Looking After Yourself on the Trails – Dr. Marty Hoffman

Marty Hoffman

A few years ago, Dr. Marty Hoffman came to Australia to run what was known as back then, the TNF100, now UTA and with the race just a few weeks away now, I thought it a good time to revisit what one of the most preeminent guys in the business has to say when it comes to knowing and looking out for the dangers on the trail.

You see, the biggest issue on the trails is you – and that’s not meant in a rude or derogatory sense before we see toys thrown out of the pram. Your own accountability and knowing when to look out for some of the warning signs is really important stuff. This type of thing gets easier the more you run and race, and as you get to know your body better. However, there’s also the ‘suffer factor’ to consider too. Some people are very adept at knowing how to ‘suffer’, pushing themselves harder than their body might be able to cope with. But Marty thinks otherwise: “I think we tend to have a throttle that will prevent pushing too far. For instance, people seek water before severely dehydrated.  They slow down to cool off when they become overheated.”

Marty Hoffman knows his stuff. He is Professor of Physical Medicine & Rehabilitation at the University of California Davis, Chief of Physical Medicine & Rehabilitation at the VA Northern California Health Care System, Director of Research for the Western States Endurance Run, and Chief Medical Officer for the Ultra Medical Team. He has published over 100 original scientific publications mostly related to applied exercise physiology with focus on human locomotion, human performance and exercise-associated hyponatremia.

So in the name of understanding more, here’s a few questions we threw at Marty for some of his advice and insights. Read and take this in – this man knows his stuff.

What are the biggest heath issues you see in ultra runners during / after a race?

“Hyponatremia is the most potentially serious issue.  GI symptoms and blisters are the most common though,” says Marty. I remember a time when because of all the hot weather we have over here, so many people would be concerned with dehydration, when really we were focused on the wrong thing. I still remember my last TNF100 back in 2013 and chugging away with 3 litres at the start to CP1… what a waste of energy and overkill on the old water supply. Now the advice is ‘drink to thirst’.

What are the causes leading to above issue? 

“Symptomatic hyponatremia is from overhydration – not from inadequate sodium intake.  In fact, excessive sodium intake can make matters worse by stimulating thirst and enhancing overhydration.

“Blisters are from inadequate training, poor attention to foot care, using different shoes during a race, etc.  GI symptoms are also multifactorial, and if we had the full answer to eliminating such symptoms, I would make a lot of runners very happy,” adds Marty.

Talk through some of the steps ultras runners should take before embarking on their first big ultra in terms of education and getting in the know about the potential issues. 

“Frankly, I think people are often best to not listen to the so-called experts and do what seems most appropriate based on how their body feels.  It really doesn’t have to be that complicated.  Obviously, they need to get a fair amount of running training in, but in terms of eating and drinking, that is best left to responding to what their body tells them,” adds Marty. There you have it folks, listen to everyone and follow no-one as the good ultra saying goes.

Nutrition is notoriously hard for runners to get right and if got wrong can lead to one extreme or another. In your opinion, how should runners best tackle getting to know how much food they should ingest?  

“Again, listening to the body is the guide.  Drink when thirsty. Eat when hungry, and what looks good.  Recognize that a big part of the energy needs will come from stored fat.  Part of the adaptation from training is to teach the body to mobilize fats stores.  Also, it is important to not do anything too different during a race than in training.  Learn what works during training, and use that approach during the race.

“When it comes to hypotrema, which is known for being a real issue in runners, the symptoms may include nausea, headache, fatigue and then seizure. Avoid it by drinking to thirst and avoiding excessive sodium intake.”

An enlarged heart is  something you hear about in runners as a result of the training we do and the fact that the heart is a muscle. What’s your general guidance here around making sure we don’t go to extremes? 

“Well, the jury is out on the potential cardiac injury issue. But, we don’t see ultramarathon runners dropping like flies, so I’m not too concerned that there is a serious risk.  I’m actually more concerned about the potential injury that could result from training for shorter races that must be done at a higher exercise intensity than ultramarathons.”

What do you think are some of the longer term effects that ultrarunners may notice? 

“That’s something we are looking at in the Ultrarunners Longitudinal TRAcking (ULTRA) Study.  You can google that and probably get some hits that will give you a little more information on the study.  Hopefully, in another decade or so, we will know more about the potential long-term consequences.  For now, we can say that ultramarathon runners tend to use the health care system less than the general population, and tend to be more likely to be in a stable relationship than the general population.  Asthma and allergies were the only medical issues that seemed more common in ultrarunners than the general public.”

Now, a big bug bear… Sports drinks. Hype or credible?

“I think the evidence is pretty solid that the energy aspect of sports drinks has value compared to not taking in any calories, but there are sources for calories besides sports drinks.  Indeed, the complex carbohydrate will be better at preventing an insulin rush, and fructose has been linked to GI symptoms.  The electrolyte content in sports drinks is of no value other than probably helping to maintain hydration a bit, but we’ve found that hydration state can be maintained without a lot of sodium.  I intend to be drinking water on Saturday, so that probably tells you the most about what I think.”

Our thanks to Marty Hoffman for his excellent words.

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I'm a mediocre runner who can bat above his average when I train hard. A man of extremes, I do enjoy everything life offers and consider it an absolute pleasure just to be able to put one foot in front of the other and let my mind wander somewhere different.

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