The Athlete’s Downfall

The folly of placing the fittest and fastest on pedestals. 

5280 April 2016
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In Colorado, we’re all athletes in the making. It doesn’t matter if you’re uncoordinated or can’t complete a two-mile jog. The notion of fitness permeates life in the Centennial State to such a degree that it’s almost impossible to escape. It matters not whether you were born here or moved here later in life; eventually, the not-so-subliminal messaging—that your inner athlete is just waiting for her chance to shine—gets through. Then, somewhat inexplicably, you find yourself thinking ridiculous thoughts like, I should start going to CrossFit every day, or How bad could an Ironman really be?

Yes, Centennial Staters admire those who eschew the couch for the trail, and we practically worship those who take their workouts a step further by running marathons or competing in triathlons. And why wouldn’t we? According to the U.S. Department of Health and Human Services’ 2008 Physical Activity Guidelines for Americans, adults should be getting at least 150 minutes of moderate-intensity aerobic activity each week plus strengthening activities at least eight days a month. Not surprisingly, a hearty majority—an estimated 83 percent—of Colorado adults participate in some form of physical activity and do many things right when it comes to fitness.

But this is Colorado. We don’t stop at five kilometers. Instead, three-mile jogs morph into marathons and sprint-distance triathlons become Ironmans. And suddenly you’re no longer exercising for the health benefits; you’ve become what Dr. Iñigo San Millán, director of sports performance at the University of Colorado Sports Medicine and Performance Center, calls a “Colorado freak.” These are people—and their numbers are growing, according to organizations such as USA Triathlon, USA Cycling, and Running USA—who not so long ago might’ve huffed and puffed their ways around Wash Park once a week but today could be considered borderline elite athletes. They train as hard as the best, and they compete in the most challenging events on Earth.

Here’s the catch: “Professional athletes have entourages to help them,” San Millán says. “The majority of Colorado freaks are doing this on their own, even if they happen to have a sponsor or two. They don’t know how to train, how to eat, how to recover, or how to balance their lives, and this brings issues to this population.”

“Issues” may be something of an understatement because the list of downsides that people are loathe to discuss is long and varied. Time. Money. The lure of performance enhancers. The fights with your spouse. The dangers of the backcountry.

On top of all that, the human body simply isn’t equipped to withstand a 100-mile footrace or to repeatedly dead-lift a 600-pound tractor tire. “These people are writing checks their bodies can’t cash,” says Doug Jowdy, Ph.D., a Front Range sports psychologist. “There’s only so much a body can take.” And, Jowdy points out, the damage isn’t restricted to the physical. “People can become too attached to exercise because it gives them something they can’t get elsewhere. That can lead to emotional injury.”

In our fat-and-getting-fatter society, it’s difficult to comprehend how Coloradans’ outsize love of movement could be a bad thing, but there does come a point when more isn’t better. It’s in that murky space, where pain sometimes masquerades as pleasure and happiness hinges on getting in your next workout, that the dark side of fitness lurks. Here’s why.

Because even the strong-willed bow to Facebook.

Along with the widespread inability to communicate using more than 140 characters and rising divorce rates, you can add “working out too much” to the long list of societal ills that can, in part, be blamed on the popularity of social media.

“Social media has taken endurance training to new heights,” says Brendan Trimboli, a Durango-based energy analyst who has competed in more than 30 ultramarathons since 2008. “It allows you to ask yourself if you’re less accomplished than that guy, if you’re doing less than that guy. I’m guilty of that—of trying to keep up.”

It doesn’t seem like something you should feel ashamed of—getting in an extra workout is usually a good thing—unless you’ve already asked your body to carry you 75 miles that week or you have an injury you should be nursing back to health. “Social media is hard; it prompts you, teases you,” says Durango’s Hannah Green, a 25-year-old distance runner who recently underwent surgery to repair a deep bone bruise to her knee. “And that’s especially difficult when you’re injured. You try to do things you shouldn’t do.”

Because competitive athletes tend to be affirmation addicts.

We all like a pat on the back, but when you crave—even need—positive feedback, things can get messy.

“There’s definitely a personality type associated with competitive athletes, especially endurance athletes,” says sports psychologist Doug Jowdy. “These people are achievement-oriented but often have unrealistic expectations; they’re perfectionistic, very type A; they’re self-critical. And they compensate through exercise.”

Translation: The act of crossing a finish line or seeing improvement based on your Garmin’s data can serve as a booster shot of confidence.

“If you can transfer the skills you learn being an athlete—dealing with pressure, being goal-oriented—to other aspects of your life and gain confidence elsewhere, that’s ideal,” says Jamie Shapiro, Ph.D., assistant professor for the Master of Arts in Sport and Performance Psychology program at the University of Denver. “These folks need to learn to find self-worth from other areas of life.” Why? Because family, work, injuries, an aging body—you name it—will inevitably get in the way of your fitness routine.

