Fuelling for Endurance Events: The Dietitian’s Guide to Going the Distance

Endurance sport is as much a nutrition challenge as a physical one. Getting it wrong means hitting the wall. Getting it right means going further, feeling better, and finishing strong. Dietitian and endurance athlete Robbie Green explains the science behind the strategies – and the practical steps every endurance athlete should know.
LBSM Podcast Ep 5 Robbie Sports Nutritionist

Episode 5 | Ask the Expert | Guest: Robbie Green – Registered Dietitian and Endurance Sports Nutrition Specialist


Marathon runners, triathletes, long-distance cyclists – the world of endurance sport is one of the fastest-growing areas of participation sport. It is also one of the most nutritionally demanding, and one where poor fuelling [Podcast] decisions can derail months of training in a single event.

In this episode of the London Bridge Sports Medicine podcast, Dr Ajai Seth is joined by Robbie Green, a registered dietitian with a specialist interest in endurance sport nutrition [Article] and a serious endurance athlete himself. What follows is a comprehensive guide to fuelling for endurance – from the underlying energy systems to race-day strategy.

What counts as endurance sport?

Robbie defines endurance sport as sustaining submaximal effort for prolonged periods – typically beyond an hour. Running, cycling, swimming, and triathlon are the classic examples, but the metabolic demands of the event matter more than the distance alone. Events that severely tax the body’s carbohydrate stores and require a strategic approach to fuelling qualify, whether that is an Olympic-distance triathlon or a 24-hour ultra.

One thing Robbie is clear on: “It takes planning and determination and a lot of strategy. These are things that the majority of people won’t be able to just put their running shoes on and undertake.” But the gradual building of training – and fuelling – over time is exactly what makes these events achievable.

The energy systems: a brief guide

Understanding why nutrition matters [Podcast] so much in endurance sport starts with understanding how the body produces energy. Robbie outlines three key systems:

  1. Anaerobic system: produces energy without oxygen – fast and powerful, but lasts only seconds to minutes. Think sprinting or heavy lifting. Produces lactic acid as a byproduct, which is why muscles burn and fatigue quickly.
  2. Glycolytic aerobic system: produces energy using carbohydrate and oxygen. This is the primary system for sustained moderate-to-high intensity effort – running pace, cycling pace. The fuel is glycogen, stored in the muscles and liver, and there is roughly 2,000 calories of it available. The critical point: it runs out in approximately two to three hours without being topped up.
  3. Fat oxidation system: produces energy from fat stores. The average person has 50,000–60,000 calories of fat available – essentially limitless. The catch is that it produces energy more slowly, meaning it cannot sustain the same exercise intensity as the glycolytic system.

The goal of endurance training – and endurance nutrition – is to make the body better at using fat for fuel while preserving glycogen for when it really needs it. Running out of glycogen is what causes “hitting the wall” or “bonking”: a sudden, dramatic loss of energy that is very difficult to come back from mid-event.

Training nutrition: train low, compete high

One of the best-researched strategies in endurance nutrition is “train low, compete high” – deliberately exposing the body to low-carbohydrate states during certain training sessions to drive fat-burning adaptations, while arriving at race day with glycogen stores fully topped up.

This can be implemented in several ways:

  • Eating a lower-carbohydrate diet during certain training blocks
  • Training twice in a day and eating inadequately between sessions (going into the second session with depleted glycogen)
  • Fasted training – running or cycling before breakfast

Robbie is honest that these approaches are often unpleasant, and typically result in compromised performance during the session itself. The physiological adaptations do occur – the research supports this – but evidence for improved performance outcomes is more limited. His key message: “Don’t push yourself into making yourself feel unwell when you’re training. Find that happy medium.”

The most important variable is variety. Training at the same pace, the same distance, and with the same nutritional approach every day produces limited adaptation. Mixing fasted sessions with fully fuelled sessions, shorter efforts with longer ones, and varying intensity produces far greater gains. “The biggest differences to my own performance came when I started mixing things up,” says Robbie.

Carbohydrate loading: what the evidence actually says

The classic image of eating three bowls of pasta the night before a race reflects the principle of carbohydrate loading, but the practice has evolved considerably from its origins.

