Photo from Mount Royal, Frisco, Colorado.

"That is happiness; to be disolved into something complete and great. When it comes to one, it comes as naturally as sleep." - Willa Cather

Thursday 3 June 2010

BMI in women's running

Ilsa Paulson (above) won the Twin Cities Marathon in 2009, beating Colleen De Reuk, with a time of 2:31. Should women runners strive to be her weight to be fast, or is she unhealthy?

I've been looking forward to writing this for quite a while. It's a topic basically everyone is hesitant to broach because weight, for some reason, is such a sensitive topic. But what if for a moment, we all talked about weight in women's athletics honestly and realistically?

First, on being skinny:

I would have had to be blind to not notice that the top 5 female finishers at Copenhagen Marathon were thinner than me. First the winner, Colleen Van Deuk has a BMI of 17.3 (normal: >18.5) and certainly has a higher BMI than Ilsa (above), who has beaten her. I saw Anne Sofie Pade Hansen, number three at the Copenhagen Marathon, walking around near me after the race and was astounded by how thin she was. Here is an old picture of her where she weighed more than she does now:

My friend Mette, who took 5th has slipped comfortably into the below normal BMI over the last year and I challenge anyone to find an elite female runner of the 5000 meter to marathon distance who is of normal BMI.

And, correct me if I'm wrong, but most women who enjoy running competitively would also like to be as thin as these women, but it is HARD to stay so thin. But what is even harder, is knowing where to stop with the weight loss before it becomes unhealthy.

On not being too thin:

In college I lost a lot of weight and for a while plateaud at a happy 5'6" 105 lbs (BMI 16.9). Everyone told me I was too thin, but I felt just AWESOME. But my periods stopped and I felt more and more, well, asexual, and by the second year of med school, I fell to 95 lbs, was admitted to the hospital due to almost being killed by a bacterial gastroenteritis which caused me to lose an extreme amount of blood and was discharged to many follow-ups which revealed what I had feared: my estrogen was too low, I had osteoporosis in some spots and osteopenia everywhere and even had multiple painless stress fractures. I embodied the female athlete triad. Partly against my will (anorexics are crazy), I gained weight and then just kept on gaining. My periods didn't come back and I was just depressed.

Anyway, as of this morning, I'm at 115 lbs (BMI 18.6) and would love to lose at least 5 lbs, bringing me back to where I was a year and half ago when we moved to Denmark. I want to be healthy and feel good and be a fast runner. I want it all. But can I? Can we? I just had this discussion while on a run with Helle and the thought of weight loss is exhillarating to us both (and most people would also look at her and not find she had anything to lose). Don't we all want to be that perfect thin weight without having any health problems? Why is it that all non-elite athletes who are thin are attacked for being "too thin", while elite athletes with the same BMI are praised? What IS actually healthy? I KNOW, I'm a doctor, I should know this, but I don't.

I will quickly add that many people say that the best female ultra runners don't need to be thin. And there is some evidence of this. But if you look at the largest ultras (not that there are any nearing the size of a large city marathon), the female winners also tend to be thin, though there are exceptions.

Here was the winner of the 24 hour run world championships in 2010, Anne Celine Fontaine (who ran a sweet 240km) and the winner of the 2008 USATF 50 mile championship, and course record holder, Suzannah Beck.

I hope if I wave a magic wand now, an interesting conversation will develop in the comments section /**** (that was the wand)

Oops. I almost forgot about this freakishly good running song of the day: Farewell to Wendo by Mock & Toof (deserves it's own blog post, which I won't write)


Ellen said...
This comment has been removed by the author.
PiccolaPineCone said...

