Nutritional implications for ultra-endurance walking and running events
Open accessAbstract
This paper examines the various nutritional challenges which athletes encounter in preparing for and participating in ultra-endurance walking and running events. Special attention is paid to energy level, performance, and recovery within the context of athletes' intake of carbohydrate, protein, fat, and various vitamins and minerals. It outlines, by way of a review of literature, those factors which promote optimal performance for the ultra-endurance athlete and provides recommendations from multiple researchers concerned with the nutrition and performance of ultra-endurance athletes. Despite the availability of some research about the subject, there is a paucity of longitudinal material which examines athletes by nature and type of ultra-endurance event, gender, age, race, and unique physiological characteristics. Optimal nutrition results in a decreased risk of energy depletion, better performance, and quicker full-recovery.
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The calories consumed by some ultra-endurance athletes is reported to be between 36 and 53% of their racing energy expenditure.
“the calories consumed by some ultra-endurance athletes is reported to be between 36 and 53% of their racing energy expenditure [13, 15–17].”
From International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing (2019) · cites this paper as [13]
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BackgroundUltra-Endurance Exercise and Oxidative Damage: Implications for Cardiovascular Health
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BackgroundMagnesium Metabolism and Deficiency
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Effects of exercise on protein and amino acid metabolism
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“[172] examined the effect of quercetin supplementation on inflammation after three consecutive days of cycling and following an ultra-endurance run.”
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“Both inadvertent symptoms such as gastrointestinal challenges and injury, including those that are dermatologically related, increase the risk of insufficient food and fluid intake with and without the addition of environmental challenges [31, 32].”
BackgroundHoffman, M. D., Pasternak, A. V., Rogers, I. R., Khodaee, M., Hill, J. C., Townes, D. A., Scheer, B. V., Krabak, B. J., Basset, P., & Lipman, G. S. (2014) · Sports Medicine · doi:10.1007/s40279-014-0189-3 · Cited by 112 · cited 1× · see citing works
“Both inadvertent symptoms such as gastrointestinal challenges and injury, including those that are dermatologically related, increase the risk of insufficient food and fluid intake with and without the addition of environmental challenges [31, 32].”
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Exercise-associated hyponatremia and hydration status in 161-km ultramarathoners
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“Common GI challenges that hinder intake include nausea, abdominal cramping, bloating, diarrhea, vomiting, flatulence, and belching [26, 36].”
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“Hydration As little as a 2% reduction in body mass due to dehydration has been said to result in performance decrements as well as hemorheology, metabolic dysregulation, heat intolerance, and cardiovascular strain [103].”
BackgroundAerobic Exercise Training Increases Skeletal Muscle Protein Turnover in Healthy Adults at Rest
Pikosky, M. A., Gaine, P. C., Martin, W. F., Grabarz, K. C., Ferrando, A. A., Wolfe, R. R., & Rodriguez, N. R. (2006) · Journal of Nutrition · doi:10.1093/jn/136.2.379 · Cited by 108 · see citing works
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“[74] attempted to test an intake of 85 g and found that it did indeed decrease performance due to provocation of GIS.”
BackgroundQuercetin and Endurance Exercise Capacity: A Systematic Review and Meta-analysis
KRESSLER, J., MILLARD-STAFFORD, M., & WARREN, G. L. (2011) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31822495a7 · Cited by 105 · cited 1× · see citing works
“[194] encompassing the above research concluded that quercetin supplementation can improve human endurance exercise capacity in a small but significant magnitude (~3%).”
BackgroundOral salt supplementation during ultradistance exercise
Speedy, D. B., Thompson, J. M. D., Rodgers, I., Collins, M., & Sharwood, K. (2002) · Clinical Journal of Sport Medicine · doi:10.1097/00042752-200209000-00004 · Cited by 104 · cited 1× · see citing works
“9 g/L of fluid consumed to allow for fluid retention, more recent data have shown no benefit to hydration [19, 27–29, 104, 115] or blood serum sodium levels [19, 28, 29, 115] by consuming supplemental sodium during these races.”
BackgroundAngus, D. J., Hargreaves, M., Dancey, J., & Febbraio, M. A. (2000) · Journal of Applied Physiology · doi:10.1152/jappl.2000.88.1.113 · Cited by 101 · see citing works
Costa, R. J. S., Gill, S. K., Hankey, J., Wright, A., & Marczak, S. (2014) · British Journal of Nutrition · doi:10.1017/s0007114514000907 · Cited by 99 · cited 1× · see citing works
“This is subsequently associated with poor recovery from exercise and sustained fatigue [14, 15].”
BackgroundFood Intake and Electrolyte Status of Ultramarathoners Competing in Extreme Heat
Glace, B. W., Murphy, C. A., & McHugh, M. P. (2002) · Journal of the American College of Nutrition · doi:10.1080/07315724.2002.10719254 · Cited by 97 · cited 1× · see citing works
“In fact, many studies have demonstrated that increases in the hourly rate of CHO and overall energy intake are correlated with faster race times in ultra-endurance events [8, 18, 41].”
BackgroundMicheletti, A., Rossi, R., & Rufini, S. (2001) · Sports Medicine · doi:10.2165/00007256-200131080-00002 · Cited by 96 · see citing works
Hew‐Butler, T., Sharwood, K. A., Collins, M., Speedy, D. B., & Noakes, T. D. (2006) · British Journal of Sports Medicine · doi:10.1136/bjsm.2005.022418 · Cited by 93 · cited 1× · see citing works
“9 g/L of fluid consumed to allow for fluid retention, more recent data have shown no benefit to hydration [19, 27–29, 104, 115] or blood serum sodium levels [19, 28, 29, 115] by consuming supplemental sodium during these races.”
