Overtraining Syndrome, Part Two: Treatment and Prevention

Stay the CourseThe term ‘overtraining’ is a bit of a misnomer. It implies that the only way to suffer it is to train excessively. But with running–and ultramarathoning in particular–excess is as relative as it is requisite, a critical component to success, some would argue. Indeed, those who’ve experienced overtraining will frequently note that their malaise developed under the same or less training volume than they’ve logged in previous months or years.

Rather than simply training too much, overtraining syndrome is an imbalance of the stress-rest relationship: too much stress, not enough rest. And it’s not just running that is stressful.

This is part two in three-part series (Part One: An Overview and Part Three: The Trail Ultrarunning Specifics) on overtraining, functional concepts in overtraining treatment and prevention.

Overtraining As Imbalance: ‘Fight and Flight’ Versus ‘Rest and Digest’

A foremost pioneer in holistic, balanced training, Phil Maffetone, has been a powerful voice in endurance sports for over 30 years. Maffetone has worn many professional hats as a chiropractor, acupuncturist, athletic trainer, teacher, and coach. But it was his work with triathletes, namely six-time Ironman Champion Mark Allen, that put Maffetone and his ideas to the forefront of endurance sport.

He is an advocate of holistic training, noting that maximal athletic performance–and general health–lies in the balance of stress and rest. In his book, The Big Book of Endurance Training and Racing, he notes that overtraining syndrome is, quite literally, a stress-rest imbalance. He takes it further, to describe it as a neurological imbalance of the sympathetic and parasympathetic nervous systems. The sympathetic system is responsible for action–it drives our muscles and makes our heart race, both before and during running. Once our exercise ceases, the parasympathetic system takes over to facilitate the ‘rest and digest,’ the restoration and repair. According to Maffetone, overtraining is not simply running too much, but an overall excess of sympathetic and inadequate parasympathetic activity.

That said, that ‘flight’ versus ‘rest’ balance can also be understood as a balance of revenues and expenses. Training is a physiological stressor; all bodily systems are engaged to varying degrees when running. Despite the perceived stress relief we feel from it, running is a taxing expense on the body, which a person must pay for via restorative revenues; sleep and adequate nutrition being the foremost sources of rest.

The intricacies of overtraining appear when you consider that training is not the only expense we incur. We are constantly nickel-and-dimed throughout our day with many other expenses large and small. Work and school, friends and family, travel and illness–to name only a few–all represent secondary expenses. And they add up. Before long, the balance sheet is in the red if we’re not careful.

Maffetone recognizes these multidimensional contributors to both stress expenses and restful revenues. He details how to get the most from your training stresses, maximize restful revenues, and otherwise minimize the non-running expenses, which will be described below.

Striking Balance: Elite Performance in the Real World

Eugene, Oregon has a wealth of resources for runners. Its physical environment is nurturing with cool temperatures and great trails and the University of Oregon draws significant talent in both athletic and intellectual realms.

Examples of that resourcefulness include two women with equally impressive athletic and academic credentials:

Kimber Mattox is a former Oregon High School State Champion in cross country, a school-record holder and All-American at Willamette University (Salem, Oregon) before taking her talents to the University of Oregon, where she registered the second fastest 3,000-meter steeplechase time in school history in 2012. She now holds a Master’s Degree in Human Physiology and is a faculty instructor in the department at the U of O. In her sparse, spare time, she assistant coaches Oregon women’s cross country, and competes post-collegiately, having recently made finals at the USATF Championships in June. Mattox owns a personal best of 9:57 in the steeple.

Brett Ely is an elite marathoner with an impressive resume in and out of running shoes. She has qualified for the past three US Olympic Trials Marathons and has a personal best of 2:38 at Grandma’s Marathon in 2011. Professionally, she has worked at the U.S. Army Research Institute of Environmental Medicine where she worked in thermal physiology and hydration science. She is now a doctoral candidate in Human Physiology at Oregon, studying cardiac physiology and the relationship between elevated sympathetic nervous systems and disease processes. In her spare time, she is aiming to notch her fourth qualifier this fall at the California International Marathon.

