Apparently it's just a matter of stuffing yourself like a turkey

...and the confusion continues. Be prepared for the longest post ever. ;)

Old Leggio

First, the legs. According to my Sports Doc the bone scan is inconclusive - for now. She explained to me that a hot spot isn't necessarily a stress fracture. Especially not when there aren't any other syptoms (mine showed up by surprise on a 'no pain here' leg). Apparently hot spots can appear right after a long long long run (I did a 40K 2 days before the scan) and are a sign of normal bone remodelling.

She also explained to me that stress on the connective tissue lights up on a bone scan, and that the same goes for a stress fracture that has recently healed. That's why she normally doesn't order a bone scan (my GP did) and opts for an MRI.

For now she says: run and cycle your butt off. Take the running by the day. I should watch my legs and phone her if and when I do get any symptoms. So, I will. And I will take it easy and mix up the running with a lot of cycling (according to a (ultra)marathoner I recently chatted with, several (ultra)marathoners add cycling to their training schedule to get less stress on the legs. I'll take it.).

Hello McFlurry

Second, food. And lots of it. The Sports Doc wants me to see a sports dietician. I'm the last person to call myself skinny, but she thinks my fat percentage is low-ish and my physique is quite skinny. Hmmmpfffff. And she wants me to be sure that I'm getting all the fuel my body needs. I figured 'I eat a lot, and lots of veggies', so I'm fine. Yeah, apparently that's not enough. The sports dietician has some kind of percentage-chart to work out my diet. I'm scared. ;) That she tells me to stop drinking alcohol and stop eating chocolate cake, that is. ;)

Plus, the Sports Doc wants to figure out whether or not I'm okay on my calorie-intake. I'm at 2500-2700 a day, I guess. She says 'at least 3500 for long distance runners'. Uhm...sounds like a lot to me! She didn't applaud my suggestion to add ice cream and cupcakes to my diet. Bummer! ;)

So, like any sane girl would do, I spent the night on Google. :) And found this:

"Inadequate nutritional intake is more common in female athletes than in their male counterparts. Proper diet is paramount for active individuals to maintain adequate energy during physical activity and for postactivity recovery."

and this:

"Component Summary
Dietary components include macronutrients (carbohydrates, protein, and fat) and micronutrients (fluids, electrolytes, vitamins, and minerals). Specific requirements are presented in the Table in the Summary of Nutritional Requirements and Sources section.



Carbohydrates are necessary to meet energy needs, more so in endurance athletes than in strength athletes.
Carbohydrate needs are commonly based on the athlete's body size and activity level. Individuals engaged in moderate-duration, low-intensity exercise require 5-7 g of carbohydrates per kilogram of body weight. By contrast, those participating in long-duration and high-intensity exercise require 7-12 g of carbohydrates per kilogram of body weight (see the Table).
Fruit, vegetables, brown rice, enriched whole-grain breads, whole grain cereals, rolled oats, beans, legumes, and sweet potatoes are good examples of healthy carbohydrate foods.


Active individuals have a heightened protein requirement because they have a high percentage of lean muscle mass to support, they need protein to repair muscle tissue that is damaged during exercise, and they require additional protein for energy during exercise.
The amount of protein required depends on the type of activity being performed. Researchers recommend protein intakes of 1.2-1.4 g/kg/d for individuals participating in endurance sports and 1.6-1.8 g/kg/d for those involved in anaerobic activities (see the Table).

Benefits of substituting carbohydrates with protein include the following:
•Enhanced weight loss
•Reduction in truncal adipose tissue
•Optimal maintenance of blood glucose levels
•Improved lipid profile

Protein-rich foods include lean pork and beef, poultry, fish, eggs, beans, tofu, and low-fat dairy products. Women at risk for having a low protein intake are those who restrict their energy intake to achieve weight loss or those who eat a vegetarian diet.
In the past, some investigators expressed concerns that a high-protein diet can cause renal damage. However, no conclusive evidence suggests that a high-protein diet negatively affects healthy adults with normal renal function. In addition, some researchers have raised questions about whether a high-protein or low-carbohydrate diet may increase the all-cause mortality risk in women. Further research is necessary to determine if this is the case.


Fat provides essential elements for the cell membranes and is essential for the absorption of fat-soluble vitamins. Fat should account for 25-30% of a person's energy intake. Diets should be limited in saturated and trans-fats, while providing adequate amounts of essential fatty acids (linoleic and alpha-linoleic acid). In women, the following intakes are advised (see the Table):

•Linoleic acid intake 11-12 g/d
•Alpha-linoleic acid intake 1.1 g/d

Functions of essential fatty acids include regulation of blood clotting, blood pressure, heart rate, and immune responses.
Dietary fatty acids should come from naturally lean protein foods, nuts, seeds, nut butter, fatty fish (eg, salmon, trout), fish-oil supplements, flaxseed oil, safflower oil, canola oil, sunflower oil, corn oil, avocados, and egg yolks. Women should avoid consuming fats found in processed foods because of their highly saturated nature.
Low-fat diets are not recommended for active individuals. Low-fat diets decrease energy and nutrient intake, reduce exercise performance, and decrease oxidation of body fat stores. Fat provides the most energy per gram of all the macronutrients and can help in achieving a positive energy balance. Dietary fat maintains concentrations of sex hormones and may prevent menstrual disturbances.