BackgroundProtein degradation during endurance exercise and recovery
Dohm, G. L., Tapscott, E. B., & Kasperek, G. J. (1987) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-198710001-00011 · Cited by 92 · cited 1× · see citing works
“It has been posited that supplemental protein or amino acids on top of this intake during an ultra-run may improve performance through provision of amino acids for use as a fuel source and to attenuate muscle damage [99].”
BackgroundHart, N., Sarga, L., Csende, Z., Koltai, E., Koch, L. G., Britton, S. L., Davies, K. J. A., Kouretas, D., Wessner, B., & Radak, Z. O. (2013) · Food and Chemical Toxicology · doi:10.1016/j.fct.2013.01.051 · Cited by 91 · see citing works
Intravenous iron supplementation in distance runners with low or suboptimal ferritin
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Dietary quercetin supplementation is not ergogenic in untrained men
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'Runner's trots'. Gastrointestinal disturbances in runners
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Race Diet of Finishers and Non-Finishers in a 100 Mile (161 km) Mountain Footrace
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“This being said, adequate food and fluid intake is related to a successful finish of an ultra-endurance race [7, 24] and an important key to attaining this adequacy seems to be an appropriate nutrition strategy during the race [25].”
BackgroundMoore, D. R., Areta, J., Coffey, V. G., Stellingwerff, T., Phillips, S. M., Burke, L. M., Cléroux, M., Godin, J.-P., & Hawley, J. A. (2012) · Nutrition & Metabolism · doi:10.1186/1743-7075-9-91 · Cited by 85 · cited 1× · see citing works
“To maximize protein synthesis, and thus muscle remodeling and recovery [89], it is suggested that endurance athletes consume a minimum of 20 g of protein at 3–4 h intervals to maximize muscle protein synthesis [75, 90].”
BackgroundFat Metabolism During Exercise: A Review. Part III: Effects of Nutritional Interventions
Jeukendrup, A., Saris, W., & Wagenmakers, A. (1998) · International Journal of Sports Medicine · doi:10.1055/s-2007-971932 · Cited by 85 · see citing works
Is the GI System Built For Exercise?
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“Although the evidence of this is mainly anecdotal, intestinal carbohydrate transporters can indeed be up-regulated [186, 187] and gastric emptying rates can be enhanced with training [188].”
BackgroundEffects of medium-chain triglyceride ingestion on fuel metabolism and cycling performance
Van Zyl, C. G., Lambert, E. V., Hawley, J. A., Noakes, T. D., & Dennis, S. C. (1996) · Journal of Applied Physiology · doi:10.1152/jappl.1996.80.6.2217 · Cited by 80 · cited 1× · see citing works
“[193] found that performance in cyclists who rode for greater than 2 h in a 40 km simulated time trial had greater performance with supplemented beverages containing CHO+MCT during the trial rather than either CHO or MCT alone.”
MethodNo effect of nutritional adenosine receptor antagonists on exercise performance in the heat
Cheuvront, S. N., Ely, B. R., Kenefick, R. W., Michniak-Kohn, B. B., Rood, J. C., & Sawka, M. N. (2009) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.90812.2008 · Cited by 80 · see citing works
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“GIS occur less frequently after adequate training or when relative exercise intensity is reduced [189, 190].”
BackgroundGastrointestinal problems as a function of carbohydrate supplements and mode of exercise
Peters, H. P. F., SCHELVEN, F. W. V., Verstappen, P. A., de Boer, R. W., Bol, E., Erich, W. B. M., TOGT, C. R. V. D., & de Vries, W. R. (1993) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-199311000-00003 · Cited by 79 · cited 1× · see citing works
“Endeavoring to prevent GIS is important as it is one of the most common cited reasons for inadequate intake during events [176, 177] and is positively correlated with increasing duration [178].”
BackgroundAssociation of Gastrointestinal Distress in Ultramarathoners With Race Diet
Stuempfle, K. J., Hoffman, M. D., & Hew-Butler, T. (2013) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.23.2.103 · Cited by 78 · cited 2× · see citing works
“Endeavoring to prevent GIS is important as it is one of the most common cited reasons for inadequate intake during events [176, 177] and is positively correlated with increasing duration [178].”
BackgroundHydration Strategies, Weight Change and Performance in a 161 km Ultramarathon
Hoffman, M. D., & Stuempfle, K. J. (2014) · Research in Sports Medicine · doi:10.1080/15438627.2014.915838 · Cited by 77 · cited 4× · see citing works
“However, weight changes before and after an ultra-distance event do not provide an accurate indication of hydration status and weight loss greater than 2% does not necessarily have serious adverse consequences on performance [104].”
BackgroundInfluentialOxidation of Solid versus Liquid CHO Sources during Exercise
Pfeiffer, B., Stellingwerff, T., Zaltas, E., & Jeukendrup, A. E. (2010) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181e0efc9 · Cited by 75 · cited 1× · see citing works
“These carbohydrates can also be provided in gel or bar form as it was recently demonstrated that carbohydrates in a beverage are oxidized at similar rates to carbohydrates from a gel [53] and from a bar [54].”
BackgroundNoakes, T. D., & Speedy, D. B. (2006) · British Journal of Sports Medicine · doi:10.1136/bjsm.2005.020354 · Cited by 75 · cited 1× · see citing works
“In fact, this shift appears to be a primary result of fluid overload and is unrelated to sodium losses [109].”
BackgroundEffect of nitric oxide synthase inhibition on mitochondrial biogenesis in rat skeletal muscle
Wadley, G. D., & McConell, G. K. (2006) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00549.2006 · Cited by 73 · cited 1× · see citing works
“It provides many health benefits in humans [158] and has shown to encourage mitochondrial growth in rodents [159].”
