Sportsmedicine: The running problem that can kill you

John Robertson, N.D.
January 2005
Location
Northwest Runner

While the health benefits of running are varied and numerous, there are also health problems that, if not caused by running, are at least associated with it. These problems are largely self-inflicted and, if not completely preventable, are most often fixable with an accurate diagnosis and appropriate treatment. Obvious examples include overuse injuries and overtraining, which we've discussed frequently in this column. A problem often associated with endurance exercise that can be harmful enough to become life threatening is eating disorders: a group of related problems with eating that includes anorexia and bulimia. With emphasis on leanness in endurance sports and in sports that focus on appearance, such an environment can easily lead to unhealthy strategies for weight loss.

Sports with high rates of eating disorders for women include swimming, diving, figure skating, gymnastics, dancing and distance running. For men, add wrestling, jockeying, body building and rowing as sports that often necessitate weight restriction and thus often lead to unhealthy eating. And yes, while most of the attention for eating disorders rightly focuses on women, men represent about 10% of all cases.

Anorexia, or an aversion to eating, and bulimia, binge eating and purging, occur most commonly in young women 14-25 years of age, but can begin much earlier. Considered a psychological disease that can be very difficult to treat, successful outcomes are much more likely when bad eating habits are discovered early in the stage of disordered eating and not after progressing into a full-blown eating disorder. Of the five to eight million American women with an eating disorder, half will completely recover, 30% will be at risk for recurrence and the remaining 20% will always struggle with it. Five percent of anorexics will die from the disease -- the highest mortality rate of any psychological illness.

The incidence is on the rise; a recent PBS NOVA documentary "Dying to be Thin" refers to anorexia as "an alarming epidemic. "The broadcast in its entirety is available on their website at www.PBS.org/NOVA/thin, and is an excellent overview of the problem.

For runners convinced that getting leaner will make them faster when they are already quite lean, the additional weight loss will be mostly come from muscle and not fat, depleting muscle one has worked hard to get and which makes one faster. Of course, when runners see world champions Paula Radcliffe at 5'8" and 120 pounds and Haile Gebrselassie at 5'5" and 120, it doesn't help any.

Also, if an athlete exercising strenuously artificially restricts calories by either eating less or purging with vomiting, laxatives and the like, the resulting lack of vitamins, minerals, protein and calories leads to a general lack of energy, an inability to finish workouts, and eventually, poorer performances.

The roots of eating disorders

How does an eating disorder begin? Often as a by-product of social pressures to be lean. Too often our young kids buy into the cultural stereotype that to be lean will bring beauty, success and happiness. Psychologist Craig Johnson warns parents about any 10- year old who wants to go on a diet. He considers dieting a young girl's worst enemy. "Wanting to go on a diet tells you something is wrong," says social worker Susan Willard. And what went wrong may be anything from not doing well in school, sports or just about any activity. Or it may be that their perception of how they should look is unrealistic, the result of millions of commercials with thin, "beautiful" people.

Research tells us that by age seven the typical girl already has ideas of what is the right and wrong way for her body to look. Psychologists consider this disordered thinking. This often leads to the conclusion that the solution for any source of misery in life is getting thin or thinner, and that life will invariably get better as a result. With the constant media bombardment of young, thin people who are obviously popular and having fun, the solution is right at hand: lose weight, and by any means possible. If parents are dieting, the "getting thin at any cost strategy" is even further ingrained.

Feeling emotionally fragile by focusing on the body and what foods to eat can restore a sense of control. Particularly during puberty, with hormonal surges and resulting body changes, adolescents become disappointed in their bodies and search for solutions through weight loss.

Dr. Johnson goes on to state that in some girls who are genetically susceptible and who diet, the brain's neuro- chemistry is altered, which leads to obsessive-compulsive behaviors similar to alcohol and drug addiction. So dieting for most kids is not necessarily harmful, but for those who are genetically predisposed, it can spiral out of control into an eating disorder. There is no way to know who is at risk and who is not.

Warning signs

Psychologists warn against the typical teenage behavior of bonding over shared body loathing : "You don't look nearly as fat as I do." "Yes I do!" Also, be aware that the statement "I feel fat" is code for "something's bothering me." Check out what else is going on in their lives that may be troubling them.

Other red flags include: * Wanting to become a vegetarian, which is a good way to control what you eat. More often the concern is restricting fat content rather than animal product. * Favorite foods get eliminated from the diet -- hamburgers, pizza, ice cream. * The list of foods that won't be eaten keeps getting longer. * There are several reasons to skip meals: I'm late for school, I've got homework to do, etc. * Spending less time doing activities that were previously enjoyable and adding more exercise instead, above and beyond team workouts.

Sorting out the difference between usual adolescent behavior and problem behavior can be difficult. Changing outfits several times in order to "look right" is pretty normal. Retreating from relationships, admiring skinny people, not eating much at dinner and having frequent stomach aches causing missed meals is a problem.

If problem behavior is noted and you are concerned, get help, but first get help for yourself by getting informed. Talk to an eating disorder specialist, usually a nutritionist, to get a plan of action. Usually if an eating disorder is caught early on, the chance of recovery is much better.

If you are a parent or coach, other helpful tips include:

* If your kid wants to go on a diet, ask why. If it's to try and fit in with the group, find other strategies to lose weight, but don't talk about body size and shape. If the reason is concern about how their body looks, get help. * Between ages 11-14 the average girl gains about 40 pounds, about a third of their adult weight. * Teach even young children how unrealistic the media- driven "ideal body" is. * Avoid praising or condemning a person because of body shape. * Have evening meals together! * Keep in mind: Anyone camping out in the bathroom after meals is suspect for vomiting or laxative use. * If your child is overweight, avoid restricting food intake, just have healthy food around and encourage exercise as a family. * Girls or boys who are perfectionists, eager to please and compulsive are the most prone to developing an eating disorder.

In an attempt to tease out an eating disorder at the high school level, several states have added these questions on their preseason sports physicals: "Do you want to lose or gain weight?" and "Do you lose weight for your sport?" A yes answer leads to further questioning, and a referral when needed.

The most important concept to come away with regarding eating disorders is that they are psychological problems of distorted body image that occur in those who are predisposed, and they are potentially very dangerous. Being aware of the warning signs and seeking professional help early on is the best chance for a cure.

As distance running appeals to dedicated and disciplined kids who tend to be lean, it may be just a short step from using those attributes for success to the onset of more worrisome obsessive behavior leading to an eating disorder. One bit of advice for those who coach women distance runners is never to suggest that getting leaner will lead to faster times. While this advice may be true, the potential harm of encouraging weight loss in an athlete who is already trying their best to please can tip a fragile balance towards harm.

For more information on this important topic for parents and coaches alike, check out the following: www.hedc.org www.4woman.gov/body www.edap.org