Running And The Damage Done. (The dark side of ultrarunning).

"Because there's a conflict in every human heart between the rational and the irrational, between good and evil; and good does not always triumph. Sometimes the dark side overcomes what Lincoln called the better angels of our nature. Every man has got a breaking point. You and I have one. Walter Kurtz has reached his. And very obviously, he has gone insane." - General Corman, Apocalypse Now

General Corman - Apocalypse Now

Three days in, the pain is taking hold. Not a normal everyday day DOMs pain, but deep down pain, and that old nagging injury is back screaming at you. Your body wants you to stop, you take the pill. The pain is still there, but now it's manageable, a background noise that you can live with. And you keep on taking the pills until you finish. Then you stop and your body kicks into inflammation overdrive, everything swells up. That old nagging injury, now its permanent damage.

Somewhere, you crossed the line from exercise as health and fitness and enjoyment to obsession and finishing at all costs. I've covered some aspects of the courage aspects of this in previous blog posts, here, here and here. However, there is a flip side to this, when you ignore constant pain signals from your body and mask them with drugs it can only go one way eventually. If that's the price your willing to pay then that's fine. But sometimes in the heat of the moment our judgment is clouded.

'I caught you knocking at my cellar door'

To be clear I'm not talking about illegal or performance enhancing drugs, this is no professional cyclists EPO commentary or class A drugs to mask pain in professional sports scenario. Ultra running as they say is the last true sport, about as pure as it's going to get. No prize money, no sponsorship, no recognition. One day this will probably change, but for the moment not.

This is about pain killers and anti-inflammatories and to a certain extent nutrition.  If you can buy something over the counter, this doesn't mean it's safe or doesn't have side effects, especially if taken in large quantities over a long period of time.

The use of pain killers in ultra running is well known, and it happens at all levels. Once I was running along next to a woman who was leading the womens section of the race, she said something along the lines of 'time to take some more paracetamol' and popped a couple of pills as we ran along. A story told to me by a competitor in one of the multi day desert races; at night when the medical tent was closed two plastic carrier bags of pills were left outside of the tent, with a note saying 'if you're in pain take these' and 'if you're really in pain take these' above each bag. Another story told to me about one of the top mountain marathoners, when asked what he ate for two days he replied 'Ibuprofen'. Yes, use of the old marine candy is rife, and of course, I've done it myself.

Moonlight Mile - Why it may not be a good idea

When you exercise and there is significant DOMS (delayed onset of muscle soreness) there is an inflammation response. This response is part of the healing process, substances like prostaglandins and histamines are being produced, helping to repair the area and remove damaged parts of you. In the case of actual injury, the pain is telling you something more, it's telling you that you are injured and you should stop doing what you are doing or you are going to damage yourself even more.

This is beyond the pain that all endurance athletes are familiar with, the pain of pushing to the limit, this is the pain of injury and possible permanent damage.

Anti-inflamatories and pain killers are interfering with the healing process. Tucker & Dugas (2009:238) list the following problems with non steroidal anti-inflammatory drugs (NSAID) like Ibuprofen and Aspirin

1. Ulcers - long term use of NSAIDs can cause stomach ulcers to develop
2. Kidney damage
3. Joint cartilage damage. Long term use of some NSAIDs can cause joint cartilage degeneration
4. Slower muscle protein synthesis after exercise. Both Ibuprofen and Acetaminophen (Tylenol, Paracetamol) have been shown to slow the process
5. Impaired healing process

So not only are you taking part in an event that may be damaging your cartilage and reducing muscle protein synthesis anyway, the pain killers you are taking are probably making it worse!

The British National Formulary. (BNF click here) lists every medication in use, what it's used for and what its known side effects are. Here are a few of the most common anti-inflammatories and pain killers and their side effects as listed in the BNF.

NSAIDs ( Ibuprofen, Aspirin, Diclofenac) side effects listed include:

"Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur. Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn’s disease has been reported"

Paracetamol

"Side-effects rare, but rashes, blood disorders (including thrombocytopenia, leucopenia, neutropenia) reported; hypotension, flushing, and tachycardia also reported on infusion; important: liver damage (and less frequently renal damage) following overdosage."

Co-codamol

"Side-effects: nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce respiratory depression, hypotension, and muscle rigidity; other side-effects include abdominal pain, anorexia, bradycardia, tachycardia, palpitation, oedema, postural hypotension, seizures, malaise, hypothermia; hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache; sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, muscle fasciculation; blood disorders (including thrombocytopenia, leucopenia, neutropenia), miosis, visual disturbances, flushing, sweating, rashes, urticaria and pruritus; pancreatitis also reported; important: liver damage (and less frequently renal damage) following overdosage with paracetamol."

Tramadol

"Produces analgesia by two mechanisms: an opioid effect and an enhancement of serotonergic and adrenergic pathways. It has fewer of the typical opioid side-effects (notably, less respiratory depression, less constipation and less addiction potential); psychiatric reactions have been reported.diarrhoea; fatigue; less commonly retching, gastritis, and flatulence; rarely anorexia, syncope, hypertension, bronchospasm, dyspnoea, wheezing, seizures, paraesthesia, and muscle weakness; blood disorders also reported."

