I've recently been checked for the early stages of diabetes. I'm 50, eat very well, complete annual marathon training, and don't drink much, but there is a high occurrence of diabetes in my family (three of my siblings and my mother are diabetic). How do I carbo-load while marathon training without aggravating or creating more diabetes issues? Thank you–Richard Richard, Your's is an interesting question and a tough hand to be dealt. Still, having a family history with probable predisposition to diabetes and actually having diabetes mellitus type 2 aren't the same thing. Without knowing your height, weight, hemoglobin A1c level, and fasting glucose level, it is a bit difficult to say whether you have diabetes or not. You seem to have a healthy lifestyle with good exercise habits and food choices, so I'll assume that you have a BMI less than 25, that you have pre-diabetes, and you are not on any medications for diabetes at this time. I don't think you need to carbo-load for your training runs. You should eat a well balanced diet and try to mix your foods so the glycemic index is less than one. I think of a potato alone as an example of a glycemic index of one, which means that the starch is easily absorbed into the blood stream and blood sugar peaks quickly. Mixing the potato with meat and vegetables pulls the glycemic index down–you get slower absorption and a lower peak of carbohydrate in the blood stream. Eating fewer refined foods does the same thing. If your total calorie intake matches the calories you burn through running and daily activity, you should maintain your weight and muscle glycogen levels. As race day approaches, you may be able to increase the carbohydrate portion of your diet, but you should discuss this with your physician, especially if you are on medications. It sounds like you are doing all you can to ward off the disease, and you're a great example that exercise is medicine. Try the American Diabetes Association for some more reliable information on diet and fitness. Hope this helps. Cheers, Bill Have a question for the Sports Doc? E-mail him at firstname.lastname@example.org . NOTE: Due to the volume of mail, we regret that Dr. Roberts cannot answer every e-mail.
I have a family history of osteoarthritis, particularly in the knees. I began running recently and I’m wondering if I’m doing myself any harm. For many years my knees have popped and cracked, but they only hurt if I put a lot of weight on them, as I might when climbing a steep trail. They do not bother me when I run. If I am destined to have osteoarthritis, am I making it worse by running? I don’t run more than 10-15 miles per week.–Corey Corey, This is a great question and one that probably generates many conflicting answers. Running at a recreational level, away from steep climbs and ascents, should not cause any problems for your knees. Pops and crackles that are not associated with pain or loss of joint motion are just pops and crackles–they have little medical significance. There does seem to be a familial tendency to develop osteoarthritis, but there are no guarantees either way. You may end up with OA of the knees or you may not; running at your level will most likely not be the cause. Osteoarthritis is a non-inflammatory deterioration of the articular cartilage of the knee. The articular cartilage does not have a blood supply that courses through the full depth of the structure and the cartilage depends upon the sponging effect of weight bearing to get some of its nutrition. Running may help this process and three to five miles, three to five times a week could actually be a benefit and help ward off early onset of OA. There are studies of mice and men (and women) that show equal or less OA of the knees in runners compared to sedentary people. If you become symptomatic with running, you might consider changing to another activity or limiting your running to within the pain-free range. While it is hard to top the ease and convenience of running, the health benefit of any activity that raises your heart rate and makes you breathe hard for 30 to 40 minutes three or more times a week will give you the same health benefits as running. There are even great health benefits from casual or conversational walking. So keep running as long as you can and keep active for a life time. Hope this helps. Cheers, Bill Have a question for the Sports Doc? E-mail him at email@example.com . NOTE: Due to the volume of mail, we regret that Dr. Roberts cannot answer every e-mail.
