By Ashley Arnold
When I first started running in high school, it was simply because running was an inconvenient requirement needed to get over hurdles on the track. If someone asked me to run more than 400 meters, I laughed. After all, who in their right mind would want to run long distances? I was a sprinter. And runners? Runners were, in my mind, insane.
At least that’s what I thought during my freshman year of high school, 14 years ago. Less than one year ago, I ran and won my second-ever 100-mile race, Colorado’s famous Leadville Trail 100 (which is 402 laps plus some change around a track, by the way). Somehow I’d become one of those insane runners. And I loved it.
Ultrarunners are runners who train for and compete in races longer than a marathon. When I moved to Colorado about five years ago for an internship with Trail Runner magazine, I started seriously running trails. I was lustful for dirt and mountains and wide-open vistas above tree line. I spent weekends in the wilderness. And, if I missed a run, I was miserable.
I registered for races, and as soon as I finished one and had to rest and recover, I was depressed. Ultrarunning became my drug of choice, albeit a healthy one when compared to a myriad of abused substances … but still a drug.
Except it doesn’t have to be.
I’d like to think I’ve learned a great deal about how to balance my health as an endurance athlete. But before I learned that balance, I certainly experienced physical and mental health disturbances that result from too much of an activity that I assumed was doing nothing more than serving me. And, I reasoned, if I experienced the downsides of my sport, then other women probably did, too.
Don’t be frightened. Even with the little data that we do have (there isn’t very much, since ultrarunning is a nascent sport), ultrarunners are, on the whole, a rather healthy bunch. In fact, a recent study published in PLOS (Public Library of Science) concluded that “compared with the general population, ultramarathon runners appear healthier and report fewer missed work or school days due to illness or injury.”
The only negative results from the study of more than 1,000 ultrarunners indicated “a higher prevalence of asthma and allergies than the general population.” And the higher rate of asthma is likely due to the amount of time ultrarunners spend outside in our environment and its poor air quality, rather than the actual running.
For women in particular, though, a 2013 study published by the International Journal of Sport Nutrition and Exercise Metabolism indicates that the female athlete population—endurance athletes in particular—have a higher-than-average risk for iron deficiency anemia. Evidence that “the iron-regulating hormone hepcidin is transiently increased with acute exercise,” suggests that this mechanism leads to anemia. Plus, after long bouts of an activity like ultrarunning, we experience increased gastrointestinal blood loss, increased cell turnover, and hematuria; not to mention the blood loss associated with menstruation.
Still, something like this is easily managed with keen attention to diet. And to be honest, I don’t know many female runners with iron deficiencies. (Perhaps it’s because the successful runners I know closely monitor themselves to ensure they are receiving all the required nutrients.) But my intuition told me there was a more complex story at hand, one that had more to do with psychology than anything else. So I talked to fellow female runners, and medical professionals familiar with the sport, to find out more.
Stress, self worth, and the nervous system
While, according to the Mayo Clinic, running has been proven to pump up your endorphins, provide in-motion meditation, and improve your mood, there’s still the old adage: too much of a good thing can be a bad thing. As people who run a lot, this is an easy obstacle to come up against. Take Boulder, Colorado, ultrarunner Gina Lucrezi for example. “Training is a major part of my life. Actually, it is my life,” says the 31-year-old who recently quit her full-time job to focus on training and racing trails. “When it isn’t going well, or when I’m injured, everything else in my life seems to be affected. If I have an awful workout, I’ll be bummed all day. On the contrary, if the workout goes really well, then I’m having the best day of my life.”
It’s as though we sometimes cannot avoid letting our success and setbacks (good workout vs. bad workout, for example) as runners dictate our value as people. And it’s a slippery slope, explains Functional and Chinese medicine practitioner Tressa Breindel, a Boulder-based ultrarunner herself, who focuses much of her practice on neuro-endocrine-immunology. “Maintaining rigid ideas of self causes us stress,” says Tressa. “For a female ultrarunner, this may mean that the goals you choose are reflections of who you think you are and what you think you need to be OK [either in your own eyes or in the eyes of others].”