These women offer a unique perspective with both and elite running ability as well as expertise in human physiology. Moreover, they are experts at balancing the demands of elite-level running with academic careers. I was able to sit down with them both recently and get their perspective on the art and science of sustainable training.

Treating and Preventing Overtraining

Step 1: Balance Training Expenditures

As stated in part one, brief periods of overreaching can result in performance improvements (a concept referred to as super-compensation), provided that adequate rest follows that period of heavy training or stress load. This rest–either absolute or relative–represents both a decrease in stressful cost and an increase in restful revenue. One or both must occur to avoid overtraining imbalance.

By the time that full-blown overtraining is present, you are beyond unbalanced. You are deeply in debt; the checking account is overdrawn, the loan defaulted, and collections are on their way. That said, simply increasing revenue streams–resting more, decreasing life stress, eating better–is rarely enough.

You must stop training. Period. The systems described in part one–namely the neurological and endocrine–need significant repair and restoration. Any training that stresses these systems represents additional stress that the system cannot handle.

While neither woman has experienced severe OTS, Ely has had her run-ins. She notes that, during her college years, “I had a week where I couldn’t sleep.” That was an obvious sign to her that she was imbalanced, requiring one to two weeks of complete rest from running. Later, repetitive injury issues as a post-collegian have derailed several competitive build-ups, including a DNF at the 2012 Olympic Trials Marathon due to a hip injury. Since then, Ely notes that “maturity” and “going with the ebb and flow” of daily life have been critical to avoidance of overtraining and injury, “I’m flexible; if I’m not feeling it, I’ll try again tomorrow instead of forcing it.” One could argue that her recent success in her mid-30s might also be due to the same philosophy.

Cut training by 75 to 100% of total run volume as well as any other activity that raises the heart rate over 100 beats per minute. Moreover, because of the effects on skeletal muscle, limit impact activity as much as possible.

Cut all high-intensity, anaerobic training. This includes hilly trail running, which spikes heart rate and drives the anaerobic system far more than most runners (without heart-rate monitors) realize.

Switch to non (or minimal)-impact activity. The literature or medical opinion is equivocal on some versus no activity in OTS treatment. Some degree of activity may be helpful to aid in tissue and joint mobility. Maffetone recommends walking, gently generating blood flow with minimal impact stress while also providing low-level aerobic exercise with minimal stress. However, if you experience significant muscle soreness as described by Fatigue Athlete Myopathic Syndrome, avoid all impact activity. Instead, engage in low-impact, low-aerobic mobility exercise such as swimming or yoga.

In their literature review on overtraining, Kreher and Schwartz (2012) note that, with periods of both overreaching and overtraining, resumption of training should only occur when primary physical symptoms fully resolve and motivation to train returns, beginning with a very low intensity and duration,a mere five minutes, and increase gradually, until an hour is tolerated. And only then can relative intensity increase.

Use objective metrics to monitor training stress. Progressive, sustainable training and avoidance of overtraining is all about establishing and maintaining a balanced budget of revenues and expenditures. Where the difficulty arises is when we fail to accurately determine the true value of our expenses and revenues. How much more stress-fully expensive was your long run that you pushed in the final miles? How less valuable is your night’s sleep, disrupted multiple times because of a crying infant or high-maintenance pet?

Maffetone puts heavy emphasis on heart-rate-based training. His ‘Maximum Aerobic Function’ effort, the level at which we still burn fat and avoid stressful anaerobic training intensities. This is an individualized heart rate, estimated using age and other factors (though it can also be measured with functional testing). This specified heart rate represents a level of effort that not only minimizes training stress, but it represents a standardized effort level by which to compare training progression or signs of overtraining.

Maffetone recommends periodically running the same distance on the same training ground (for his protocol, a flat, five-mile route) and monitoring your overall pace while strictly adhering to one’s maximum aerobic heart rate. This represents a way of tracking stress. With sustainable training, one’s average pace should improve within a training block and over years of healthy, balanced training and racing. Decreases in speed at the same heart rate represents a state of over-stress, excessive training or non-running stress and inadequate rest.

