My Boston Marathon Race Recap
Marathons are not an easy task. If you want to run a marathon and run it well, it can take months of preparation. This includes hours of running, strength work, mobility, message, ice baths, and meal prepping. For many people who are not professional athletes, this is being done in addition to a full time job. I started my marathon preparation for Boston in November of 2016. This means I had nearly 5 months of preparation. I am guessing nearly 300 hours, or more, including all of the things mentioned above.
The challenge with marathon training is that there are no guarantees. There is no guarantee that you will not get injured or that the weather will cooperate on race day. Like anything in life there are things you can control and things you can’t control. What can be controlled during a marathon is pace, hydration, and fueling. To some…
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I love to listen to podcasts. Lately I have been listening to a variety of podcasts about the ketogenic diet. It seems to be gaining momentum. Some tout its benefits for enhancing sports performance, and others for therapeutic reasons, longevity, diabetes, and weight loss. I have been well aware of the ketogenic diet as a dietary therapy for epilepsy, specifically for children. I remember learning about the ketogenic diet while obtaining my degree in nutrition and thinking, “wow, I am glad I don’t have to follow that diet.” It is restrictive and hard to follow, especially for a child. At this point the research on the ketogenic diet for health reasons and performance is interesting, but I recommend people proceed with caution.
The original ketogenic diet was designed as a 4:1 ratio of fat to protein and carbs. The diet consists of 80% of the daily energy intake from fat, 15% from protein, and 5% from carbohydrate.1 There are some variations and modifications that have been introduced including changing the ratio of macronutrients or no restriction on daily energy intake. The types of fats recommended on the ketogenic diet have also been modified to include more polyunsaturated fats from fish, oils, and nuts. Athletes may be able to consume higher amounts of carbohydrates and proteins and still maintain ketosis because they have a higher energy demand than non-athletes. To achieve ketosis the daily carbohydrate intake for most people is around 20 grams per day. To keep that in perspective, 20 grams of carbohydrate is equivalent to one apple, one small tortilla, ½ cup beans, or 1/3 cup of pasta. That is it! That is all the carbohydrates you can consume in one day.
So what is ketosis? For those people who do not have a background in biochemistry or biology this process is complicated so bare with me. The goal of the ketogenic diet is to induce ketosis. Ketosis is a normal metabolic process to fuel the body when carbohydrate stores run out. The body shifts from burning carbohydrates for fuel to burning fat. After a period of several days of fasting or a drastic reduction in dietary carbohydrate intake, the glucose (carbohydrate) reserves become depleted and no longer sufficient to support normal fat breakdown or to supply energy for the brain and central nervous system.1 For those that remember the Krebs cycle or TCA cycle in biology class, basically there is not enough glucose to provide oxaloacetate to the Krebs cycle. This (oxaloacetate) is an important metabolic intermediate for the Krebs cycle and also needed for the oxidation of fat. Fats (as free fatty acids) can’t cross the blood brain barrier and thus glucose (carbohydrate) is the main energy supply for the brain.
How do we get energy to the brain during times of fasting or on low carbohydrate diets? This energy is supplied by ketone bodies, which are generated by a process called ketogenesis. This process occurs when acetyl-coA (an intermediate of fat breakdown) can no longer enter the Krebs cycle and ends up in the liver or mitochondria. The liver and mitochondria use the acetyl-coA to make ketone bodies (acetoacetate, 3-hydroxybuterate, and acetone). Ketone bodies are able to cross the blood brain barrier and thus able to supply the brain with energy. In a nut-shell, when carbohydrate supplies are low, the body breaks down fat to produce ketones, which supply energy to the muscles and brain.
Some people may read this and think that they have to go on a ketogenic diet to burn fat and otherwise they are always burning carbohydrate. This is not true. Our muscles and other tissue have no problem using fat for fuel, but because free fatty acids don’t cross the blood brain barrier the brain is not able to use fat for fuel, unless it is broken down into ketone bodies. In between meals we use a combination of fat and carbohydrate to fuel our bodies. The carbohydrate is coming from the liver, where it is stored. When we eat a meal high in carbohydrate our bodies switch to burning more carbohydrate than fat. Once the meal is digested and absorbed we switch back to using fat and carbohydrates for fuel. The ketogenic diet is different in that there is very little carbohydrate in the diet and thus the body switches over to burning predominantly fat for fuel. Keep in mind that the diet also consists of mostly fat. So yes, the body is burning fat, but that does not mean it is burning all your body fat stores for energy. It is using a combination of fat consumed in the diet and stored fats. In a regular, non-ketogenic diet the same principle applies, but the body is using both carbohydrates and fats for fuel. In between meal the body is using fat from the diet and stored fat.
