Case
We have a former runner, age 42, in the program. She had back problems requiring surgery a few years ago and stopped running and gained 50 pounds. She has lost 22 pounds, now 226 pounds, and is preparing to run a 25K race in May. She is on the New Direction VLCD, 3 meal replacement shakes and 1 bar daily.
Will she be able to train on the VLCD or should we adjust it? If she is still on the VLCD at race time, should we take her off or make adjustments?
Treatment Recommendation
If her goal is to win the race or be highly competitive, I would recommend she discontinue. If her goal is to participate and just to finish, she could give it a try. She will learn early in training whether her regimen is too intense as she will bonk. I find that it is highly variable from patient to patient. Steve Phinney still does bike races and climbs mountains in ketosis. In general, if patients are planning a high intensity activity, then I discourage them from starting until after the race. If it is a social race (like a walk/run or easy 10K), then I think most can do that. —John Hernried, MD, FACP
The simple fact that this is brought up as a question for permission would cause me to say no. If this was my patient, I would move to an low calorie diet. —Christopher Case, MD
It seems this is a little early to be training for essentially a half marathon. I think for the next month she should be OK with the VLCD and the training schedule, but as the Saturday training gets longer, she will need extra carbs before and after the run that day. I suspect she will be at her goal within the next 3 months and she should be transitioned to facilitate the training. —Peter H. Jones, MD