hours), I recommend adding in some nutrition from other macronutrient sources. Examples are nut butters, jerky, or trail mix. Use of various fuel sources prevents "gut rot" and can help preserve muscle. Work with a sports dietitian to determine your exact fueling needs and plan for your event.

Remember - fueling is only one part of the equation. You also need to take sleep, strength training and mobility work, and stress management into account. But with these dietary tips, you'll be well on your way to fueling a year free of injuries and full of PRs!

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