Because endorphins are habit-forming.

You’ve heard of “runner’s high”: that mythical place runners swear exists, where pain and suffering dissipate and exercise feels (almost) as good as sex. If you’ve never felt it, runner’s high might seem like a fairy tale—except science backs up its existence. Although questions persist about how it all works, neurochemicals (like endorphins) and neurotransmitters (like serotonin) produced in the brain as a result of stress can induce a pain-free euphoria and post-workout contentedness. Those feelings can be therapeutic—and highly addictive.

“I suffered from some depression in my early 20s,” says Paul Hamilton, 29, a sponsored Colorado ultrarunner who lives out of his truck during training season so he can be closer to the trails. “But I found extraordinary healing by running in nature.” Not only did Hamilton find that trail running served as a form of active meditation, but he was also almost certainly enjoying the effects of neurochemicals. “Endorphins are some of the best antidepressants out there,” says Dr. John Hill, a primary care sports medicine specialist at the University of Colorado Hospital. Which is all well and good—until an injury prevents you from getting your fix. Whether you’ve become addicted to the way neurochemicals make you feel or you use them to battle some form of mental anguish, going cold turkey can be agonizing. “People come to me bleeding emotionally,” Jowdy says. “They can’t get that reward and they feel empty, frustrated, and hopeless.”

Because fitness is f&%#ing expensive.

Here’s (approximately) how much dough you can expect to spend, depending on your particular discipline. Keep in mind if you’re not competing in a local event, you’ll need to add the cost of airfare and baggage (a bike can cost up to $300 round trip), lodging, and food to your total.

—iStock

To train for and compete in a triathlon: 

Wet Suit ($200)
+ Swim Cap ($10)
+ Goggles ($40)
+ Gym membership with lap pool access ($50/month)
+ Road bike ($4,000)
+ Bike shoes ($150)
+ Helmet ($100)
+ Socks ($15)
+ Cycling clothing ($300)
+ Sunglasses ($100)
+ Tools/spare gear ($100)
+ GPS device/bike computer ($130)
+ Gels/drinks/food ($80)
+ Running Shoes ($150)
+ Running Clothing ($120)
+ Event Entry Fee ($200)
= $5,745

To train for and compete in a road marathon:

Running shoes ($150)
+ Running clothing ($120)
+ Socks ($15)
+ GPS device ($250)
+ Hydration belt ($40)
+ Gels/drinks/food ($80)
+ Event entry fee ($200)
= $855

To train for and compete in a long-distance cycling event:

Road Bike ($4,000)
+ Bike shoes ($150)
+ Helmet ($100)
+ Multiple pairs of socks ($30)
+ Multiple layers of cycling clothing ($500)
+ Sunglasses ($100)
+ Tools/spare gear ($150)
+ Gels/drinks/food ($80)
+ Gloves ($25)
+ GPS Device/bike computer ($130)
+ Event entry fee ($200)
= $5,465

Because there’s something called the female athlete triad—and it’s not awesome.

—iStock

When female athletes don’t give their bodies the fuel they need to expend the energy they want to, a troika of nasty medical problems can ensue.

1. Energy Deficiency 

This is the root of the problem: Whether an athlete is purposefully restricting caloric intake or doesn’t know she isn’t eating enough, energy deficiency forces her body to alter critical physiological systems—like growth and reproduction—to conserve energy for survival. Athletes who are energy deficient will often feel fatigued and unable to focus.

2. No Menstrual Cycle 

When the body halts menstruation because of low energy stores, the suppression of estrogen—an important developmental hormone—leads to decreased bone growth and bone strength.

3. Low Bone Mass

 A poorly fueled body that has been compelled to curb estrogen is unable to support bone health. The result can be osteoporosis and stress fractures. Although not all are caused by low bone density, stress fractures account for up to 16 percent of injuries in runners and up to 20 percent of all athletic injuries.

Because seemingly minor irritations can morph into agonizing indignities.

The Problem: Chafing

Cause: Friction, either skin on skin or skin on fabric

Presentation: Red, rashlike irritation, sometimes accompanied by bleeding, which most commonly occurs on the nipples, thighs, groin, armpits, and shoulders.

In-race quick fix: Remove the offending fabric if you can. Turning clothing inside out can help; rubbing a layer of ChapStick over the irritation can work in a pinch.

Avoid: Use lubrication. Vaseline is OK, but runners and triathletes like BodyGlide, while cyclists swear by Chamois Butt’r and DZ Nuts.

The Problem: Blisters

Cause: Friction

Presentation: Pockets of fluid (pus, blood, serum) materialize under the top layer of skin, usually where socks or shoes rub the skin.

In-race quick fix: Hopefully you have some moleskin in one of your drop bags; if not, you’ll have to decide if it’s worth stopping at a medical tent to get some.

