Don't Forget the Salt!

Recently, in the United States Olympic Marathon Trials, a runner named Ryan Shay collapsed and died five miles into the marathon.  He was a veteran runner, 28 years old, and was use to frequently running at great distances: he was a five time national champion and had been running since he was in high school.  After reading about his death in the newspapers the next day, I became interested in what would have caused a runner of his caliber to collapse and die.  I had heard of runners dying before during races, but I was never sure why it happened.  To me it seemed odd that someone who was in such good shape should die from an exercise that they’d been training for for years.   If running gets someone into such good shape and helps build up their heart and prevent them from obesity, heart attack, blood clots, etc. then how could this death have happened?  Granted I am not a runner and therefore am not familiar with a runner’s training schedule or how much of an effect such a great task like a marathon would have on the human body.  I am using this paper as a way of further understanding the reasons why deaths occur from racing, the effect of extreme running of the human body, and if the marathon is too taxing on the human body and should be banned and how deaths in racing can be prevented.

Within the running world there is still misunderstanding about what could cause a runner to die from running.  After Shay’s death Mary Wittenberg, the president of the New York Road Runners (who sponsored the trials) said “It’s heart-wrenching.  These things happen, but they’re not supposed to happen at the height of an athlete’s life and career and on one of the biggest days of their career. There must be a reason for it all, but it’s certainly not clear to us right now” (1).  There are many different ways that runners have died in races in the past, most often from cardiac arrest.  When someone overworks their heart by doing too much aerobic exercise, the blood vessels in their body start to inflame from being overstressed.  As the blood vessels become inflamed they scar, which leads to a buildup of fibrin and “artery sclerotic plaque”.  Because of this build up it closes the diameter of the blood vessel, allowing for more heart attacks to occur (7).  Another cause of death in runners, and more common in marathons, is Hyponatremia, a disease which occurs when an athlete drinks too much water.  This seems totally obscure, since we are often told that when exercising it is important to keep hydrated as you constantly are losing water when you sweat.  Four runners in the past decade have died from Hyponatremia, and though this is not a large number, it is still an important disease to understand (2).

Hyponatremia is usually defined as being a “sodium imbalance brought on by excess fluid consumption” (2).  When a person sweats from physical exertion they are not only losing water but they are losing sodium as well.  If runners running for long distances are sweating constantly but only replenishing their body with water then they create and imbalance in their bodies between water and salt.  Though they are gaining more water they don’t have the same amount of salt as before, therefore they have very low sodium and electrolytes levels in their blood.  This is why it is not necessarily good for runners to continuously be drinking water during a race, or drinking a lot of water before or after the race.  In fact, the Houston Marathon lessened the number of water stops by half, from 30 to 16, and the Baltimore Marathon had only 15 water stops instead of the usually 18 (2).  It is also important that, according to doctors, the runner does not gain any weight during the race, as this gain in weight would be primarily from water consumption and would increase the chances of the runner being inflicted with Hyponatremia. 

Going back to Ryan Shay, the runner previously mentioned in this paper, there are definitely some unusual differences between him and other runners.  It was noticed during the first autopsy after his death that Ryan Shay had an enlarged heart, which was known by him and his parents since he was 14 years old.  This is not necessarily “weird” for an athlete like Shay.  After all, the heart is like any other muscle in the body and, with exercise, it will grow larger.  According to Joe Vigil, a PhD in exercise physiology and Shay’s Coach, "There's nothing wrong with an enlarged heart if it's the right kind” (3).  However, it is unknown whether his enlarged heart was a product of having run for so long or if it was a birth defect.  There are not many tests today that are precise enough to detect whether an enlarged heart is a problem, according to Dr. Stephen Grant, “It’s not a cut-and-dry test” (4).  A perfect way to test whether the heart was a problem would be to stop the athlete from running for a month and then measure the muscle mass of his heart.  If the heart was normal, than it would shrink in size like any other muscle because it is not being worked.  If, however, it stays enlarged, then the doctors would know something was wrong with the heart and therefore it may not be a good idea for the person to run.  Sadly, Shay may have not been able to do this test and they would never know if his heart was capable of holding up under such extreme conditions.  "The thing that made him such a great runner may have killed him," Joe Shay, Shay’s father, told The Associated Press (3).