BackgroundCosta, R. J. S., Teixeira, A. M., Rama, L. M. P. L., Swancott, A. J. M., Hardy, L. D., Lee, B., Camões‐Costa, V., Gill, S. K., Waterman, J. P., Freeth, E. C., et al. (2013) · Nutrition Journal · doi:10.1186/1475-2891-12-13 · Cited by 72 · cited 4× · see citing works
“found that it is in fact less reliable than relying on thirst as an indicator of hydration status [15].”
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“Although preloading with dietary fat, specifically medium chain triglycerides (MCT), has strong literature support to potentially improve performance based on its capacity to serve as a fuel source and spare muscle glycogen [63, 64], the majority of studies have found no glycogen preserving effect or improvement in sh…”
BackgroundMascher, H., Ekblom, B., Rooyackers, O., & Blomstrand, E. (2011) · Acta Physiologica · doi:10.1111/j.1748-1716.2011.02274.x · Cited by 71 · cited 1× · see citing works
“Numerous studies have reported increases in mixed muscle protein synthesis following a single bout [85, 86] of exercise, and both short-term (i.”
BackgroundA Perspective on Fat Intake in Athletes
Pendergast, D. R., Leddy, J. J., & Venkatraman, J. T. (2000) · Journal of the American College of Nutrition · doi:10.1080/07315724.2000.10718930 · Cited by 70 · cited 1× · see citing works
“Bringing calorie intake closer to energy expenditure using fat also improves performance when compared to a larger caloric deficit without extra fat [61, 62].”
BackgroundEpigallocatechin-3-gallate Increases Maximal Oxygen Uptake in Adult Humans
Richards, J. C., Lonac, M. C., Johnson, T. K., Schweder, M. M., & Bell, C. (2010) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181bcab6c · Cited by 70 · cited 1× · see citing works
“Some human studies have shown positive effects for endurance including V02 max [145], fat oxidation, and insulin sensitivity [146] in an untrained population; however, studies on trained subjects are yet to show benefits [147–149].”
BackgroundNutritional and Fluid Intake in a 100-km Ultramarathon
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“In competition, field research suggests that ultra-endurance athletes finish their races with an energy intake between 36 and 54% of energy expenditure [18, 34].”
BackgroundCHO Oxidation from a CHO Gel Compared with a Drink during Exercise
Pfeiffer, B., Stellingwerff, T., Zaltas, E., & Jeukendrup, A. E. (2010) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181e0efe6 · Cited by 69 · cited 1× · see citing works
“These carbohydrates can also be provided in gel or bar form as it was recently demonstrated that carbohydrates in a beverage are oxidized at similar rates to carbohydrates from a gel [53] and from a bar [54].”
BackgroundMuscle damage, physiological changes, and energy balance in ultra-endurance mountain-event athletes
Ramos‐Campo, D. J., Ávila-Gandía, V., Alacid, F., Mendez, F. S., Alcaráz, P. E., López-Román, F. J., & Rubio‐Arias, J. Á. (2016) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2016-0093 · Cited by 69 · cited 1× · see citing works
“[33] have found that the magnitude of the energy deficit is correlated with performance, which suggests that reducing this energy deficit may be an advantage.”
BackgroundOral Quercetin Supplementation and Blood Oxidative Capacity in Response to Ultramarathon Competition
Quindry, J. C., McAnulty, S. R., Hudson, M. B., Hosick, P. A., Dumke, C., McAnulty, L. S., Henson, D. A., Morrow, J. D., & Nieman, D. C. (2008) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.18.6.601 · Cited by 67 · cited 2× · see citing works
“[173] supplemented half of their 63 ultra-endurance running trained subjects with quercetin combined with niacin and vitamin C for 3 weeks leading up to and during a 160 km ultramarathon.”
BackgroundMethodJówko, E., Sacharuk, J., Bałasińska, B., Wilczak, J., Charmas, M., Ostaszewski, P., & Charmas, R. (2012) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.22.6.486 · Cited by 66 · see citing works
Effects of an extreme endurance race on energy balance and body composition - a case study.
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Effects of carbohydrate (CHO) and fat supplementation on CHO metabolism during prolonged exercise
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Gastric emptying in marathon runners.
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“Endurance training itself appears to enhance gastric transit time [191], and higher energy intakes during training further enhance this rate [192].”
BackgroundPsychophysiological response and energy balance during a 14-h ultraendurance mountain running event
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The Effects of EGCG on Fat Oxidation and Endurance Performance in Male Cyclists
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Nutrient intake and performance during a mountain marathon: an observational study
Kruseman, M., Bucher, S., Bovard, M., Kayser, B., & Bovier, P. A. (2005) · European Journal of Applied Physiology · doi:10.1007/s00421-004-1234-y · Cited by 58 · cited 2× · see citing works
“This being said, adequate food and fluid intake is related to a successful finish of an ultra-endurance race [7, 24] and an important key to attaining this adequacy seems to be an appropriate nutrition strategy during the race [25].”
BackgroundBurke, L. M., & Hawley, J. A. (1999) · Current Opinion in Clinical Nutrition and Metabolic Care · doi:10.1097/00075197-199911000-00015 · Cited by 57 · cited 6× · see citing works
“Van Zyl CG, Lambert EV, Hawley JA, Noakes TD, Dennis SC. Effects of medium-chain triglyceride ingestion on fuel metabolism and cycling performance.”
BackgroundInfluentialEffect of quercetin supplementation on maximal oxygen uptake in men and women
Ganio, M. S., Armstrong, L. E., Johnson, E. C., Klau, J. F., Ballard, K. D., Michniak-Kohn, B., Kaushik, D., & Maresh, C. M. (2010) · Journal of Sports Sciences · doi:10.1080/02640410903428558 · Cited by 55 · see citing works
Common Ultramarathon Injuries and Illnesses
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“Climate and environmental-specific injuries include blisters and sunburns in hot temperatures, [26] and frostnip and frostbite in cold temperatures [37].”