Avoid: Keep your feet moist by using lotion every day, and on race day slather your feet with Vaseline. Don blister-free socks and wear shoes that fit.

The Problem: Runner’s Trots

Cause: Unknown; researchers surmise organ jostling, decreased blood flow to the intestines, and pre-race jitters might be contributing factors

Presentation: It feels like your everyday bout of diarrhea, except there’s often nowhere to relieve yourself—unless you’re cool with using the bushes.

In-race quick fix: You’re kinda SOL (pun intended).

Avoid: Take Imodium an hour before the start; limit fiber within 24 hours of the race; avoid caffeine on race day; drink fluids before and during your event.

The Problem: Incontinence

Cause: Stress applied to the bladder during exercise causes leakage (experts suggest weakened pelvic muscles could be a factor)

Presentation: Ever laugh so hard you peed a little? It’s kinda like that. Studies suggest up to 30 percent of female runners experience it.

In-race quick fix: Find a Porta Potty or, honestly, don’t worry about it. A little urine never hurt anyone.

Avoid: Doctors say pelvic-strengthening exercises can help. Most runners wear an absorbent pad, bring wet wipes, or just change clothes after the race.

The Problem: Nausea/Vomiting

Cause: Pre-race anxiety, decreased blood flow necessary for digestion during a race, and a sudden change in exertion after the race can all cause GI distress

Presentation: You feel like—or actually end up—puking.

In-race quick fix: Take it easy on the energy gels; stay adequately hydrated; and pop an antacid if you have one.

Avoid: Finding a way to avoid nausea and vomiting takes trial-and-error research—meaning, you need to find out what combo of race-day nutrition works for you.

The Problem: Excessive Snot

Cause: Unknown, but up to 40 percent of endurance athletes suffer from exercise-induced allergy symptoms

Presentation: Runny nose, sneezing, itchiness, and congestion can occur.

In-race quick fix: The “snot rocket.” Depress one nostril while blowing through the other to clear it—without using a tissue.

Avoid: Using a nasal spray that relieves your runny nose is about all you can do.

Because Colorado’s fickle terrain can mount a sneak attack.

Pounding the pavement has its advantages: A jog on an urban running path is quick and convenient. But many of Colorado’s endurance elite prefer the knee-saving qualities, challenging topographies, and distracting beauty of backcountry trails. Which is exactly what Dave Mackey was looking for on May 23, 2015, when he headed toward Boulder’s Bear Peak on an overcast 40-degree morning.

“I had planned a three-hour run,” says Mackey, a well-known and decorated trail runner sponsored by shoemaker Hoka One One, “but the outing took a bit longer than that.” After cruising up Shadow Canyon and South Boulder Peak—a 3,000-foot climb—Mackey summited Bear Peak around 9 a.m. and began picking his way down a scree-filled path on the west side of the mountain. He’d done this route on a hundred previous occasions, but this time the earth moved under his feet. “I stepped on a giant rock, and it rolled,” he says. “I tried to catch myself, but I took an out-of-control 50-foot fall.”

Although he tumbled a long way over rough terrain, Mackey says he’s certain the compound fracture of his left leg happened when the 250-pound boulder came to rest on his lower leg. As luck would have it, the two-time USA Track & Field Ultrarunner of the Year had just minutes before passed a friend on the trail; Paul Gross was still close enough to hear Mackey’s screams and was able to lift the rock off his shattered leg with the help of a tree branch. It then took several good Samaritans and the Rocky Mountain Rescue Group four hours to evacuate a bloodied Mackey from his precarious perch to Boulder Community Health.

“Before that day, the worst injury I’d had was a sprained ankle,” Mackey says. The Bear Peak accident was something altogether different: Over the subsequent six months, Mackey endured 12 surgeries, including procedures to stabilize his leg, address myriad infections, insert rods and plates, and place bone and muscle grafts. Mackey knows he’ll likely never again be 100 percent, but he hopes he can at least get back into running someday. He also knows he was lucky. “If it had been later in the afternoon or during the winter,” Mackey says, “I might not have survived. There might not have been someone on the trail to help me.”

Because the temptation to use performance-enhancing drugs is surprisingly strong.

Endurance sports require near superhuman physical feats. As such, athletes have been experimenting with all kinds of substances in an effort to improve performance since…well…forever. To wit: Early 20th-century Tour de France cyclists took strychnine (used as a pesticide today) and held ether-soaked handkerchiefs to their mouths to stay alert and dull the pain. Today, the Tour de France, the Olympic Games, and other high-profile sporting events employ drug testing in an attempt to root out would-be cheaters. But blood and urine checks on amateur and sponsored endurance athletes competing in even relatively well-known events are much less frequent. With the help of Dr. John Hill, who served as the medical director for the Leadville Race Series for seven years, we looked at a handful of medications* for which endurance athletes are finding intriguing off-label uses. —Matt Hart

Methylphenidate (Ritalin)

Prescribed use: A stimulant used to treat ADHD, narcolepsy, sleep apnea, and shift-work-associated sleep disorders.