I would start the discussion by asking, why use BMI as the indepedent variable? It is a blunt tool that ignores factors crucial to athletes, most importantly it treats muscle, bone and fat all the same. Mass is mass. It also ignores gender. My impression was that it was developed to classify the various degrees of obesity as well as the severely underweight but I don't see it as being applicable to athletes. Here is my study of 1: 2006 - 5 km: 17:36. BMI: 19.5. 2010 - 5 km 17:55, BMI: 18.9. The BMI is lower b/c I have unfortunately replaced muscle with fat and this is reflected in the 5 km time. In my mind,body fat is probably the better independent variable to use though admittedly harder to come by.
p.s. cocotte's bmi is 15 but she probably needs to learn to walk before she can take on Ilsa and Colleen.

Danni said...

Hmmmm. A few random thoughts. First, for those of us who are not professional runners, why live life that way? If it's hard to be that skinny, why do it? To me, being that thin isn't even attractive. On me or anyone else. I don't give a crap about elite runners. I am not one nor do I strive to be one. I ran my marathon PR at the weight I am now and could have run faster if I had the experience I have now. . . maybe I could run faster if I lived a life of misery and starvation but that doesn't sound rewarding to me. I've been 15 pounds lighter and wasn't necessarily faster and certainly wasn't happier.

My next thought is that it's really unhealthy, as you know already, to obsess about weight, especially when it has had terrible consequences in the past. It's one thing to not want to be fat, but quite another to really want to be underweight to look like elite runners. And let's face it, not every underweight runner is elite or even fast. My fat ass kicks plenty of skinny ass at races and I'm not even in top shape for "me."

Of course, I do mountain ultras so my idols are the likes of Olga and Nikki Kimball. Both I know struggle(d) with weight issues but both are talented and strong and are better role models for success in my sport. Olga has placed top 10 at Western States, which is a huge achievement. And, she has beat you ;) And, she doesn't strive to be underweight. Again, this is focused on a different sport -- you seem focused on road running. . . but I hope something coherent emerges from this rambling. Maybe it won't. Ultimately, I feel like I have finally gained the wisdom to appreciate that life and running is about so much more than the mental and emotional flogging of scale obsession.

LK said...

I'll just say that in my opinion, BMI is a total crock! I'm 7 pounds from being in the "overweight" category. Everyone in my workplace thinks I'm skinny, but, more likely, I'm average for an athlete, and muscle weighs a heck of a lot more than fat and displaces fat at a 5:1 ratio per pound. I prefer to look in the mirror, as vain as that sounds, to determine what seems healthy. For me to get down to the bottom top 1/3 of the "normal" BMI weight score (14 pound weight loss), my face would look ematiated (I've been there before). There's also a certain amount of satisfaction when I toe the line in a race where I'm trying to place top 3 and beat much lighter, svelte runners. Yes, my body gets beat up more because of my weight (182), but that's something I have to live with.

On a different note, I can assure you that one runner mentioned in these comments is NOT overweight. I get to enjoy watching her walk naked across the bedroom every morning after she wakes up and I NEVER get tired of seeing that piece of beautiful art. Absolutely perfect! It would make a college girl jealous! ;)

Danni said...

Larry, just so we're clear, I never said or would say that she's overweight. She's obviously not. Only that she's *not underweight* and is awesome.

Mapp said...

Am I happy being slim? Yes, I am. Do I want to be like Isla? Certainly not! I don't find it remotely attractive and think she just looks sick. But more than the aesthetic side of things, I just don't want to know how she will be and feel when she gets older...

A woman in my running club back in London is in her mid 50's. She is a fast runner if you consider her age-group results, and just ran the London marathon in just under 3.20. She is also totally obsessed with her weight (I am not making this up: she weights her SOCKS before chosing her outfit for a race). Sure, she is skinny, and looks pretty decent when fully dressed. When wearing shorts and a crop top... well, I guess it is an acquired taste. And more importantly, she has multiple health problems, and keeps getting injured... and it is anyone's guess how many more years she'll still manage to run... And I am absolutely convinced her health issues are totally related to being too skinny.

So as for me, if I had to chose, I'd rather be healthy and still be running in 20 years time than losing weight and jeopardising the chance of doing sports well past retirement age!