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148 PATHOGENESIS OF THE HYPONATREMIA OF EXERCISE
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Sodium Supplementation and Exercise-Associated Hyponatremia during Prolonged Exercise
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“9 g/L of fluid consumed to allow for fluid retention, more recent data have shown no benefit to hydration [19, 27–29, 104, 115] or blood serum sodium levels [19, 28, 29, 115] by consuming supplemental sodium during these races.”
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Gastrointestinal bleeding in competitive runners
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“GIS occur less frequently after adequate training or when relative exercise intensity is reduced [189, 190].”
BackgroundFrykman, P., Harman, E. A., Opstad, P. K., Hoyt, R. W., DeLany, J. P., & Friedl, K. E. (2003) · Wilderness and Environmental Medicine · doi:10.1580/1080-6032(2003)14[240:eoamee]2.0.co;2 · Cited by 50 · see citing works
Nutritional Determinants of Bone Health
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“A deficiency in both or either calcium and vitamin D increases the risk of low bonemineral density and stress fractures [119].”
BackgroundWilderness Medical Society Practice Guidelines for Treatment of Exercise-Associated Hyponatremia
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Effects of Six Weeks of Quercetin Supplementation on Physical Performance in ROTC Cadets
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Energy expenditure during 2 wk of an ultra-endurance run around Australia
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An Ultracyclist with Pulmonary Edema during the Bicycle Race Across America
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“In fact, sodium supplements taken in excess can result in inadequate weight loss and even unnecessary weight gain [118].”
BackgroundEnergy Expenditure in the Race Across America (RAAM)
Hulton, A. T., Lahart, I. M., Williams, K. L., Godfrey, R., Charlesworth, S. A., Wilson, M. G., Pedlar, C. R., & Whyte, G. P. (2010) · International Journal of Sports Medicine · doi:10.1055/s-0030-1251992 · Cited by 42 · see citing works
Nutritional Intake during an Ultraendurance Running Race
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Hypomagnesemia. A review of pathophysiological, clinical and therapeutical aspects.
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Protein turnover rates of two human subjects during an unassisted crossing of Antarctica
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No Fluid Overload in Male Ultra-Runners During a 100 km Ultra-Run
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“The eccentric contractions involved in running cause the greater portion of body mass lost as muscle mass comparatively [82] to more concentric-based ultra-endurance activities such as cycling [84].”
BackgroundUtter, A. C., Nieman, D. C., Kang, J., Dumke, C. L., Quindry, J. C., McAnulty, S. R., & McAnulty, L. S. (2009) · Research in Sports Medicine · doi:10.1080/15438620902901474 · Cited by 36 · see citing works
Contemporary Nutrition Approaches to Optimize Elite Marathon Performance
Stellingwerff, T. (2013) · International Journal of Sports Physiology and Performance · doi:10.1123/ijspp.8.5.573 · Cited by 36 · cited 4× · see citing works
“Carbohydrate Given that the majority of an ultra-endurance athlete’s training is spent engaged in lengthy durations of aerobic activity, many of these athletes are well adapted to utilizing lipids via oxidative phosphorylation [35].”
BackgroundInfluentialWinger, J. M., Hoffman, M. D., Hew-Butler, T. D., Stuempfle, K. J., Dugas, J. P., Fogard, K., & Dugas, L. R. (2013) · International Journal of Sports Physiology and Performance · doi:10.1123/ijspp.8.5.536 · Cited by 36 · cited 2× · see citing works
“9 g/L of fluid consumed to allow for fluid retention, more recent data have shown no benefit to hydration [19, 27–29, 104, 115] or blood serum sodium levels [19, 28, 29, 115] by consuming supplemental sodium during these races.”
BackgroundVitamins, minerals and race performance in ultra-endurance runners - Deutschlandlauf 2006
Knechtle, B., Knechtle, P., Schulze, I., & Kohler, G. (2008) · PubMed · doi:10.5167/uzh-12145 · Cited by 33 · see citing works
Feeding the ultraendurance athlete: practical tips and a case study.
Clark, N., Tobin, J., & Ellis, C. (1992) · PubMed · Cited by 31 · see citing works
Knechtle, B., Knechtle, P., Rüst, C. A., Rosemann, T. J., & Lepers, R. (2011) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0b013e31821606b3 · Cited by 29 · cited 1× · see citing works
“This being said, adequate food and fluid intake is related to a successful finish of an ultra-endurance race [7, 24] and an important key to attaining this adequacy seems to be an appropriate nutrition strategy during the race [25].”
BackgroundVeränderung der Körperzusammensetzung bei einem Ultralauf
Knechtle, & Bircher (2005) · Praxis · doi:10.1024/0369-8394.94.10.371 · Cited by 28 · see citing works
Knechtle, B., Knechtle, P., Mrazek, C., Senn, O., Rosemann, T., Imoberdorf, R., & Ballmer, P. (2011) · Journal of the International Society of Sports Nutrition · doi:10.1186/1550-2783-8-6 · Cited by 27 · see citing works
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Is Sodium Supplementation Necessary to Avoid Dehydration During Prolonged Exercise in the Heat?
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“Published data has shown that as high as 90–96% of ultraendurance runners use sodium supplements [27, 29, 104].”
