Doc’s Talk 10-07-2012

Dr. Scaff talked about marathon readiness and supplements.

Month 8 Marathon Readiness
October is month 8 of your training, and at this point you either have the marathon in your body or you don’t.  Any concerns or panic you have about getting ready are psychologic problems, and reacting to those feelings is what leads people to push too hard and get hurt.  Dr. Scaff sometimes gets patients who come to him and say, “I’ll give you all the money in the world just get me through the marathon, I don’t care if my leg falls off, just help me finish,” and he doesn’t want to see anybody in the office like that.  You should get any problems taken care of as they arise.

Dr. Scaff would venture to say that if today were the day of the marathon and you were going to run it right now, that over half of those who have trained with the Honolulu Marathon Clinic would do as well or better today than they will do on Marathon Sunday, and the others might do just a little bit worse because they had not really planned on it.  The point is, you have the ability, it’s there, so let’s not let the genie escape from the bottle.  This means you should weigh yourself.  Your weight today is the weight you are going to be on the day of the marathon, or maybe 2 pounds heavier.  Maybe you should even consider gaining a little at this point, because remember, for every 3 pounds you lose, 2 pounds of that are fat and 1 is bone, blood, and muscle; so you get injured.  Dr. Scaff’s advice, therefore, is if you don’t like your visage for this year, start working on it in January, because at this point you are in your marathon body already.

Marathon Clothing
At this point you should have picked your running clothes and practiced in them.  You know exactly what you are going to wear on the day of the marathon, including the socks.

If the shirt you are going to wear does not say anything it “should” say something.  You are running for somebody, even if it is just yourself.  Do not be afraid to wear a shirt that says something because as you read in the paper, 2012 is going to be the biggest Honolulu Marathon we have had in about 20 years.  It is really not that big as far as outsiders, they expect 15,000 Japanese, but we have 15,000 locals as well.  You are going to see a lot of friends out there, somebody is going to recognize you, so be prepared for that.

Your shoes:  You already have the shoes you are going to run in, and heaven forbid the sole comes off the week before the race.  If they are very old, if you do not think they can make it through the Marathon, get a pair, but you want to have 100 – 200 miles on them before you run the marathon, you want them to be very comfortable.

Tapering and Preserving
So nothing changes.  You have got the marathon in you body, and everything now is tapering or preserving what you have.  Next week’s bus run should be your long run of the year, after that no more long runs.  More than 18 miles is a long run.  Don’t be afraid to back off.  The studies that have been done have shown that people who start backing off tend to do better.

Dr. Scaff’s book and the Honolulu Marathon Clinic are the only running resources in the nation that train people to finish a marathon in 9 months.  Before the Honolulu Marathon Clinic started everybody said this was impossible.  Well, it is not impossible, the Honolulu Marathon Clinic has a 99% completion rate, but the first marathon will not necessarily be your best marathon, …but it will be a personal record no matter what!  So it is good to do lousy just to keep improving as you get older, so you can make yourself look good.

When the Honolulu Marathon Clinic was first staring, they sent a 30-something year old nurse, who was an ultramarathoner, to a health food store and asked her to say, “I’m new in town, what do I need for proper nutrition for a marathon?”  They gave her $100 bill and she spent $110.  The supplements she bought were only good for 30 days, meaning she was going to have to spend $1,000 a year for nutritional health (nutraceutical health).

In Your First Marathon – The Last Word In Long Distance Running, by Jack H. Scaff Jr., M.D., F.A.C.S.M., (available for purchase at the Honolulu Marathon Clinic on Sundays and online at: you will read about Tom Knowell, who at the age of 60 ran across the United States, 63 miles a day, no supplements whatsoever, except for beer.  The book also relays the story of two individuals with PhDs in biochemistry who do not take any supplements and yet they are world class, or very good age group marathoners.

Jack Wilmore, one of the best exercise physiologists in the world, was visiting the Honolulu Marathon Clinic one Sunday and one of the runners asked, “How do I run better?”  Wilmore said, “You want to run better, you run more. Nothing else.  You add the miles.”  A lot of runners get up to 50, 60, 70 miles a week, and that is probably the ideal for doing best performance, but that is not a good idea for the first year, because it just takes too much out of you.  What the Honolulu Marathon Clinic wants to get to is 30 – 40 miles per week, but they are not saying that you should not do more.

The Swanson nutraceutical catalog is over 100 pages in length.  All of this is good for our health, but how can you possibly take them all?

In Your First Marathon – The Last Word In Long Distance Running Dr. Scaff says you do not need to take supplements, …but will you?  Yeah, probably.  In fact, Dr. Scaff takes supplements.  Does he think they are doing him any good?  Not really.  But that’s faith.  So long as it does not hurt you and it is not too expensive, Dr. Scaff does not have any real strong reservations.

