Where do you draw the line?

When you are surrounded by marathoners, ultramarathoners and ironmen/women, the conversations have a tendency to skew towards our beloved sport which we so vehemently profess and religiously proclaim; it would seem awkward and a little out of place to raise a topic like this if you don't want to invite certain outbursts or disdainful glances. Some may even "unfriend" you in FB.

Well, I hope it doesn't burst your bubble but what has to be said, will need to be said. 

This is not just someone who chooses to pick on runners who have gone "rouge" and deviated to the extreme, just because he can't stand the sight of a super macho Lance Armstrong like figure of fitness in front of him. This was a research done by an avid exerciser, and a credible cardiologist Dr. James O' Keefe. He said, "As great as exercise is, it's like a powerful drug. More is better up to a certain dose, but after that there is a point of diminishing return, and it may actually detract from (heart) health and even your longevity." He pointed out that extreme exercise like marathons causes the heart to undergo certain stress, evident in a 50% increase of the enzyme Troponin. (This is what we test for in acute myocardial infarction/heart attack). Extreme sport also over-taxes the heart resulting in inflammation and some muscle cell death. The resultant damage lead to scar tissue formation which in turn increases the tendency towards abnormal heart rhythm such as atrial fibrillation. Bad news?

In the same article, Dr. Carl Lavie pointed out that there is a limit to how exercise contributes to life span. Beyond a certain point, extreme activity has a negative or harmful effect that cut away at any improvement that a runner may have accumulated. Though she did point out too that when it comes to comparison with the non-runners, the same group who engaged in extreme activity did not seem to do worse in terms of longevity. But losing that benefit to the heart is what weighs in heavily on this topic. 

I am not here to debate the validity of the study though it may seem to me that to substantiate something like this, more cohort studies need to be conducted. But based on the science of it, it sounds darn scary. Especially to someone like me who is venturing into ultra trail/ultra marathons (and well, triathlon too). 


From an objective point of view, I have my reservation about it. For one, I am thinking about the Tarahumara or the Running people. These are native American in the Northwestern Mexico with amazing running ability. If they are the gold standard of ultra running, then perhaps Dr. O'Keefe should conduct more studies on them! And if Dr. O'Keefe's theory is true, the Tarahumara should probably be near extinction by now. If you have read the book Born to Run by Christopher MacDougall, the Tarahumara have been at it for centuries!! Natural selection would have selected them out if the above theory holds water. But they are alive and kicking and they are still running! 

Secondly, there are a lot of confounding factors that the above studies have not looked at. For example, our modern diet and stressful life style. It doesn't take a rocket scientist to figure out that our food is largely processed, genetically modified, pesticide treated and less than wholesome to say the least. On the other hand, the staple diet of the Tarahumara is remarkably simple consisting of corn, beans and chia seeds, which I think may hold the answer to this riddle. Our stressful lifestyle contributes to increase incidence of heart disease too. It is a well known fact. Just because you are a runner, you can still have a lousy/stressful lifestyle. And couple that with inadequate rest/sleep, you have yourself a time bomb! 

There is a whole library of information when it comes to nutrition and supplement that we need to consider when we are taking on extreme sports like marathon, ultramarathon or triathlon. One area to start is our attention to diet and life style putting particular emphasis on recovery and also knowledge of our own physical condition. Rest when you need to. Don't deprive yourself of that much needed sleep. You can still have a social life but if excessive drinking still constitute a large part of it, then perhaps you need to be realistic and just aim for 'Moderate' exercise. If you get my drift. 

When you have chest pain, shortness of breath or even blackouts, please do not ignore the signs. Get yourself checked out by a cardiologist. You may be one of the small statistic of runners in the general population that has a predisposing heart condition such as HOCM, or some other heart disease. 

As a medical practitioner, I can see what the article is aiming at. What it is pointing out isn't necessarily out of disrespect to people like us who engage in extreme sports. Nor is it an excuse for couch potatoes to carry on with their sedentary lifestyle. It is a mere caution. And sometimes, we have to learn to heed certain warning, yet having the clarity of mind in what is it that we are actually doing. We are not indestructible. I would say to my fellow marathoners that you have to be careful too. Don't get into the heat of joining races after races without knowing yourself i.e. your condition, your training (if it is adequate or not), your diet, your lifestyle and above all, WHY you need to do this? If you are clear about all that...I am pretty sure nothing can stop you. Leave alone an article like the above. 

Well, I know that nothing is stopping me. Do you?


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