Endurance Athletes and Health

When I was handed a copy of my ECG test there was a warning at the top of the page “ ** abnormal rhythm ECG **”.  That had me worried. I took it home and gave it to my wife—who was a cardiac rehabilitation nurse her previous life—and she laughed at me. Yes, it was abnormal … because my resting pulse is 45 beats/minute. The machines don’t tell the difference between someone who is really fit and in the process of having heart failure.

14-06-25 ECG Test

Followers of this blog know that I write a lot about racing, training and equipment. Today’s post is on an even more important issue: health. While training makes you healthy, it can also have a detrimental  impact as well. I’ve been on a journey lately which has been informative and reassuring. It is one that most endurance athletes should consider also taking.

My Starting Point: Youtube

I came across a viral TED Talk presentation that Dr. James O’Keefe did entitled “Run for your life! At a comfortable pace and not too far”.  It is a very long video and incredibly thought provoking but the key message is that if you want to have a healthy heart, then you should not exercise too much or too hard.


This video elicited a lot of discussion. Here’s a sample of it from Runner’s World Magazine. (By the way, if you don’t already you should follow Alex Hutchinson who regularly writes on the latest findings in training).

Former World Long Distance triathlon champion Torbjorn Sinballe—who had to retire while quite young due to heart issues—wrote a thought provoking article on heart risks for athletes. In this he writes:

My story is not unusual, at least among top endurance athletes. Other professional triathletes have gone through similar or worse scenarios. The most prominent were Greg Welch and Emma Carney, both of whom ended their careers in the early 2000s due to a dangerous arrhythmia called ventricular tachycardia. Welch went through an incredible nine heart surgeries to stabilize his condition, but lives and blesses the sport with his ever-positive spirit to this day. Chris Legh discovered a hole in his heart in 2003, but still competes at age 41 and this year came a mind-blowing fifth at the stacked Ironman Melbourne. And finally you may recall that two years ago two-time Ironman world champion Normann Stadler was rushed through valve repair and aortic replacement surgery because of an aortic diameter of 70 millimeters (nearly twice the norm) and a big leak at his valve. He has a similar condition to what I have, but did not discover it in time. In addition, hundreds if not thousands of age groupers have lived through similar conditions.

I will add our local World Champion at Adventure Racing Nathan Fa’avae to the above list. It was announced just this week he needs surgery for ‘heart flutter’.

Checking out the Heart

While James O’Keefe highlights the issue of ‘Phidipiddes Disease’, he actually does not give any advice on what to do about it, besides back off on your training. The more I looked into it the more I found dissenting views. But with the prospect of a 3,200 km bike race taking me through Eastern Europe this summer, Lis and I decided to see a local cardiac specialist and get some tests done.

At our first meeting it was very interesting to see the dynamics between the doctor and Lis. The two of them had quite differing views of what causes coronary artery disease. He was in favour of what he called “evidenced based medicine”, aka cholesterol—suggesting that at my age I should be considering going on statins to lower cholesterol—while Lis believes from her research that the larger issue is inflammation and that cholesterol is vitally important for bodily functions. I just sat there and listened. One thing that came through was that the doctor was not keen on ‘older’ endurance athletes like me continuing our efforts, likening us to aging cars which unless you back off will wear out.

Apparently the normal cardiac stress test would be a total waste of time for me given my fitness. This consists of nine minutes on a treadmill and I would hardly have a sweat at the pace they used. So it was decided to get an MRI done which would show any structural damage to the system.

The doctor who did the MRI was the wife of the cardiac doctor (she was training for a half marathon!) and knew me as ‘the guy sent in by his wife’. Only partially correct, but Lis does take good care of me! We did the test and the results came back clear. My heart was normal, with no enlargement or other problems. Great news! The cardiac doctor told me that he had recently been at a conference and the subject of Phidippides disease was all the talk. Probably because there are more and more cardiac doctors hitting middle age who enjoy endurance sports.

So the news was all is good with my heart. At least that is ready to race.

The ‘Free’ Diet

Recently, Ben Greenfield has been running a series of lectures on endurance athletes and the thyroid (‘How to destroy your thyroid’). Lis followed the program with great interest and learned how extreme exercise affects the thyroid. She has also been looking at the impact of endurance sports on the immune system, inflammation, etc. One of the key considerations is that when we train/race our body becomes acidic and we need to try and have as alkaline a diet as possible (to help with this we have a water filter which also alkalizes the water).

Lis’ research led to her recommending that I adopt what I call the ‘Free Diet’. I call it the ‘Free Diet’ because it is a diet which is:

  • Meat free (i.e. vegetarian)
  • Dairy free (i.e. vegan)
  • Soy free
  • Gluten free
  • Sugar free
  • Alcohol free (easy – I quite drinking alcohol in 1985)

Yes, the diet is Spartan (to say the least!)—and almost impossible to follow when I’m travelling for work—but intellectually I know that it is best for my health so we do our best to follow it while at home. Means a lot more work for poor Lis who is the chef.  What has surprized me is the impact it has had on my asthma. Some background …

After working for five years in China I developed very bad asthma. It got to the stage in 2009/10 that I basically had continuous chest infections. It was as if I was a lifetime smoker. That is one of the reasons why I ended up working in the Pacific Islands for the World Bank: in 2010 the doctors basically told me that for at least two years I was not permitted to travel to China or major cities like Bangkok, Jakarta or Manila.

As would be expected, my asthma and chest infections affected my training and performance. I vividly recall a track session in Sydney when I had to stop early due to the very nasty stuff coming out of my lungs. What a drag.

With Lis’ advice I went vegan (I was already vegetarian) and this made a good improvement. Over time I got on top of the chest infections, but still needed to use my abuterol inhaler for competing, as well as heavy training—especially on cold days. Of course it didn’t always work, as evidenced by my asthma attack on Day One of the 2011 Tour Divide which led me to withdraw.

What has really surprised me is that the ‘free diet’ has had such a great impact on my asthma. I am able to train hard in cold conditions and have not needed to use my inhaler. In fact last weekend was the first time I needed it in two months—it was 3 degrees C and I was towards the top of Spooner Range breathing very hard. I felt that I could in fact have got away with not using it, but decided that it was better to be safe than sorry.


It’s been an interesting (and expensive) journey. I have taken comfort from the fact that my test results indicate that my heart is up to the challenges I’m putting on it, although as the cardiac doctor says that I am 54 so there will come a point in time when I need to back off. I do think that there is some merit in this so I’ll be doing less Sufferfest videos (Lis wishes I’d bin them), and much more endurance level heart training. It’s prudent for all of us on the wrong side of 50 to get our hearts checked out so we don’t find ourselves with Phidippides disease, or dropping dead all of a sudden while training or in a race.

While the ‘free diet’ is tough, I can feel that it’s having a positive impact on my asthma, and from what Lis has learned it’s also really good for my thyroid and overall health. In the end, I want to stay active for as long as I can and if that means forgoing things like ice cream (most of the time!), it’s a small price to pay. After all, aren’t Ironman triathletes and other endurance sport aficionados the ultimate in delayed gratification? We train for ages for a one days race.

So hopefully the engine will get me through the upcoming challenges, and I will try and do my best to maintain it at optimum level for more years of racing.

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