BackgroundPreexercise medium-chain triglyceride ingestion does not alter muscle glycogen use during exercise
Horowitz, J. F., Mora‐Rodríguez, R., Byerley, L. O., & Coyle, E. F. (2000) · Journal of Applied Physiology · doi:10.1152/jappl.2000.88.1.219 · Cited by 26 · see citing works
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Gastrointestinal symptoms during long-distance walking
Peters, H. P. F., ZWEERS, M., BACKX, F. J. G., Bol, E., HENDRIKS, R. H. A., Mosterd, W. L., & de Vries, W. R. (1999) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199906000-00002 · Cited by 25 · cited 1× · see citing works
“The intake of the nutrients fat, fiber, and protein, have all been linked to GIS during exercise [182].”
BackgroundPaulin, S., Roberts, J., Roberts, M. G., & Davis, I. D. (2015) · Extreme Physiology & Medicine · doi:10.1186/s13728-015-0022-0 · Cited by 25 · cited 1× · see citing works
“However, because reductions in body mass can be attributed to substantial breakdown of body tissues such as adipose and muscle [11] and increases in weight can result from reduced diuresis as well as decreases in intracellular osmolytes including glycogen, proteins, and triglycerides, this would be an ineffective stra…”
BackgroundCase Study: Nutrition Planning and Intake for Marathon des Sables—A Series of Five Runners
McCubbin, A. J., Cox, G. R., & Broad, E. M. (2016) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2016-0016 · Cited by 25 · see citing works
Rapid orocecal transit in chronically active persons with high energy intake
Harris, A., Lindeman, A. K., & Martin, B. (1991) · Journal of Applied Physiology · doi:10.1152/jappl.1991.70.4.1550 · Cited by 24 · cited 1× · see citing works
“Endurance training itself appears to enhance gastric transit time [191], and higher energy intakes during training further enhance this rate [192].”
BackgroundRaschka, C., Plath, M., Cerull, R., Bernhard, W., Jung, K. A., & Leitzmann, C. (1991) · Zeitschrift für Ernährungswissenschaft · doi:10.1007/bf01651957 · Cited by 23 · see citing works
Case Study: Nutrition and Hydration Status during 4,254 km of Running Over 78 Consecutive Days
Dempster, S., Britton, R., Murray, A. M., & Costa, R. J. S. (2013) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.23.5.533 · Cited by 23 · see citing works
Vistisen, B., Nybo, L., Xu, X., Høy, C., & Kiens, B. (2003) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00118.2003 · Cited by 22 · see citing works
Feeding the Ultraendurance athlete: Practical tips ami a case study
CLARK, N., Tobin, J. W., & ELUS, C. (1992) · Journal of the American Dietetic Association · doi:10.1016/s0002-8223(21)00869-5 · Cited by 22 · cited 1× · see citing works
“However, the energy demands of their specific activity will vary, predominantly depending on the duration, intensity and type of exercise being engaged in [38].”
BackgroundNutrition Update for the Ultraendurance Athlete
Getzin, A. R., Milner, C., & LaFace, K. M. (2011) · Current Sports Medicine Reports · doi:10.1249/jsr.0b013e318237fcdf · Cited by 21 · see citing works
Oliver, S. J., Golja, P., & Macdonald, J. H. (2012) · High Altitude Medicine & Biology · doi:10.1089/ham.2011.1087 · Cited by 20 · cited 1× · see citing works
“Increases in intensity, duration, demand of terrain [45], experience level of the athlete [40], and altitude [46, 47], all, increase carbohydrate needs.”
BackgroundLaTulippe--a case study of a one hundred and sixty kilometre runner.
O'Hara, W. J., Allen, C., Shephard, R. J., & Gill, J. W. (1977) · British Journal of Sports Medicine · doi:10.1136/bjsm.11.2.83 · Cited by 19 · see citing works
Miller, S. L., Gaine, P. C., Maresh, C. M., Armstrong, L. E., Ebbeling, C. B., Lamont, L. S., & Rodriguez, N. R. (2007) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.17.5.456 · Cited by 18 · cited 1× · see citing works
“efficiency with training, a certain degree of metabolic efficiency does occur to mitigate amino acid oxidation with training [95], however, the rate of oxidation still increases over 2 h of endurance activity resulting in a several fold increase compared to resting conditions regardless of training level [96, 97].”
BackgroundSelected Human Physiological Responses During Extreme Heat
Brown, J. S., & Connolly, D. (2014) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000000787 · Cited by 16 · cited 1× · see citing works
“Some events span several days, including those that have no scheduled breaks [2].”
BackgroundCase Study: Simulated and Real-Life Energy Expenditure During a 3-Week Expedition
Koehler, K., Hülsemann, F., de Marées, M., Braunstein, B., Braun, H., & Schaenzer, W. (2011) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.21.6.520 · Cited by 16 · see citing works
Effects of Short-Term Quercetin Supplementation on Soldier Performance
Sharp, M. A., Hendrickson, N. R., Staab, J. S., McClung, H. L., Nindl, B. C., & Michniak‐Kohn, B. B. (2012) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0b013e31825cf22d · Cited by 15 · see citing works
Cox, C. E., Gaskill, S. E., Ruby, B. C., & Uhlig, S. D. (2003) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.13.3.286 · Cited by 14 · see citing works
Dietary Requirements for Ultra-Endurance Exercise
Singh, A. K., Pelletier, P. A., & Deuster, P. A. (1994) · Sports Medicine · doi:10.2165/00007256-199418050-00002 · Cited by 13 · cited 2× · see citing works
“It is not uncommon to train for longer than 6 h at a time as some events require more than 24 h of continuous activity [30].”
BackgroundNutritional Intake during a Simulated Adventure Race
Zimberg, I. Z., Crispim, C. A., Juzwiak, C. R., Antunes, H. K. M., Edwards, B., Waterhouse, J. M., Tufik, S. B., & de Mello, M. T. (2008) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.18.2.152 · Cited by 12 · cited 1× · see citing works
“these food and drink choices have become less tolerable and appealing [183, 184].”