A myth I hear often is that people on the ketogenic diet can eat as many calories as they want and still lose weight and body fat. The concept of energy in vs. energy out is still relevant here. If you are consuming more calories than your body needs you will gain weight. Period. It does not matter what diet you are on. Yes, some macronutrients might be utilized differently than others, but the law of thermodynamics still applies. This myth may exist because many people feel more satiated on a ketogenic diet. Fat is a highly satiating food and many people following this diet report eating a high fat meal and not feeling hungry for hours afterwards. They may eat 2-3 high fat meals during the day and feel full, but their overall calorie intake was equal or lesser than their calorie requirements for the day. Sorry folks, but there is not magic diet in which you can eat as many calories as you want and still lose weight.
I believe this provides some insight into the ketogenic diet. Basically, the goal of the diet is to switch over from using a combination of carbohydrates and fat as fuel to using predominantly fat or ketone bodies as fuel. Now you are probably wondering what benefits there might be to following this type of diet. Why would someone want to use ketones instead of glucose? Many people wan to know if it is a safe diet to follow. I am going to explore this question in future blog posts, so stay tuned.
In January, around the first of the new year, I sat down with my calendar and started planning out my races for 2016. My first goal was to run a marathon in order to qualify for the Boston marathon in 2017 and my second goal was to complete a half ironman distance triathlon. I spent quite a bit of time searching for local races and trying to plan out my race calendar to accommodate my goals. It made sense to do a spring marathon to qualify for Boston and a late summer/early fall half ironman. I chose the Steamboat Marathon in June and the Harvest Moon Long Course Triathlon in September. In June I achieved my goal of qualifying for Boston (while winning the race). On September 18th I also completed my goal of completing my first half ironman distance race, but it was not easy.
I knew it was going to be a hot race because I followed the weather forecast during the days leading up to the race. I was happy that it was not going to be cold or rainy. Race morning it started out a little breezy. When my swim wave was about to start there was a gust of wind out of nowhere. The wind did not stop there. The swim started off like any other race, but when we reached the middle of the lake it was choppy with white caps and occasional large and unpredictable waves. I struggled to find the buoys and got off track a few times. After sucking in a few gulps of water I was only able to take breaths on one side, which threw me off of my usual bilateral breathing and made it even more difficult to stick to a straight line. I never once felt like I was going to drown and never panicked, which I owe to the horsetooth triathlon training open water swims this summer. When I finally got the home stretch I really started to feel good. I just wanted that damn swim to be over so I swam as hard as I could for the last 400 meters to the finish.
I was the most worried about the bike portion of the race. I had to change a tire the day before the race due to having a staple (or something similarly sharp) stuck in my tire. I changed the tire, but was unable to take the bike for a test ride. So I pumped the tired full of air and made sure I had everything I needed in case I got a flat on the course. I got on the bike and felt relief to be done with the swim. After heading out of the reservoir and onto highway 36 I started to really notice the wind. I decided I would not let it bug me because I was not the only one out there having to deal with it. It got so bad a few times I had to get out of the aero position because I thought it might blow me off the road. I finished the first lap in good time, but was worried about my run. I have traditionally always felt great during the run in olympic races, but this was over twice the distance on the bike. I decided to take the second half a little easier and save my legs for the run.
By the time I made it back to transition it was getting hot. The wind was still blowing, but it was not a cool wind. It was a warm, blustery wind. I got my running shoes on and some nutrition and headed out for the run. My legs felt a little heavy, but they always do when I first get off the bike. After about a half mile I started to get in the groove. I made sure to stop at the aid stations for water or gatorade. I was passing people, lots of people. My pace was good, not too fast. I made it through the first lap feeling good and glad that I only had one lap to go. I felt good until about mile 9 and then my legs started to feel heavy again. I drank half a coke, a handful of pretzels, and 2 large glasses of water. Maybe I just needed some instant sugar and fluids. That helped for another couple of miles, but the heat finally got to me. By mile 11 I was hurting. I kept thinking to myself “just put one foot in front of the other.” After mile 11 my pace significantly slowed, but I finished. I was so relieved to make it to the finish line. I did it! I completed the half ironman triathlon. The weather was not perfect, but I did not have any major technical difficulties or medical emergencies.