Athletes like it because: It increases performance by heightening energy, focus, and aggression—all good things for long-duration events.

But there are downsides: It can cause fever, sore throat, headache, and vomiting. Long-term use of stimulants can lead to suboptimal sleep (and all its corresponding maladies).

Levothyroxine (Synthroid)

Prescribed use: Treating hypothyroidism, a common hormonal imbalance that causes fatigue, weakness, and weight gain (among other symptoms) and disproportionately affects women middle age or older.

Athletes like it because: It improves energy levels and battles the fatigue caused by high-intensity, high-volume training. The drug also increases metabolism, ostensibly making weight loss easier—a serious draw for endurance athletes.

But there are downsides: The meds can lead to osteoporotic fractures, heart arrhythmias, jitters, insomnia, and increased heart rate, among other side effects.

Sildenafil (Viagra)

Prescribed use: Treating erectile dysfunction.

Athletes like it because: The drug inhibits an enzyme that controls blood flow in specific parts of the body, including (but not, ahem, limited to) the pulmonary system (i.e., your lungs). Athletes competing at high elevations use the drug to mitigate the effects of high-altitude pulmonary edema, or fluid in the lungs.

But there are downsides: The main anti-performance side effect is a drop in blood pressure. Other negatives include stroke and heart attack, as well as headaches; flushing in the face, neck, or chest; and upset stomach. There are conflicting studies on the drug’s effectiveness for athletes: A Stanford University study found a 39 percent increase in time-trial performance at a high elevation, but subsequent University of Miami  research found “no clear benefits.”

Prednisone (Deltasone)

Prescribed use: Treating inflammatory and autoimmune diseases such as allergy disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, and breathing disorders. It’s also sometimes used to treat side effects plaguing cancer patients.

Athletes like it because: It provides an incredible energy boost for day-to-day training or multiday events. It also suppresses the body’s natural inflammatory processes, diminishing stiffness and pain and therefore allowing athletes to return to training more quickly.

But there are downsides: Prednisone can bring on headaches, dizziness, weight gain, and difficulty sleeping, as well as extreme mood swings or personality changes. Long-term use of the drug can lead to serious health issues, including osteoporosis, vision problems, and life-threatening infections.

Testosterone  

Prescribed use: This hormone is used to treat males with hypogonadism. It’s also commonly prescribed as treatment for age-related decline of testosterone production.

Athletes like it because: The main anabolic steroid hormone produced by your body, testosterone is the primary driver of virility: It increases muscle mass, strength, energy, motivation, and greatly improves recovery from exercise.

But there are downsides: Side effects can include enlargement of the clitoris in women and breast swelling and shrinking of the testicles in men, as well as acne.

Acetazolamide (Diamox)

Prescribed use: This carbonic anhydrase inhibitor is used to treat glaucoma, epilepsy, and acute mountain sickness.

Athletes like it because: It affects CO2 balance in the body, which increases respiration and therefore lessens the effects of racing at high elevations. It’s popular among athletes who live low but want to race high because it can prevent the headaches, nausea, and dizziness caused by acute mountain sickness.

But there are downsides: Diamox can induce a distracting tingling sensation in the fingers and toes; very rarely, it can cause electrolyte imbalances.

*All of these drugs, except for sildenafil and levothyroxine, are banned by the World Anti-Doping Agency. 

Because you might tick off your immune system.

While moderate exercise has been shown to bolster the immune system, overdoing it on the athletic front can actually decrease the body’s ability to fight everyday bugs. “The line between peak performance and overtraining-fueled sickness is almost invisible,” says Stephanie Morish, a certified holistic nutrition consultant who works with clients of Denver Sports Recovery, a drop-in center that gives both professional and everyday athletes access to state-of-the-art recovery tools. “High-performance athletes often have suppressed immune systems, making them susceptible to colds and infections.” How does too much physical exertion reduce the immune system’s prowess? People who are training for big races tend to skimp on three things: calories, sleep, and time spent off their feet. These ingredients combine to do the body a real disservice. “The body just breaks down,” Dr. John Hill says. “That’s how many high-level athletes know they’ve overtrained—they get a cold.”

Because being a competitive athlete can bring out your demons.

It’s difficult for Wendy Greene to pinpoint exactly why or when she became too focused on her body and fitness. Maybe it was at 12 years old when she first began lifting weights with her dad when they were living in northern Wyoming. Or maybe it was when she was assaulted at 19 years old. Or maybe, she says, she has been compulsive and anxious since she was born. “Genetics loads the gun sometimes,” she says. “Life pulls the trigger.”

