Sunday, March 29, 2009

Running: Physiologically Speaking
The Marathon and Hormones Edition

At times during the day, when I’m busy attending to patient affairs and practicing clinical medicine, I sometimes feel as if I’m Clark Kent, because hidden behind my long white coat and the stethoscope that adorns my shoulders like a Christmas ornament is a speed-crazed super runner that is unknown to anyone within the confines of the hospital. This suits me just fine because contrary to what someone might think, when I’m at work, I generally do not like to think about running because not only does it distract attention away from the patient at hand, but also because no one could or would understand my passion for it anyway. So as a general rule, running and clinical medicine don’t mix, at least for me.

But like they teach all the students in medical school, patients don’t read textbooks and there are exceptions to every rule. True to form, every once in a while, especially when I’m at the peak of marathon training, some running thoughts inexplicably force their way into my head even as I’m seeing patients and dealing with issues that have nothing to do with running. Below is a sampling of the random thoughts that flowed through my head this week as I was working. Some of it will be beneficial to you all, some not very much so. Read ‘em at your own risk.

Weighing In
Some kid came in early last week for evaluation of poor weight gain. He was a scrawny looking prebuscent kid who’s only abnormality I found after performing all the necessary tests, was having O.C.D. parents. As I was explaining to both mom and dad that their boy didn’t have malaria or parasites living within him, the boy said something that completely surprised me. “I’m okay. I’m not weak, or sick, or anything. I work out everyday. I can probably bench-press the doctor if I wanted to.” It would have been funny if it wasn’t so blatantly obvious. After some mild chuckling and further assurance that everything was indeed fine, I shooed the whole family out of my office and went to weigh myself. Sure enough, another 3 pounds lost since the beginning of the month. All together that makes 10 since the beginning of January! No wonder the kid picked up on it. I was turning into a stick figure faster than Haile Gebrselassie running a marathon!

Okay, I know for most of the population, this would be a cause for celebration, but for me, this is anything but since I’m already underweight for my size as it is. Unlike most everyone who have problems losing weight, I find it extremely difficult to keep the pounds that I have. Marathon training I’ve found is the worse for me since I tend to eat less even as I’m running more. Friends and patients have asked me how I lose weight so easily and I reply by asking them how they gain weight so easily (No I don't, but I so want to!). Last month, I was in contact with a nutritionist in my department who advocated many small meals for me throughout the day instead of the three large ones I’ve habitually consumed. It worked for a while, until I couldn’t find time anymore to have my seven meals and so now, instead of the three big meals that I started out with, I’m having only about three small snacks a day. So not good.

I’m hoping to get back to eating more regularly and eating healthy and gaining back my 10 pounds after the marathon. Ideally I want to gain 20, but that’s as likely as me running a 2:30 marathon so yeah, maybe in the next lifetime. I’m saying after the marathon too not because I think I want to keep my weight down to maintain top efficiency for the big race (as some friends have suggested), but rather it is because I think it’ll take me not running for an extended period to gain the weight back. It is not funny how many times I’ve wished that some of the obese kids I see in clinic everyday could just lend me an extra twenty pounds or so…

A Cure For Childhood Obesity
Speaking of obesity, Mr. Petes at Runner Write wrote an interesting article last week on how to solve the traffic problems in big cities like New York. He proposes the elimination of roads for cars and the construction of running routes to encourage people to run to work everyday. Not only so, but instead of parking lots, there’d be showers and lockers for each employee to change and clean up after their run.

I thought this was a brilliant idea, but thought it could be further extended down to children commuting to school. Instead of school buses picking up kids everyday, we can have coaches lead walking and running groups to school every morning. Given the lack of physical education and playground time in schools these days (most of the kids I see on average report only 2 gym sessions in school per week), they need all the exercise they can get. Traveling to school on one’s two feet (like they do in other parts of the world) would be a pivotal start. I’m sure the rates of childhood obesity would plummet if we could somehow implement that strategy.

Menstruation and Marathons
I don’t know if many of you know, but as part of my job description, I help young women deal with their menstrual problems on a daily basis. Whether it is a problem of frequency, irregularity or pain, I’m often the one that’s called upon to perform the detective work necessary to determine if there’s a hormonal basis for the abnormality. Most of the time, within the first fifteen minutes of the interview, I can tell that the issue is psychological or social and not hormonal. Yet I still find myself listening to the stories, hoping to nail down the root cause of the concern. In a perverse sort of way, I find the menstrual cycle very intellectually stimulating, similar in many respects to a marathon training cycle. The interplay of the rise and fall of different hormones at different times within the menstrual cycle parallels the synchronous nature in which different types of runs complement each other in a marathon training program. Not only so, but just as emotional stress can create havoc in a woman’s inherent cycle, so too can physical or psychological stress interfere with the success of marathon training.