I ended up finishing 19th overall female and 3rd for my age group. For my first race of that distance I am happy. I know with a hectic summer schedule of vacations, weddings, and professional conferences that it was difficult to get all of the quality training sessions that I would have liked. I set up a plan and I knew I would have a few breaks in the training, but I did the best I could.
Before this race I was contemplating doing an ironman triathlon. In fact, I was thinking of doing the Boulder Ironman next June. It would be tough just two months after the Boston marathon, but I was thinking it might be a good challenge. After this race I am having second thoughts. I feel that it would be too much to put on my plate to train for both Boston and an ironman. I also can’t contemplate doing a triathlon of double the distance. I am sure I could do it, but I am not sure I want to. I feel that I would need to designate almost an entire season just to training and preparing for an ironman. So I have decided to focus on the Boston marathon and maybe another half ironman, but I may also try my hand at an ultra marathon. For now I will relax, focus on strength and conditioning, and start building my Boston marathon training plan.
I have shared some of my health issues on my blog in the past including my struggles with iron deficiency anemia and overtraining. During my experience with overtraining I left one detail out because at the time I thought some of my thyroid issues I was experiencing were related to overtraining and pushing my body too hard. After my marathon in 2010 and the subsequent elevated heart rate that I experienced I made an appointment with one the of the campus doctors. During our appointment he did some lab tests including thyroid stimulating hormone (TSH) and thyroid antibodies (thyroid peroxidase). The labs indicated that I had hyperthyroid and that the thyroid antibodies were elevated. He diagnosed me with a condition know as Hashimoto’s Thyroiditis. I was in denial at the time because my thyroid was hyperactive (hyperthyroid) and typically Hashimoto’s presents as an underachieve thyroid. I was also in denial because I felt that all of these issues were related to the marathon training and would eventually go away with adequate rest and recovery. I put the diagnosis behind me and went on with my life.
After taking a month off after my marathon my heart rate came back down to normal and I was able to start training again. In fact, I was able to compete in the collegiate national championships for triathlon that April. After graduating with a master’s degree in human nutrition I went on to my dietetic internship at the University of Houston in Texas. I continued to train while I was there and had no thyroid symptoms. When I got back to Colorado after the completion of my internship I trained for another marathon and continued to have no problems with my thyroid. I thought for sure the doctor had falsely diagnosed me. I even had my TSH checked at one point and it was within the normal range (I did not have the thyroid peroxidase checked or the free T3 and T4).
Everything seemed to be going well until this past winter. I started to feel out of sorts and not myself. I had a hard time getting out of bed in the morning on some days and would long to just lay in bed all day. My mind felt sluggish. I remember worrying that someone at work would notice that it was taking longer for me to process information. I had trouble finding the words to explain things. I was still exercising, but some days it felt like it took all of my willpower just to make it to the gym. I know something was off so I made an appointment with a local physician. Here is an article from Fuelary.com about symptoms of both hypo- and hyperthyroid.
After explaining my past diagnosis and my symptoms the physician ordered a thyroid panel blood test, which included the thyroid antibodies, TSH, and thyroid hormones free T3 and T4. It seemed like a really long time before I received the results, but it was confirmed, I had Hashimoto’s Thyroiditis. There was no denying it any longer. My thyroid peroxidase numbers were around 500 and normal or negative results would be closer to zero. My thyroid is literally attacking itself. This means that I will likely have to be on thyroid medication the rest of my life and it means that my thyroid levels will likely fluctuate, but eventually I could lose the function of my thyroid completely. Yikes!
Hashimoto’s is one of the most common causes of hypothyroidism. It is an autoimmune disease and much like other autoimmune diseases, there is no cure. Sometimes I blame myself for the disease. If only had listened to my body and not overtrained for that marathon, or, if only I had taken better care of myself when I was younger. The truth is that the true cause of the disease is unknown. There are only theories as to why people get Hashimoto’s (and many other autoimmune diseases), which includes a genetics, a bacterial or viral infection, stress, damaged or leaky gut, pregnancy, and even gender. Likely it is not one factor that leads to an autoimmune disease, but many factors.
