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Running and Running related Injuries – Training Nutrition and RED-S Prevention

Part 3 of our Series on Running and Running Injuries

Your Guide to Optimal Training Nutrition and RED-S Prevention

A well-planned plant-based diet can be both healthy and performance-enhancing. The key is ensuring enough energy and carbohydrates to support both athletic performance and bone health.

Carbohydrates: An Underrated Factor for Bone Health

Did you know that carbohydrates are crucial not only for athletic performance but also for bone health? Carbohydrates are the body’s main energy source and play a key role in maintaining bone mass. Inadequate carbohydrate intake can reduce bone density and increase fracture risk, regardless of total calorie intake.

Potentially Higher Fracture Risk with Plant-Based Diets

Some studies suggest that vegans may have a higher risk of bone fractures – around 2.3 times higher than people who eat an omnivorous diet. Vegetarians also show a 25% increased risk (1,2). One possible reason could be energy availability: plant-based diets are often high in fiber, which increases satiety. Although that’s beneficial in general, it can sometimes lead to a lower overall energy intake, and in particular fewer carbohydrates – which may affect bone health (3,4).

Carbohydrates for Athletes: How to Do It Right

For endurance athletes, the proper amount and timing of carbohydrate intake are especially important. Below are the current recommendations:

Before Training:
1–4 g of carbohydrates per kilogram of body weight (g/kg) should be consumed 1–4 hours before training. Meals with mixed carbohydrates like glucose and fructose are particularly helpful for replenishing overnight-depleted liver glycogen stores (5–7).
During Training:
For training sessions lasting over an hour, 30–60 g of carbohydrates should be taken in per hour. For particularly long sessions (over 2.5 hours), intake can be increased to as much as 90 g per hour. A combination of glucose and fructose (in a 1:0.8 ratio) improves absorption and performance (5,6,8).
After Training:
To optimize recovery, it’s recommended to consume 1.0–1.2 g/kg of carbohydrates per hour in the first four hours post-exercise. Combining glucose and fructose speeds up glycogen replenishment in both the muscles and the liver (6).
Daily Requirement:
Depending on training intensity, endurance athletes need between 6–12 g of carbohydrates per kilogram of body weight per day. High-intensity training requires more energy, which is why the upper limit can be 10–12 g/kg (5,6,9).

Low Carbohydrate Availability and Its Consequences

Insufficient carbohydrate intake, also known as Low Carbohydrate Availability (LCA), can severely compromise both health and performance. Recent studies show that LCA increases the risk of Relative Energy Deficiency in Sport (RED-S), which is associated with bone damage, reduced iron stores, and diminished performance. In over 90% of overtraining cases, inadequate energy and carbohydrate intake have been observed (10). What’s particularly concerning is that even when total calorie intake is adequate, too few carbohydrates can speed up the onset of RED-S.

Conclusion: Plant-Based Eating Done Right

A well-planned plant-based diet can be both healthy and performance-enhancing. The key is ensuring enough energy and carbohydrates to support both athletic performance and bone health. Athletes should be mindful of their specific nutritional needs and make sure they eat the right foods at the right times. For vegans and vegetarians, this often means taking a more detailed look at nutrition in order to prevent potential deficiencies.

>> Download here our “Handout Guide Versorgung Training” (PDF) <<

Sources

Iguacel I, Miguel-Berges ML, Gómez-Bruton A, Moreno LA, Julián C. Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis. Nutr Rev. 2019;77(1):1–18.
Ogilvie AR, McGuire BD, Meng L, Shapses SA. Fracture risk in vegetarians and vegans: the role of diet and metabolic factors. Curr Osteoporos Rep. 2022;20(6):442–52.
Heikura IA, Uusitalo ALT, Stellingwerff T, Bergland D, Mero AA, Burke LM. Low Energy Availability Is Difficult to Assess but Outcomes Have Large Impact on Bone Injury Rates in Elite Distance Athletes. Int J Sport Nutr Exerc Metab. 1. Juli 2018;28(4):403–11.
McKay AK, Wallett AM, McKune AJ, Périard JD, Saunders P, Whitfield J, u. a. The Impact of a Short-Term Ketogenic Low-Carbohydrate High-Fat Diet on Biomarkers of Intestinal Epithelial Integrity and Gastrointestinal Symptoms. Int J Sport Nutr Exerc Metab. 2023;1(aop):1–11.
Pöchmüller M, Schwingshackl L, Colombani PC, Hoffmann G. A systematic review and meta-analysis of carbohydrate benefits associated with randomized controlled competition-based performance trials. J Int Soc Sports Nutr. 5. Januar 2016;13(1):27.
Podlogar T, Wallis GA. New Horizons in Carbohydrate Research and Application for Endurance Athletes. Sports Med. Dezember 2022;52(S1):5–23.
Wallis GA, Podlogar T. DIETARY CARBOHYDRATE AND THE ENDURANCE ATHLETE: CONTEMPORARY PERSPECTIVES. 2022;35(231).
Kloby Nielsen LL, Tandrup Lambert MN, Jeppesen PB. The Effect of Ingesting Carbohydrate and Proteins on Athletic Performance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 20. Mai 2020;12(5):1483.
Brietzke C, Franco-Alvarenga PE, Coelho-Júnior HJ, Silveira R, Asano RY, Pires FO. Effects of Carbohydrate Mouth Rinse on Cycling Time Trial Performance: A Systematic Review and Meta-Analysis. Sports Med. Januar 2019;49(1):57–66
Mountjoy M, Ackerman KE, Bailey DM, Burke LM, Constantini N, Hackney AC, u. a. 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. September 2023;57(17):1073–98.

Running and Running related Injuries – Training Nutrition and RED-S Prevention

Your Guide to Optimal Training Nutrition and RED-S Prevention

Carbohydrates: An Underrated Factor for Bone Health

Potentially Higher Fracture Risk with Plant-Based Diets

Carbohydrates for Athletes: How to Do It Right

Low Carbohydrate Availability and Its Consequences

Conclusion: Plant-Based Eating Done Right

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