I guess it is all a matter of when does "thin" becomes "too thin"... and that's where the problem is, because once one starts losing weight, it is only too tempting - and exhilarating - to try and lose a bit more. That's especially true, I find, of long distance runners, who tend to be driven and control freaks (well, I am, at least!). You actually find that a lot of them, especially women, started running TO LOSE WEIGHT...

People focusing on trail running for some reason seem to have a more healthy attitude to weight... Karine Herry, Corinne Fabre, Laurence Klein, these women are all top trail runners, and they are not skinny, just slim, lean, and muscular (and in my view far more attractive than Isla!)... And Laurence Klein has a marathon PB of 2.37.. gained last year, at... 40! Now, if I needed a role model, I'd rather chose her!

End of rant!

Diana said...

I have to agree with Piccola Pine Cone that BMI is a horrible method for measuring weight or the overall health of an individual. It was developed in the nineteenth century by a Belgian astronomer interested in studying the averages of the human body within a large population, and its creation is steeped in the cultural concerns of the time. It was never intended to measure the health of an individual the way the medical community has come to use it. I loathe the use of BMI for the reasons PPC stated above in her comment.

Furthermore, I'm a little troubled by one of the sentences in the post: "Don't we all want to be that perfect thin weight without having any health problems?" What's so perfect about a weight that leaves us vulnerable to sickness and injury or even causes health problems? That doesn't seem so perfect to me.

Yes, losing weight can feel good. I also believe it can be difficult to stop, because being lighter can make you feel faster. But does the actual number on the scale really, truly matter, or is it a matter of having something to control? I threw out my scale a few years ago, and I have refused to be weighed at the doctor's office before, simply because knowing my number only makes me want to control it.

I'm not an elite runner, so I am not faced with the stress of winning competitions and meeting professional expectations. As an aside: I don't know if I agree that elite athletes are praised for being so skinny. I can only say that I wish a focus on health and running would shift away from becoming thinner and achieving a desired BMI. Better to eat well, work hard in workouts to get stronger and faster and ultimately to enjoy the running.

SteveQ said...

First, you have to acknowledge the "more babies born during full moons" thing - there's absolutely no evidence, but ob/gyns and nurses will tell you it seems true. That's because they LOOK for it; if they see the two together, they remember it, if they don't, they ignore it.

You see a skinny woman win a race and remember it, because you want that to be reinforced. There are plenty of counterexamples, but you ignore them.

This is coming from a guy who was once 5'11 1/2 and 128 lbs. and running 32 minute 10K's and now 6'0", 155 lbs. and running closer to 38. I could say it's the weight (30 years older is more likely). VO2(max) is directly proportional to mass, so the less one weighs, supposedly the better - and Matt Carpenter's measurement of 90 is due to his being 118 lbs. at 5'6". But he doesn't always win!

There's only so low one can go before one loses strength, so the smaller one's frame, the better, which is why Tegla Laroupe at 74 lbs (4'7") had an advantage and why top male marathoners are all about 5'2"-5'3." You're never going to get to their weight and you shouldn't try!

When weight goes low enough, one obsesses about food. I know from experience. It's not worth it; if I made a living from running, I might consider low weight for a year or two, but what price misery?

Sadly, I think Ilsa's hot. That's my own neurosis - I was engaged to a woman who died from a heart arrhythmia from malnutrition, trying to lose weight when she was already too thin - and I still think Ilsa's attractive. I'd also think she was attractive if she weighed a lot more, thank God.

Okay... getting too long here.

cherelli said...