BackgroundWilliams, M. H. (1997) · Cited by 12 · see citing works
Energiebilanz bei Langzeitbelastung: eine Fallstudie
Knechtle, Bisig, Schläpfer, & Zwyssig (2003) · Praxis · doi:10.1024/0369-8394.92.18.859 · Cited by 9 · see citing works
Macronutrient Consumption Prior to, and during, a Mountain Marathon
Mahon, E. (2014) · American Journal of Sports Science · doi:10.11648/j.ajss.20140201.12 · Cited by 8 · cited 2× · see citing works
“[49] on mountain ultramarathon runners found that despite over 65% of athletes reporting that they intended to increase their CHO intake in the week prior to the event, no participants came close to their CHO-loading recommendations of 10–12 g/kg/d in the 48 h leading up to the event.”
BackgroundThe Importance of Carbohydrate, Fat and Protein for the Endurance Athlete
Graham, T. E. (2000) · doi:10.1002/9780470694930.ch13 · Cited by 7 · see citing works
Knechtle, B. (2013) · Zurich Open Repository and Archive (University of Zurich) · doi:10.5167/uzh-92140 · Cited by 6 · cited 1× · see citing works
“Currently, ultra-endurance runners consume an approximate average of 12% of energy as protein during racing [98].”
BackgroundZwölf Stunden Laufen führt zu einem nachweisbaren Abbau des subkutanen Fettgewebes
Knechtle, Zimmermann, Wirth, Knechtle, & Kohler (2007) · Praxis · doi:10.1024/1661-8157.96.38.1423 · Cited by 6 · see citing works
Marathon Des Sables: A Scientific Case Study
Ryder, J. J., Grantham, N., Kellett, D. W., McNaughton, L. R., Lovell, R. J., & JONES, G. E. (2004) · Research in Sports Medicine · doi:10.1080/15438620490280576 · Cited by 5 · see citing works
Importance of Gastrointestinal Function to Athletic Performance and Health
Rehrer, N. J., Laughlin, J. M., & Wasse, L. K. (2013) · doi:10.1002/9781118692318.ch43 · Cited by 4 · cited 1× · see citing works
“Running in particular appears to result in more pronounced GIS than other activities [175] as well as a dehydrated state compared with a euhydrated state [179].”
BackgroundArmin, F., Maike, S., Wolfgang, K., Götz, K., & Beat, K. (2008) · Pakistan Journal of Nutrition · doi:10.3923/pjn.2008.283.286 · Cited by 3 · cited 1× · see citing works
“It is important to emphasize that regular adequate intake of vitamins and minerals is required for optimal performance and that consuming extra vitamins and minerals through supplementation immediately before or during an ultra-endurance event has not shown to provide any performance, health or recovery benefits [141,…”
BackgroundFive Year Survival Rates at an Exercise Based Cancer Rehabilitation Institute
Peterson, B. M., Repka, C. P., Hayward, R., & Schneider, C. M. (2010) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000384626.61126.ea · Cited by 1 · see citing works
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Tiller, N. B., Roberts, J. D., Beasley, L., Chapman, S., Pinto, J. M., Smith, L., Wiffin, M., Russell, M., Sparks, S. A., Duckworth, L., et al. (2019) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-019-0312-9 · Cited by 164 · see citing works
Nutrition for Ultramarathon Running: Trail, Track, and Road
Costa, R. J. S., Knechtle, B., Tarnopolsky, M., & Hoffman, M. D. (2019) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2018-0255 · Cited by 118 · see citing works
“Nevertheless, total caloric expenditure rates, using validated accelerometry and/ or breath-by-breath indirect calorimetry methodologies, appear to be positively associated with overall exertional stress (Vernillo et al., 2017; Williamson, 2016).”
BackgroundNutrition in Ultra-Endurance: State of the Art
Nikolaidis, P. T., Veniamakis, E., Rosemann, T., & Knechtle, B. (2018) · Nutrients · doi:10.3390/nu10121995 · Cited by 70 · see citing works
Ishihara, K., Uchiyama, N., Kizaki, S., Mori, E., Nonaka, T., & Oneda, H. (2020) · Nutrients · doi:10.3390/nu12041121 · Cited by 61 · see citing works
Devrim-Lanpir, A., Hill, L., & Knechtle, B. (2021) · Nutrients · doi:10.3390/nu13020491 · Cited by 57 · see citing works
Boldt, P., Knechtle, B., Nikolaidis, P. Τ., Lechleitner, C., Wirnitzer, G., Leitzmann, C., Rosemann, T. J., & Wirnitzer, K. (2018) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-018-0237-8 · Cited by 54 · see citing works
“Diet choice immediately before running or the composition of the personal diet might be influenced by the announced race distance [74, 75].”
BackgroundAl-Beltagi, M., Saeed, N., Bediwy, A., Elsawaf, Y., Elbatarny, A., & Elbeltagi, R. (2025) · World Journal of Gastroenterology · doi:10.3748/wjg.v31.i22.106835 · Cited by 51 · see citing works
“For those needing energy closer to exercise, a small, low-fat, low-fiber snack can be consumed 30-60 minutes before physical activity to provide fuel without overloading the digestive system[195].”
Analysis of food and fluid intake in elite ultra-endurance runners during a 24-h world championship
Lavoué, C., Siracusa, J., Chalchat, É., Bourrilhon, C., & Charlot, K. (2020) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-020-00364-7 · Cited by 39 · see citing works
Witard, O. C., Hearris, M. A., & Morgan, P. T. (2025) · Sports Medicine · doi:10.1007/s40279-025-02203-8 · Cited by 34 · see citing works
“Follow-up studies are warranted to investigate the ergogenic potential of co-ingesting protein with CHO on ultra-endurance performance [78, 79], given previous observations of improvements in protein balance with protein plus CHO ingestion during a 6 h bout of exercise [13].”
