| Doctors Warn Distance Running May Accelerate Health Problems |
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Boulder, Colorado, May 22, 2002 -- Henry Guzman, a Boulder, Colorado, resident and long-distance runner, suffered kidney failure after running a 54-mile race in South Africa last June. After recovering, he plans to run the race one more time to raise money for the Orphans of AIDS Trust Fund. (SHNS photo by Marty Caivano The Daily Camera)
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By Sharon Glarion
Scripps Howard News Service It wasn't until Henry Guzman passed the 48-mile mark that he ran into trouble. Days before the 90K (56-mile) race in June, doctors had advised the Boulder, Colorado, resident, who had suffered a stress fracture in his leg, not to run the long-distance course in Durban, South Africa. Guzman ignored the advice. He downed eight tablets of ibuprofen per day to kill the pain and reduce inflammation. The strategy carried him through the initial 12 miles of the rolling-hill course. Then the pain became unbearable. He swallowed six more tablets, hoping they would carry him to the finish line. Three hours later, he popped six more. "Distance runners can be stubborn," said Guzman, 37, who crossed the finish line after 10-1/2 hours. "Don't tell a distance runner that he can't do anything because he'll do it just to show you he can." It wasn't until five days later that Guzman realized just how ill he was. During the race he had become severely dehydrated, and the high doses of ibuprofen had constricted the blood flow to his kidney. As the popularity of running marathons and ultra marathons -- races longer than 50K -- increases, some doctors say the sport can be dangerous, causing permanent, and sometimes life-threatening, health problems. Many physicians go as far to say that any amount of running is hard on the body, especially for those runners older than 40. Instead, they recommend walking, swimming or cycling. "Many of us feel that it is not a healthy sport," said Nelson Trujillo, a cardiologist and director of cardiac rehabilitation for the Boulder Center for Sports Medicine. "It requires a lot of observation during the race to be sure people don't get into trouble. Muscle protein can damage the kidneys, metabolic abnormalities can happen. It is very hard on the body to do these things. It's a very demanding endeavor." But doctors -- many of them runners themselves -- readily admit that many long-distance runners participate in these sometimes multi-day ordeals for reasons other than health. "They are not doing the 100 miles for the benefits to the body," said Robert Mazzeo, an associate professor of kinesiology and applied physiology at the University of Colorado. "They are doing it for the thrill of competition." Nonetheless, doctors say, repeated dehydration can cause permanent kidney damage. And runners unaware of pre-existing heart problems may suffer a heart attack under the duress of a long-distance run. In more rare cases, runners may die from valves blocked by the increased heart muscle mass they developed through training. Other, more common problems, such as stress fractures, or exercise-induced arthritis, may not be life threatening but can cause chronic pain. "If you want to prevent long-term pain in your knees, you should pick something that has less of an impact," said Joanne Halbrecht, an orthopedic surgeon at the Boulder Institute for Sports Medicine. "Tone down mileage, change terrain or change to a sport that doesn't involve as much impact like swimming or cycling. But for some people it's worth it for them. This is their passion." By 48 miles, Guzman was vomiting, so he stopped drinking. It felt like someone had beaten his lower back with a baseball bat, he said. Guzman continued running, but eventually the pain forced him to walk much of the last three miles. He rallied and jogged the last 400 meters into the stadium. But what distressed Guzman most was not his health, but that his dream of crossing the finish line in 7.5 hours had been dashed. He finished in 10.5 hours. Medics at the medical tent told him he was fine. But he didn't eat for several more days because of nausea, including during the 26-hour flight back home. Three days after he returned to Boulder and five days after the race, Guzman's stomach became enlarged and his face was bloated. Tests revealed only 5 percent of his kidney was functioning. He was hospitalized for a week and placed on dialysis, which he continued every other day for 10 days after he was released from the hospital. Guzman cut back his mileage for about six months, but by fall, he ran another 50-mile race. He doesn't know for sure if he has sustained long-term kidney damage, but he knows he is more susceptible to dehydration and kidney problems. Experts say many potential health problems from long distance running stem from not drinking enough. Top marathon runners lose about 5 liters of fluid or 10 percent of their body mass during a race, Mazzeo said. Because of the low humidity, Colorado runners don't sweat as much as runners in other areas of the country and don't realize how much fluid they lose. Dehydration can lead to complications such as heat exhaustion, which includes excessive sweating, a weak pulse, fainting and vomiting. It can also progress to heat stroke, a potentially fatal condition, with symptoms that may include dry skin, a body temperatures of up to 106 degrees and unconsciousness. Those doing long distances could also experience ketosis, a condition that occurs when hard-to-replace carbohydrate stores have been depleted, Mazzeo said. Instead of carbohydrates, the body begins to burns fat and turns it into a source of fuel called ketones. Over time, mental confusion can occur. Dr. Trujillo of the Boulder Center for Sports Medicine said heart muscle growth from exercise typically results in better performance. However, in some people, as the muscle thickens, the electrical impulses become disorganized and the heart can beat irregularly or stop suddenly - a condition known as cardiac arrhythmia. Trujillo thinks all runners should be screened for heart disease before starting a training program. Problems can also develop in those who run shorter distances. Scott Winston, 49, a competitive runner from Maryland, says 18 months ago he developed kidney stones from repeatedly dehydrating during running. Although Winston never competes in races longer than a 10K, he says he never carried water on his weekly 12- to 14-mile training runs. "It was the most painful thing I ever had," said Winston, who has been running competitively since age 13. Since kidney stones can reoccur, Winston drinks 10 to 12 glasses of water a day and drinks every 20 minutes on his longer runs, he said. The biggest orthopedic risk for long distance runners are stress fractures in the foot, leg or hip, said Halbrecht, an orthopedic surgeon. While there is no way to prevent stress fractures, runners must stop running for six weeks to heal, Halbrecht said. Those who don't continue to experience pain and the stress fracture might require surgery or might not heal, she said. Typically, runners suffer stress fractures when they increase mileage for a marathon or ultra marathon, she said. "Seasoned marathoners understand it's not just this marathon they are going to risk but the next three if they continue to have pain," she said. A new device that uses ultrasonic waves can accelerate healing by 40 percent, but renting the device costs $3,000, so it is typically used only by elite athletes. Some people can tolerate long distances without injury, Halbrecht said. But runners older than 40 are more prone to inflammation, causing joint pain and accelerating arthritis, she said. Early signs of arthritis include pain around kneecap or joint and later on swelling. Guzman still runs between 80 and 100 miles per week, including two 50-mile races and four marathons per year. On June 17, he will be back in South Africa to try to finish what he set out to do the year before. This time he's running to raise money for the Orphans of AIDS trust fund. "I don't think I maximized my potential in achieving my goal in my race," Guzman said. "This is the only race that has haunted me. Some people may think it's crazy. I have to go and see what happens." (Contact Sharon Glairon of the Daily Camera in Boulder, Colorado, at www.bouldernews.com.)
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