Whatever it was, Greene, 33, says she’s always had a tendency to be at the extreme end of everything. For example, Greene didn’t just continue lifting weights to stay in shape; she began competing in bodybuilding events. And she didn’t just go to CrossFit; she became a CrossFit instructor. Her other jobs—as a wildland firefighter and now a surgical trauma nurse at Denver Health—have also fed her need for constant, high-pressure stimulus. “I’ve always had an inability to focus,” Greene says. “I like things that make me pay attention because if I stop, I have to face myself.”

Facing herself became unavoidable in 2011. Greene’s anxiety and other emerging compulsions—like obsessively counting calories, chewing food and then spitting it out, and working out to the detriment of her social life—had her drowning in what felt like a pool of depression. She went to see a therapist, who helped Greene understand she might be experiencing orthorexia (an obsession with eating only healthy foods) and compulsive exercise disorder (prioritizing exercise over everything else), both mental health issues that research suggests are more common among competitive athletes. “I wasn’t underweight,” Greene explains, “so no one knew I was struggling.” But she was. “Social media didn’t help. CrossFit stuff is all over Facebook, and I felt the pressure to maintain the appearance—the abs, the bicep veins, the superhero look.”

Greene checked herself into Denver’s Eating Recovery Center for a 40-day partial hospitalization in 2011. The program changed her life by giving her coping skills. “In addiction, everything is black or white,” she says. “I had a hard time dealing with gray.” She learned though. She took herself off Instagram. She began looking at food not as strictly good or bad. She resolved to call a friend if she was isolating herself. Today, she still does CrossFit but limits it to a few times a week. “I’m still obsessive, and working out is still a part of my life,” she says, “but I’ve discovered that there’s more to life than CrossFit.”

Because rest can become a four-letter word.

It’s no secret that those who gravitate toward endurance sports tend to be aggressively type A and atypically driven to succeed. Those personality traits are perhaps partly responsible for one-time recreational athletes morphing into elite endurance racers. But they’re also probably responsible for a lot of sports-related injuries. Sarah Bay, 36, an Aurora-born marathoner and triathlete, says she’d take the “probably” out of that sentence.

In 2003, a friend talked Bay into doing the Big Sur Marathon. The pretty, petite blonde admits she didn’t train much for that race, but she competed so well she qualified for the Boston Marathon. She was hooked. “That race started my running craze,” Bay says. “I ran waaaay too many marathons in 2004.”

In those days, Bay says, she had no idea what rest and recovery were. “For me, it was always train more, more, more,” she says. “I didn’t know taking a day off was good for my body.” The result? Catastrophic injuries. In February 2005, she sustained a stress fracture to her left heel. Eight weeks later, she started running again—too fast, too much, too soon—and got plantar fasciitis in her right foot. To battle the pain so she could continue to run, Bay got cortisone shots in her right foot—and promptly tore her plantar tendon. Throughout that summer she continued to run, despite knowing her feet were in a state of distress. When she finally got an MRI in September, the images showed absolute devastation: bone edema, soft-tissue swelling, stress fractures, and a complete rupture of the plantar fascia. Translation: Bay’s feet were wrecked.

That didn’t stop her from running a marathon in October—before she forced herself to stop for nearly two years. “It was awful,” Bay says, “and stupid.” That may be the case, but it’s not uncommon. “World-class athletes take days off,” says the University of Colorado Sports Medicine and Performance Center’s Dr. Iñigo San Millán. “In fact, world-class athletes sometimes take weeks off. These folks in Colorado, they don’t. They are skipping the recovery phase.” Recovery, according to San Millán, allows microtears in muscles and tendons to repair themselves. It allows hormones—like cortisol and testosterone and estrogen and others—to rebalance. “The body takes a breath,” San Millán says. “And that’s critically important.”

Today, Bay has fully transitioned from marathons to triathlons, and she takes days off (albeit begrudgingly). She’s also hired a coach and spends four to five hours each week at Denver Sports Recovery trying to take better care of her body. “When I started training, I had no idea how much sleep I needed or how to fuel my body appropriately,” Bay says. “I mean, I was eating Lean Cuisines and running every day. It was not a great training plan.”

Because you’re probably going to hurt yourself.

Local orthopedic surgeons Dr. Andrew Parker and Dr. Michelle Wolcott, as well as primary care sports medicine specialist Dr. John Hill, break down some of the more common ailments that limp into their offices.

CrossFitters

Anterior knee pain: usually related to stress or overuse or incorrect form when lifting

Achilles tendonitis: inflammation in the tendon caused by overuse

Rotator cuff tendonitis: caused by lifting too much weight above the head or using incorrect form when lifting

Lower back pain: usually related to strain from lifting too much weight or not correctly balancing when lifting

Runners

Anterior knee pain: sometimes attributed to weak glutes and inwardly rotated thigh bones (although the cause could be due to a variety of factors)

Plantar fasciitis: inflammation and tears in the plantar fascia near the heel caused by too much stress on the heel

Shin splints: sometimes caused by too-long strides

Stress fractures in legs, feet, and hips: often caused by low bone density, overuse, weak muscles, or doing too much too quickly

Meniscus tears: typically caused by an acute twisting or bending of the knee

Achilles tendon injuries: sometimes aggravated  by speed training, running uphill, or landing on the forefoot.