Early protocols recommended first depleting glycogen stores completely, then loading heavily. That approach has since been replaced. Current recommendations focus on scaling back training in the taper period and increasing carbohydrate intake during those final days. The target range is wide – five to 12 grams of carbohydrate per kilogram of body weight per day, depending on the event and the individual. At the upper end (12g/kg) you are talking about Tour de France volumes – approaching a kilogram of pasta – which requires liquid nutrition supplements to be achievable.

Practically, during the pre-race loading period, Robbie suggests temporarily shifting away from the usual health-focused approach to carbohydrates. High-fibre whole grains are normally recommended – but in the days before a race, refined, quickly digested carbohydrates are actually preferable. “The priority shifts from achieving optimal health to simply getting those fuel stores where you want them for the event,” he says.

The golden rule: never try anything new on race weekend. Whatever the loading strategy, it needs to have been tested in training.

Race morning: fuelling before the start

Most endurance events start early. Most athletes will not be eating a full meal at 4am. But getting carbohydrate on board before the start – and doing so without upsetting the gut – is critical.

The research (from sports nutritionist Asker Jeukendrup, a leading figure in this area) provides a useful framework based on timing:

  • Four hours before: up to 4g carbohydrate per kg body weight
  • Three hours before: 3g per kg
  • Two hours before: 2g per kg
  • One hour before: 1g per kg

These are guidelines, not rules. What matters is finding what works for your gut. Robbie’s own solution, arrived at through trial and error: waking four hours before the event and eating oats made with water – carbohydrate only, nothing that might slow gastric emptying or sit heavily. Not the most exciting breakfast, but one that works.

The principle: on race morning, this is not a health breakfast. It is a fuelling exercise. Prioritise carbohydrate, minimise anything that could cause gut issues, and stick to what you have practised.

During the event: keeping the tank from running dry

The most important conceptual shift in race-day nutrition: do not wait until you feel empty before eating. By the time glycogen is depleted, the damage is done. The wall is not recoverable mid-race – at least not without significant time lost.

The strategy is to maintain a trickle of carbohydrate into the bloodstream throughout the event, reducing the rate at which glycogen stores are drawn down. This means fuelling from early on, even when you feel fine.

Research guidance:

  • Under 90 minutes: additional carbohydrate during the event is generally not necessary; hydration is the priority
  • Over 90 minutes: aim for around 60 grams of carbohydrate per hour (roughly equivalent to two energy gels), with variation depending on the event, intensity, and individual tolerance

What you use during the event – gels, bananas, raisins, sports drinks, real food on the bike – matters less than getting the carbohydrate in consistently. Gut tolerance during exercise varies enormously between individuals. The digestive system is diverted during hard effort as blood flow goes to the working muscles, which suppresses appetite and can cause nausea. Training the gut to accept food during exercise is a real process, and one that needs to happen in training, not on race day.

Hydration: enough but not too much

Dr Seth raises an important medical point: over-hydration during endurance events – drinking too much plain water – is a genuine risk. It dilutes sodium and other electrolytes in the blood (a condition called hyponatraemia), which can be dangerous. Yet many athletes drink far less during training than they do on race day, simply because of nerves and easy access to water.

Robbie’s guidance: train your hydration strategy just as you train your nutrition strategy. Drink consistently and regularly rather than in large volumes. Urine colour is a reliable practical indicator – pale straw (or “champagne”) is the target; dark yellow signals dehydration; clear signals over-hydration. Isotonic drinks that combine carbohydrate and electrolytes are preferable to plain water, particularly in longer events.

The three principles to take away

  • Have a plan – and practise it. Know what you will eat the night before, the morning of, and during the event. Trial it during training. Nothing new on race day.
  • Vary your training nutrition. Expose your body to different states – fasted, carb-loaded, mid-session fuelled – to drive adaptation, but always keep your race-day plan in mind.
  • Ask for help if you’re stuck. Online resources abound, but individual variation is enormous. If you cannot find what works for you, a sports dietitian can help identify the root cause of performance barriers or gut issues.

