Potential Long Term Health Effects of Ultrarunning with Nick Tiller PhD (2021) #195
Episode overview:
Originally released on October 14, 2021.
Nick Tiller Research is a fellow at the Lundquist Institute at Harbor-UCLA where he studies clinical respiratory and exercise physiology, and the physiology / pathophysiology of ultra-endurance exercise. He is also a columnist at Skeptical Inquirer Magazine, and the author of The Skeptic's Guide to Sports Science.
Episode highlights:
(20:01) Recap of potential cardiovascular health effects: athletes who train high volumes are not at risk, races and high intensity training are more likely to be problematic, the emergent state of ultramarathon research
(27:20) Respiratory risks of racing ultras: chronically no different than other endurance sports, drops in acute lung function, most are not clinically significant, asthma or other conditions mean you start from a lower baseline and can experience clinically significant problems
(35:23) The renal system: UTMB health policy, banning NSAIDs, duration, heat, altitude, dehydration, and hyponatremia all compound, NSAIDs make everything worse, acute kidney dysfunction in ultras is common and generally non harmful, chronic effects are unknown
Our conversation:
(0:00) Introduction: emphasizing the “potential” in the potential long-term health effects of ultras, repeat offender Nick Tiller, Nick’s new paper, the narrative that ultras are unhealthy, the responsibility to informed health
(2:56) The Haywire Heart: the cyclical nature of sports myths, keto example, “how too much exercise can kill you”, public response, banter
(6:20) Nick’s new paper: negative public feedback is typically false dichotomies or slippery slopes, examples, the goal of the paper is to show exercise is good for you, yet participate in ultras safely
(8:57) The 10 year principle: the goal is to promote behavior that results in net improvement a decade down the line
(10:00) System-by-system design: overview and discussion outline, integration between body systems is crucial, arbitrary system distinctions are useful for research, emphasis on potential outcomes
(12:33) Overview of potential health effects: cardiovascular, respiratory, and renal implications, more literature exists around cardiovascular function, most endurance athletes have “abnormal” heart function
(14:23) Training versus racing: potential cardiac implications, Ben Lavine’s study, no greater risk was found in athletes exercising 30+ hours per week
(17:08) Cardiovascular risks of racing ultras: 2-4 races per year, single 20-30 hour efforts are more suspect for negative health effects, example
(20:01) Recap of potential cardiovascular health effects: athletes who train high volumes are not at risk, races and high intensity training are more likely to be problematic, the emergent state of ultramarathon research
(22:10) Ironman study: study design, all variables returned to baseline one week later except for one athlete who retained heart problems, some athletes may be more susceptible to negative cardiovascular symptoms
(25:06) Deviations from homeostasis: day-to-day training does not disrupt homeostasis, racing disrupts homeostasis greatly, marathon example, you cannot practice race distances in ultras
(27:20) Respiratory risks of racing ultras: chronically no different than other endurance sports, drops in acute lung function, most are not clinically significant, asthma or other conditions mean you start from a lower baseline and can experience clinically significant problems
(30:00) Get screened for respiratory risks: test before your first ultra, you don’t want to find out on the mountain that you are at risk
(30:52) Long-term airway damage: chronic inflammation to the airways can occur with high volume, especially in cold and dry air, examples, limited data in ultrarunners, cross country skiing and olympic examples
(34:19) Training in polluted areas: airway damage due to wildfire smoke, the negative health effects of rapidly breathing in bad air may counteract the positive benefits of exercise
(35:23) The renal system: UTMB health policy, banning NSAIDs, duration, heat, altitude, dehydration, and hyponatremia all compound, NSAIDs make everything worse, acute kidney dysfunction in ultras is common and generally non harmful, chronic effects are unknown
(38:47) Compounding stressors: NSAIDs and other stressors compound nonlinearly, emphasizing thinking about the long term, kidneys do not heal well
(40:51) The potential for long-term injury: this potential risk is present with any maladaptive response, examples from the renal system, pulmonary edema, right ventricle damage
(42:22) Renal health takeaways: stay reasonably hydrated, avoid NSAIDs, analgesics don’t harm the kidneys but can mask injury-related pain
(45:31) Health for masters athletes: being aware of preexisting conditions for athletes who start ultras later in life, the potential for chronic maladaptations in long-term runners, age of peak performance increases with distance
(48:38) Examples of coaching masters athletes: new athletes are checking boxes and learning strengths and weaknesses, experienced athletes require less guessing
(49:59) Screening for ultrarunning: potential benefits and drawbacks, this may have more application in masters athletes and lifelong runners, myocardial scarring example
(52:55) Health for female athletes: total energy availability, take two minutes to read section 6.3, female athletes are more susceptible and have higher consequences regarding low energy availability
(54:03) RED-S: relevant to all sports and athletes, more relevant to ultras due to high energy expenditure, more relevant to female athletes due to bone health and menstrual cycle
(55:37) The female athlete triad: ample energy intake for recovery, bone mineral density, estrogen concentration, relevance to bone health and musculoskeletal injuries
(57:13) Energy intake and volume: inconsistent day-to-day volume makes energy intake difficult to gauge, a case to avoid low carb interventions, the risk versus reward is not worth it, especially for female athletes
(1:00:15) Try to meet your energy intake needs: tools for athletes, educate yourself, you improve during recovery so focus on nutrition, sleep, and mental health, bad practices will eventually catch up with you
(1:02:45) Wrap-up: banter, debunking pseudoscience
(1:04:25) Nick on chiropractic: complementary alternative medicine, not a mainstream practice, enormous disparity between scientific validity and claims, injury from chiropractic interventions, the only potential benefit is placebo and the risks are not justified
(1:08:26) Outro: giving thanks, approaching 100 [in 2021 – now 200] episodes, share the KoopCast, thanks for listening
Additional resources:
Potential Long Term Health Problems Associated with Ultra-Endurance Running: A Narrative Review
Nick’s interview on triathlete magazine
Nick’s book- The Skeptic’s Guide to Sports Science
SUBSCRIBE to Research Essentials for Ultrarunning-https://www.jasonkoop.com/research-essentials-for-ultrarunning
Buy Training Essentials for Ultrarunning on Amazon and Audible.
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