I am a 41-year-old man. I've been running for more than 30 years. An MRI recently confirmed that the tightness and burning in my left glute and hamstring, and my lower back stiffness, are bulges and tears with the L4/5 and L5-S1 discs. I just had a steroidal injection, which reduced my pain by 50 to 60 percent. My question is this: Do you believe that long-distance running has caused my disc issues? I tend to think that my disc problems are the result of age and the bad posture, poor lifting, and the occasional incident (like a wave-rider mishap 10 years ago), but some health professionals are discouraging my running, as though it is definitely the culprit. What do you think? Thanks–Chris Chris, It sure is easy to blame things on running, but there is little data to support the contention that running causes disc disease or hastens its progression beyond an individual’s genetic predisposition. Sports that I consider high risk for disk injury include rowing, football, wrestling, hockey, gymnastics, tennis, and golf; all share some or many of the common mechanisms of herniation-flexion, rotation, and compression of the spine. In straight-ahead running on the roads or the track, the compressive loads are probably minimal compared to the forces that occur in the lumbar spine of a football interior lineman (or woman). So to answer your question, I would say that it is slightly possible that your running caused your disc problems and quite possible that running can make your pain worse at times. I tend to side with your assessment that genetics, bad posture, poor core strength, improper lifting, and the incidental incidents like the “wave rider” crash did more to damage the discs. Herniated discs usually take 6-12 months to “heal” and during that time it is important to stay fit with walking or any activity that does not flair your pain. You should look at your core strength and do simple strengthening activities like forward, side, and back bridges to help support your spine. Fredericson and Moore have a nice article on core stabilization here . I would also recommend that you find a provider who works with athletes and is skilled in manual therapy to assess your pelvis and low back. If the pelvis is rotated, you can get pain in the buttocks, groin, and hamstring that is similar to radicular disc pain. With time and strengthening, you should be able to get back to running, but it will be a long term project. I hope this helps. Cheers, Bill Have a question for the Sports Doc? E-mail him at firstname.lastname@example.org . NOTE: Due to the volume of mail, we regret that Dr. Roberts cannot answer every e-mail.
Dr. Roberts, After having a baby in March, I learned that I had a deep vein thrombosis caused by May-Thurner syndrome. I was very active during my pregnancy and ran or exercised all the way to my due date. I had no swelling until four days after giving birth. I had three days of surgery to remove the DVT and now have a filter and stint. I dreamed of running a marathon soon after delivery since things had gone so well, but now, five months post delivery, I am struggling to even run ten feet. Will I ever run again, and what can I do to try and rehab my leg?–Taylor Taylor, Deep vein thrombosis is a tough problem for runners and other athletes because the return to activity can be so difficult. May-Thurner Syndrome is caused by compression of the left common iliac vein by the overlying right iliac artery, resulting in impeded venous blood flow from the left lower extremity, sometimes causing a DVT in the left leg. This is made worse by the weight gain of pregnancy. It was not caused by your running during pregnancy. You are struggling with Post Thrombotic Syndrome, a condition that can occur in up to 50 percent of DVT patients. It is most prevalent following recurrent DVT in the same leg. In a normal vein there are valves that keep blood moving forward toward the heart as leg muscles and the normal blood pressure squeeze and push the blood upstream. A DVT damages the venous valves and the blood is pulled back toward the ankles by gravity. This back pressure causes swelling and pain, sometimes excruciating pain. Post Thrombotic Syndrome usually subsides with time, although there is little data to give you an evidence based answer to the problem. Until the pain subsides with daily activities, I usually I have my patients use support or compression stockings to the knees and or, depending on the extent of the previous clot and the response to the stockings, to the thighs. Then I have them use the stockings only with running. Most have been back to full activity without the stockings in 2 years, but a few have taken longer to be pain free. Although I have not seen people who have many years of pain, it is reported in the literature. On the bright side, I took care of a 20-something woman with Post Thrombotic Syndrome for about 2 years in the 80’s and she can still beat me on foot, on skis, or on a bike–easily and consistently–so there is hope yet for your running. I hope this helps you. Enjoy your baby. Cheers, Bill Have a question for the Sports Doc? E-mail him at email@example.com . NOTE: Due to the volume of mail, we regret that Dr. Roberts cannot answer every e-mail.