The Interwebs have been busy today, busy with the circulation of a video featuring Dr. James O’Keefe – And this has got ultra runners and endurance athletes talking. Is ultra running and endurance sport actually bad for your health, or rather your heart?
Having watched the video, it’s hard not to be captivated, and slightly concerned with what James offers up if you’re pretty uneducated in this area, as I am. I am no expert in cardiology, so don’t take me as such. All I aim to do with this article is open up the debate somewhat and get others to share their opinions and views too.
As a former ultra-runner, James knows our community and understands us well, and he has since completely pulled back from running extreme distances as a result of research he has carried out as a cardiologist. Before we get into the meat of what he talks about, I’d like to share with you a story of mine, and one of the reasons why I decide to commit some words to screen.
Three and a half years ago, I was sat at work on a normal Monday morning. I was at the time in the middle of training for a 100 miler. At just gone 11am I literally collapsed at my desk and blacked out. A second or two later I felt what I can only describe as a bolt or burst of energy run straight through me, followed by a racing heartbeat which was hitting well over 180 sat down.
I felt awful. People rushed over to see if I was OK and I laid down on a sofa for 20-30 minutes to try to calm down and get my heart rate back on track. I’m not joking when I literally thought that was it. Goodnight Charlie, your time has come. I thought if this is what a heart attack is, then I think I’m having one. Having calmed down I went to the emergency doctors to try to understand what the hell had just happened. They did blood tests etc… and everything was normal. I told them about my running and I was referred to a cardiologist. To cut a long story short he suspected that I’d suffered a heart arrhythmia, and that the sudden jolt or burst of energy I’d experienced was indeed my heart regulating itself and jolting me back into action. He couldn’t be 100% sure that this was the case, but he said he’s seen it quite a few times in endurance athletes and as a rower, had actually suffered from it himself.
So as you can see, its a topic that is pretty close to my heart (for want of a better phrase), and something that I’ve paid particular attention since this incident. Indeed, only last August I went for a regular ECG (I go every 12 months), and this caused all manner of issues because I was detected as having an irregular heartbeat. Subsequent scans and a full-blown heart MRI have show that everything seems to be in check, but for me, a regular yearly visit to the cardiologist is now an essential date on my diary, and I believe should be for all ultra and endurance athletes.
My cardiologist was pretty good about it all. His attitude was certainly not to tell me to stop doing what I’m doing, but he did say that it’s becoming more and more of an area that he and his colleagues are paying more attention too. So given my experience, I was particularly interested to see what James O’Keefe had to say on the topic. I’ve pulled out some highlights below, but also there a rather excellent overview from Sam Robson too, which aims to provide some reasoned argument too.
One of the first examples James cites is the story of Pheidippides, the Greek herald who ran the 26 miles from Marathon to Athens to proclaim victory against the Persians, whereupon he promptly fell down dead. But other versions of the Pheidippides story have him running from Athens to Sparta (150 miles), then back again – slightly more than 26 miles. Secondly, and this is where I sit, it’s probably a myth, but we know that human beings are more than capable of such feats of endurance, so it’s not beyond the realms of possibility. However, when James talks about ‘running far’, this is different for different people. It’s also different depending upon where you are in your training and ultra careers too. Personally I think problems arise when people try to do too much too soon. And maybe this might have been the case with me initially.
James also reflects on the death of Micah True, who died last year at 58 whilst out on a routine training run. The coroner’s report said that the death was due to a pre-existing heart condition, resulting in thickening of the left ventricular compartment. This scarring of the heart fits the sorts of heart defects that Dr. O’Keefe suggests are related to extreme exercise – Pheidippides cardiomyopathy as Peter McCullough describes it.
As I said earlier, for a really good commentary of the video with further insights on the data, there is a great and balanced breakdown and analysis from Sam Robson who says;
“I don’t claim that there is no merit to the claims that running extreme distances causes heart problems, but the evidence that I have seen so far is open to interpretation. Firstly, there are a large number of extreme athletes that haven’t suffered from any form of heart defect (pulling Micah True and Jim Fix out as arguments against running ignores the much larger body of similar runners who haven’t died young from heart conditions).
“As Dr. O’Keefe mentions towards the end, he has had a lot of negative correspondence from runners who refuse to believe these controversial claims. I have tried not to let my love of long-distance running bias my opinions too much on this (although obviously it has to some degree), and don’t for one minute claim that there is any intentional misinformation on the part of O’Keefe and colleagues. However, I differ in my interpretation of what I have seen, and whilst I am not an expert in this specific field I do have a lot of experience in the interpretation of biological data (it is my job after all). My biggest worry is the way that the media sensationalises stories like this and encourage a more sedentary lifestyle (although this is clearly not what the authors intend). For now, I’m going to carry on running and enjoying myself, without worrying too much about this until I see some compelling evidence that I should not be doing what I love.”
This is the important bit for me. Having that heart issue back then hasn’t stopped me running – if anything I’m quicker and stronger than ever before – I love to run, I love training and I love running in the bush. OK, so it’s made me think twice a little, and as a result I also ensure that I was a good break from running each year too. For me it’s about moderation. If we’re honest, ultra-running is an addiction and too much of it can be a bad thing, just like any drug.
Like all things in life you need balance.