Eat A Well-Balanced Diet
So you have just got to eat a well-balanced diet.  Ninety percent of your potassium is in your muscles, and a hamburger has potassium in the same amount.  So, eating a well-balanced omnivorous diet is a good supplement.  Bananas are good, but they do not have that much potassium, believe it or not.  So eat well-balanced diet.  Basically, an omnivorous diet, with 35% fat, is a good, good diet.

But if you are going to take supplements, what supplements does Dr. Scaff recommend you take?

Potassium is an important element.  Gatorade has it.  Ninety percent of the electrolyte potassium is stored in the muscle.  Ten percent is in the blood stream.  That is the potassium/sodium pump:  The muscle contracts, potassium goes out, sodium goes in.  If your serum potassium is low, you have lost 75% of your total body potassium.  And then you can develop arrhythmias, or all sorts of problems, and cramps.  The problem is, supplemental potassium requires a prescription because if you get too much it is lethal.  Therefore, there is not very much in Gatorade or anything else. Remember, potassium is one of the 3 drugs used for lethal injection.  They put you to sleep, then they give you the potassium and your heart stops.  So you don’t want too much of it.

Something that is not tested for is magnesium, and magnesium is as important as potassium, as a matter of fact, in Dr. Scaff’s office, if they get a person with palpitations, borderline potassium, they administer potassium.  If the patient still has palpitations, they just a priori put them on magnesium.  Magnesium is not measured during the routine metabolic profile.  So if you think your muscles are tired, ask your doctor when he does your next profile, to check magnesium.  Most magnesium tests are normal, so Dr. Scaff says he would not worry too much about it.

Take a multivitamin.  You can buy Centrum Silver or the Kirkland brand, it is 2 – 3¢ per day and has everything you need.  If you read the percentage of the recommended minimum daily amount, it is usually 100% or higher.  So you are already getting that.

Vitamin C
Then if you wanted to take something that is good for general health, you might want to take vitamin C, but not more than a gram a day or 500 mg a day, because you are getting some of it already in your supplement.

Vitamin B12
B12 is a good choice
.  As you know, gastric acid allows the body to absorb B12.  As we get older we make less B12.  If you are over 55, take one B12 tablet, and if you will notice it has something like 1500 times the minimum daily requirement, …that should be enough, …or maybe just one 3 times per week, or once a week. You do not need much.  If you are going to take something, and you are running in the higher mileage or older ages, take B12.

Dr. Scaff talked about this in beer.  Selenium is good for your bones and everything else.  So, if you cannot drink beer or ale, you can get selenium tablets.  This is not necessarily a bad idea, but Dr. Scaff does not strongly recommend it.

Vitamin D
Someday the Honolulu Marathon Clinic is going to have an entire talk by a specialist on vitamin D.  Even though runners are out in the sun, vitamin D deficiency is a lot more common than people tend to realize.  Dr. Scaff believes 1,000 units per day is enough, even in the sunshine area of Hawaii.  It has been noted that when they test vitamin D levels, some people who have been running, even though they take vitamin D, they are on the low side, and this leads to a whole bunch of other problems.  You can look up vitamin D on the Internet and you will see it is involved in everything, so taking Vitamin D is not a bad idea.

Anything else?
Not really.
  As a matter of fact, iron is best absorbed (for menstruating women this is important) in meat, rather than from a pill because in meat the iron is on the trans-heme molecule which the body recognizes and takes it right in, and says “Welcome home, you’re a friendly supplement because you come from one of our brethren,” meaning the cow or the horse or wherever it is you get your meat from.

So that is supplementation in a nutshell.

Age and Weight Gain
A world famous gerontologist who was head of the United Nations Commission on Aging, recently died, he was 85 or 90.  Thirty years ago he said that as you got older you should gain weight.  He said you should gain 6 pounds every decade.  He was castigated by the medical community for saying that as you get older you should get heavier.  And you know what?  He’s right.  The references are all there.  After the age of 75 or 80 the heavier you are the longer you live.  Now that does not mean you have to gain 400 pounds, but it means that you don’t really want to weigh the same amount as you did when you graduated from high school.  So if you can fit in your high school graduation uniform you are malnourished.

So as we get older we want to be a little more liberal in our diet, and we want to check every so often by gaining a pound or 2 to see if we can.  When an older person cannot gain weight and starts to lose weight it is called “failure to thrive”.  So the easiest way to check is once in a while, you can do this right after the marathon, pig out for a couple weeks, gain 3 or 4 pounds, know you’re in good health, and then you can go back and all your supplements and your diets and all the things are not going to do much for you, and start training again for March.

For some good reading on nutrition, Dr. Scaff recommends everyone check out the daily postings on Dr. Alan Titchenal’s “Got Nutrients?” web site:

Here is a recent posting:

October 5, 2012
Anyone knowledgeable of the U.S. labeling laws for dietary supplements can easily find illegal labels on store shelves or product websites. A small government study of 127 dietary supplements marketed for weight loss or immune system support found that 20 percent of the products had prohibited disease claims on their labels.

Consumer Link
Report: Some dietary supplements illegally labeled

Research Link
Office of Inspector General: US Dept Health & Human Services