Illnesses & Risks in Endurance Athletes

Endurance runners think a lot about injuries, but often miss the early signs of illness, fatigue and system overload. In this episode, Dr Abongile Qamata breaks down the hidden health risks runners face. Learn how to spot red flags early, protect your body, and stay healthy enough to keep showing up on race day.

Transcript

SPEAKER_02 1:36

She's involved in cyclones events. She's also a coach as well. She is currently coaching the Adventist Athletics Club, the Howton Region. I hope you will find our discussion useful. Welcome, Dr. Kamata, and thank you so much for making time to be with me in this podcast. And thank you for following as well. How are things? How are you doing? How are things on your side?

SPEAKER_01 2:04

Thank you for inviting me. Um things are well. I'm currently training for the Durban 70.3 triathlon. I've just come back from the Cape Town cycle tour, which was supposed to be a training ride, but it didn't go very well. But I'm not really worried because it wasn't a race for me, it was more training than anything.

SPEAKER_02 2:33

I know you and your husband are actively involved in triathlon events. Do you want to tell us a bit about that?

SPEAKER_01 2:40

Sure. We started out as runners, I think as most of us do. And then he went on and did his first Comrades Marathon in 2014. When he came back in One Piece, I decided I would try it out also. So I also ran Comrades in 2015 and 2016. Then after that, um there were just too many demands on my body, but also on my life in general. So I toned down on my running mileage from ultra to short distances. And then I started looking at triathlon, and then I started training, and so I went into triathlon in 2018, and then I think he joined then the following year. And we've been doing swim cycle runs since then.

SPEAKER_02 3:43

That's great, man. That's very interesting to see a couple involved in one thing, and I'm sure you've learned a lot in the process. Yeah, it's a very strenuous event. It's something I'm also pursuing.

SPEAKER_01 3:57

I think you're gonna do great. Um, it's very interesting. Um, yes, very strenuous and demanding, especially on one's time. Um, but it's it's fun. And I mean, for a lot of us adult swimmers, that's the most intimidating part about triathlon. But it is possible to start to start swimming as an adult and actually do well and go on to do full Iron Man events like my husband has done.

SPEAKER_02 4:30

So yeah, wonderful, man. Our conversation today is about illnesses and risks in endurance running. And these days we are busy, we are at peak training, especially those who are training for Comrades Marathon. So we want to just see what are the illnesses that um endurance runners um are exposed to. Because I know um we focus on on injuries most of the time, but we forget um or we neglect the part of about illnesses. So why why why do you think uh runners often overlook illnesses as as a as a training-related issue?

SPEAKER_01 5:10

Sure. Okay, so I agree with you that a lot of times runners often think in terms of injuries, they think about their muscles, joints, biomechanics, etc. But illness is actually one of the biggest disruptors of training. Um, and we're seeing that illness is isn't random. It usually happens when the total stress exceeds the recovery capacity of the body. So instead of just thinking, oh, what's wrong with me, oh, what's wrong with my muscles, it's better to think of it from a system's perspective, what in my system is overloaded. Um, and then that will direct your thinking and therefore the management of whatever it is you are experiencing.

SPEAKER_02 5:57

So, yeah, because um we we we sometimes think illness is coming from somewhere else, but it is definitely related to what we do, especially with the increase in mileage and and and and intensity of work. So, what are the common illnesses that athletes usually come to you complaining about?

SPEAKER_01 6:17

Sure. So athletes often complain about recurrent respiratory tract infections, flues, colds. They often complain about um gastrointestinal symptoms, ranitami, and all those things. Um athletes also just complain about general fatigue that's not responding to rest. Yeah, those are the most common ones.

SPEAKER_02 6:45

And do you think they are linked to the increase in mileage and intensity of work? How are they linked to all of that?

SPEAKER_01 6:53

Oh, absolutely. I think they are linked. Um, because I mean one of the biggest mistakes that we as athletes make is stacking up stress without increasing recovery. So you increase your mileage, you increase intensity, and we have regular, busy lives. You're not sleeping enough, and your body can only hold so much. So your body is not just gonna collapse in one day, but over time it loses its margin. And when things like fatigue, illness, and you start plateauing uh in your training, that's when you need to think there's probably something wrong that's happening. If we talk about mileage, for example, there's a rule of thumb. You you can't just, for example, run 15 kilometers this week and then double it next week. You need to gradually increase your mileage um rule of thumb 10% per week. Um, but also from an intensity perspective, you can't always do speed sessions. You need to mix it up. That way, your muscles have an opportunity to rest, to recover, and adapt to all the training that you're doing.

SPEAKER_02 8:09

Yeah, that's true. Because sometimes we we we just keep increasing the mileage and intensity and not think of rest as part of training so that we are we are protected from all of the injuries and the illnesses that come with such an intense program.