This brings us to the question of whether running marathons are really healthy for the human body after all.  Is the human body designed for such extremes?  Marathons have been around from ancient times, since Phidippides, who ran 26 miles to Athens after the battle of Marathon to tell the Athenians about their victory.  However, after running this far-reaching feat, he died of exhaustion (5).  Marathons are popular and are run in cities throughout the world, and hundreds of thousands of runners come to run for many motives: trying to finish as fast as they can, or just to finish the marathon, or to complete a half marathon.   Marathons are 26.2 miles long and runners spend many months, even years, training themselves for this feat.  However, a marathon seems like something not everyone should doing-maybe there are certain genes that allow for someone to run in a marathon.  Should there be limits?

A scary phenomenon in the running world is “ultrarunning” in which athletes run longer distances for longer amounts of times.  Unlike the tens of thousands of people who run in marathons all over the world, only “an estimated 5,000 to 10,000 American runners compete” in ultrarunning (6).  There are many different events that they run, called “ultraevents”, which can be trail races and/or multiday and transcontinental races.   According to the New York Times, “while courses are marked with exactitude, ultrarunning is only loosely regulated and lacks uniform safety standards. Even so, deaths are rare” (6).  Still, deaths have occurred in these types of sports, and it becomes a question of health, and whether the people running should be doing these types of events and affecting their bodies in such a way.  A sort of “motto” in the ultrarunning world seems to be that “discomfort is key” and that “pain, discomfort and difficulty with breathing are to be expected in such an event” (6).  However, in normal exercise, a good rule of thumb is that if you are feeling dizzy, or having any discomfort, or can’t breathe, than you should stop.  Many times, for ultarunners, they themselves don’t know when the best time is to stop or when they have crossed the line.  “Even though a primary attraction of ultrarunning is to test limits, it is not always so easy to recognize the line between mere suffering and crossing a dangerous threshold,” ultrarunners and ultrarunning race organizers have said (6).  Does pushing oneself to the limit, to the point where there in physical pain, seem healthy?  In my opinion, the human body does not seem to have evolved to be pushed to such extremes, and to try these feats seem harmful rather than healthy.

The question now becomes whether we should have marathons or not, or is there is a way to prevent deaths in running.  Obviously athletes should respect the physical taxation it has on the human body and that they shouldn’t take running a marathon lightly.  They should be well trained, have been running for at least a year, and be wary of the consequences that come with undertaking such a task.  However, I also think that necessary screening procedures should be done to make sure that the person running is in the optimal health to be doing so.  Ryan Shay was unlucky in the fact that he had an enlarged heart that did not seem to have any harmful consequences until this last race.  I think abnormalities such as these should be treated with caution.  New, more precise tests should be constructed to ultimately test whether a person’s body is up to the task of running 26.2 miles.  I believe that events such as “ultrarunning” should be prevented because this seems to do more harm to the body than good.  But for marathon runners, who take the sport seriously and train well, I believe it is a good test for them.  With the proper amount of training, resting period and prevention of diseases (cardiac rest, Hyponatremia) a marathon can be a good event to try and conquer. 

Primary Sources:   

1)      http://www.nytimes.com/2007/11/04/sports/othersports/04marathon.html?pagewanted=1&_r=1 , Lynn Zinser, New York Times, November 4, 2007

2)      http://www.washingtonpost.com/ac2/wp-dyn/A9158-2003Oct23?language=printer, Dan Steinberg, Washington Post, October 24, 2003

3)      http://www.usatoday.com/sports/olympics/summer/track/2007-11-03-us-marathon-trials_N.htm, Dick Patrick, USA Today, November 3, 2007

4)      Dr. Steven Grant

5)      http://www.lakepowell.net/marathon.html, Paul Ostapuk

6)      http://query.nytimes.com/gst/fullpage.html?res=9907E6D81F3FF934A35750C0A9629C8B63&sec=&spon=&pagewanted=all, Jere Longman, New York Times, March 7 2004

7)      http://www.totalityofbeing.com/ArchivedAerobics.html, Dr. William Wong, 1999