Trail runners can accomplish this same metric using known trail routes. Technology such as GPS watches and heart-rate monitors can document effort and performance which one can compare to previous runs in previous weeks, months, or years. For example, with the simple addition of a heart-rate monitor, Timothy Olson can chart his true training progress on the brutally steep, ‘Pete’s Punisher’ route in the foothills outside Ashland, Oregon by comparing his ascent times versus heart rate. Simply running the route faster does not equate to improved fitness; that can be accomplished by learning the best footholds or simply putting forward greater physical and mental effort. Instead, running faster with the same or lower heart rate is the true measure of sustainable fitness.

Step 2: Manage Non-Running Stresses

Training is a significant stress in our lives, but it’s not the only one. We are constantly nickel-and-dimed by other large and small expenses in our lives, and they add up. Most successful runners are dedicated, hardworking, detail-oriented people. This permeates our existence, often making them as successful out of running shoes as in them. But that commitment and ability can become more taxing than you bargained for. Successful training and performance, and preventing overtraining, therefore is about finding balance and prioritizing our activities: maximizing productivity but minimizing the cost.

Maximize sleep and nutrition. This is an easy one, and for the most part, well-executed by ultra trail runners, who might be the most savvy with nutritional excellence amongst endurance athletes. A diet rich in healthy fats, whole fruits, and vegetables, and limitations on processed foods is an integral part of maximizing restorative revenue. Consistent sleep volume and schedules is also important. Conversely, an involuntary sleep disturbance or a loss of quality sleep is a leading indicator of training imbalance.

As part of the active treatment of overtraining, Maffetone recommends the following:

  • Limiting all processed foods, namely processed starches, grains, and sugars which are thought to have strong, pro-inflammatory effects;
  • Consuming smaller, more frequent meals to keep blood sugars consistent and limit metabolic stresses;
  • Maximizing natural anti-inflammatory foods including omega oils, and certain nuts and berries; and
  • Limiting intake of caffeine which drives the sympathetic response.

Active relaxation. For many, running represents our most important stress reliever. But when it become a major stressor, we’re left with few options to calm the system. Besides sleeping, active relaxation techniques can be a powerful brake to a hyperactive sympathetic system, and more quickly activate that restorative parasympathetic system. Examples of active relaxation techniques with minimal physical stress include yoga and meditation; both activities use active, mindful breathing and a present-centered mindset to turn off the many internal stressors and facilitate a restful state.

Meditation and a peaceful, present-centered approach has been a huge part of Timothy Olson’s success over the past three years. Prior to the 2012 Lake Sonoma 50 Mile, he and I were doing a light shake-out jog on the trails above his house in Ashland the day before the race. As we neared the end of the run, he stepped off the trail and said, “You go ahead. I’m going to sit in the woods and meditate for a bit.” While brief, this had a positive, calming effect on him that weekend and was undoubtedly a major contributing factor to his success.

Periodize your life. Too often, we increase our training volume while trying to maintain the same level of non-running activity. Work, family, and relationship desires and obligations pose major contributions to overall life stresses. We want to do well and be generous contributors in all areas of life, but when engaging in heavy training, something has to give.

Ely, a self-proclaimed ‘Type-A’ personality, notes that she had to learn this lesson the hard way on multiple occasions. She notes that two major stress fractures occurred at times when non-running stresses were high: performing home improvements and getting married. “I would do a hard training run, then come home and hang drywall for five hours”, causing one major injury episode. Another occurred while planning her wedding, clearly a positive event but nonetheless a significant time and energy stress.

Periodize your life by planning and performing non-running tasks at down times in your training cycle. This might include things such as home-improvement tasks, major family and social occasions, and work projects. Then, commit to dedicated rest time during periods of heavy training. This, undoubtedly, is best accomplished with clear communication and collaboration with your employer, family, and friends. While this might seem to be a major sacrifice, making the most of your training and the sacrifices involved is what will ultimately make those sacrifices worthwhile for everyone involved.

Prioritize. Keeping perspective and prioritizing your time and activity during serious training is also important. Not every tasks requires or is deserving of your absolute best efforts and energy. Indeed, Ely, despite a clear track record of over-achievement, has come to the same conclusion through her experiences as an elite runner and scientist. After years of struggling to strike a balance and suffering multiple injuries trying to do too much, she’s concluded that, “Not everything worth doing is worth doing well. Some things you just need to get things done.” And those times are when training and resting take top priority, when your ultimate goal is to perform well.