Hmm, I'm not a fan of BMI at all. Like others have said it fails to account for the differences in body muscle/ fat composition. Perhaps bodyfat AND BMI should be included in this discussion. Whatever, i guess it's a matter of knowing where your line in the sand is. You are either an elite athlete willing to forgo some elements of long term health to gain results in the present time; or you are a successful competitive athlete who needs a little extra energy for the rest of life like a job and children. Also, there is a fine line between wanting to be "a few lbs lighter" and becoming obsessive about weight - which you have admitted to being susceptible to in the past (I delved a little into the same thing in my teens and recall that exhilerating sense of control - but to the exclusion of so much else). Will you know when you have crossed that line? Oh and I am SOOO not a fan of the skin and bones look in the arms or upper legs. A little healthy bodyfat and muscle tone while still being slim is FAR more attractive. I agree with others that any trail runners I see look far healthier than the road runners.

Olga said...

Yikes, ouch:) OK, first of all, from a medical/athlete stand point I completely on the side of Piccola saying that BMI is an arbitrary number. To be clear, since my name was brought up, my BMI is 22.5. My fat is around 20% by densitometry (which was taken 2 years ago twice at different weight and waist/hips measurements, as well as by calliper test, so I know it by heart and can always tell you where I am). That's just to begin with. Fat vs muscle give numbers that screw BMI. I am 5'5" and stand at 135 lbs (with fluctuations 5 lbs either way, yes, that much, I bet it would drive you nuts, but it is period dependant and post-race influenced, and I stopped fretting about it). I have a huge muscle mass though, noted by massage therapist and doctors (and regular by-standers, too bad I can't find time to become a body builder, I'd be awesome at that!).
Now, to the first picture. That girl looks sick and reminds me of nazi camps, elite athelete or not. This particular one is unhealthy. I'd say same thing for the Paula Radcliff and alike, although she is not as bad. Still - sick. For them - it's a job. They make a choice. As I said in some other comment, neither you, nor I or 100% (yes, all of us here) of readers here are elite athletes. Neither one of us will ever be - sorry, live with it. We'll get better (or so we strive for, and I believe we will as we try hard), but we will never be elite. I'd stop comparing to those just simply on this fact based.
Now, to the possible core question - does shaving a few oz's make you a faster runner? Depends. Likely. Especially at road short races, to a certain point of course (before you get to be emaciated). Has to be proven for each of us though. While yes, majority of ultra-goddesses (since it's the only field I know) are still on a less-fat side for sure, a few are in a healthy "athletic overweight" issue (like ones we discussed, although normal by regular people's standards). But, again, the real scientific experiment would be to have each of them either gain a few pounds or fat (not muscle) or loose it and have them perform under same training and race conditions - and look for TIMES, not placing (I have to agree that those couple we discussed in email, while won, have not run "elite" times).
I am an experiment of one, and have no answers. When I had my best, fastest year, I raced at 145 lbs. I had PR's at trail 50k, 50M, 100k, placed that infamous top 10 at WS and made 4 100M races a year with 22 ultras total. By the time last 100 miler rolled, I got down to 130 though...just for that one, in 6 weeks, I dropped over 10 lbs. I had a good race. I don't know if I had done better, worse or same at 140.
Now, to MY core - and what seems to be Danni's core too:) Why??? I LOVE my life! I was at 117lbs once and kept it for 2 years, I really enjoy looking at those photos. Do I want to go back? I'd like to look like it, yes - I am a normal female. BUT, I don't want it bad enough to make sacrifices for it, it is NOT THAT important to me. I have way too many more responsibilities - and fun - in life than focusing on what to eat by gramm/calorie (while I do eat healthy and watch the general trend), I feel strong, I am able to do my workouts without exhausting myself for the rest of the day, I get looks and compliments, and - I have that dude who keeps watching me with his jaw dropped every morning:) What's more to wish for???
And as he said, and I said numerous time, it's fun to beat skinny asses at the races...JK!

LK said...

Danni: I knew what you meant. No offense taken. :) -Larry

SteveQ said...

btw, Helen's blog lists data from Feb 2008 when she was 166 cm. and 66.8kg. and 19.4% body fat - beat her in a race and then you can revisit the question!

SteveQ said...

