“Well, that doesn’t sound very healthy,” my mother opined when I told her about my weekend. It had been my first time as a pacer1 and when my runner and I first met, she was 50 miles into her first 100-mile attempt. I wanted to tell my mom all about it when I woke up the “next” morning (11:30 am, after a couple hours of sleep).
And “well,” my mother had said in response, “that doesn’t sound very healthy.” I did not want to listen to her… but was she right? I wasn’t sure I could just brush her off. My mother has been a serious, 7-days-a-week endurance athlete for 4 decades. She’s no dabbler, and she’s no weekend warrior.
She also reminded me of a comment my father, once the #1 Ironman in the world in his age group, had when he saw me reading Ultramarathon Man: “I would call what he does impressive. I would not call it healthy.”
What did Mom and Dad, two highly decorated (certainly much more so than I) endurance athletes, mean by “healthy”? Does ultrarunning, defined as training and competing in running races longer than a marathon, fit in a lifestyle that maximizes one’s lifespan and, more importantly, one’s healthspan: the time period in our life during which we are free from the pain, disability, disease, and malaise of old age?
The answer to this question will not reveal itself to me definitively in the short-term, although the effects of running all night made themselves known to me that following week of my life. I forgot things at the grocery store, fell behind in school, and, to my wife’s consternation I’m sure, became markedly impaired in my ability to filter signal out of emotional noise. I can trace all these effects back to the sleepless night I spent on the trail, and this list does not even include possible invisible symptoms like temporarily elevated blood glucose and inhibited insulin response. I could not master myself physically or emotionally until I caught back up on sleep, which took several days.
What about long term effects of running so much? Ultrarunning, inconveniently, is terribly and unnaturally hard on your joints. It’s true that human beings are quite adapted to long journeys over land (we walked, after all, from Africa to the tip of South America) but not at the typical competitive pace of 4, 5, or 6 miles per hour. With that speed comes pounding impacts, 90-180 of them every single minute, that evolution did not prepare us for.
Women are uniquely prone to musculoskeletal injury: although we are not that much lighter than men, our muscles are disproportionately smaller, and their attachment points at ligaments are disproportionately smaller in cross-sectional area. If that weren’t enough, they’re also much stretchier and more prone to breakage, thanks to estrogen’s efforts to prepare us to survive childbirth. This is why far more women than men get knee replacements.
Our bones are also much less massive than men’s bones, even when adolescent eating disorders, which affect girls disproportionately, haven’t permanently robbed them of mineral density. Women suffer more osteoporosis because even a modest amount of bone loss will hit a smaller skeleton harder.
The specter of distal disability stalks women tirelessly, frequently overtaking us in middle and old age. It often strikes in the form of a fall, which imprisons the woman in her bed and precipitates a slow, painful downslide to the grave.
Just as I am not doing this for the health of my joints, so also am I not doing this for heart health: 150 minutes of “cardio” per week is all that is recommended by the American Heart Association. And it’s difficult to imagine much risk of musculoskeletal injury involved in a lifestyle of, say, 30-minute bike rides Monday through Friday.
I could possibly mitigate some of the orthopedic risks with a strict regimen of strength and stability training, and this is certainly worth trying. But why take these risks? Why run further than I “have” to? What am I getting in the tradeoff, that maybe Mom and Dad can’t see, that no doctor could measure on an EKG or a blood panel?
I saw a man’s gravestone in the cemetery near my house recently, adjoined side-by-side with his wife’s, which bore her name and a chiseled image of a pair of praying hands. His gravestone, meanwhile, depicted an old-fashioned model train. While I do not believe in spirits, that was the friendliest I have ever felt with a dead man, the kind who had loved his little model trains so much he wanted one on his final resting place. Perhaps there will be a pair of stone running shoes perched atop mine.
When I was twelve, I started running to get out of my conflict-ridden house and out of my anxious head. I ran to escape my fears and worries about becoming a woman, especially about becoming a lesbian. I ran so I could go somewhere else, anywhere I chose, without adults, without anyone else at all… Alone and Free.
How many troubled young women stop taking care of themselves and go astray around that age? But twelve-year-old CFF knew that if she wasn’t okay, then she wouldn’t be able to run, and then she’d have to stay home, so she had to make sure she was okay.
Every time I run, a part of me is still twelve, and a part of me is still fourteen, and sixteen, and nineteen, deep body memories, the parts of me forever young. My young selves feel closest to me in the midst of the furthest distances.
Because I care about ultrarunning, I care about myself. I care about how much sleep I get, enough to decline a third beer on a Saturday night. I care about what I eat, because everything I eat has to be carried with me on the next run. I care about drinking water, enough to get up, about once an hour, from my bench in the lab where I work, and make the long walk down to the mailroom where I keep my water, because water is not allowed in the lab. These little steps are true self-love: they make sure I have enough energy to do the things I love to do.