Be present-centered. In her role as coach, Mattox is keenly aware of the multidimensional stresses of her collegiate runners. She and the Oregon coaching staff are advocates of being present-centered, “Sometimes runners will go to class and all they think about is practice, then come to practice and all they think about is class”, noting that, with this state of mind, even easy running can be stress producing. By being present-centered, she notes, “Practice becomes a stress relief rather than a stress-producer.”

Surrender without giving up. When non-running life stressors are too great, sometimes even an easy run is too stressful. For anyone, even professional runners devoid of 40-hour work weeks, this is bound to occur at various times; crazy travel schedules and social commitments, regardless of being positive or negative, drain our system.

Sometimes the best training runs are those we do not do. While Ely cites greater maturity leading to this reality, Mattox, at the tender age of 24, already possesses that wisdom. As a high-school sophomore, she won the Oregon State Cross Country Championship in 2004, which she accomplished less than a day after playing a full play-off game for her high school soccer team. But, interestingly, she quit cross country the next day, “There was a lot of pressure and I hated it; it was too stressful.” She didn’t run competitively again until midway through college.

Since then, she’s been acutely aware of stressors on her athletes at Oregon, noting one instance where, before practice, one of her athletes was showing visibly clear signs of stress and anxiety. “Instead of running, she and I went for a walk.” Indeed, some of the most important workouts are the ones we don’t run.  Both Ely and Mattox cite the concepts of trust, discipline, and faith as critical to successful running and life balance.  Surrender is about having the faith that, if you rest, you’ll come back stronger tomorrow.

Manage expectations. Often the expectations from running and how we perform poses a significant stress, causing not only poor choices in how we train but also driving an ongoing stress cost through elevated anxiety, especially in the days and weeks preceding competition. Moreover, the mounting expectation after poor performance only drives overtraining syndrome even further: more anxiety, more poor training choices, more stress.

Having quit cross country in high school because of the pressure, Mattox’s rise to become the second-fastest steepler Oregon history, a program known for being among the elite track programs in the country, is even more noteworthy. That formative early experience was critical to her rise. When she transferred from Division-III Willamette University to Oregon for her final year of eligibility in 2011, she noted that, “There were no expectations. I just wanted to see what I could do.” That balanced mindset resulted in enormous personal improvement and high achievement, both on and off the track.

Perspective. Ultimately, in order to strike balance with running and life, one must realize that running is only a part of who we are; it can greatly enhance the quality of our lives, but no single training block or race performance will make our lives great. Nor will a poor performance have the opposite effect.

No doubt benefited by their expertise in human physiology, Mattox and Ely know this inside and out, realizing that there are limitations not only to what the body can handle, but as to how their biggest passion can impact their lives. Ely might have put it best when she said, “Running is a passion, but a choice. Sometimes the right choice is not to run.”

* * * * *

Next month, we will discuss the implications of overtraining on ultramarathon running, as well as the special challenges that ultrarunners face in striking balance in their running. We will also explore two ultrarunning case studies of runners who experienced severe overtraining symptoms.

Call for Comments (from Meghan)

  • What types of non-running stressors do you have? Which of these do you know affect you more than others? Which of these affect your running the most?
  • Have you seen examples in yourself when your stress and rest volumes are imbalanced?
  • How do you know when to take a rest day, when the right choice is not to run?
Joe Uhan

is a physical therapist, coach, and ultrarunner in Eugene, Oregon. He is a Minnesota native and has been a competitive runner for over 20 years. He has a Master's Degree in Kinesiology, a Doctorate in Physical Therapy, and is a USATF Level II Certified Coach. Joe ran his first ultra at Autumn Leaves 50 Mile in October 2010, was 4th place at the 2015 USATF 100K Trail Championships (and 3rd in 2012), second at the 2014 Waldo 100K, and finished M9 at the 2012 Western States 100. Joe owns and operates Uhan Performance Physiotherapy in Eugene, Oregon, and offers online coaching and running analysis at uhanperformance.com.

There are 19 comments

  1. Ryan

    Thanks for posting this article, lots of good information.