Fluids and electrolytes

Dehydration impairs performance; therefore, athletes must remain well hydrated. Adequate fluid intake is approximately 2.2 L/d for women aged 19-30 years, and increased drinking is required for active individuals or those in hot environments (see the Table).
Athletes should consume 400-600 mL of fluid 2 hours before exercising. During exercise, 150-350 mL (6-12 fluid ounces [fl oz]) should be ingested every 15-20 minutes. For exercise lasting longer than 1 hour or occurring in hot environments, the fluid should be a drink containing carbohydrates and electrolytes.[6] Postexercise meals should include fluids and foods containing sodium, because diuresis occurs with the ingestion of plain water.

Vitamins and minerals

Female athletes are at increased risk for iron, calcium, vitamin B, and zinc deficiencies. These nutrients are vital for building bone and muscle and for energy production. Vegetarians are particularly at risk for developing deficiencies in these vitamins and minerals.
Iron insufficiency is one of the most prevalent nutritional deficiencies among the female athlete because of menstrual losses (see the Table). Iron deficiency may lead to fatigue. Ferritin values are commonly used to reflect iron stores; however, their reliability in the female athlete is questioned.

Excessive iron ingestion may also cause problems, including gastrointestinal distress, constipation, and iron toxicity."

and this (this is the last one: promise):

"Energy Needs
Total daily energy expenditure (TEE, TDEE)

A female athlete's TEE is calculated by using the following equation:

where REE is the resting energy expenditure, PAL is the physical activity level, and TEA is the thermal effect of activity. Various means exist to estimate REE, PAL, and TEA.
Resting energy expenditure (REE)

Calculations of REE that are conducted in a laboratory by means of indirect calorimetry are the most accurate.

An alternative is the use of equations that incorporate anthropometric variables. The Harris-Benedict equation is most commonly applied to athletes. This equation is as follows:

REE = 655 + (9.5 X weight) + (1.9 X height) – (4.7 X age)
where REE is given in kilocalories (kcal) per day, weight is in kilograms (kg), height is in centimeters (cm), and age is in years (y).

Physical activity level

The PAL value can be determined by using accelerometers, heart-rate monitors, activity diaries, or self-reported activity estimates. Depending on their occupation and daily activities, female athletes may be considered to be moderately to extremely active (ie, have PALs of 1.6-2.5).
Thermal effect of activity

The TEA is calculated as follows:

TEA = weight X duration X METs

where TEA is expressed in kcal, weight is in kg, duration is in hours (h), and METs are the metabolic equivalents of the task being performed, in kcal/kg/h.

METs are found by consulting the Compendium of Physical Activities — a coding scheme developed by Ainsworth et al that classifies specific physical activity by rate — and are determined by dividing the metabolic rate during activity by the metabolic rate at rest. A MET value of 1 is defined as 1 kcal/kg/h, which is approximately the energy expended when a person is sitting quietly. Different physical activities are associated with different MET values. For example, weight lifting is equal to 6.0-8.0 METs."

Heck of a lot of info, but it IS quite interesting. Lot of it is a no-brainer actually, but there is some info in there that I did not know of. Worth reading for every recreational female athlete/runner, in my opinion. For what that's worth. ;)

Guys, stop reading

Third, my 'baby machine'. Any guys out there reading this? You might want to stop reading now. As in, NOW! If you don't, and think I'm a freak after this, I did warn you!

What the Sports Doc also told me (the Redhead will understand!) is to stop taking my birth control pill for the time being. Why? Not because she wants me walking around with a huge pregnant belly. Nope. She wants to see if the baby machine will still work without the birth control pill (have been taking it since I was 16 - because I had awful migraines). There are no signs that it wouldn't work (that's what she said), but she still wants to rule out any signs of amenorrhea. Better safe than sorry. I kind of like her 'better safe than sorry' kind of approach.

So, that's the story. For now. I'll just take this thing by the day. :) Please feel free to share any thought on nutrition, etcetera!


ltlindian said...

when your body fat percentage gets too low, you will stop menstrating. maybe that's what she's checking for, you skinny thing! :) It might be another clue that you are underweight. Bummer about having to eat more..... NOT! :):)

Silly Girl Running said...

@Itlindian: Thanks for your sweet comment. :) And, uhm...I'm a lot of things, but underweight is not one of them. ;)

Jen Feeny said...

So your post today just confirms my suspicions, we redheads are freaks of nature. :) Sounds like your doc is taking you seriously and I love that she's being so thorough! I hope you can figure out what's going on so that we can both finally be out of Limboland with these stupid injuries! Enjoy the cycling and take care with the running, I do NOT want you stuck in a boot with a stress fracture!!! If you ever want to compare notes or discuss the fun-fun girly stuff shoot me an email anytime. (redheadrunning @ gmail)

misszippy said...

I think you've got a great doctor here to be so proactive. Take her advice and make sure you are doing all the right things to keep injuries at bay!

So glad you don't have a sfx. Jealous, but glad!

Rose @ Eat, Drink, and Be Meiri said...

You have a lot to ponder. But, it's good to have someone on your team helping you try to figure things out.

LaVonne said...

That is great news about your "SF" and that you can run now...yippee!! Have fun running, cycling and eating.

The Green Girl said...

I agree with Miss Zippy, it's great to hear you have a doctor that cares.

Hope you can work this all out soon!

Unknown said...

Great news, great doctor and great lot of information! :-)

I wouldn't say you are underweight, but you definitely ARE skinny (also given the size of your running skirt :-) ) and you not thinking that you are skinny is a tiny step from a very slippery edge. This is not being rude, but it's caring about you, since too low fat percentage and body weight has been proven dangerous and contra-productive performance wise.

Great to hear you can run again! Good luck