Exercise May Be Dangerous During Pregnancy
I don’t want people to freak out over this because it is only one paper, and it’s from Europe no less. (Apologies to Xenia and whoever reads this from across the pond) According to this study (pages 12-13 here), exercise, even as little as 30 minutes per day, can dramatically increase the risk of pre-eclampsia during pregnancy. Really? Now I’ve already spoken to several colleagues about this, and they seem to think that this study only applies to a selective population that is already at high risk but still I am at least a little worried. More confirmatory studies are on the way.

I guess if this were proven true, it’d be just one more excuse to be lazy...considering you are pregnant of course. So from now on, if I hear that a female runner all of a sudden loses motivation and is sitting on the couch all day eating Doritos, rumors are going to start to fly. Just sayin’.

Hormone Doctor or Performance Enhancement Guru
Almost on a weekly basis, one of my patients, or their parents will ask if stopping some medication that I’ve prescribed for them previously will interfere with their athletic performance. Most of the time, I’m somewhat perplexed by the question because enhancing performance on the court or the ball field or track was never discussed as a potential positive side effect when starting the medication in the first place. And then it hit me late last week, as I was working at the office while ordering the Boston Marathon jacket online. Because I’m a hormone doctor, practically every medication I prescribe can be considered performance-enhancing. Seriously. Almost every single one. A partial list of common medications I write for include testosterone, estrogen, androstenedione, insulin, growth hormone, and IGF-1, and every single one has been banned by the I.O.C. and M.L.B. I wrote a tongue-in-cheek essay on this when the Mitchell report came out a couple years back, but I seriously hadn’t realize how prevalent my involvement in this arena was, or could be. So in essence I could be called a performance enhancing guru and be responsible for a whole generation of dopers out there. This is somewhat of a frightening proposition.

On the flip side, I wonder if people are getting suspicious of me running such great times recently. After all, I might not be so “clean” either. As I’m writing this, I’m wondering how long it would take for the Boston Marathon race officials to e-mail or call and ask me for a urine sample. If they don’t, and I end up running a sub-3 in three weeks, I wonder if I can voluntarily drop trough right at the finish line and ask the race officials to take my pee and run some tests. I’m sure they’d appreciate the honesty.

That’s all from me today folks. Can you tell I’ve got marathon fever up in the head? Hope you all are enjoying your weekend. I’ll be back later to recap the week of marathon training, which will the last for me before the taper. Wahoo!


Running and living said...

Very interesting post. I have to comment on the pregnancy and exercise study. I ran throughout my pregnancy, 6 miles, 5-6 times a week, 9 and later 10 min/miles or so. I did a great deal of research on pros and cons for exercise while pregnant, and came accross James Caplan's research (Case Western U). He has published a ton and has a book out as well, that summarizes his research findings. Lots of good stuff that has proven correct in my case: strong muscular but thin babies, easy deliveries (I was in labor for 6 hours and pushed for 15 min only), easy pregnancies (mine was super easy and actually my already low blood pressured dropped even more), easily soothed babies (everyone said my son was so easy to handle and so happy all the time), higher IQs, reaching musculoskeletal milestones earier (mine turned at 2 weeks and I had to show this to the pediatrician bc she did not belive it), etc. V interesting research, all controlled for potential confounding variables (not like my individual case study).

carpeviam said...

Great post, Doc! Once you are this close to a marathon, it's hard to NOT think about it during work hours.

I giggled at your bit: Friends and patients have asked me how I lose weight so easily and I reply by asking them how they gain weight so easily (No I don't, but I so want to!). Comedy gold!

Just finished my last long run today. Bittersweet.

Good luck in our last 3 weeks! ;)

Michelle said...

Great post Lam!

Very interesting read!!

The Happy Runner said...

Very interesting stuff here!

On the pregnancy and exercising point, I exercised for about 30-60 minutes, about 6 days a week throughout my pregnancy. I didn't run but I did walk, practice yoga, and do some low-impact aerobics and strength training. I felt great and had a very easy pregnancy. Like Running and living, I had a very easy pregnancy and after a manageable labor, only pushed for 20 minutes.

Exercise really worked well for me! My only regret is not running throughout my pregnancy -- walking was fine but running would have been better!

Jamie said...

Very cool post Lam! With only 3 short weeks left to Boston marathon fever is is full force. It's hard not to relate everything back to the big race!

J said...

Very informative post! Your doctor job sounds really cool!

Kristina said...