She heeds caution, saying we might tune out our physical or emotional needs in the pursuit of these mental constructs: I am an athlete, or success = x, or, if I don’t train this much, I will be slow/fat/no good/people will think badly of me/I’m not tough. And psychological stressors such as these add an even heavier load to the already-present stress innate to endurance training and racing.
But, on the flip side, Gina says: If we do accomplish something amazing—like running 100 miles for example—we feel completely elated.
When I finished Leadville for the first time in 2009, I started crying. It was my first 100-miler and even the thought of running the distance made me tired. (I did fall asleep during the race several times.) While on the course, I spent nearly 24 hours ricocheting through what felt like every possible emotion. I crossed the line exhausted, amazed, and so very thankful that I could do something so seemingly gargantuan as run 100 miles.
Then, in 2013, when I won, it felt easy. I’m sure this was partly due to the fact that I had run the course before. I could imagine every step and could visualize the result. But still, I was having, as Gina says, “one of the best days of my life.” But why?
Well, for one, I allowed the unnecessary stress of thoughts like, “Can I do this?” or “I’m not in shape,” to slip away, and instead focused on only the task at hand: run, eat, drink, repeat. It felt easy. Wonderful.
“We are far more powerful than we ever thought possible,” chimes in Elinor Fish of Carbondale, Colorado. Elinor is an ultrarunner, former managing editor at Trail Runner magazine, and the host of Run Wild Retreats, specialized trail running and yoga retreats for women. “Ultrarunning gives us permission to push ourselves far outside our comfort zone to do something daring, even a little dangerous. In that process, we tend to discover the depths of our power and strength.”
So, if we are able to discover our strength through ultrarunning, we will only get stronger and stronger, right? Well, that depends on what you do post race. “Your body can’t tell the difference between you choosing to do all this physical activity and it needing to do it in order to survive,” says Tressa. “So, it will keep pumping out the necessary signals to keep you going … until it can’t.”
Your overworked system is demanding rest.
“I often see people riding this sort of inexplicable ability to train a lot or keep training after a long, hard race, even to their own disbelief,” Tressa says. “If they take advantage of this, they will often dip into a level of deficiency and fatigue from overuse that takes quite a while and some concentrated effort—or non-effort, really—to heal from.”
The Withdrawal Effect
Unfortunately that “healing process” can, with the wrong outlook, feel miserable. Until I recognized there were other activities I could pursue during my off-season that I couldn’t pursue while running, I, too, was part of the misery train. I was cranky, restless, and felt almost sick sometimes when I couldn’t run. Like any drug addict, I was suffering from withdrawal.
“Ultrarunning causes endogenous opioids (endorphins) to be released,” says Dr. Dave Young, an emergency physician in Boston who has spent time studying ultrarunners. “I can only guess that when people run long distances, they may become tolerant to endorphins, similar to opiate abusers developing tolerance and requiring a higher dose to get high.
“If this tolerance develops, then it is possible that an individual could experience withdrawal from endorphins, resulting in depressed mood, restlessness, agitation, and increased pain.” Still, he confesses, it’s a difficult area to study given the inherent variability in mood from person to person and situation to situation.
And, while there may not be a medical study providing conclusive evidence on this topic today in relation to ultrarunners in particular, I can assure you there is no denying that post-race depression exists. “There is a lull that comes after a big event,” says longtime elite ultrarunner and former Women’s Adventure cover subject Krissy Moehl of Boulder, Colorado. “After months of focusing and training, it can be difficult when it’s accomplished. I’ve found that I need to avoid scheduling ‘what’s next’ after a big event and instead focus on recovery. It’s just as important as a race goal.”
While Krissy admits it’s been hard for her in the past to take recovery seriously, she’s realized that after a race she is “not only physically exhausted, but also exhausted at a deeper nervous system and immune system level.”
So what does she do? “I like to work on other things like yoga, climbing, reading, cooking, cycling, and writing—all of the activities I don’t really get to do when spending the majority of my time running.”
