The Mysterious Syndrome Destroying Endurance Athletes

Nils van der Poel was* a long distance speed skater who set impressive records and wrote about his training regime. His book is https://www.howtoskate.se/. He trained ambitiously for 3 years, won Olympic gold medals and retired! He followed a very analytically minded path and avoided overtraining.

See also brief overview article about him:

https://runningmagazine.ca/sections/training/olympic-speed-s...

(*) He changed his name since, to a more common name, so using past tense seemed humorously appropriate.

For those interested in the topic, this book is an amazing and extremely scientific read. Scott was a world cup nordic skier and mountaineer. I am a nobody but got to train with him before my first ultra and it was eye opening. I would upload every workout and if my HR zone was too high he would text me and say "Slow down! I don't care if you're walking at a snails pace."

https://uphillathlete.com/product/training-for-the-uphill-at...

This article was written in 2015. Nowadays most elite ultra-runners do have coaches, and follow data-driven training regimes. This is a trend in all professional (and, to a lesser degree, amateur) sports, but it is definitely quite noticeable in a sport where athletes used to basically be dudes and girls who liked running fast in the mountains and did that a lot. A lot of that data-driven training is aimed at maximizing training load without going into overtraining.

As a result of this and other optimizations (most notably higher carbs consumption during races, but also better heat training, better recovery protocols, better shoes, etc.), races keep getting faster. The article mentions the course record for the WS100 dropping by 50' between 2004 and 2012. Since then, it has dropped by another full hour (13h46 this year).

Well, the marathon was inspired by a hero who died from exhaustion after running.

https://en.wikipedia.org/wiki/Pheidippides

I'm not in this space, on either the athlete or the biomedical side - but it sounds like a "more is better" running mindset and mythos is colliding with the biological realities of human bodies which either (1) Were not carefully designed for this kind of duty cycle, or (2) Have accumulated quite a few deleterious mutations in the generations since that design, resulting in frequent operational failures at well below the hoped-for spec.

Might anyone know if indigenous groups such as the https://en.wikipedia.org/wiki/Rar%C3%A1muri - where extreme distance running seems part of their traditional culture - have been studied in this regard?

I haven’t read OP, but there are enough people in our culture with a monomanaic tendency who only need an obsession to go overboard all unsupervised. So they might start running a little, of course slow to start because they physically can’t take it, but after a point they might not notice that adding more and more activity volume can’t just be done forever just based on your gut, dayfeel, and no pain no gain. Or someone reads about meditation and starts doing hour-long meditations, then soon retreats. Then their mind gets hit with an uncomfortable and disturbing realization while their minds are figuratively in a bad and structurally weak yoga pose. But why didn’t the meditation book warn about this? The meditation book aimed at people who successfully will do it for twenty minutes a day and will have 90% no long-term follow through.

OTS and long-covid are remarkably similar

once the body/brain/CNS starts treating cytokines produced by exercise (and illness) as a pathogen instead of doing stress adaptations, you will become perpetually ill and unable to exceed aerobic threshold (or lactate threshold) without PEM

and there's no escape, no amount of rest will cure it, there's no supplement or drug that will reprogram your mitochondria at that point

and right now all research is effectively dead for long-covid, forget OTS which will never happen

* https://imgur.com/a/OzP83pd

* https://i.imgur.com/v6BnoJG.png

* https://i.imgur.com/VpEwjp0.png

I wonder if this is due to a lower rate of coaching. I don’t have a ton of first hand knowledge but most other endurance sports the athletes usually come up through well organized teams. Maybe the lack of organization (which is great for other reasons) leads to less coaching and therefore missing someone to tell you to rest and recover before you go over the edge.

I definitely experienced this in training for my marathon and half Ironman (which I had stupidly signed up for in consecutive months). I didn't follow my training plan properly and tried to cram all the volume in the last month or two and it didn't end well. I was able to make it through the half Ironman through pure adrenaline, but I laid in bed for the following two weeks and barely moved. I had no motivation to do anything whatsoever.

It turns out that I was deficient in plenty of vitamins: D, B12, iron. I'm sure these were all symptoms of OTS. I didn't feel the same in any of my workouts until maybe 4 months later. Even then, it took very gradual build-up after those 4 months to get back to where I was. Taking vitamin supplements helped, sure, but the true cure was just ramping down the exercise a lot and getting proper sleep over months.

I empathize with these athletes because exercise is addicting; it feels almost morally wrong to take days off. There's also always someone better than you. But as I got older, I realized that recovery is just as important (if not, more important) than the actual work. In fact, that's where all the gains are made.

I found a few helpful pointers with structuring my workouts now is to:

* Increase training volume <10% W/W. It gives your body time to adapt and also helps with preventing injury.

* Mixing in recovery weeks is also really helpful with helping your body adapt.

* There's no way around doing a lot of volume when training for endurance events, but keeping your HR lower the whole time is a good way to make sure you don't overtrain and can show up the next day.

Experienced distance runner here. This is not new or mysterious.

> Overtraining Syndrome is where a lack of recovery from training stress results in underperformance, often combined with Mood Disturbances such as reduced Motivation, depression and anxiety

https://fellrnr.com/wiki/Overtraining_Syndrome

Wasn't this kinda inevitable? When I was little a marathon was considered a monumental athletic performance achieved by few. Nowadays it's like everyone who has ever put a pair of trainers on has "run" a marathon (completed would be more accurate, because many people walk a significant part of it). Yeah, I know, I know, gatekeeping is not cool etc. etc.