    I've been told by my chiropractor that he believes I have very high sympathetic dominant traits. I've always struggled with becoming fatigued quicker than other runner friends when training high volume. Is there any truth to individuals being parasympathetic or sympathetic dominant, and would this really affect the way you train, or how quickly you can become overtrained?

    1. OOJ


      Thanks for the comment.

      Though I haven't come across any research in this area, I feel that *personality* plays a substantial role in the ability to cope with stress. And, as a self-applied Type A, I feel like I "rev higher" (e.g. higher sympathetic tone) and have a tougher time relaxing. This is both nature and nurture for me (sorry, mom).

      How, exactly, this might directly or indirectly affect rest, recovery and OTS (versus other stress-related syndromes) remains to be seen.

      Interesting, Brett Ely – who contributed to this post – is currently studying how sympathetic tone is related to incidence of polycystic ovary syndrome. This, as it seems, is yet another connection between stress (and sympethetic response) and how it affects various body systems.

      I would love to see a study that links personality type and stress coping ability to incidence of overtraining, overall training capability, and performance. However, the enormous amount of variables would make such studies very difficult.

      1. Charlie M.

        5 mile progression run + 1 hour yoga + half-hour meditation + Vegan Protein/Vegetable Carb recovery = ParaSympathetic Peace

        Frequent 10 mile intense tempos + Milkshake Recovery + Huge Processed Carb Recovery + TV "relaxation" + Obsessing about Next Run = Sympathetic Roller Coaster and Gold Medal peformances for 5 years (followed by huge crash and inability to run 1 mile around the block)

        1. Ryan

          I would agree with you Charlie. I've changed my diet to get most of my carbs from fruits and veggies. With the exception of eating rice or pasta once a week or so, I've cut grains from my diet substantially.

          Although, I still feel like I always need to be "on the go." I've always been an anxious person, so maybe I need to try yoga and meditation? Who knows.

      2. GMack

        I don't think Ryan is refering to "personality", but rather the nervous system response to physical activity and to overtraining. Endurance atheletes are typically in the realm of parasympathetic response due to the higher volume and lower intensity efforts. The indications of fatigue, however, may appear the same as sympathetic, which are associated with noradrenaline-intensive exercise. If I understand his question, it's "are certain people parasympathetic or sympathetic dominate: do they naturally make better distance runners or sprinters?"

  2. Alex

    Quote from the bodybuilding word: Overtraining is just undereating. Of course, blanket statements like that can never be 100% true, but I think it does often apply – with a caveat. I would add that overtraining is probably more often prompted by undereating of quality foods, rather than absolute undereating, as defined by a chronic caloric deficit. That is, you may be getting sufficient calories, but insufficient nutrition. This is "undereating" in a sense, but isn't likely to be cured by another row of oreos. I'd also suggest that excessive alcohol consumption (which seems rather common in the MUT community) can disregulate anabolic hormone production, and thus compromise recovery.

    Not that this is anything like a revelation. Eat sane amounts of actual food, and don't drink like you're at a frat party every night.

    1. OOJ

      Agreed, nutrition plays an enormous role, and I do feel a lot of runners – by virtue of their hobby – feel as though they have a license to make more poor nutrition choices.

      However, my experience – amongst the higher level athletes in ultrarunning – is that their nutrition is phenomenal.

      Their phenomenal nutrition is a part of their driven personality. And that personality type is what is worth noting: how might that drive cause someone to "bite more than they can chew", in the holistic life-balance sense?

      1. Alex

        Agreed, high level athletes usually (though there are certainly notable exceptions) prioritize healthful eating. I do think it's worth noting that there is enormous disparity in what each individual athlete believes to be their optimal diet, however. What we see, then, to somewhat answer your latter question, is a trend towards the extremes. While there are certainly those who simply aspire to eat "well" (Kilian and Krar come to mind), it seems many, if not most, elite MUT runners consume a diet that is either wholly vegetarian/vegan, paleo, or close to either end of the spectrum. Contrast that with elite road and track runners, and you'll find that they largely don't eat restrictive diets. This is not to say that veg/paleo/etc. cannot be effective eating patterns (I'm paleoish myself, honestly), just that excessive anxiety over one's eating can be yet another stress, which is never productive.