Another longstanding Boulder-area elite ultrarunner agrees. “I have certainly experienced what I call ‘post-race blues’ after long races and heavy training cycles,” says Darcy Africa. “I think that when I’m running a lot, my endorphins are firing, and when I take a break right after, everything slows down. I try to always have something on the calendar to look forward to so as to avoid that downturn.”
But truthfully, to some extent, the downturn can’t be avoided. And here’s why: During an ultramarathon our bodies are forced to pump out tons of hormones in order to maintain basic homeostasis. “During the race, the receptors for hormones and neurotransmitters are flooded,” says Tressa. “This causes an at least temporary down-regulation of receptors on the brain cells and synapses.”
As soon as the race is over, we stop this high-level hormone secretion, and what happens? Fewer receptors equal less signaling to the brain cells, and as a result, depression.
Further, depression, anxiety, and mood disorders are now looked at as states of inflammation, something we certainly experience after ultrarunning. “Researchers noticed that when people are sick they feel depressed, in the same way that people who are depressed feel—even though they aren’t, technically—sick,” says Tressa. “When we look at chemical signaling in depressed people, we actually see a lot more inflammatory signaling than in normal controls.”
Not only do said hormone changes dramatically affect the brain, for females, this depletion also affects our cycles. (If you add post-race iron deficiency anemia to this, you’re in for a hell of a ride.) “A menstrual cycle requires energy to prepare the uterus for implantation of an embryo, and the loss of blood and tissue when no embryo is implanted must be regenerated by the body,” says Dr. Young. “In situations of extreme stress, the body undergoes many physiologic changes to preserve energy, and it is presumed that, for women, this non-essential process is halted. Of course, in situations of extreme stress, becoming pregnant isn’t ideal for the mother or fetus, and therefore, in amenorrheic women, it is avoided.”
For every handful of women who experience amenorrhea that I’ve met, though, I’ve also met a dozen who train and race hard and still maintain regular cycles. Darcy is one of them. And I’m willing to bet it’s because she’s “tuned in” to her body’s needs. “When I’m training, I have to pay close attention to how much I eat,” she says. “When I’m training a lot, I eat a lot more. I’m not a calorie counter, but when my appetite increases, I pay attention.”
While Krissy admits to having struggled with irregular periods when she first started running, her ability to pay attention to her body has alleviated the issue. “In college, my cycle was not regular. Once I turned 26, I decided I was not okay with having an irregular cycle and worked with a doctor to learn what I could do to improve nutrition, training, and stress to ensure I was on track,” she says. “Having a regular period is a healthy sign to me that my body is getting what it needs along with training and racing long distances.”
Keeping the balance
Krissy’s words are vital for us to understand if we wish to be healthy female athletes. Off-balance hormones mean an off-balance body.
As of now, there are few—if any—conclusive studies about the long-term effects of ultra endurance sports and the female body. And yet, the truth is, science only goes so far. In the end, we have to learn to really pay attention to our own bodies, because we’re all different. If we don’t take care of ourselves, we’re going to get injured. And most of us in this sport aren’t only interested in running long now. We want to be able to keep running throughout our entire lives.
Perhaps the best thing to do then, offers Tressa, is meditation. In fact, she prescribes it to every client she sees—she says that our ability to meditate is directly related to minimizing the stress to our homeostatic system. There’s new research to back up her claim. According to a study by the Biomedical Research Institute of Barcelona published in Feb. 2014, “mindfulness meditation can alter neural, behavioral, and biochemical processes.”
So perhaps it isn’t the number of miles we run each week, the foods we eat, or even the hours of sleep we get—although those are certainly important for an athlete to tune into—maybe it’s meditation that will make or break the running drug. Let running just be that: running. And I should point out some anecdotal evidence here: Every dissatisfied female runner I know scoffs at meditation.
“Our warped mental constructs of self-identity, which we often were taught by our parents and others or decided about ourselves as a result of environment at a very young age,” says Tressa, “keep us from truly attuning to ourselves. And only from being able to attune to ourselves can we maximize our full potential.”
This feature article was originally published in Women’s Adventure magazine‘s Summer 2014 issue.