Cutting-Edge Research

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A novel new addition to race week at this year’s Western States Endurance Run was the first-ever Medicine & Science in Ultra-Endurance Sports Conference. Medical research is one of the three pillars of the Western States Foundation Mission, and the formulation of a research conference in conjunction with the race has been in the works for several years. Dr. Marty Hoffman, Western States Research Director, spearheaded the formation and organization of the inaugural event, where a significant portion of the research presented was actually conducted at Western States.

Over 100 medical professionals, scientists, race organizers and volunteers and eager-minded runners attended, and were treated to a myriad of novel and useful bits of wisdom.

My Quick Hits From The Symposium The Heart Aches, But It’s Only Temporary

David Oxborough, PhD, is a professor of cardiovascular physiology at John Moores University in Liverpool, UK. He presented on the effects of ultra-endurance exercise on cardiac function, and dropped a lot of folks’ blood pressures by reassuring the attendees that, while 100-mile races exact short-term stresses on the heart, none pose long-term dangers. Moreover, he cast doubt on the recent studies that running harms the heart, criticizing the method of research and review process. In short: Oxborough concluded that ultrarunners’ hearts are, by and large, normal and healthier than those of the general population.

Over-Achieving Ultrarunners

The medical research oracle in action – Dr. Marty Hoffman.

The medical research oracle in action – Dr. Marty Hoffman.

Marty Hoffman, MD, professor of Physical Medicine and Rehabilitation at University of California Davis, provided some insights into his extensive Ultrarunners Longitudinal Tracking (ULTRA) study. His study of over 1,200 ultramarathon runners added even greater reassurance about running long distances. He noted the top chronic conditions affecting ultrarunners are allergies (25% of respondants) and exercise-induced asthma (13%), and that – interestingly – cancer affected 5%. As to the last, he notes, many people take up running as cancer survivors.

Remember That Trend? It’s The Opposite Now

Kevin Kirby, DPM, MS, Professor of Biomechanics at the California School of Podiatric Medicine, presented the latest research on foot strike and shoe type in running. Kirby cited the vast majority of research on foot strike – including that of elite and recreational runners, alike – which shows that most runners heel strike. Additionally, a recent Western States study found that runners who struck on the mid-foot or forefoot had higher muscle damage than rear-foot strikers. What’s the best shoe? “Both cushioned and light,” Kirby concluded. This was music to the ears of the Hoka, Montrail and Altra fans out there.

More From The “Keep It Simple” Camp

Hoffman and Tamara Hew-Butler, DPM, PhD, Professor, Exercise Science at Oakland University presented on hyponatremia and its physiology and the current research in ultra-endurance events. Both reinforced the evidence that humans generally conserve salt during exercise and require no supplemental salt to maintain blood sodium, even citing a recent study that found no difference in blood sodium levels between sodium and placebo pill intake during endurance exercise. However, die-hard saltlovers out there cheered a bit when both noted that – for reasons unknown – a small subset of runners become both dehydrated and hyponatremic at Western States. Hoffman told me, as an aside, that he believes that some runners over-supplement in training, possibly impairing sodium-sparing mechanisms during races. My theory? It could be the lack of heat acclimatization at hot races such as Western States, where the body is not acutely prepared to spare sodium over that prolonged period of heat exposure. Researching cold-weather ultras might be the next logical step.

Nevertheless, both Hew-Butler and Hoffman’s advice was simple – “Thirsty? DRINK. Craving salt? Eat something salty! Feeling bloated? Stop drinking!”

Chewing The Fat

Stephen Phinney, MD, PhD, is Professor Emeritus of Medicine at University of California Davis, and is a pre-eminent researcher in the US on low-carbohydrate nutrition. Together with Dr. Jeff Volek, he is studying the effect of lowcarbohydrate, enhanced-fat-burning metabolism in ultra-endurance athletes. Preliminary results of his “Fat Adapted Substrate Oxidation in Trail Elite Runners” (FASTER) study include higher VO2Max values and significantly better fat metabolism – and decreased carbohydrate intake – by athletes on a high-fat, low-carb diet.