Cyclists

Acute injuries from crashes: frequently, head injuries and broken clavicles and upper extremities

Numbness in hands: nerve compression often triggered by putting too much weight on the wrists while riding

Neck and lower back pain: tightness in the trapezius muscle usually attributed to riding with a curved back

IT band syndrome: caused by friction of the connective tissue between the quad and the hamstring, which can happen when the knees are pointing too far in or out

Achilles tendonitis: inflammation in the tendon caused by overuse or because a rider’s calf muscles are too tense (sometimes remedied by moving cleat position)

Patellar tendonitis: caused by fatigued adductor muscles, which can be related to bike fit or an athlete’s unique hip rotation

Triathletes

Rotator cuff injuries: usually attributed to overuse or weak shoulder blades or back muscles

Bicep tendonitis: often caused by overuse or by hunching forward while biking

Nutritional deficiencies: usually ascribed to insufficient caloric intake for the amount of fuel burned while swimming, cycling, and running

Lower back pain: experts sometimes blame a limited range of motion in the hips or bad posture when running or cycling

Because when you said “I do” you thought your penchant for endurance sports was covered in the “in sickness and in health” section.

Max and Andrea Fulton have been together for 19 years. He’s handsome with a slightly crooked smile; she’s beautiful in the way only natural redheads can be. They’re sitting next to each other on the opposite side of the booth from me at Benny’s Restaurant and Tequila Bar in Cap Hill. They clearly love each other; their gentle teasing gives it away. But because I’ve asked them to tell me how Max’s proclivity for endurance sports affects their marriage and family, they’re not quite as sure about me.

Andrea warms up pretty quickly, though. “Max lives his life as close to death as possible,” she says with a laugh. “Unfortunately, I’m the most risk-averse person I know.” She isn’t totally joking about the 39-year-old father of her two young children. Max has completed more than 130 endurance events—marathons, triathlons, ultramarathons, road-cycling races—in the past 17 years. In summer 2015, he completed the Ironman Boulder, the Leadman series, and Run Rabbit Run 100—about 450 miles of racing total—in approximately three months. Oh, and he ran the Boston Marathon in 3:06 that year, too. When I ask him why, Max says, “Being in shape is nice, and I’m really competitive, and, well, I want to find out what my limit is. I don’t get pushed to my limit during everyday activities.”

I look at Andrea and ask if she’s ever reached her limit—with all the training and racing and resulting injuries, including stress fractures and a broken collarbone. “It’s sometimes challenging for me that Max has so many passions,” she says. “I struggle with the fact that I don’t really have that many.” I suggest it might be difficult for her to find the time for such leisure pursuits with kids and her job at the Denver Art Museum and Max’s long list of athletic addictions. “Sometimes I get resentful that he gets to take that time,” she says, explaining it was more challenging when their kids were babies than it is now. “But he’s grateful for it, which really helps. Plus, I get a lot of flower arrangements in August, which is always a brutal month [full of endurance events].”

The Fultons try to limit the potential for disagreements about training and racing when they can. It’s a savvy move considering how frequently experts like sports psychologist Doug Jowdy, Ph.D., see what’s colloquially referred to as “divorce by triathlon.” “It’s not uncommon that athletes can become more passionate about their chosen sports than about their spouses,” Jowdy says. Fortunately, that’s not the case with the Fultons—probably because they work so hard to make sure it isn’t. For example, Max gets up early—like 5 a.m. early—on weekdays to get in his training so it doesn’t interfere with the rest of the family’s day. When Max has a race out of town, the Fultons try to make it a family affair, something that can be enjoyable for Andrea and the kids as well as for Max. And when endurance event season is over, there’s a moratorium on talking about it or planning for the next season—at least for a few weeks. “Our biggest challenge with this has always been time,” Max says. “It’s our most valuable resource. Andrea does get her time, but it’s less than mine. It’s something we work on.”

Because a lot of scary medical stuff can go down during an endurance race.

Dr. John Hill, director of CU’s primary care sports medicine fellowship, has not only overseen Leadville 100 biking and running events as a medical director—he’s also experienced them as an athlete. Below, he helps us break down eight serious ways the human body can react to the stress of competition.

Hallucinations

If your blood-sugar level drops too low, your brain—which feasts on glycogen from the liver—can begin to starve. When that happens, Looney Tunes–style delusions set in: Boulders morph into giant Chipotle burritos and purple gorillas begin chasing you in the dark. “Being confused and seeing things, especially at night, happens to most long-distance endurance athletes,” Hill says.