Nutritional Knowledge and Dietary Practice in Elite 24-Hour Ultramarathon Runners: A Brief Report
Citarella, R., Itani, L., Intini, V., Zucchinali, G., Scevaroli, S., Kreidieh, D., Tannir, H., Masri, D. E., & Ghoch, M. E. (2019) · Sports · doi:10.3390/sports7020044 · Cited by 27 · see citing works
Mielgo‐Ayuso, J., Calleja-González, J., Refoyo, I., León-Guereño, P., Córdova, A., & Coso, J. D. (2020) · Nutrients · doi:10.3390/nu12020316 · Cited by 26 · see citing works
“Although the diets of elite Kenyan [52] and Ethiopian [53] runners meet the macronutrient recommendations for endurance athletes, numerous field report case studies show that there are few endurance runners that actually comply with the recommendations that have been established throughout scientific literature [50].”
BackgroundArribalzaga, S., Viribay, A., Calleja-González, J., Fernández‐Lázaro, D., Castañeda-Babarro, A., & Mielgo‐Ayuso, J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18115737 · Cited by 24 · see citing works
Factors influencing ultra-endurance athletes food choices: an adapted food choice questionnaire
Blennerhassett, C., McNaughton, L. R., & Sparks, S. A. (2019) · Research in Sports Medicine · doi:10.1080/15438627.2018.1530999 · Cited by 21 · see citing works
“It is generally accepted that a “nutritious” diet, rich in vitamins and minerals is essential to the habitual diet of athletes training for ultra-endurance activities (Williamson, 2016).”
BackgroundInfluentialNutritional interventions for improving the endurance performance in athletes
Veeranna, R. P., Janhavi, P., Divyashree, S., & Peddha, M. S. (2020) · Archives of Physiology and Biochemistry · doi:10.1080/13813455.2020.1733025 · Cited by 21 · see citing works
“Furthermore, it helps to increase fluid storage (Williamson 2016).”
BackgroundKinrade, E., & Galloway, S. D. R. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.765888 · Cited by 18 · see citing works
“Maximising CHO availability before and during such events is therefore a key to maintaining performance (Williamson, 2016).”
BackgroundVisual Hallucinations in 246-Km Mountain Ultra-Marathoners: An Observational Study
Huang, M., Chang, K.-S., Kao, W., Li, L.-H., How, C., Wang, S., Lin, Y., Hwang, Y., Chien, D., & Chiu, Y. (2021) · The Chinese Journal of Physiology · doi:10.4103/cjp.cjp_57_21 · Cited by 15 · see citing works
Svenningsen, F. P., Pavailler, S., Giandolini, M., Horvais, N., & Madeleine, P. (2019) · Sports Biomechanics · doi:10.1080/14763141.2019.1642953 · Cited by 12 · see citing works
“Consequently, periods of running are intertwined with periods of walking (Librett, CONTACT Pascal Madeleine pm@hst.aau.dk © 2019 Informa UK Limited, trading as Taylor & Francis Group Yore, & Schmid, 2006; Millet et al., 2011; Vernillo et al., 2017; Williamson, 2016).”
BackgroundInfluentialEating habits and nutritional knowledge among amateur ultrarunners
Kosendiak, A. A., Król, M., Ligocka, M., & Kepinská, M. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1137412 · Cited by 12 · see citing works
“This has been confirmed by studies, which showed a positive correlation between high carbohydrate consumption and the results in endurance sports (9).”
ResultRyan, T., Daly, E., & Ryan, L. (2023) · Nutrients · doi:10.3390/nu15204330 · Cited by 11 · see citing works
Inamura, N., Taniguchi, H., Yoshida, S., Nishioka, M., & Ishihara, K. (2024) · Scientific Reports · doi:10.1038/s41598-023-51048-6 · Cited by 11 · see citing works
Pharmacological Aspects and Health Impact of Sports and Energy Drinks
Oprea, E., Ruta, L. L., & FARCASANU, I. C. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-815851-7.00003-6 · Cited by 11 · see citing works
Roca, E., Nescolarde, L., Brotons, D., Bayés‐Genís, A., & Roche, E. (2020) · Nutrition · doi:10.1016/j.nut.2020.110806 · Cited by 6 · see citing works
“In this sense, what we eat influences our body ́s capabilities to adapt to 56 training and post-exercise recovery [4,5].”
BackgroundFan, C., Guo, R., Liu, J., Yang, J., Zhang, L., Cui, Y., & Wang, W. (2025) · Food Hydrocolloids for Health · doi:10.1016/j.fhfh.2025.100263 · Cited by 5 · see citing works
Training, Changes in Nutritional Requirements and Dietary Support of Physical Exercise
Margaritis, I. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-810422-4.00012-9 · Cited by 5 · see citing works
Performance demands in the endurance rider
Williams, J. M., Douglas, J. L., Davies, E., Bloom, F., & Castejón‐Riber, C. (2020) · Comparative Exercise Physiology · doi:10.3920/cep200033 · Cited by 5 · see citing works
Ishihara, K., Inamura, N., Tani, A., Shima, D., Kuramochi, A., Nonaka, T., Oneda, H., & Nakamura, Y. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18105153 · Cited by 5 · see citing works
“Optimal nutrition leads to a decreased risk of energy depletion, better performance [32], the prevention of acute cognitive decline, and improved athlete safety on ultramarathon courses with technical terrain or those requiring navigation [5].”
