Running longer than a marathon is unhealthy... says Jacob Fuglsang

I am writing this in response to an article written for Politiken, Denmark's major newspaper, in the Sunday September 19th editon. The article is called "På kanten af kroppens formåen" -"On the edge of our body's capability." I want to discuss what Jacob says the dangers are in ultras and where I disagree - and where I think there are additional dangers he doesn't mention.

He starts with making the very broad generalization:
"For at tage spørgsmålet om sundhed først: Det er ikke sundt. Det ved deltagere og det er videnskabsfolk enige om."

"If we start with the question of health: It isn't healthy. Participants know it and scientists are in agreement"

The "it" he is referring to is racing a longer distance than a marathon. I will first caution Jacob that he should be more judicious with his generalisations. There is no reason to believe that hopping up to a 50k distance is more dangerous than a marathon. It depends on how one runs it. And it is dangerous to start an article saying all scientists agree when there is discussion of many different types of dangers and studies with meaningful evidence are lacking.

But what is it he and the expert, Michael Voigt, he interviews say are dangerous about these long races?

1. Kidney failure. He explains well that during races there is constant small bleeding in our muscles and, as a results, proteins are released into our blood which the kidneys have trouble clearing. This can lead to kidney failure.

My response: this is exactly true, but it happens every time we exercise and it is also part of the process of building new muscle. Muscle breaks down and is built up again at some point, but the waste products need to be eliminated. If one is dehydrated, one is always at risk of clogging the kidneys with the breakdown proteins (myoglobin), regardless of how far one runs. If one stays adequately hydrated during an ultra, one will not have kidney failure. It is really that simple.

An example from my own life (where I did it wrong). When I was doing a vascular surgery rotation, I was afraid of having to pee during the 7-8 hour surgeries, so I basically stopped drinking. After one of those surgeries, I went on an hour run and when I got home, I urinated something that resembled cola. I went to the ER and got IV fluid (now I would just drink a lot of water) and everything was ok. Luckily I got hydrated in time to avoid kidney damage from the proteins sitting there, stuck in the tubules (the real damage comes - and possible kidney failure - if they're not cleared out fairly quickly. I say "fairly" because it depends how much protein you've got stuck in there and what your glomerular filtration rate is to begin with).

I would say that kidney failure is not something that is in of it self dangerous in ultras, but is a running danger one should be aware of. The best way to avoid it in a race, especially when it is hot, is to drink lots of sports drink which is isotonic with our intravascular fluids (I'm talking veins here). Most sports drinks are close enough to this that they work. And they will also help one to avoid the other major risk of overhydration from water alone - hyponatremia. (One doesn't become low on salt unless one is sweating, so if you've stopped exercising, plain water is fine).

2. Fracture.

Agreed, obviously. But again, it is not a danger inherent to ultras. I would say one is more likely to break a bone by going out downhill skiing than running an ultra. I guess I would not even mention it as a specific risk. But then again, considering Steve Q's track record, it may be a particular risk to certain people.

3. Avoid painkillers.

Here Jacob simply didn't go into any sort of detail other than to say pain killers increase the risk of kidney failure. But there are different types of painkillers with different dangers.

Ibuprofen/Ibupren - this is the prototypical NSAID - decreases kidney function by inhibiting with the body's formation of prostaglandins, which are protective to the kidneys and stomach among other things. The same goes for all other NSAIDS. They should be avoided in races. I used to feel differently, but I read a very well-written, well-researched article in the New York Times, which changed my mind. They decrease performance and are potentially dangerous for our kidneys (and cause stomach upset - but that is a minor consideration when taken short term).

Tylenol - if you take 4 grams or less (that is 8 tablets) a day and you don't have a liver disease, there is no danger. The only problem is, it doesn't work for muscle pain. But if you have a headache, feel free to indulge. It is not a risky medication unless you overdose.

Opioids - no matter where you live, you need a prescription to get these and you can't even drive a car when taking them since they make you so drowsy. They also make you nauseated. They work for pain, but would be overall a huge detriment in an ultra due to the side effects. If you have pain that bad, just don't run.

Immunosuppressive steroids - ex. prednisone (like opioids banned from races and by prescription only) - these work for swelling and long term for certain types of pain. Some ultra runners have taken them to keep going days in a row. I actually do believe they are effective at reducing pain due to swelling. I agree, however, they should be banned from all sporting events as they prevent proper recovery and are quite dangerous to take long term. Short term, they present the same dangers as Ibuprofen, but even more pronounced, and can cause a psychotic-type reaction in certain people.

4. But the brain does fine.

Jacob discusses here how running benefits the brain. It is true that it is good for depression and mood and also for increasing one's pain threshold for the rest of the day (though as for ultras, I usually feel I have MORE pain afterwards :)), but I believe long-distance runs (marathons included) can also be dangerous for the brain. And this is not something I have any research to back up.

1-2 days after a very challenging athletic event (the longer and more physically exerting, the more profound it is), I have trouble thinking as clearly and acting as quickly as usual. Especially when I was working with patients daily in ophthalmology, I found I had a lot of trouble examining them. For anyone who works in a job where another's life/vision is potentially in danger, I would highly recommend taking at least one day off after a marathon/ultra/ironman to avoid potential harm to another. Exactly what this is caused by, I am uncertain, but believe it is shunting of essential nutrients away from the brain and to the recovering large muscle groups.

Psychiatrically, ultras are also dangerous because of the level of commitment they require to perform well in them. One may find oneself abandoning all one previously perceived as important (relationships, dedication to work, etc.) in order to find time to achieve the goal of a certain ultra - and that is probably the biggest danger of all. Trust me, I know. Plus the attitude of wanting to finish at all costs is dangerous for obvious reasons.

Finally, the overall statement that ultras are unhealthy, I think is false. I do not think there is evidence to support this either. I think ultras have risks, but I don't think that a few days or a few weeks after an ultra that one is less healthy. And I think training the heart and muscles to achieve that sort of endurance is healthy, at least physically.

That's all I have to say in response to Jacob.

If that was boring, here are some pictures from our tri club championship last weekend. The most notable part of the tri was the water being about 13 degrees C - I'm not going to look it up, but am wagering that is around 55 degrees F. Suprisingly, I LOVED it. Well, not the first two minutes, but after that it really was wonderful.

Our club captain, Anette.



First woman out of the water, Maria.


Rikke, who beat me by less than 30 seconds. Grrrrr.....
Søren, first place for the men:





Have I mentioned that I spend a lot of time dreaming at inopportune times?

Running song of the day: Driving to LA by Household Names (from Austin, for those who might live nearby :))