And Chris Solinsky's making news as the first "fat guy" to break 27 minutes in the 10K @ 73kg. and 185cm. - neglecting to mention he's also the first non-African.

Fast Bastard - World's Fastest Hematologist said...

Hi all. Great discussion. I think everyone is in 90% agreement. I have a few points.

1. BMI is getting slammed here. It's used a lot in medicine, and while it may not be perfect, it's a rough number that is used to guide dietary decisions. I know of no better alternative. Most healthy athletes are clamped within 1 or 2 BMI points, so in those cases BMI doesn't make sense.

2. I'm glad that Larry has a chance to see Olga walk across their bedroom naked every day.

3. I think there is little doubt that distances from 5000 to marathons tend to get won by people with lighter builds. For these individuals, as Steve Quivck says, there is a perfect weight that's neither too light nor too heavy. It's my guestimate that a lot of women exist on the lower end of that perfect weight, whereas most men, even elites, tend to be a little heavy. How many years has Chris Solinsky been running great, but not world-beating times? He sure got fast after losing those few extra pounds. Men tend to build muscle easily and, like it not, muscle slows us down. Lance Armstrong has commented on how he was always struggling to stay lean and was told never to do any upper body work. Most men gain weight as they age, sometimes solely because of muscle. Even if it's all muscle, it still has to lugged aorund in a race.

4. Her name is Ilsa, not Isla. Isla, by the way, is the daughter of Paula Radcliffe, whose weight is insanely low, too. As an aside, my young niece, who is half Malaysiian, half Danish, is called Ayla, pronounced like Isla.

5. Steve, Ilsa said in an interview with Runnersworld that she often gets handed the children's menu when she goes out to eat with older people. You two would look odd on a date, methinks.

6. On a personal level, my weight is always inversely proportional to my running performance. I'm a moderately heavy runner and within my little window of weight, I tend to be in the heavy range. I set my best PR (1:13 half marathon) a couple of months after getting braces. I agree with everyone above about healthy weight etc. but I also think the honest truth is that light=fast, at least for men. Sealegsgirl, on the other hand, is on the low end of her weight window and has been getting faster along with gaining a few pounds.

7. Western society's perception of perfect weight varies with sex. Few men are tempted to go below BMIs of 20, simply because it brings no status to be that skinny. Quite the opposite for women. Barbie has a BMI of 12, while Ken's is 23 (source: psychiatrist specializing in anorexia; might be inaccurate).

8. In life outside running, it's very controversial which weight is ideal. There are conflicting studies out there, all full of confounders. In my specialty, cancer medicine, it's well-known that being in the low end of anormal BMI is a risk factor and a low BMI is downright dangerous.

SteveQ said...

@Fast Bastard: I'd take that chance with Ilsa. I dated a woman who was 4'1" and 48 lbs. once and could've passed for 9 years old.

Wow, I'm coming off badly here!

A quick Google search finds women finishers at Western States ranged in BMI from 19.4-21.9 and in another study of women 100 milers, the fastest three were 21.5-22.9

Coach Jen said...

Like others said BMI alone is difficult to use for judging, you could almost make better comparisons with using body fat % and muscle. According to BMI alone, I would have had the same BMI with a weight of 105 (5'6") at two different points of my life; in high school as a dancer while eating minimal food and restricting calories and a few years ago when I ran my half/full marathon PRs but was eating healthy at had much more muscle. At the first time I lacked energy and looked unhealthy, but when running I was eating plenty, but training hard and felt great but wonder if I could have had a little more energy to go even faster had I kept a few more pounds.
On a side note you and I are the same height and weight and I too would love to drop 5 lbs, but have a feeling that my love of ice cream and wine may prevent this :-)

sea legs girl said...

I knew I would get crucified, but I didn't know it would be because of my inordinate love of a Belgian astronomer. I have to wonder what I should have used instead of BMI: average density? nutritional status? Okay, I agree I'd love to have included %fat, but as if I have access to that. I had to use some sort of measurement and it is better than weight alone. But the pictures tell most of the story, so you gripers can all just skip over the BMI part when you read the post and it won't change much.