Bonking

This is a system-wide collapse caused by depleted fuel stores. Athletes will feel weak, fatigued, and disoriented because they are low on glucose and/or glycogen, which the muscles and brain need to function. “Once someone gets to this point,” Hill says, “it’s difficult to save their race because they need nutrition but can’t eat. We can give them anti-nausea drugs and salty snacks. It doesn’t always work.”

Exercise-induced Asthma

Dust, cold temperatures, dry air, extreme exertion, and high elevation can provoke asthma symptoms like coughing, wheezing, shortness of breath, chest tightness, and excess mucous. Sometimes the symptoms
are serious enough that physical activity must
be stopped immediately.

Hyponatremia

Drinking too much fluid can cause the concentration of sodium in athletes’ blood to drop to dangerous levels. Sodium helps regulate the amount of water in and around cells; when there’s not enough sodium relative to the H20, the body’s water levels rise and cells swell. Weakness, brain herniation, seizures, and coma can result. “The medical consensus is if you trust your thirst,” Hill says, “you’ll be OK.”

Hyperthermia

During hyperthermia the body is unable to regulate its internal temperature and becomes overheated. Most people have heard the term “heat stroke” but may not know it’s a medical emergency. If the body’s temp gets as high as 105, internal organs can be damaged, and without treatment, you can die. “We sometimes have to use immersion tubs to rapidly cool these athletes,” Hill says.

High-altitude Pulmonary Edema

A condition that usually occurs above 8,000 feet in elevation, high-altitude pulmonary edema (HAPE) happens when fluid—instead of oxygen—floods the alveoli in the lungs, causing extreme breathlessness. Without medical treatment (at a lower elevation), HAPE can be fatal.

Rhabdomyolysis

When muscle tissue breaks down, which can occur when athletes overstrain their bodies, muscle fibers are released into the bloodstream. These fibers can cause renal failure—and sometimes death, particularly when an athlete takes ibuprofen, which can accelerate kidney deterioration. “Some of these disorders are hard to diagnose,” Hill says. “I mean, who feels good 70 miles into a race? My advice: Go to the medical tent if you feel bad.”

Sports-related Sudden Cardiac Death

Undiagnosed heart conditions—like coronary artery disease or hypertrophic cardiomyopathy (thick ventricles)—can be irreversibly aggravated during endurance events. With participation in endurance sports increasing over the past 15 years, sudden deaths from previously undiagnosed heart conditions have made headlines in publications from USA Today to Men’s Journal to Scientific American.

Because death is an honest-to-God possibility.

1 in 76,000 

The approximate fatality rate for athletes participating in a triathlon, according to a study released by USA Triathlon in 2012.

1 in 114,000

The approximate fatality rate for athletes participating in a marathon, according to a 2010 study focusing on 30 years’ worth of races in the United States, Britain, and the Netherlands.

4,250

The estimated number of sports-related sudden cardiac deaths in the United States each year, according to a 2011 study circulated by the American Heart Association.

At least 10 

Athletes—from long-distance mountain bikers to triathletes to ultrarunners—who have died competing (or shortly after competing) in Colorado events since 1992.

Playing With Pain

What it feels like to run the Leadville 100. —Dougald MacDonald

I first noticed the twinge in my left calf around mile 25 of the Leadville Trail 100 Run, shortly after finishing a helter-skelter scramble down the rutted dirt track called Powerline. By Twin Lakes, at mile 39.5, my steady gait had become a lopsided hobble. I told my crew—four friends and family members who were supporting my somewhat quixotic first attempt at a 100-mile race—I might have to drop out. But ultramarathons are all about not quitting, despite fatigue, nausea, blisters, and pain. Everyone goes through “rough patches,” and I thought this might just be mine. After gulping some ibuprofen, I limped out of Twin Lakes and began the long climb toward Hope Pass, the race’s high point.

I had not been a hard-core runner for long. Unlike many thousands of Coloradans, I’d never even run a marathon. Rock climbing was my sport. But the summer before my Leadville race, I took a bad fall and lost the confidence necessary for serious climbing. I felt like I needed a big but relatively safe new challenge. Running the Leadville 100, the “Race Across the Sky,” seemed to be the ticket. I gave myself one year to prepare for Leadville’s high-elevation course.

I ran my first half-marathon that October and then a 50K in early spring. In May I finished the 50-mile Collegiate Peaks Trail Run near Buena Vista at the stately pace of 13.5 minutes a mile—exactly as planned. My training was working, and I felt good about my chances of finishing within Leadville’s 30-hour cutoff in August. My wife, however, was not happy. I ran nearly every day, often for hours, and rock climbing—her favorite sport—had largely been abandoned.