The bottom line

Endurance sport rewards preparation, and nutrition is inseparable from training. The energy systems are well understood, the strategies are well researched, and the framework is clear: keep glycogen stores from running out, train the body to use fat efficiently, hydrate consistently, and practise everything in training before race day.

The application of all of that is deeply individual. What works for one athlete – oats and water at 4am, a specific gel every 20 minutes, isotonic drinks throughout – may not work for another. Finding what works takes time, experimentation, and often a willingness to feel uncomfortable in training so that race day is not the experiment.


Robbie Green is a Registered Dietitian specialising in endurance sport nutrition. He works with recreational and competitive endurance athletes across running, cycling, and triathlon.

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Dr. Richard Antbring
MBBS, MSc, MRCP, FFSEM
Consultant Partner, LBSM
Consultant in Sport and Exercise Medicine

About

Dr. Richard Antbring is a dedicated Sport and Exercise Medicine consultant with extensive experience in diagnosing and treating a wide range of both acute and chronic musculoskeletal conditions and injuries. 

Within his private practice he provides comprehensive care for individuals, young and old, from all walks of life, across all levels of physical activity, from elite and recreational athletes to those who lead a slower pace of life; helping them recover from injuries sustained from sports, daily activity, and work-related incidents.

He has a vast experience addressing a full spectrum of conditions such as ligament sprains, muscle strains, dislocations, and more complex, long-term overuse issues like tendonitis and stress fractures. 

His work also extends to treating people with medical problems related to physical activity e.g. concussion, overtraining syndrome, and nutritional deficiencies.

Having worked extensively within professional football, Dr. Antbring has a special interest in lower limb injuries, especially groin pain, and ankle and knee injuries.

Clinical Expertise and Holistic Care

Dr. Antbring is committed to providing individual and personalised care that is specific to the needs of each of his patients. 

He is a highly skilled diagnostician, combining advanced clinical reasoning with evidence-based assessment tools, to ensure an accurate diagnosis. He often utilises ultrasound scans during consultations for real-time diagnostic imaging, allowing him to provide immediate and detailed insight into his patients’ conditions. 

When required, Dr. Antbring is able to access and arranges advanced imaging such as X-rays, MRI or CT scans to further investigate or confirm a diagnosis.

He is an excellent communicator, with a strong belief in empowering patients through education and collaboration. Dr. Antbring takes time to ensure his patients understand their diagnosis and treatment options and are fully committed and engaged in their treatment.

His focus on structured and individualised rehabilitation plans, together with using advanced non-surgical techniques, such as ultrasound-guided injections and shockwave therapy helps patients recover efficiently and return to their daily and physical activities as soon as possible. 

Dr. Antbring strongly believes that the key to recovery is by treating the person as a whole, rather than just focusing on the specific area of injury. He works closely with other healthcare professionals such as physiotherapists, strength and conditioning coaches, Pilates specialists, podiatrists and dieticians, to ensure your path to recovery is smooth, and focuses on longer term prevention as well as immediate treatment. 

Experience in Elite Sports

Dr. Antbring has gained extensive experience working in elite sports environments. His background includes providing medical care for Fulham FC Academy team where he focused on the unique challenges of managing the health and development of young athletes; treating conditions such as back pain, Apophysitis (overuse injury of the hip) and growth plate injuries like Osgood-Schlatter disease; ensuring that they received the highest standard of medical care during their progression toward professional football careers.

He currently works at West Ham United FC and Leyton Orient, where he supports the performance of the 1st team players, managing conditions such as ACL injuries, Achilles tears and tendinopathy, groin and hamstring injuries.

In addition to his work in football, Dr. Antbring has also worked as a doctor for the Lawn Tennis Association (LTA), offering his expertise in musculoskeletal care to wheelchair tennis players. 

His involvement in sports like football and tennis has helped him develop a keen understanding of the specific needs of athletes, enabling him to deliver expert care tailored to the demands of their respective sports and helping them safely return to peak performance following injuries.

Special Interests in High-Intensity Sports

Dr. Antbring has had a strong interest in sport and exercise since childhood, and in later years has developed a personal passion for high-intensity sports and fitness activities, including HYROX, HIIT, CrossFit, and weightlifting. 