I am the fastest I've ever been now and at a higher BMI than I had 1-2 years ago. It's because of training. But if I keep training AND lose weight, I'll get faster, to a point. But I'm nowhere near that point of being too light. It is just extremely difficult to realize exactly when one has gone too far.

I agree Steve, I'm more obsessed with food when I weigh less, but I am always so extremely obsessed anyways that no one would notice the difference. Oh, and is Ilsa single? Though for her sake I hope she dates someone who can talk some sense into her.

Larry, thanks for the comment! Feel free to write about Olga walking around naked anytime. That was exceptionally touching.

SR, you on the other hand, are not allowed to write about Olga walking around naked.

sea legs girl said...

Marathon Princess, cool that we share weight and height! I also love red wine, but not ice cream. Lactose intolerance may be what helps me to lose those pounds.

mmmonyka said...

This is a really interested post and discussion. Mostly because I have never really cared about my running weight. I am such a non-scientific approach runner... But it now seems to me that it is a pretty important issue for distance runners and I should be more careful. I am 6' and my weight is somewhere around 140-144 (I think) and it seems that to be a good distance runner, I should lose some of it. Maybe 135? I did run my HS 1500m PR at 144ish weight (4:41) and am not sure whether losing few pounds would have made me faster. I do not think so thought. I used to run with bunch of very fast middle distance runners and a lot of them were not skinny at all. Well honestly, I was one of the skinniest ones.
But I feel that if I lost few pounds now, it would help me to be faster distance runner. I will try and let you know how it goes.

sea legs girl said...

Mmmonyka, it's certainly not my intention to suggest an of my readers should lose weight! And losing weight is no guarantee for getting faster; it has to be accompanied by the same intense training. And no one says anyone needs to feel compelled to get faster. That being said, it is your decision!!!

Re ealier comments:

Steve Q, your logic about Helen Lavin vs. me could be thrown right back at you with Devon Crosby Helms vs. Helen Lavin. Granted I don't know DCH's BMI (I just googled it and was disturbed to get my own blog?!), but I suspect is is quite low. Once HL beats DCH, then we can take up this discussion again. :).

Diana, I never properly thanked you for that interesting tidbit about the BMI astronomer. That's quite a nice factoid.

Confession: When I really think about who's body I would MOST like my body to resemble, it is Kami Semick's. I actually think she has a normal BMI, but very low body fat. So, despite the fact that she could probably get faster at shorter races if she weighed less, I find myself admiring her more the way she is.

Fast Bastard - World's Fastest Hematologist said...

"@Fast Bastard: I'd take that chance with Ilsa. I dated a woman who was 4'1" and 48 lbs. once and could've passed for 9 years old."

There's a story that deserves a blog post all its own.

amazon said...

I don't know that I have much to add here, except that I can't remember ever hearing praise for elite athletes for being as thin as Ilsa is. In my experience, as others have said, people do tend to get faster as they lose weight, but there is always a point where that trend reverses, and I can't think of anyone who has managed to avoid going past that threshold when losing weight.

And about BMI, I do agree that it's somewhat meaningless when it comes to athletes. My husband, who is short(ish) and muscular is borderline obese by the BMI standards, and of course that notion is absurd.

Amber Dawn said...

I certainly don't know the answer, but I know that my usual race weight (Ironman Peak) is 105lbs. I only weigh that for about 2 weeks and it generally takes me an entire summer of high volume to get there (no dieting). Normally I sit comfortable at 110, year round. 2 weeks before my first 50miler (at the end of May) I decided I should be at race weight. For some reason all of the above info didn't occur to me and I just thought I could diet my way down 5 lbs. I ended up catching a horrific chest cold that has now turned into pneumonia. I am pretty sure if I had just kept eating/drinking normally I would have stayed healthy and been able to run the race. This is a lesson learned for me. I think it is different for everyone, and some people are build leaner than others. I know I won't ever make the mistake again of trying to force my body to a particular weight.

mmmonyka said...