Meanwhile, the world record marathon time must be reaching its irreducible minimum.

It seems to me like more and more people are now pushing distance to set themselves apart from everyone else. If you say "I ran a 2:30 marathon", most people won't know if it's impressive or not. If you say "I ran 10 marathons, backwards, while juggling 10 pineapples" suddenly people are interested.

"Mysterious"

"Overtraining syndrome"

I don't see why it's so mysterious, fatigue accumulates until something tips you over the limit

Interestingly the same that can happen to the mind. I can't recall the source of the article but it mentioned a mathematician working so hard on a problem for a long time that at some point he could no longer use his brain power to continue doing moderately difficult level math.

I don't particularly find surprising that someone pushing so hard can end up this way, we aren't limitless in our abilities after all.

It’s well known ultra training destroys your heart.

In any sport.

They tested the blood of marathon runners and found heart attack markers in many of them because the heart muscle is being damaged and healing and scarring and hardening the muscle leaving young ultra trainers with the heart of an 80 year old.

The best modern advice is don’t overtrain.

https://youtu.be/Y6U728AZnV0

From the article:

“He’d waffle between jittery agitation, as though he’d just had seven cups of coffee, and a fatigue so profound that he could hardly get off the living room couch.”

“I was convinced I’d come down with some severe condition that was going to kill me,” he says. For the next two years, Roes’s life became a series of waiting rooms and tests: blood work, brain scans, heart screenings. “I was having severe fevers and extreme phases where I would go into such a brain fog, I thought I might black out,” he says. The tests yielded no definitive diagnosis.

—

I have lived this myself. I’m not an ultra runner but many of these symptoms These runners have I have without ever being into exercise. And it runs in my family. They keep finding little weird things in my test results, but it’s never anything that leads to a diagnosis or affect. They label me with a psychological disorder only.

I’m inclined to think that both my issue and these runners issues has to do with how they handle oxidative stress and the damage that can do to the neurological system. We know these runners are fueled by a sort of addiction to the running. And that’s going to involve dopamine. But since you have to metabolize dopamine using monoamine oxidize enzymes, you’re going to create hydrogen peroxide, and oxidative stressor, as a product. In my opinion to understand, neurological disorders, you need to understand how oxidative stress damages the neurons and the immune system.

And it seems by even just thinking about this I was right I just googled over training and oxidative stress and came up with this paper

https://pmc.ncbi.nlm.nih.gov/articles/PMC3435910/

The four theories of the disorder from the same magazine, which includes oxidated distress as one of them

https://www.outsideonline.com/health/training-performance/ov...

So I’m assuming the people this affects probably have some mild genetic issue that makes them a little bit worse at handling oxidative stress of some sort. This could be with glutathione peroxide or catalyze or any of the nutrients needed for us to absorb the cofactors that enable us to get rid of oxidative stress.

Humans seem to be like horses. A little bit of bad luck and we're half crippled for life.

Tim Noakes is cited in the article for his 1987 book "The Lore of Running", I wonder if people following its 2021 "Real Meal Revolution" about keto would be subject to the very same OTS or not in the long run.

The description of it as well as one of the theories on the cause make me think of burnout:

> Kreher and others believe that the mind plays an equally important role. Because your central nervous system influences your brain as well as your physiology, he theorizes that true overtraining syndrome is triggered by a combination of psychological and physical stress.

> “That’s the multi-system nature of the condition,” Kreher says. “The interaction of the mind and body is incredibly influential.” To finish a 100-mile race requires a psychological thrashing, and some runners have described a kind of post-race depression. As they try to rally to train for the next goal, perhaps beating themselves up for their prior performance, that mental stress, in addition to the physical depletion, could bring on OTS.

A friend is working on an app that can help address this: https://www.koopai-endurance.com/app/

I'm super interested in what drug or gene therapy we don't know about is causing this.

paywall

> A thin-faced, introspective Montanan, Wolfe had recently quit his job as an assistant U.S. attorney in Helena to concentrate on running for the North Face’s global athletic team.

Well yeah, that seems more important. /s

Article is faintly ludicrous.

Extreme endurance exercise is bad for your body. Medicine has understood this for years. Marathon runners, cyclists and swimmers have one of the highest incidences of atrial fibrillation once they pass age 60. If you took a blood test right after running a marathon, doctors would think you’re having a heart attack.

> Back in Montana he started running 25, sometimes 30 hours a week, fasting to drop any extra weight off his already thin frame and beating himself up in the margins of his training logs.

> Skaggs told me after Hardrock, he took a single day off, then started training for a marathon. “Stupid-hard running,” he says, “and the symptoms just kept getting worse and worse.”

This article is about people who are damaging their bodies through extreme, unnatural exercise - and then they are surprised that they’ve damaged their bodies. This publication is blithely unaware of how ridiculous this sounds. Like reading a Reddit thread of coke addicts earnestly cheering each other on to consume more and more coke, then being disappointed when their nose disintegrates.

I suppose it’s scientifically interesting that we don’t know the cause down to the biomolecular level. But that’s not surprising either. Other than genetic disorders that can be traced to a single faulty protein, or those caused by some external causative agent like a toxin or a virus, we don’t really know the root cause of that many diseases.

Click bait title.

> he inhaled a peanut butter and jelly sandwich at the kitchen table

Well that can't help for sure.

This seems like it should be obvious that it should happen. The human body was not designed for ultra-marathons. At a certain point the body shuts down out of self-preservation, because the mind is exhausting it too much.