His personal enthusiasm for these challenging disciplines has had a significant influence on his practice and makes him uniquely positioned to understand the physical demands placed on these athletes and allows him to provide specialised care for fitness enthusiasts engaged in similar pursuits. 

Training and Qualifications

Dr. Antbring graduated from the prestigious Queen Mary’s University of London in 2015.

During this time, he developed a strong foundation in musculoskeletal medicine and sports injuries, equipping him with the knowledge and skills to treat a broad spectrum of conditions.

In addition to his medical degree, Dr. Antbring has completed a Master’s in Sport and Exercise Medicine, which he achieved with distinction. He also holds a Postgraduate Certificate in Musculoskeletal Ultrasound imaging, further enhancing his diagnostic capabilities and enabling him to perform ultrasound-guided injections and other procedures with precision.

Life Outside Medicine

Outside his clinical work, Dr. Antbring is passionate about maintaining his own fitness through high-intensity workouts like HYROX and HIIT sessions. A typical day for Dr. Antbring starts with his own fitness routine, whether it’s a gym session or an early morning run.

He is devoted Arsenal supporter and Formula 1 enthusiast, and proudly backs McLaren on race days. When he’s not cheering on his sports teams, Dr. Antbring loves to travel, ski, and spend quality time with his family, embracing life to the fullest both in and out of the clinic.

Areas of Interest

Dr. Antbring’s key areas of interest include:

  • Acute and Chronic musculoskeletal injuries
  • Overuse injuries
  • Groin pain
  • Hip, knee, and foot injuries
  • Diagnostic ultrasound
  • Shockwave therapy and 
  • Ultrasound-guided injections
  • Paediatric sports injuries and rehabilitation
  • Tendon, muscle, and joint pain
  • Sports trauma and injury prevention

Consultations and Referrals

Dr. Antbring offers private consultations at the London Independent Hospital. He provides both in-person and virtual appointments.

His calm and patient-centred approach has given him an excellent reputation within the musculoskeletal medical world, and he is highly trusted and respected by his patients and peers. 

He welcomes referrals from other healthcare professionals, as well as direct, self-referrals. He is covered by all the main insurance companies and also accepts self-pay patients.

Dr. Lewis Raiman
MBBS, MRCGP, FFSEM
Consultant in Sport and Exercise Medicine

Consultant Partner, LBSM

About

Dr. Lewis Raiman is a highly experienced Sport and Exercise Medicine consultant specialising in the diagnosis, treatment, and prevention of sports-related and musculoskeletal injuries. 

He works privately at Highgate Hospital – Nuffield Health, where he runs regular weekly clinics.

While he frequently works with athletes recovering from acute injuries such as sprains, fractures, and ligament tears, Dr. Raiman also focuses on managing chronic conditions like tendinopathies, bone stress injuries and other overuse injuries. 

With extensive experience working with elite sports organisations, including West Ham United FC as the Academy Doctor, and The FA as a Performance Doctor, Dr. Raiman is highly regarded for his expertise in treating professional athletes and high performance, active individuals. 

He has also served as a Wheelchair Tennis Doctor for the Lawn Tennis Association (LTA) and worked as a Track Cycling Field Doctor at the Commonwealth Games.

These roles, especially within football and tennis, have shaped his areas of clinical interest, and he is particularly skilled in treating conditions and injuries of the knee, ankle, shoulder and wrist, including ACL injuries, Achilles tendinopathy, calf tears, shoulder impingement, rotator cuff tears, tennis and golfer’s elbow.

His expertise extends far beyond the world of sports, as he provides care to individuals of all ages and activity levels, from young athletes to older adults. In his clinics he often sees individuals who have sustained work related injuries, or injuries from everyday activities.

For patients facing joint issues like osteoarthritis, Dr. Raiman employs non-surgical treatments such as targeted therapies, joint injections, exercise plans, and lifestyle modifications, to relieve pain and improve mobility, often helping delay or even prevent the need for joint replacement surgery. 