Hope Pass was a bitch. On the downhill side of the 12,540-foot saddle, bolts of pain shot up my left leg with every footfall. But at Winfield, the turnaround point halfway through the race, an old friend joined me as a pacer and I got a second wind. This is what a 100-mile race is all about, I told myself. Suffering is just part of the game. Then night fell and I could no longer run at all: I lurched like Quasimodo. In the glow of my headlamp, every pebble seemed like a boulder. I had a blister the size of a silver dollar on one foot, but that was a mere annoyance compared to my throbbing calf. Still, I kept going.

The sun rose at May Queen, the race’s final aid station. It was only 13.5 miles to the finish, and I’d already traveled more than 60 miles since my injury—what was another half-marathon? But my strained calf muscle had swollen to twice its normal size and my will was broken. I begged an official to cut off my wristband, ending my bid at 86.5 miles.

Regret kicked in as soon as I could walk comfortably again, about a week later. If I’d started down that final leg to the finish, could I have made it? I vowed to return to Leadville the following August to find out. However, once I started training again, I discovered a nagging ache in both hips. I quit ultrarunning for good. I had been willing to suffer to finish at Leadville, but I wasn’t going to risk premature hip replacements to go back. I, unlike so many other endurance athletes, couldn’t reconcile the notion that being competitive meant always being in pain. Suddenly, rock climbing was looking like a whole lot of fun again.

Fighting The Fog

What it feels like to have overtraining syndrome. —MH

The buzzing woke me—again—and I reached over to silence the alarm clock. I’d been hitting “snooze” every 20 minutes for three hours. Sleepiness wouldn’t loosen its grip, and I was grumpy that I still felt the dread of getting up caused by this deep fatigue. It had been two months since my last ultra-distance race, and I hadn’t managed any meaningful training since. My 36-year-old body just wouldn’t respond. Downstairs, I poured a second mug of coffee and wondered how many French presses it would take to kill me. I decided I didn’t care.

I’d been swimming in this milieu of exhaustion since returning home after my first attempt at southern Colorado’s Hardrock 100 Mile Endurance Run—arguably the most challenging, and definitely the highest in elevation, 100-mile ultramarathon race in the country. In preparation for the midsummer race, I had competed in ski-mountaineering events and finished my off-season training with 100,000 vertical feet of uphill trudging in one week. Instead of feeling primed for the season, I started spring training trying to regain a zest for life. Not yet realizing what I needed was more rest, not more exercise, I began the athlete’s version of cocaine and Valium—coffee and melatonin—to get in the 100- to 120-mile weeks required for a good showing at Hardrock.

Not surprisingly, my Keith Richards–style workout plan resulted in a disappointing go at the 100-mile loop through Silverton, Lake City, Ouray, and Telluride. I was crushed. I resolved to get right back after it. I would train better and harder and, in doing so, keep my dream of being a professional athlete alive. I had left a six-figure tech job to live the meager but adventurous life of an ultrarunner, using paltry stipends from a few sponsors to get by. I quickly learned that being a professional endurance athlete is not exactly like being a pro baseball player; however, I felt indebted to my benefactors nonetheless. I had to perform, win races, be sponsor-able. And to do that, I had to get the fuck out of bed.

There is a pervasive training philosophy in ultra-distance sports that more is always better: more miles, more intensity, more time on foot. And it works—to a point. But when the stress-recovery balance is off for long periods of time, you go backward physiologically and your performance suffers. Life and running post-Hardrock wasn’t good. I would wake up in cold sweats. My sex drive became a distant memory. When I did manage to hit the trail, my muscles would ache for weeks. It wasn’t until my mother sent her 100th text telling me to “Answer the phone!” that I realized I’d been avoiding friends and family because I was depressed—and ultimately suffering from overtraining syndrome (OTS).

OTS is a sneaky ailment. Today, I can see that it took advantage of what made me a good endurance athlete in the first place: motivation, love of training, and ambition. These attributes aided in my demise by making it difficult for me to make a sober decision about whether I needed to frequent the couch or the trail.

When I finally realized my body was cooked, I spent my days in bed—tired, sad, embarrassed, and feeling like a failure. After a couple of weeks, my hormone-producing adrenal glands rebounded; I felt better, but it was months before I felt any enthusiasm about running, and my performances were (are?) still subpar. Now, at 40 years old, it’s impossible to ascertain if my inability to excel is age-related degradation or the result of unhealthy training throughout my 30s. As I sit here today, sipping maté tea—yes, I had to give up the devil coffee bean—I wonder what my athletic career could have looked like. And I chew on the notion that OTS may have killed my dream.

What Is OTS?

While researchers have yet to reach a consensus on a mechanism, biomarkers, or treatment (beyond rest) for overtraining syndrome, most experts agree the condition occurs when an athlete trains beyond the body’s ability to recover. In short: Each athlete has a threshold for physiological stress, and when the load exceeds this limit for too long, it can cause a cascade of reactions that can result in hormonal, nutritional, emotional, muscular, and neurological imbalances. Essentially, the body melts down and stops responding. —MH

—Photography by Tom Speruto unless noted otherwise