Medical Advice for your First Marathon
Distance: Most first time marathoners have been training for at least 4 months. There are many training guides for novice marathon runners and all of them will have you gradually increase your long runs to build stamina. They will also include rest days to help your body recover and adjust to longer distance running. Following a training guide will help you get to 20+ mile runs a few weeks before race day. It is important to follow your schedule closely and remember to actually rest your body on the rest days since most of the injuries we see on race day are aggravations of overuse injuries from training. Remember also that your long runs are designed to build endurance and should be run at a comfortable slower pace.
Nutrition: Everybody has their favorite weight loss diet, but that isn’t your problem; you are training for a marathon. Remember this: carbs are good! Carbs help you build up your glycogen stores; muscle glycogen is your main source of energy when running. You will deplete glycogen stores on a long run and carb loading will help you increase your exercise capacity for longer runs. More recently experienced marathoners have made some reasonable arguments for a lower carb, fat burning diet to help improve endurance once muscle glycogen is depleted in the second half of the marathon. Some trainers now suggest a high fat diet for 1-2 weeks prior to a marathon to increase fat burning capacity and then follow that with the old advice of several days of carb loading just prior to race day. Protein is also a very important part of your training diet. Good quality protein is needed to help repair your muscles after exercise. Greek yogurt is a good option for this since it has twice the protein and half the sugar of standard yogurt. Try to eat protein within an hour of your workout as you recover from your longer runs.
Of course, we still want you to have a normal healthy diet whether or not you are training for a marathon. We still recommend a diet high in fruits and vegetables (at least five servings a day with a good mix of colors), nuts and beans, dairy products (milk, cheese, and yogurt), and high quality protein (fish, lean meat, poultry or eggs).
Race Day:The biggest concern for a first time marathon runner is hitting the wall. The “wall” is caused by dehydration and carb depletion. You can avoid both of these by planning your fluid and carb intake in your training and on race day.
Fluids: You need fluids when you run. The amount of fluid loss depends on how fast you run and the ambient temperature. If you want to know how much fluid you actually lose when running, you can weight yourself without clothes before and after a long run (although we advise you to wear clothes while you are actually running). Each pound of weight lost is equal to about 16 ounces of fluid lost.
A good rule for a four-hour marathoner is to drink 6 ounces of fluid every 20 minutes. Since we have aid stations about every 2 miles along the course, you will do well to take a cup of Gatorade (our sponsoring sport drink) at every aid station.
Typical temperatures for the NVM is 40 degrees at the start of the race and 60 degrees at the finish. If it is warmer, you may need a little more water along the course. The Gatorade will provide you with sodium, fluids and carbohydrates. You are going to burn about 100 calories or more per mile while running and muscle glycogen stores are depleted after about 6 miles. If you drink 6 ounces of Gatorade per rest stop (18 ounces per hour), you will take in about 32 grams of carbohydrate or 130 calories per hour. That should be about right for most 4 hour marathon runners.
Over hydration both before and during the race should be avoided. You will lose a lot of salt in sweat as you run. Drinking too much plain water before and during the race increases the risk of hyponatremia, which is a very serious medical condition in distance runners. Although Gatorade supplies some sodium, it may be helpful to eat a pretzel or other salty food in the second half of the race. We will have that on the course for you.
Another concern with excessive fluid intake is that your stomach will empty much more slowly when you are running. If you drink too much too fast, the fluid will nowhere to go. Slow and steady fluid replacement will help you avoid puking at the side of the road. Most runners find that to be an unpleasant experience during a marathon. On race day, it is good to drink 16 ounces of water or a sport drink about 2 hours before the start of the race, then to maintain a steady reasonable fluid intake of about 6 ounces every 20 minutes throughout the race.
Sport Gels: Energy gels contain 80 to 150 calories of carbohydrates. You may wish to use them mid or late in the race to avoid carb depletion. Don’t wait until race day to see how your body handles an energy gel. Your body has to adjust to the pure carb load and you want to be sure you test this in your training routine. Overindulgence in use of sport gels can lead to diarrhea – another unpleasant event on race day.
Speed: If this is your first marathon, your finish time will be your personal best. If you really want to finish this race, run at your own pace. The NVM is a beautiful course. The first half of the course has very gentle hills and gentle curves. It will be a little cold at the start. It is really easy to come out too strong and too fast. Your own adrenaline and the company of lots of fast runners will just pull you right along with them. But, stick to your race plan. Wear a watch. The course has accurate mile markers at every mile. Pay attention to your planned mile pace. You know the pace you can easily run on your long training runs. Stay closer to that time and enjoy the course. It really is beautiful and wouldn’t it be nice to finish strong and upright with a little kick left?
Medical Support for the Napa Valley Marathon
We have aid stations approximately every 2 miles along the course. Experienced Kaiser Permanente physicians, nurses and physical therapists are located along the course at each aid station from 9.4 miles onward. Ambulances are located at the finish area and at several points along the course. There is a sag bus that follows the field to offer transportation to runners who cannot finish the race.
The medical team supplies first aid to runners. We cannot dispense any medications along the course. In addition, we do not recommend runners take NSAID type medications such as ibuprofen, naproxen, or aspirin during the race. NSAIDs can cause nausea, stomach upset and they will decrease blood flow to your kidneys. If you need an NSAID, take it after you finish and you feel well hydrated (peeing nice and clear is a good sign that you are back to normal hydration).
The medical team at the finish line offers assistance to any runner with a medical problem. The medical center in the finish area has experienced medical staff and is equipped with cots, blankets, and medical supplies. Physical therapists are available in the Vintage HS quad area. Massage therapists are located in the Vintage HS gym.
-Jim Cotter, MD