The Same Pill at Mile 20

NYC Marathon week: what endurance athletes take, and what your protocols can learn from them

Endurance athletes take supplements to get through stress. Most of your patients take them to get out of it.

On Sunday, November 1, the New York City Marathon runs its five-borough course for the 50th time. Tens of thousands of runners will line up on Staten Island with a pharmacology plan more disciplined than most clinics write. They know their caffeine in milligrams per kilogram and which mile the gel goes in. A lot of them will also take something in the start corral just because it feels responsible.

Same people, same morning, two completely different habits. One is good prescribing. The other is insurance. The difference between them is worth building into every protocol you send us.

Quality comes before timing

Everything below is about when and why to take something, so start with the part that has to be true first. Every product in the OK Capsule formulary is third-party tested on a skip-lot basis, and our GMP-certified facility in Reno came out of its last four annual audits with zero observations. A perfectly timed dose of an untested ingredient is precision aimed at the wrong target. If you have never seen how a manufacturer actually operates, come visit Reno, then go visit someone else's facility.

What runners get right, and what they get wrong

Start with caffeine. The International Society of Sports Nutrition puts the effective dose at 3 to 6 mg per kilogram of body mass, most commonly taken about 60 minutes before the effort, and notes that pushing to 9 mg/kg buys side effects rather than speed. For a 70 kg runner that is roughly 210 to 420 mg, timed to the clock, with a ceiling. That is better prescribing than most adults get for anything.

Now water. For years marathoners were told to drink ahead of thirst. At the 2002 Boston Marathon, researchers drew blood from 488 finishers and found that 13 percent were hyponatremic, their sodium diluted by fluid they did not need. Among women it was 22 percent, and three runners came in below 120 mmol/L. Water is about as benign as an intervention gets. Given without a ceiling, it put people in the medical tent.

Caffeine is attached to a moment, a mechanism, and a body weight. Water is attached to a fear. A supplement with a job is a tool. A supplement without one is a superstition with a lot number.

Vitamin C and the clock

The cleanest illustration is a single molecule, and the question it raises isn't whether to take it, but when.

In 2009, Michael Ristow's group gave young men 1,000 mg of vitamin C and 400 IU of vitamin E daily through four weeks of training. The placebo group got the training adaptations that exercise is supposed to produce. The antioxidant group did not. The authors' explanation is that the burst of reactive oxygen species during exercise is the signal: it switches on PGC-1α and the cell's own antioxidant defenses, and if you mop it up, you mop up the adaptation with it.

So timing changes the job. Swallowed every day through a training block, high-dose antioxidants compete with the very stress the athlete is training to adapt to. Race week is different. The training is done, the adapting is over, and the job becomes supporting normal immune function through a period of intense physical stress. Same molecule, different job, depending on where it sits on the calendar. That puts vitamin C in race week and the days after, not in the hours around ordinary training.

A race week protocol, built from the formulary

Here is what a marathoner's race-season order could look like from our formulary, with each product given a job and a window.

• Vitamin C 1000 mg for race week and the recovery days that follow, to support normal immune function during periods of intense physical stress.
• Magnesium Glycinate 133 mg in the evening slot through the training block. Glycinate is the form I reach for when gentleness on the stomach matters.
• Iron 18 mg as ferrous bisglycinate, and only when lab work supports it, to help maintain healthy iron levels. This is the clearest case for a finish line: dose to the lab value, then retest.
• Creatine Monohydrate 750 mg through the training block for runners doing intervals or strength work. The evidence in endurance athletes points to repeated hard efforts and sprint finishes rather than steady aerobic pace, and it can add a little body mass, so it belongs in training, not race week.
• Carnitine Tartrate 500 mg for the heaviest training weeks and the days after the race. L-carnitine supports muscle recovery after strenuous exercise; it doesn't change strength or power. It is a recovery tool, and that is the job it gets.

What stays out matters as much. No high-dose antioxidants stacked around routine training runs, and nothing taken just in case because it feels like insurance. Our pouches are organized by time of day, so each of these lands in the slot where it does its job instead of in a pile on the counter.

Give every protocol a finish line

A marathon training plan is the only health protocol most people will ever follow that has a date printed on it. It builds, tapers, peaks, and ends at a specific spot in Central Park. Then the runner recovers and the plan changes.

Your patients live without a race, so their supplements never taper. Give each item in a protocol a finish line of its own: the event or lab value it's tied to, a dose sized to the person, and the date or the lab value at which it stops or gets reassessed. Quarterly is a reasonable default. With no minimums, rewriting a protocol every quarter costs you nothing but the decision.

Athletes time the support to the stress. Most people take the support instead of the stress.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.