As a dietitian/nutritionist my first reaction was to turn to my diet. Surely diet must play a role. I may never know if my diet contributed to the disease, but perhaps I can manage the disease with diet or at least slow down the progression of the disease? There are theories that gluten may play a role, or perhaps it is a leaky gut that is the problem, maybe dairy? The research is scarce. Information on the internet is full of misinformation and misinterpretation of the few studies that are available. You would think that if this is the most common cause of hypothyroid it would be a little better researched, but why bother? It is not deadly and it can be managed by simply popping a thyroid pill everyday. From my experience that is now most physicians approach the treatment.
Even with the thyroid medication, I often sense there is something off with my thyroid. Some days I am full of energy and feel great. Other days I am wrecked with anxiety and feel tired and sluggish. It does not matter if I sleep well or not. I have been able to manage the best that I can and I have been determined to not let it slow me down. I was able to train and win a marathon this spring. I have been able to train for a half ironman distance triathlon and I just received confirmation of my entry into the Boston marathon in 2017.
I plan to continue to experiment with my own diet as well as recovery strategies including stress management and improving sleep quality. During this time I will continue to blog about my personal journey with my autoimmune disease. I will include the research studies available on Hashimoto’s and diet as well as other treatment/management options. My hope is that my personal story will help others struggling with an autoimmune disease. I also hope that it inspires people who are experiencing the symptoms of a thyroid condition to get the lab test done and seek treatment and support.
Starting the day with a proper breakfast can help set you up for the remainder of the day. I noticed that when I ate a high carbohydrate diet without much protein that I was hungry within a couple of hours. When a little protein and fat is added to breakfast I can feel satisfied for hours. Most people think of pancakes as a high carbohydrate meal. For many people balancing a few pancakes with the addition of an egg or two can help increase protein content of that meal. I have an egg intolerance so eggs with breakfast are not a good choice for me. In addition, this means using another pan to cook eggs and making more of a mess. This may not be a good option on a work-day morning or on a morning when there is a workout planned within a couple of hours. These high protein pancakes paired with nuts or nut butter can be very satisfying and can be the perfect fuel to start the day.
I purchased a similar pancake at the grocery store, but it cost about $5-6 per bag with only about 3-4 servings. I decided to make my own pancake recipe. These pancakes are also gluten free so they are great for people who may be intolerant to eggs and/or gluten.
The basic ingredients you will need: Gluten free oat flour, whey protein powder (whey protein isolate), buttermilk, coconut flour, baking soda, baking powder, xanthan gum, organic milk or almond milk (keep in mind almond milk is not high in protein) and coconut oil (or vegetable oil) for cooking.
Mix all the dry ingredients together in a large bowl. This will make about 3-5 servings. I take about 1 cup of mix from this mixture and I will place the remaining pancake mixture into a container to make pancakes another day. I usually store the remaining pancake mix in the fridge. Place the 1 cup of mixture into a separate bowl.
Heat a large skillet or flat pan on medium heat and add about 1-2 teaspoons of oil.
Take the 1 cup of the dry mixture and add 3/4-1 cup of milk (depending on how thick or thin you enjoy your pancakes). Mix using a large spoon and let stand for 2-5 minutes.
Once the pan or skillet is heated and coconut oil is melted, make sure oil is covering the pan. Add a large spoonful of pancake mixture to the pan (spread out the mixture to desired thickness). If you have a large pan you can cook several pancakes at once.
Cook one side until the pancakes is browned. Also the pancake will be easier to flip. If you are having trouble getting the spatula under the pancake to flip, cook for another minute or two. Flip the pancake using the spatula and cook on the other side until lightly browned and the pancake is cooked all the way through.
Place pancakes on a 9″ plate and top with almonds or almond butter. You can also top with walnuts. I use a small amount of real maple syrup on top of my pancakes, but this is not necessary.
Alternative pancake mixtures:
To make blueberry pancakes: Add 1/2-1 cup of blueberries after mixing in the milk. Frozen blueberries work well, however, you may end up with purple colored pancakes.
To make orange cranberry pancakes: Mix 2/3 cup of milk with 1/3 cup of orange juice concentrate and then add t
o 1 cup of dry pancake mixture. Add 1/3 cup of craisins or dried cranberries (or cherries). Top with slivered almonds.
Be creative and make your own pancake flavorings. Some other ideas include adding dark chocolate chips, coconut flakes, or even adding pumpkin to the wet ingredients to make pumpkin pancakes.