      2. Jason

        I respectfully disagree. Eating boatloads of carbs, like most runners and I were taught for years (and still taught for that matter), is not "phenomenal nutrition", it is a "sacrifice of calories" for energy vs. nutrition. Carbs replace nutrition. (Quality) High fat / low carb is a great hedge against malnutrition.

        The whole idea of "calories" has been shown to be a terrible way to manage nutrition.

        1. Alex

          I don't see how you disagree with me, really. I never said anyone should eat a "boatload" of carbs, from any source. I prefer to stay around 200g a day, myself. Regardless, we have to be honest about how elite runners actually eat. To that end, you have to admit that many do eat a "boatload" of carbs. There have been analyses published on the dietary intake of elite Kenyan and Ethiopian distance runners, which found they usually eat in excess of 600g carb a day. I'm not saying that's optimal for you, me, or anyone else. But it's published data, and rather common knowledge, besides. Even in the ultra world, Kilian eats all manner of sweets and baked goods (source: his book).

          1. Jason

            Sorry Alex I was respectfully disagreeing with "OOJ", not you, about endurance runners having phenomenal nutrition. I have seen quite the opposite. Maybe I clicked on the wrong 'reply' link :)

            And in regards to Killian I think it is great to be young and (think) you do not have to worry about the long term health consequences of continually elevated insulin. I know I didn't for a long time, I was Mr. Mountain Dew :)

            1. Alex

              Ah. Understood.

              And I don't disagree that many runners seem to subsist on little but junk. OOJ, however, runs (literally and figuratively) with a higher caliber of athlete than your or I probably do (though I tag along with a few just-out-of-D1 track guys a couple times a week, and yeah, their diets are garbage). Perhaps they simply put more importance on their nutrition, as in some cases, running is their job? In any case, the elites of the MUT world do seem prone to a certain level of diet obsession, for better or worse, that doesn't seem to exist in the rest of the endurance sports world.

  3. Charlie M.

    Everything in moderation.

    I'll say it again. Live by the sword, die by the sword.

    This is the first year in 17 years (1996) that I won't have participated in a marathon or ultra-marathon.

    And I've got to say, it's a big relief! :)

    I'm already looking forward to 2014! When I can overtrain again! :)

  4. Mike

    "Limiting all processed foods, namely processed starches, grains, and sugars which are thought to have strong, pro-inflammatory effects"

    There is very little (any?) scientific evidence to support the myth of "anti-inflammatory" eating. Maffetone has some good ideas, but also some bad ones.

    1. OOJ


      Thanks for the comment.

      There is, in fact, quite a bit of evidence linking diet to inflammation. I encourage you – should you have a spare :45 – to watch this video, which was part of a debate at the University of Cape Town last fall, which is an oral review of the literature of cholesterol – a marker of inflammation (and thought to *cause* heart disease) and diet, namely the mounting evidence that excessive carbohydrate consumption is associated with increased systemic inflammation.


  5. OOJ


    Any physical motion is driven by the sympathetic system, as any physical motion is "excitatory". The misnomer, I think, is that folks think that by only "running slow all day", they are not stressing that system.

    While that is somewhat true (e.g. you're not accumulating the anaerobically-produced metabolic byproducts or stress hormones associated, such as cortisol), the sympathetic system is still activated, nonetheless.

    What is most interesting is how each individual reacts to situations of anxiety, namely races. I, for example, on the same course on a non-race day, might run x pace at a HR of 150. Yet, on race day, with psychologically-driven sympathetic system, that same pace is 170.

    Thus, my response was based on this interpretation: do some people have less sympathetic sensitivity: in other words, can they toe the line, speak to a crowd, confront a problem situation in work/home life with less sympathetic activation – and then quickly return to a relaxed, parasympathetic-driven state.

    If you subscribe to the theory that maximal "rest" = least amount of sympathetic drive per unit "work", then those folks are going to be the most productive with least side-effects.

    An interesting area of study, and motivation for us all to better manage stress (e..g "sympathetic drive") in our lives.