Okay it's probably not that bad

Yeah, I don't know what half those side effects are either, but they don't sound good. Granted, many of these side effects are rare and happen with long term use, and it wont happen to your right? Except, you'll be taking them in a state of exhaustion and dehydration and after days of eating mostly crap. If you take them for a couple of days, fair enough. But, what if you use them to get through your training runs, and you enter a couple of events a year. Before you know it, you're taking a whole lotta pills, and your pursuit of health and fitness went out the window.

Supernoodles and Superfood

The other key point when running multi day ultras is the food you eat. By its very nature it has to be calorific, portable and non perishable. You are not going to be running along with your five a day fruit and veg in your backpack unless you want to end the day eating mush.

With single day events this may not be an issue, as you can have fresh food on you or at aid stations. However on  multi days its going to be dehydrated foods and powders unless you're bush tucker man foraging for food('little did they know, there was food all around them').

On an extreme event the body is in extreme oxidation, free radicals are running around your body like freight trains. As we know these free radicals cause damage and inflammation,and it could be inflammation of the systemic kind, the type that leads to heart disease, stroke and diabetes. We now know that the relationship between free radicals and anti-oxidants is more complicated than first thought. However, there is a good chance on an ultra run you aren't really eating any anti-oxidants, and all those beneficial phytochemicals found in fruit and vegetables, you aren't eating those either.

I've seen some European runners with vacuumed pack 'real' food, no dehydrated camping food for them. I've also seen a French guy live on nothing but powder for 6 days, powdered meal replacements and energy drinks for 6 days; and he was a doctor! I can only hope the French paradox of heart disease will help him when he gets back to the standard French diet of cheese, bread and wine. I didn't ask him if eating no fibre for 6 days had an effect!

I have used supernoodles a fair amount. As you can see from the nutrition profile here, one pack contains over 500 kcals,  and it only weights 85grams, and some of the supermarket own brands are even better, with 600kcals in a packet! Now, a pack of supernoodles in themselves aren't inherently bad, the first ingredient is noodles, and depending on the brand they may also contain MSG, several types of flavouring and maltodextrin (why buy expensive sports supplements when these have the same stuff in!). On a side note, two people have told me that supernoodles are on the weight watchers list for foods that are okay to eat, presumably because they are low fat. Obviously, no one at weight watchers thought to look at the calorie content, the irony, ultra runners are eating them because of the calories and weight watchers are telling people to eat them on a weight loss plan. They do however, contain nothing really apart from starch, sugar and fat. The more expensive expedition meals aren't really any better. And to be fair, they aren't designed to be, they're designed to give you energy.

Ultra runners best friend and the reason people on weight watchers don't lose weight

However, we know that diets high in starch, sugars, saturated fats and trans fats increase systemic inflammation (Tucker & Dugas 2009). Whereas diets consisting of mainly fruits, vegetables and omega 3 fats with moderate amounts of alcohol and caffeine reduce inflammation. Don't forget when you're running to the extreme, DOMs and injury have caused inflammation, free radicals are attacking you at every corner, and at the same time you may be eating foods that are pro inflammatory, lacking in anti-oxidants and natural anti inflammatory substances, while at the same time you could be taking pain medication.

If it's a one off event for you and you only intend eating like this for a few days, then the damage will probably be negligible. But, if you are training at high intensity and mainly taking sports drinks containing maltodextrin and various sugars and are always loading up on junk carbs to get you through to the end of the run then this may be affecting your long term health. Not to mention, most endurance athletes have diets low in protein.

What can be done

During the event you can take some supplements that may help. For example, omega 3 fish oil capsules can help with the inflammation, plus the omega 3 essential fatty acids are needed by your body for a whole host of functions. Tumeric (see here) contains curcumin which is a natural anit-inflammatory, as well as an anit-oxidant, it's as safe as it gets supplement wise. You can get it in tablet or capsule form, make sure you get the standardised extract of curcumin not just  tumeric powder. (I just noticed tumeric is on the ingredient list for supernoodles, probably not enough to negate the noodles). Vitamin C supplementation of at least 1g per day when competing in events is probably a good idea as well.

When running, try to get some protein in, some good quality whey for example, and try to use foods that are as natural as possible. I like the bars from www.pulsin.co.uk , good quality ingredients, and unlike many natural energy and protein bars they don't taste like shoe polish. I managed to eat these for 6 days no problem.

It may seem obvious, but when you're not racing eat natural whole foods like fruits, vegetables, lean meats, oily fish, carbohydrates like sweet potatoes and quinoa and try not to rely on supplements and sugar.

With regards to injury, injury proof yourself with appropriate training, including strength training, interval training, mobility drills and soft tissue work. And field test all your equipment.

And lastly, know how far to push yourself and when to stop. This blog post is not meant to be judgemental, as I've done everything mentioned above, I've taken the painkillers to keep going, I've eaten the crap, I've run through the injury.  But sometimes you have to take a step back and think what this is doing for your long term health. There may be a better way, or even a few tweaks you can employ which will not only mean you ingest less toxins but improve your performance and health as well. The ultimate aim is to enjoy the activity, to immerse yourself in the run and not become sidetracked into destructive behaviours.

If none of this works then listen to the words of Percy Cercutty, Australian running coach (quoted in Tucker & Dugas, 2009;42)

"Pain is the purifier. Love pain. Embrace pain."

 Last word to Johnny Cash. The ultrarunning anthem. 'I hurt myself today, I focus on the pain, the only thing that's real'

References

Tucker R & Dugas D (2009) The Runner's Body. Rodale. New York