SLG, no worries, it is not your posts that have influenced me.
It is a pure logic thing. If you have to carry extra 5 pounds for 42k, then you will definitely feel it, right? It is like carrying extra weight in you backpack when hiking. You want to make it as light as possible. The same thing goes for running, I don't want to drag extra weight with me:)
But I love food so....I might continue carrying that extra weight:)

Drs. Cynthia and David said...

I am curious what difference nutritional status makes with respect to the weight-health continuum - what would happen if you were also eating a high nutritional density diet (vegies and meats/dairy with lots of fat soluble vitamins like A, D and K2) instead of a lot of empty carbohydrates for fuel? Under these circumstances, it might be harder to do high intensity training (without replacing carbs religiously), but would the low weight actually be unhealthy? Would you still get the same hormonal imbalances and osteoporosis? The crossfit people doing paleo seem to indicate otherwise, and report miraculous good health and resistance to disease, but I don't know how many of them are in the BMI range you're discussing. Paleolithic peoples are certainly on the thin side and they are not unhealthy. Have you ever tried that experiment? I'm only semi-paleo myself (age 53), but I'm rarely sick anymore (I had pneumonia 3 times some years ago and lifelong asthma). I have tons of running injuries, but all soft tissue, and when I fall or take a hard landing, I get a dislocation instead of a break (not necessarily good but an indication of strong bones anyway). Of course, I'd have to get a lot skinnier to test out the theory on myself and that's not happening anytime soon!

Thanks for the discussion.


SteveQ said...

@Drs. C&D: You just never hear the stories of people on Crossfit and paleo who DON'T succeed. They get shouted down like liberals on FOX.

sea legs girl said...


I just imagine the section of the article written about Ilsa in the Minneapolis Star Tribune was filled with praises for the young athlete and not a moment's mention of her being too thin. I haven't looked it up to verify. But this is always how it is. Don't you think?

Amber Dawn, I essentially agree with you. But interesting that you tried to lose weight for a 50 miler! I think it is important there is some calorie excess (compared to where one has been in the last month's time) before one runs such a long race. It is however extremely difficult to say exactly WHY some young healthy people get pneumonia and I imagine you will never be able to know whether it was the weight loss that triggered it. As a resident and medical student, I was amazed at how many young, healthy, non-smokers seemed to get pneumonia out of nowhere (especially lobar streptococcal pneumonia). I hope you get over it soon!

Well, you finally got me to look up what the Paleo diet actually is. People in Europe seem to not need to call their diets anything, they just "eat healthier" and "eat less". 1. If we really wanted to eat like our hunter gatherer ancestors, we should include bone marrow into our diet up to a couple times a month 2. I think a lot of women's menstrual irregularity does stem from a lack of fat in the diet and that especially fish fats are important, and you can be thinner and have regular menstrual cycles if you get enough fat. 3. If a woman continues to have regular menstrual cycles, the chances of developing osteopenia are extremely low. Normal estrogen levels keep women's bones strong to a large extent. Bones can in turn be made even stronger by weighing more and by engaging in more weight-bearing activities. 4. I am happy to hear you are rarely sick and have to wonder it it's not at least partly because you are at a place in your life where you have the time and ability to take care of yourself. Are you also getting more sleep and more exercise? Both of those are at least equally important in boosting the immune system as a balanced diet is. Really great questions! Thanks for asking my opinion :).

Drs. Cynthia and David said...

Thanks for your comments. Paleo is a moving target and gets interpreted in different ways- some people treat it as a mostly fruit diet, some as mostly low carb, and some as no grains/no dairy. Not very specific! Steve's comment is well taken too- whatever diet people are on, they may be very enthusiastic and vocal at first and then quietly fade away thereafter when it disappoints. Notably though the freetheanimal blog has broached the subject of failures or struggles on paleo, so some people try to keep it honest.

