Garnet Fraser is a doctor. He's also a long-distance runner who successfully completed the Canadian Death Race ultra-marathon in 2011.
So, if anybody qualifies as an expert when it comes to the potential health risks of ultra-marathoning, it's Fraser. From his professional perspective, there are indeed concerns but, in general terms, they can be minimized by proper training beforehand and by getting the right fuel during a race.
Fraser said a current hot-button topic in the medical community regarding marathoning and ultra-marathoning is the issue of cardiac stress.
On that subject, there is no definitive answer whether or not long-distance running is bad for the heart.
"There's a lot of controversy about it," said the 41-year-old Fraser, who operates a family practice in Prince George. "Different investigators did different studies and they found some changes in heart ultrasounds that were done immediately after people had done long-distance runs -- mainly marathons -- as compared to two weeks before they did the long runs, where the chambers of their heart didn't contract the same way. But, as I've looked at it -- and I haven't reviewed it in great detail -- the gist of it seems to be that at two weeks' [post-marathon] everything was sort of back to normal.
"And they did similar studies with troponins, which is a chemical you can measure in the bloodstream, and again it seems to go up immediately after, which supposedly indicates some sort of damage to the heart muscle but then by two weeks or a week [afterward] it's back to normal again."
Fraser said there's much debate about what troponin levels mean in an exercise setting.
"Normally that blood test is done after someone might have had a heart attack," he said. "If the levels go up significantly, that helps us to diagnose a heart attack, which is a part of the heart muscle that's died. So people are just sort of extrapolating from that. They're using it as a marker for damage to the heart muscle but it only goes up for a little while and then it comes back down to normal. So some people look at that and they say, 'Hey, this is bad for you, you're injuring the heart when you're doing these long races, especially if you're older and if you haven't trained fully,' and other people say, 'It doesn't mean anything. It's just a blood test of an enzyme and you'd expect it to go up when you're using that muscle and it's all back to normal in two weeks so it has no significance.' And I don't really want to weigh in on that debate because I don't think there really is a clear answer."
Fraser does support the notion that running an ultra-marathon without having trained accordingly -- especially at a more advanced age -- is not a good idea. In fact, it can have fatal consequences.
"If you don't train adequately and you're older, you can have a heart attack," he said.
Another medical concern related to running ultra-marathons is a condition known as hyponatremia, which means a shortage of sodium in the body. Hyponatremia can lead to death, but more common symptoms are confusion or hallucinations, convulsions, nausea, vomiting and muscle cramps. To guard against hyponatremia, ultra-marathon runners must take salt tablets during a race and must balance them with the proper amount of fluids. Staying hydrated is also vitally important for kidney function.
"If you get dehydrated enough, or you take enough anti-inflammatories, the blood won't flow through the kidneys and the kidney will die," Fraser said. "Kidney failure after a race is quite specific to ultra-marathon and very dangerous, obviously."
Salt and water intake goes hand in hand with staying properly fueled with food. When it comes to race-day nutrition, Fraser said runners must be careful not to be taken in by scams.
"There are a lot of people selling products which are unnecessarily complicated and unnecessarily expensive," he said. "And there are people selling some good stuff too. Stride & Glide in town is a good resource but there are sort of fly-by-nighters all over the place trying to convince people that they need to have amino acids and they need to have fat and they need to have calcium and stuff like that during their race which, in my opinion, is a bunch of baloney. You do need to have a mixture of simple and complex carbohydrates during a race -- sugars basically, the fast ones and the slow ones. You need your water and you need a certain amount of sodium and potassium. Those things are important and pretty much anything else isn't important during a race."
So, are ultra-marathoners participating in a dangerous or a healthy sport? Fraser comes down on the side of healthy but adds a caveat.
"It can be a very rewarding, very healthy activity which can really bring out passions in people but you've got to learn a lot about it," he said. "It's not like running a marathon where you can sort of get a few tips and take some Gatorade and go run a marathon. Once you get into ultra-marathoning, the nutrition, the fluids, the sodium, the potassium, avoiding dehydration, dealing with hot and cold temperatures and animals and toenails and blisters, it's just a lot more complicated. Some people educate themselves well and some people don't.
"Jeff Hunter, I've never seen anyone who actually educates himself as well as he does about ultra-marathoning," Fraser added. "As a doctor, you might think I'm more qualified but when it comes to ultra-marathon Jeff actually knows more about how much sodium to take and how much potassium and all that stuff just because he reads extensively and is very intelligent. But I know other people who do ultra-marathoning, and people who have done it at a level beyond mine, who really don't pay any attention to any of that. They're just superb athletes and sometimes they get away with it and sometimes they don't."