Dr. Raiman is also based at Imperial College NHS Trust. He is deeply passionate about bringing the knowledge and expertise he has gained from working with elite athletes and professional sports organisations to the wider population, both within his NHS and Private practice. He believes that everyone deserves access to advanced sports medicine treatment techniques and is committed to delivering the same high level of care used in professional sports to the broader community regardless of their athletic background. 

Expertise and Approach

Dr. Raiman is dedicated to providing a comprehensive and holistic package of care to his patients. He is compassionate and caring, and works hard to build up a strong rapport with his patients, empowering them through education and collaborative decision-making. 

He provides extensive and thorough assessments of sports injuries and musculoskeletal conditions, utilising imaging tools such as ultrasound scans for real-time diagnosis. 

Within the private hospital at Highgate, he has access to state-of-the-art diagnostic equipment; when necessary, he arranges additional imaging, such as MRI or CT scans, then thoroughly reviews the results with his patients to ensure they understand their condition. 

His main aim is to provide his patients with an accurate diagnosis, and timely, tailored treatment and rehabilitation plans that focus on restoring movement and function, to ensure optimal recovery and to prevent future injury.

Collaborative Care

Dr. Raiman works closely with a multidisciplinary team of specialists and has good links with local physiotherapists, strength and conditioning coaches, podiatrists, dieticians, and soft tissue therapists. 

He understands that a team approach is essential for providing the best care and outcomes for his patients. He has an exceptional reputation among both his patients and peers which is a testament to his commitment and compassionate patient care.

When surgical intervention is required, he refers patients to his trusted network of top surgeons specialising in sports injuries, ensuring continuity of care and the best possible outcomes.

Training and Experience

Dr. Raiman completed his Higher Specialist Training in London and is registered with the General Medical Council (GMC) as a Consultant in Sport and Exercise Medicine. His career in elite sports medicine includes roles with leading organisations, where he applies cutting-edge diagnostic and treatment principles to both professional and amateur athletes. 

Areas of Interest

Dr. Raiman’s key areas of interest include:

  • Musculoskeletal and sports injuries
  • Overuse injuries (tendinopathy, stress fractures, bone stress injuries, shin splints)
  • Achilles tendon and ACL injuries 
  • Shoulder, hip, knee, and foot injuries
  • Back pain
  • Football and Tennis injuries
  • Shockwave therapy and ultrasound-guided joint injections (cortico-steroid and Hyaluronic acid)
  • Paediatric (children and adolescents) sports injuries and rehabilitation
  • Injury prevention

Research and Innovation

Dr. Ramia is committed to providing the best, evidence-based care to his patients. With the ever-evolving world of medicine he understands how important it is to keep up with regular training and new research. 

His own research has significantly influenced his clinical practice, particularly in the areas of injury prevention and rehabilitation. His extensive studies on musculoskeletal injuries, biomechanics, and the role of exercise in long-term recovery have shaped his patient-centred approach, enabling him to provide evidence-based treatments tailored to each individual’s needs. 

By staying at the forefront of research on conditions like osteoarthritis and tendon degeneration, Dr. Ramia incorporates the latest advancements in non-surgical interventions, including regenerative therapies and personalised rehabilitation programs. His research-driven insights not only enhance the recovery process but also focus on preventing future injuries, ensuring that his patients, whether athletes or individuals from the general population, can return to their daily activities with improved function and reduced pain. 

https://www.researchgate.net/scientific-contributions/Lewis-Raiman-2049220560

Personal Interests

Outside his clinical life, Dr. Raiman enjoys spending quality time with his young family. He is local to the North London area and enjoys the mix of cultures and makes the most of city life.

He has extended family who live far afield in Australia and New Zealand and with a strong interest in travel he uses this as an opportunity to meet in exotic locations and explore new countries and cultures. It also makes for some healthy family banter when there is international sporting event on!

Referrals and Consultations

Dr. Raiman is committed to helping all patients—from elite athletes and fitness enthusiasts to older patients and those who lead less active lives —achieve their physical best. He offers private consultations at Highgate Hospital – Nuffield Health, on Tuesdays and Wednesday mornings, and welcomes patients seeking expert care for musculoskeletal and sports injuries. 