I thought you might be interested in this post I saw today discussing hormones and diet in connection with fertility patients: This Dr was able to get fertility up to 90% (from 40%) without in vitro treatments using a very low carb diet. He said it was useful for treating nausea too. Eric Westman at Duke has also written quite a bit about his dietary treatment of PCOS patients. I'm not sure how relevant this is for runners (presumably having good insulin sensitivity), but I thought it was very interesting.

And I should have mentioned studies such as those discussed in this (and related) posts: What is good for keeping teeth strong should be good for keeping bones strong too.

I'm sure some of my better health is due to taking better care of myself in my old age. Now if my runs would just get faster!

Thanks again.


sea legs girl said...

Whaaaa??? She's a woman, not a MAN! She has got to be done growing. Okay, not 100% of women are done growing by 20, but at least 99.9% are. The exceptions being at least to a certain degree pathologic.

SteveQ said...

A lot of people aren't done growing at 20. My friend Chuck is the extreme example, growing a foot taller during college - he was always about 4-5 years behind developmentally. I grew about an inch after 20, but didn't develop muscularly until 30.

Women do develop faster, but heavy training and concomitant low weight often delay growth in women; there's a number of examples among gymnasts.

Helen said...

This is a great discussion topic and I will have to come back again to read all the comments. I will just say that like most other 'regular' non-elite female runners that read your blog I would love to lose a few lbs (okay, maybe 10) but I don't lose much sleep over it and if I want the donut (or 3) I'll have it (them). I know I won't ever run my goal marathon time of 3:10 without being 135lbs or under (I was that when I ran my current PR of 3:17 in 2007) but it's not my priority right now. Ultras are definitely different - especially the tougher technical ones that have so many factors beyond raw speed (which is most definitely helped by lightness). I was 140lbs when I won and set a new CR at Voyaguer 50M last year and probably closer to 145lbs when I won Hellgate 100K (BMI 22.6 and 23.4). I have no doubt the likes of Nikki K, Krissy M and a dozen other ladies could take another 30 minutes+ off my times in those races but I guess I want to make the point that training, mental and physical strength and race prep can make up for a lot! Now, what did I do with that bar of chocolate...

Katie said...

This is a really great post. And something that I struggle with too. I'm also 5'6". My BMI is usually around 22.5, which makes me 140 pounds (when I'm not pregnant). This makes me sound down right fat in comparison to you, but here's the deal...I was also a 140 pounds when I ran an 18:20 5K. That season I broke 19 minutes every time I ran a 5K. I usually wear a size 6 and often receive compliments on my appearance. Thus, I generally don't feel fat, but I often wonder if I'd be faster if I lost 10 pounds. I do strive to be faster, but I don't think the elite women or men distance runners are attractive at all. In fact, I find them a bit scary looking. Whether they are healthy or not...I just don't know. I've read studies where being underweight seems to correlate to a longer lifespan, so who knows...

sea legs girl said...

Katie, wow you are one fast babe! Guess it's not surprise you run fast pregnant, too :).

But I need a little explanation here. So I have read studies where rats that are calorie restricted survive longer (though never seen a corresponding study in humans) and I have seen multiple studies in humans that show having a BMI in the middle of the normal range corresponds to living longer. Could you point me to this study/studies that show weighing less correlates with living longer?

Katie said...

Here are two articles I've seen regarding calorie restriction. The first was study done with humans, the second a study done with monkeys. I'm not a huge fan of calorie restriction, which is probably obvious given my 22.5 BMI, but I'm seeing more and more of it lately. I don't think I could ever actually do it. In fact, in the human study they preferred participants to limit exercise to maintain the restriction. That's definitely not something I'd be able to do...

The Calorie-Restriction Experiment

Dieting Monkeys Offer Hope for Living Longer