    1. Ryan

      My question actually was centered around "personality" or our internal disposition regarding a sympathetic or parasympathetic dominant trait. I've been very interested in this, because of certain symptoms that I've displayed, and the way I've been "treating" it and how it relates to my running.

      When we are constantly subjecting our bodies to the "flight or fight" response, we are going to display characteristics of fatigue, immunosupression, and a whole host of other symptoms. I think this is why I'm really good at shorter races, and begin having problems when it comes to events 20+ miles in length.

      I agree that it is a interesting area of study, and it's too bad that it's actually hard to study.

  6. Matt

    Great article that came at the perfect time! I feel that I am battling this seeing how all the doctors cant find anything wrong. Three weeks off and I feel better but still with muscles sore and tight and extreme fatigue after doing anything.

  7. Ben Nephew

    Looks like there has been some research in this general area.


    Ryan, do you have issues with fueling and/or your GI tract? For those that have a robust stress response to races, the higher levels of sympathetic activity and plasma cortisol are likely to pose problems with maintaining consistent energy level and they will do a better job of shutting down your GI tract.

  8. Ben Nephew

    I'm not finding much primary literature on this. One initial question would be is this inflammation causing disease related issues? Do runners have high rates of heart disease? Are there differences in heart disease between runners are associated with carb intake? I don't think data like this pertains to most of us:


    Here is an interesting article illustrating the importance of context:


    I'm wondering if this is similar to data on running and artery hardening. Sure, you can find some data showing that intense exercise causes hardening, but it doesn't appear to be physiologically significant at the level of the organism.

  9. Ben Nephew

    I'm very interested in Joe's thoughts on overtraining in ultrarunning in the next part of the article. I don't think we know much at all about some of the types of overtraining that we see with ultrarunners. The overtraining accounts from ulrarunners seem to be far more severe than anything I have heard from elite athletes at the sub ultra distance, with the exceptions being sub ultra runners with severe eating disorders. I don't think we really even know the long term effects of long ultra races where people run themselves into issues with rhabdo.

  10. Ben Nephew

    For those interested in some good reading on evolutionary, ecological, and behavioral aspects of stress, get Why Zebras Don't Get Ulcers by Robert Sapolsky.

    While these discussions always focus on stress and recovery, if the stress is severe enough, you may never totally recover from it, for better or worse. I wonder if some of the stories in ultrarunning have more in common with PTSD than overtraining?

    1. stevephoto

      An interesting book to read is "Slow Burn" by Stu Mittleman. This book addresses the stress of ultra running and running in general and introduces some fascinating training and dietary regiments certainly worth noting.

      Stu Mittleman has long retired from competitive ultra endurance events, but his very impressive accomplishments can be seen on his website worldultrafit.com. He was coached by Phil Maffeltone and drastically changed his diet and philosophy to gain maximum efficiency for endurance. He was recently inducted into the American Ultrarunning Hall of Fame.

  11. Ryan

    I do have problems with fueling, which is one of my problems of running longer events. I can eat pretty much anything before I run, but have problems during running.

    If I eat/drink too much while running I end up with some pretty gnarly stomach cramps and nausea.

  12. Mumby_Box

    Some thoughts in this article and those who reported struggling with it in the first article…
    I’ve had OTS for a couple years now. There were a lot of factors that went into it, including extreme stress in my interpersonal life, exercise addiction, and a lot of calorie restriction. Anyways, the success I’ve had in treating it so far have been in very small steps. My first improvement was found in supplementing DHEA which I was very deficient in. My thyroid was off, but didn’t show up through TSH levels until later (T3 was very low, however.) Treating the thyroid helped, too. Generally, I think a good first step is to get a good overview of what your hormones are doing via bloodwork and start trying to correct them with a decent health professional. The suggestions about activating your para-sympathetic system through meditation, gentle yoga, etc, can help, too.
    Another thing that I hope may be mentioned in the last part of this series, and what helped me immensely, is something I found through digging through Alberto Salazar’s biography- taking Prozac. Like mentioned in the first article, the brain down-regulates receptors in OTS; much like you see in clinical depression. In fact, just about the only way you can distinguish clinical depression and OTS is that OTS is characterized by decreased sport performance. All the other symptoms are the same. For those suffering from OTS, SSRI’s are VERY worth a shot.

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