He is happy to receive referrals from consultants, GPs and other healthcare professionals as well as self-referrals. He also welcomes second opinions and complex cases that need specific expert assessment and intervention.

Dr. Raiman is covered by all major insurance companies, and he also sees self-pay patients. 

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    Having graduated from University of Brighton with a MSc (hons) in Podiatry, Maddie focused her career in Podiatric Sports Injuries and Biomechanics. Previously she completed a BSc (hons) in Sport Science at Loughborough University.

    A day in the life of Maddie involves consulting patients in clinic, performing gait and biomechanical assessments, measuring and fitting orthotics and braces. She also regularly teaches and presents at sports medicine and podiatry conferences.

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    Mr Saha studied medicine at the United Medical & Dental Schools at Guy’s and St. Thomas’ Hospitals before completing his higher surgical training in London and the South East. During this time, he was awarded the prestigious NIHR Clinical Lectureship in Vascular Surgery at St. Thomas’ Hospital, giving him comprehensive training in open and endovascular techniques for treating arterial and venous disease. Prakash completed his aortic surgery training at the St. George’s Vascular Institute before carrying out a specialist fellowship at the Royal Prince Alfred Hospital, Sydney.

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    Consultant Partner, LBSM
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    Dr Gajan Rajeswaran is a Consultant Musculoskeletal Radiologist at LBSM, with an extensive background of working in elite sport. He is one of the most recognised radiologists in the sports medicine field. He provides top level imaging and medical diagnostic services for patients and athletes.

    Dr Gajan Rajeswaran completed his undergraduate medical training at Imperial College London and his radiology training at Chelsea & Westminster Hospital. He has obtained two post-CCT fellowships in musculoskeletal imaging. He was appointed as a consultant at Chelsea & Westminster Hospital in 2011.

    He has a passion for all sports having worked as a radiologist at the Glasgow Commonwealth Games and London World Athletic Championships and continues to support The Championships, Wimbledon. He also continues to work with a number of Premier League and Championship Football Clubs, Premier League Rugby Clubs, England Sevens Rugby, British Athletics and the Lawn Tennis Association.

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    Dr Gajan Rajeswaran is an avid football fan and life-long fan of Tottenham Hotspur (for which he offers no apologies!). Outside of work, he spends time with his family and has a keen passion for photography.

    Dr Ajai Seth
    MBBS, BSc, MSc, MRCS, MRCGP, FFSEM
    Medical Director, LBSM
    Consultant in Sport and Exercise Medicine

    Dr Ajai Seth is a Sport and Exercise Medicine Physician. He has dedicated his career to helping people with sport and exercise related injury and illness. He consults and treats everyone from the elite athlete to the weekend warrior.

    Dr Ajai Seth is part of the British Tennis Sports Physician team at the LTA and has also provided cover to elite athletes at Wimbledon Tennis, European Tour Golf, Premier League Football, British Athletics, and the Men’s England Football academies as part of the FA.

    He also prides himself for working in disability sport and is currently the Chief Medical Officer for Team GB Wheelchair Tennis which has taken him to the Olympics and Paralympics.

    Dr Ajai Seth is dedicated to education, training and research and is a Senior Lecturer in Sports Medicine at King’s College London where he lectures in all aspects of Sports Medicine and Science.

    He also has a passion for travel and Expedition Medicine, which has seen him accompany medical, scientific and charity expeditions all around the world. He also has vast experience in treating musculoskeletal injuries from children and adolescents to veteran exercisers, both male and female.

    Dr Seth also has positions in leading Sport Medicine organisations, including the non-executive board for the UK’s largest Sports Medicine charity, BASEM and Past President for the Royal Society of Medicine. 

    A day in the working life of Dr Seth involves consulting his patients in clinic, performing diagnostics and ultrasound guided injections. He also regularly lectures and tutors students and presents at sports medicine conferences internationally. He also spends part of the working week at the National Tennis Centre, LTA, supporting British Tennis players.

    Outside of work, Dr Seth enjoys playing club tennis, triathlon, golf, running and skiing (but will give any sport a go!). He enjoys keeping fit and active and good quality family time with his wife and three children.