Fascinating post, especially as someone who did her dissertation on the social/psychological experiences of girls during early puberty.
Thanks also for the bit on pre-eclampsia, as I was one who exercised a lot throughout my pregnancy and was shocked to develop pre-eclampsia at 39 weeks.

lindsay said...

very interesting and humorous post. i'm going to have to watch my laziness and piggy eating now! ;)

i love the run-to-work/-school ideas. i bike to work in the summer/early fall when daylight works in my favor, but i'd love to be able to knock out my daily run too. plus i think the majority of america, young or old, could afford a few minutes on their feet.

your training is even more impressive now that you reveal you hardly eat! try to squeeze something down - protein shake maybe? i know it's hard when work is busy all day, but i know you don't want to be setback by a slacking nutrition. good luck figuring out a healthy balance to get all your nutrients.

Cowboy Hazel said...

That's funny about the weight loss. I certainly don't have that problem. In fact, I find it remarkable that I can run 40-50 miles a week and still gain weight. True, I eat a lot, but it's almost all healthy foods...

And the idea of having people run to work/school in lieu of driving is brilliant. I absolutely love when there's an opportunity for me to literally "run" errands. I feel so efficient. Imagine being able to do that everyday...

Susan said...

Lots to think about in this post! What a different world we would live in if people walked/ran/rode their bike to school or work every day. I studied in Rome one summer, and it was much more common for people to transportation other than their cars. Evening entertainment usually involved a walk around the city! It was no wonder the Romans were thin, not only due to the exercise, but also a lack of presence of fast food...very few McDonald's or Burger Kings around Rome.

Enjoy your taper...hope the madness doesn't set in too quickly!

Marci said...

Very interesting post Doc! I agree about the run to work shower thing. I wish I could shower at my work (we do have one shower, but its in the PE staff room, and not easily assessible. I have often wondered about the menstrual cycle and performance. I swear they are linked. I know this is antidocal, but I swear I run better at certain times, and other female runners I have talked to about this agree.
thanks for sharing your knowledge!

Andrew is getting fit said...

I'd love to run in to work each day. I probably could if I worked harder at it!

bill carter said...


I love this post as it is something I can totally understand. I will find myself in the middle of an eye exam thinking about my next run or last run or Boston or .... Also, we have doctor profiles for patients and mine says that I am a runner so often patients will talk to me about running and a 25 minute eye exam can turn into an hour long encounter.

I had to laugh about the performance enhancers because I have to admit that I am a little suspicious of how incredibly FAST you have gotten! Just kidding...

You are going to have a great Boston.

The Laminator said...

Thanks everyone for your positive comments. Honestly, it is just a tiny bit of the craziness that goes on in my head. You all have no idea...

But, if there's any running-related physiology questions or better yet, hormone related running questions...or maybe just hormone questions in general, send them my way and I'll do a little research and dedicate a future post answering them.

Spike said...

although I doubt your legal prescription of hormones is going to result in a generation of dopers, I can appreciate the irony in seeing unexpected athletic benefits giving a child/teenager a reason to manipulate facts they report to you in order to protect that advantage. What really concerns me are the type of one-off steroids they sell legally at almost every mall with a GNC or similar store. These are one molecule away from being illegal. They produce the same results and all kinds of unknown side-effects.

I believe you are in full taper mode, so enjoy as you get closer to Boston!

X-Country2 said...

All interesting thoughts.

I've been talking to my OB quite a bit about babies and marathon running, and there's a lot involved.

Xenia said...

Man, I wished I knew a doc like you when I was in HS and college and had the most erratic and painful periods of my life. Thank god that seems to have sorted itself out now or I'd be completely mental. I know, TMI, but you kinda asked for it. ;)

And seriously, if you ever want extra weight, I've got plenty I can loan you. My goal right now is to lose weight while keeping my energy levels high enough for running. Not an easy balance for me, a girl who loves her food.

aron said...

great post lam and all very interesting stuff!!! i love reading all the comments too, especially from the moms who exercised. someday when i am there i hope i am able to run/exercise through pregnancy! i hope that article is proved wrong :)

love the idea on walking to school too.

carpeviam said...

IT CAME! The BOSTON packet came! You didn't tell me that leprechauns would pop out of the envelope like confetti! What a surprise!

PS-Nice to chat on the podcast last night.

sRod said...

Thanks for all the medical knowledge! Lots of interesting thought starters.

Run For Life said...

I lose appetite when I'm in the middle/end stage of training, too. Try drinking your calories (smoothies, 100% juices, protein shakes, etc.) Or small changes in what you do eat like adding nuts and dried fruits and if you drink milk or eat cheese use the higher percentage ones.

Love the run to work idea...if only this would actually be implemented.

Your menstruation analogy had me laughing. Fortunately I have no hormonal questions right now but we all know who to ask if we do!

So what happens if you get to the finish line and are too dehydrated to give a sample to the officials? J/k

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