BackgroundKidney Function and Extreme Endurance Races: Risks, Mechanisms, and Preventing Strategies
Kulbacka, J., Dziedzic, K., Arczewski, F., Wójcikiewicz, M., Chuncia-Ileczko, M., Kacperczyk, J., Czyż, W., Zys, D., Pasek, P., & Ryniecka, J. (2025) · Quality in Sport · doi:10.12775/qs.2025.37.57434 · Cited by 4 · see citing works
John, L., Munk, M., Bizjak, R., Schulz, S. V. W., Witzel, J., Engler, H., Siebers, C., Siebers, M., Kirsten, J., Grau, M., et al. (2025) · Nutrients · doi:10.3390/nu17233801 · Cited by 4 · see citing works
“Post-race, protein becomes even more critical, with recommendations of ≥ 1.6–2.0 g/kg/day to optimize glycogen resynthesis and muscle recovery [7,38].”
InfluentialThe Crucial Role of Carbohydrate Intake for Female Long-Distance Runners : A Literature Review
Illahi, R. R., Rasyid, W., Neldi, H., Padli, P., Ockta, Y., & Cahyani, F. I. (2023) · Jurnal Penelitian Pendidikan IPA · doi:10.29303/jppipa.v9ispecialissue.7723 · Cited by 3 · see citing works
“For long-distance runners, both amateur and professional, proper nutrition plays an important role in improving athletic performance and endurance (Grzebisz, 2020; Williamson, 2016).”
BackgroundSustainable Food Support during an Ultra-Endurance and Mindfulness Event: A Case Study in Spain
Pastor, M. G. G., Díaz, F. M. S. C., Fernández-López, N., Ferro, A., & Sillero‐Quintana, M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182412991 · Cited by 2 · see citing works
Mougin, L., Stennett, R., Ely, B. R., Taylor, L., Adams, W. M., Blagrove, R. C., Longman, D. P., & Mears, S. A. (2026) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2026.05.014 · Cited by 2 · see citing works
Aktitiz, S., Kuru, D., Ergün, Z., & Turnagöl, H. H. (2024) · Turkish Journal of Sports Medicine · doi:10.47447/tjsm.0807 · Cited by 2 · see citing works
Wu, J. (2021) · IntechOpen eBooks · doi:10.5772/intechopen.101579 · Cited by 2 · see citing works
Millar, M.-L. (2019) · doi:10.51415/10321/3221 · Cited by 2 · see citing works
Colangelo, J., Smith, A., Bitterlich, N., Buadze, A., & Liebrenz, M. (2025) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2025.1708869 · Cited by 1 · see citing works
“As gastrointestinal issues are also frequently identified in UEA, special attention is often needed to take in well-tolerated and effective energy sources (24).”
InfluentialThe Effects of Acute Deep Seawater Supplementation on Muscle Function after Triathlon
Aragón‐Vela, J., Acevedo, O. G., Márquez, J. C. D. L. C., Rojas, F. J., Marín, M. M., Casuso, R. A., Plaza‐Díaz, J., & Huertas, J. R. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13082258 · Cited by 1 · see citing works
“Indeed, an exclusive consumption of water is not enough to maintain optimal muscle performance during long-duration sport events [34].”
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Gasser, B. A. (2018) · Journal of Human Sport and Exercise · doi:10.14198/jhse.2019.142.15 · Cited by 1 · see citing works
“To sum up, optimal nutrition while ultra-exercising results in a decreased risk of energy depletion, better performance, and quicker full-recovery while increasing security for further tours in the next days (Williamson 2016, Munter, 2017; Winkler et al. 2008).”
BackgroundCombined Ketogenic Diet and Walking Exercise Interventions in Community Older GroupsPreprint
Wu, J. (2021) · Preprints.org · doi:10.20944/preprints202110.0106.v1 · Cited by 1 · see citing works
“Amino acids of threonine, isoleucine, leucine, and lysine were observed for ketogenic amino acids is not true for the heart, conversely, the anoxic heart experiences the greatest [76].”
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Effect of Requisite Nutrition for Athletes of Endurance Training: A Non-Empirical Review
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Adaptation de la nutrition la semaine précédant un ultra-trail
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Ryan, T., Daly, E., & Ryan, L. (2026) · Sports · doi:10.3390/sports14030109
Amorim, R. M., Guilherme, L. Q., Filgueiras, M. D. S., Saborosa, G. P., Pires, G. F., Neumann, N. D. O., Scheer, V., Leite, L. B., Forte, P. M., Malheiro, A., et al. (2026) · Physiologia · doi:10.3390/physiologia6010021
“Ultra-endurance athletes may compete for extended periods (e.g., ranging from several hours to multiple days), with or without rest intervals, often encountering considerable challenges in maintaining adequate nutrition and hydration throughout the event [2,3].”
Штерман, С. В., Сидоренко, А. Ю., Сидоренко, М. Ю., Штерман, В. С., Славянский, А. А., & Стерлигов, Н. Г. (2026) · Food processing industry · doi:10.52653/ppi.2026.5.5.028
- Authors
- Williamson, E.
- Affiliations
- University of Toronto (CA)
- Corresponding author
- Williamson, Eric
- ORCID
- Williamson, Eric
- Venue
- Extreme Physiology & Medicine
- Published
- 2016-11-21
- Volume
- 5
- Issue
- 1
- Pages
- 13-13
- ISSN
- 2046-7648 (ISSN-L)
- PMC
- PMC5117571
- OpenAlex
- W2554963385
- Cited by
- 53
- References
- 199
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 3 · 2023: 5 · 2022: 3 · 2021: 8 · 2020: 7 · 2019: 7 · 2018: 6 · 2013: 1
- FWCI
- 0.47
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Extreme Physiology & Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- TSpace (University of Toronto) (submittedVersion, cc-by)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
- Keywords
- ultra-endurance sports, walking, running, sports nutrition, energy intake, carbohydrate intake, protein intake, dietary fat intake, vitamins and minerals, athletic performance, recovery, energy depletion
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