But self-love is only part of the picture. Dr. Peter Attia, in his book Outlive: The Science and Art of Longevity, closes his book on living longer, which contains many technical terms and acronyms like APOB, LPa, IAP, VO2 max, and Zone 2, with an unexpected and poignant meditation on the threats he has faced to his emotional health, and the often drastic steps he has had to take to protect himself (sometimes from himself). He distinguishes between “resume virtues” and “eulogy virtues” and believes that the only reason any of us should seek to “outlive” is to maximize time spent fulfilling our life’s purpose, which must involve serving, not only self, but others.
Being useful to others is as foundational to emotional health as taking good care of oneself, and I glimpsed this truth last weekend as a pacer. I have never felt valuable, indeed indispensable to someone else at any other type of race I have done, and there have been many.
By the time my runner met me last Saturday night, she had been through many months of rehab, during which she had been told by several doctors that she would never run again. A recent traumatic brain injury had affected her balance and forced her to run in minimal trainers, not much more than house slippers, over the jagged rocks that littered the multiuse trail. “If I can’t feel the ground with my feet,” she told me as she changed her socks at the main aid station, “I fall.” Also, “I normally don’t need a pacer, but today is not going well.” After running continuously since early that morning, her feet looked like bars of soap left sitting in a puddle, with thick, white, soft pieces sloughing off. I kept it professional (“They really don’t look that bad. I have seen much worse!”) and set about doing what I could for her. When she was all taped up, we set off for the back half of the race, me on my fresh feet, her on her soap feet. I said a silent Hail Mary for us as the last of the light died out of the sky.
She allayed my initial anxieties immediately. She seemed to know exactly which hills to walk up and where she could safely run, and she needed only the gentlest prodding to increase her electrolyte intake and bring herself back into balance (If you are peeing very often during a race, as she was, even though you’re not really drinking much, as she was not, you may just need salt.) She was witty and bantering and fun to run with, offering to lend her sleepy fellow runners her chronic insomnia in exchange for their feet. She thanked me over and over for seeing her through the long night. She asked how I was doing just as often as I inquired into her condition, and I’d always say “Don’t you worry about me! Your hands are full taking care of yourself.”
As the night wore on and her pace dropped along with the temperature, which, here on the east coast of the US, always plunges near dawn, she and I came to understand that she would not accomplish her 100-mile dream on this particular day. When she finally made the call, it was 5:30 in the morning, and she had run 75 miles without stopping for more than a few minutes at a time. That’s quite a lot of ground to cover for a woman whose doctors seemed to have given her up as a loss. She said that she could never have gone that far without me, which made me feel proud to have played a small part in her journey back to life.
None of this is taken into account during a typical analysis of whether a given activity or food is “healthy” or not. I believe that the reason health advice seems to vacillate from year to year, and why none of it seems particularly convincing to many of us, is because it ignores so many dimensions of the human experience in its dogged pursuit of the one-size-fits all approach. Dr. Attia calls this “Medicine 2.0,” to distinguish it from the Galenic “Medicine 1.0” and his proposed “Medicine 3.0,” which seeks to prevent the chronic diseases of aging, to tailor treatment plans to the individual, and to leave no aspect of health unexamined.
So, the right question may not be “is ultrarunning healthy for you?” but rather, “what does good health look like for you?” Because beyond a few basics that seem to hold true for everyone (don’t smoke, don’t be obese, and don’t get diabetes) what’s true for you is not going to be true for your neighbor. My wife, chronically disabled and tolerant of moderate exercise, would be miserable as an ultrarunner, and misery is utterly incompatible with health. My mother has recently taken up a 5-day-a-week Crossfit habit (on top of her usual triathlon training calendar) in her war against old-age frailty, and she is stronger than she was 15 years ago. My sister balances her daily run with chasing after her 3-year-old, who may become an ultrarunner himself based on what I’ve seen of him.
I never asked my runner to explain to me why she would want to try to run 100 miles in the wake of a disabling and traumatic accident. I certainly never asked her if she considered this part of her road to recovery to be “healthy.” Her story explains itself to me, because she and I are part of the ultrarunning family, and this is what we do.
“Is (X) good for you?”, then, may be a question only you, and your common sense, and your own experience, can answer, and I wish it were not that way and I wish we could trust doctors and I wish Someone were watching over us to ensure we don’t make any truly dangerous choices. But wishing something does not make it so, and we all must, in the end, take personal responsibility for our health. This is the blessing, and the curse, of being human.
In normal running, a pacer is a highly trained, elite runner who assists another elite runner in a record-breaking attempt by setting a goal pace for the first portion of the event. For example, a woman trying to break the mile world record would probably enlist the help of a pacer to run the first half-mile with her. This pacer would be assigned a time to hit by the coach or the event official. Maybe it would be 2:00, 2:05, or 1:58, but whatever it is, when that half-mile is up, the pacer is finished, and if the distance has been covered in the assigned time, her mission has been a success.
In ultrarunning, a pacer is more like a guide dog: we trot or hike with our runner, whom we may or may not know, usually in the dark, usually after the runner has already covered 50 miles or more. At a minimum, we must keep the runner on the course and take point in the event of a medical emergency. The best pacers make sure their runner keeps eating and drinking, feeds them continuous time and distance updates, and tends to their physical and emotional needs of the moment. Whether it’s encouragement, tough love, or a distraction from the pain, anything the runner needs, a good pacer gives it to them.