Review Finds Link Between Low Energy Intake and Injuries to Runners

WASHINGTON — Many runners are focused on increasing weekly mileage or shaving time off their 5K. Going too fast, too soon can lead to injuries, but sometimes overtraining is not the culprit — it’s not eating enough.

A new review investigates the link between how much runners eat and whether they suffer injuries. Here are some of the new review’s findings on the link between energy intake and the risk of bone and soft tissue injuries in distance runners. 

Diet and Running-Related Injury in Adult Distance Runners

While it is a well-known fact that nutrition is key to running performance, researchers at the University of South Australia wanted to see how specific dietary intake correlated with running-related injuries, including bone stress injuries. Their results were published in the February 2025 issue of the Journal of Science and Medicine in Sport.

Their goal was to identify whether energy intake, independent of body size, was a factor in injury risk. They also explored macronutrient differences (protein, carbohydrate, fat) and assessed whether sex differences played a role in how diet influenced injury outcomes.

Studies and Participants

The review included 15 studies in total, with nine eligible for meta-analysis. Across these studies, researchers analyzed data from nearly 6,000 runners, 2,364 of them women, from countries including the U.S., Australia, Japan, New Zealand, and the Netherlands.

Six studies focused on general running-related injuries: 

• They Included 5,192 runners, aged 18 to 53, and BMI 22.0 to 23.6.
• Most runners were elite or near-elite athletes with 83% considered tier 1 or tier 2.

Nine studies focused on bone stress injuries. 

• They included 750 runners, aged 18 to 26, and BMI 19.3 to 22.9.
• Most runners were less competitive, considered tier 3 or 4.

The studies also varied by gender:

• Six studies included only women.
• Three focused exclusively on men.
• Six included both women and men, four used combined results, and two offered both combined and separate data.

This mix allowed researchers to explore sex-specific differences in energy intake and injury risk, a key aspect of the review’s findings.

Energy Intake

The most consistent and striking finding: injured female runners consumed significantly fewer calories than uninjured runners. On average, their daily intake was 449 kcal lower (range: 202 to 696 kcal). Notably, this difference was observed despite no significant differences in body weight or BMI in most of the studies.

In other words, it wasn’t that injured runners were underweight, they were under-fueled. This suggests energy availability, rather than body size, plays a central role in injury prevention.

Macronutrient Findings

Here is what the review found about macronutrient and micronutrient intake.

Lower fat intake was linked to higher injury risk in female runners. Injured women consumed about 43 to 63 grams per day (20% of their total energy intake), while uninjured runners averaged 66 to 80 grams per day (27 to 29% of their total energy intake). 

This falls within, or below, the recommended ranges of fat consumption (20 to 35% of your daily intake) and may affect hormone production, inflammation, and musculoskeletal health. In male runners, fat intake appeared consistent regardless of injury status.

No significant differences in protein intake were found between injured and uninjured runners. Intake levels generally met athletic recommendations (1.4 to 2.0 grams of protein per kilogram of body weight per day), which may explain the lack of effect.

While low-carb availability has been shown in other research to impact bone and immune health, this review found no clear link between carbohydrate intake and injury risk in women or men.

Although fiber was only mentioned in a few studies, some evidence found that injured runners of both genders consumed about three grams less fiber per day than uninjured runners. The review also states that a low-fiber diet increases the chance of BSIs in both male and female runners.

Conclusion

This review adds to a growing body of evidence that nutrition plays a major role in preventing injuries among distance runners. For female athletes in particular, eating too little, even without weight loss, may increase the risk of soft tissue and bone stress injuries. The researchers also found that a low-fiber diet may contribute to injury risk in both women and men. 

Meanwhile, protein and carbohydrate intake didn’t show strong associations with injuries, and the link between diet and injury risk in male runners remains less clear overall.

Whether you’re training for a race or just running to feel good, make sure you’re fueling accordingly. Eating plenty of nutrient-dense foods, including healthy fats like nuts, seeds, olive oil, and fatty fish, can go a long way toward keeping your body strong and injury-free.

Our website content, services and products are for informational purposes only. The Well News does not provide medical advice, diagnosis or treatment. If you have medical concerns or questions, discuss with your health care professional.

You can reach us at [email protected] and follow us on Facebook and X