The most promising aspect of high-fat metabolism is the increase in natural antioxidants in fat-adapted runners. The implication is less tissue stress – including in the stomach and GI tract – as well as faster recovery from stressful exercise bouts. Stay tuned for more from this study, and from the high-fat sphere. While hard data on performance is still sparse, we’re just seeing the tip of the iceberg.

The Quickest Way To A DNF Is Through The Stomach

Paired with Hoffman’s ULTRA Study was a review of research by Kristin Stuempfle, PhD, Professor of Health Sciences at Gettysburg College. She presented research on GI distress and performance in 100-mile races, which showed it to be the number one factor in DNFs, and the secondleading cause of performance decline (only after foot problems). She discussed the factors affecting GI function, including effort and temperature diverting blood flow away from the stomach. Of interest: she found that, in general, runners who ate more had fewer issues, and runners who ingested more fat had the fewest issues. Take care of the stomach, and it’ll take care of the rest.

What We Know Is What We Don’t Know

A breath of fresh air into the Western States family is the addition of Dr. Bob Weiss as Medical Director this year. Weiss is Chief of Nephrology at the California Department of Veterans Affairs in Sacramento as well as a professor at University of California Davis. Along with extensive knowledge, Weiss presented physiology and current research on rhabdomyolosis and how it relates to kidney failure. Among runners, this is the “boogie man” we all fear: that over the course of long, hot ultra races, our kidneys will fail. Acute renal failure, according to Weiss, requires the combination of severe muscle cell breakdown plus an excessive constriction of blood flow to the kidney. The former almost always results from marked lack of fi tness and preparation; he cites a case study of five WSER runners, all of whom had pre-race injuries that interrupted training. Moreover, it usually requires runners pushing themselves too hard for too long during races. Weiss also cites NSAID use as a factor that constricts blood fl ow to the kidneys, a factor in renal failure.

Hydration is an issue in kidney function, but aggressive drinking will neither prevent or reverse kidney failure: “Don’t get dehydrated, but drink to thirst,” said Weiss. Of note: Weiss points out “there is no evidence-based practice” for treating renal failure, and he echoed the statements of Hoffman and Hew-Butler that both prevention and treatment for kidney failure must avoid excessive fluids intake to prevent hyponatremia, which is far more dangerous. The prevailing preventative message is, “be prepared, run smart and listen to your body.” Wise words from the new Medical Director.

Cooperation Is The Best Medicine

And in what might have been the most thoughtprovoking, unifying presentation of the second day, Western States Race Director Craig Thornley discussed the history of medical volunteers at ultramarathons, and posed the question: “Are medical staff a runner’s friend or enemy?” He highlighted several historical examples of runner treatment, where some runners were pulled from races without medical necessity, while others were allowed to continue, when in fact they were signifi cantly impaired. Thornley implored medical staff to “find consensus” on how to treat runners, and that may only come from communication and collaboration amongst medical volunteers. Then, he said, runners will view medical staff as “allies, not to be evaded.”

The theme of his presentation tied together the mission of the two-day symposium: that evidence, collaboration and communication should be the best-practices to better serve runners and safely guide them to the finish line. Mission accomplished, on the first try.

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About Author

Joe Uhan is a physical therapist, coach and ultrarunner in Eugene, Oregon. He is a Minnesota native and has been a competitive runner for over 18 years. He has a Master's Degree in Kinesiology, a Doctorate in Physical Therapy, and is a USATF Level II Certified Coach. Joe ran his first ultra at Autumn Leaves 50/50 in October 2010, was the bronze medalist at the 2012 USATF 100K Trail Championships, and finished 9th overall at the 2012 Western States 100. Joe works at Eugene Physical Therapy in Eugene, Oregon.

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