SPEAKER_01 8:26

Absolutely.

SPEAKER_02 8:28

Yeah. Tell me something about uh relative energy deficiency in sports. What is it exactly? And wh why is it such a hidden but common risk in insurance athletes?

SPEAKER_01 8:41

Sure. So this is something I recently started reading up on relative energy deficiency in sports. Some people call it reds, others call it red S. Um, basically, it's low energy availability, and this is something that was introduced by the Olympic society. Um basically, it means you're not taking in enough energy to support your training, your recovery, and just your basic physiological functions. And something that's important here is that this is not about body weight. You can look fit, perform okay-ish, but still from a physiological perspective, you're not fueling enough. So that's where now we start thinking about reds.

SPEAKER_02 9:32

How do I know I have it? Um, because I I think as a runner myself, I might have experienced this because sometimes my energy levels are very low, and I'm not sure whether is it because of training or maybe because of energy deficiency, as we are saying.

SPEAKER_01 9:50

Sure. So I think okay, red is it's still a developing concept. Um, and it's not one specific thing. It's a syndrome, it's a spectrum of things that you're noticing in your body. Um, and I mean it was introduced in 2014, and there's a recent um consensus statement, I think from 2024 or 2023, uh, that tried to just polish it a little bit to think beyond just um energy availability, but also to consider other um potential diagnoses. But if, for example, you are training but you're always tired, um, and I mean this is you know, just to digress a little bit from your question, low energy availability is quite common among among athletes because a lot of us, I mean, the research shows that at least 50% of athletes, especially women, are not eating as much as they should be.

SPEAKER_00 10:59

Okay.

SPEAKER_01 10:59

Especially carbohydrates. Because there's this big stigma about carbs, you shouldn't eat carbs, they're gonna make you fat. And um, I mean, there's a whole aesthetic culture now to running and cycling, and people want to look good, and good has a new definition that is slim and this and that. So now you find people, for example, starting running to lose weight, and then they're not eating enough because the goal is to lose weight, but you're stacking up all this training, and therefore you end up in a position where the energy that you're putting in does not meet the demands of the body because now there's the basic physiological functions of the body. There's you going to work, there's you running your family, and then there's training on top of that, and then you only eat a few calories a day. Your body is not gonna be happy. And one of the first things that you're going to see is that you're gonna have uh frequent uh colds and flus. I mean, it can get worse in that you for females, for example, you start missing your periods. And I mean, this was noticed a long time ago in female athletes, something that was called the female athlete triad, where they would have they would be missing periods, they'd be getting stress fractures, they wouldn't be eating well. Then the other thing, which um is also obviously uh present in both males and females, is uh bone health issues that come with um with this uh energy deficiency.

SPEAKER_02 12:42

Okay, okay, okay, interesting. Well, you're talking about uh runners or athletes avoiding to eat because they are concerned about body shape and stuff. So you talked about the importance of carbohydrates. Um is that the fuel that we need as runners?

SPEAKER_01 13:00

Um Absolutely. Carbohydrates, everybody needs carbs. From someone who's an athlete to someone who's not an athlete. Um it's the basic um fuel that you need for your body. Um if you remember back in biology primary, maybe early high school, um, they taught us about carbohydrates are for energy, um protein are for repair, um, and fats are for fuel and other functions such as hormones, etc. So if you're not taking, and carbohydrates should form a big part of your daily intake. Uh that's the biggest proportion. Um, but the important thing here is that you need to take natural, complex carbohydrates. Um, as far as avoiding carbohydrates, the ones you should be avoiding, or not necessarily avoiding, but taking the least off are your simple carbohydrates. So things like sugary drinks, cakes, biscuits, those things, those are not the cups that I'm saying you need to eat. Um, you need to think natural and you need to think complex. So choosing brown rice over white rice, for example.

SPEAKER_02 14:23

I get you. All right. Maybe, yeah, those are that's the uh the education that we learn to know what cubs do we need to take. Because obviously those with added sugars, um, those are the ones that will make us fat and sick. But healthy ones, it's what we need for fueling. Yeah. You also mentioned flu uh colds and are there early warning signs for a runner's system that is under strain?

SPEAKER_01 14:51

Absolutely. So the immune system is very energy dependent. So when your body is under strain, it prioritizes your survival functions. Um, that is your heart, your brain, your temperature regulation, and the immune system can take a hit, and it's one of the early warning signs that your your system is under strains. So that's why often you'll hear a runners saying, I often get sick every few weeks, or after a heavy training block, after a race, then someone gets sick because your body is under so much strain.

SPEAKER_02 15:29

Okay, okay. So that definitely that's that that's something that I've experienced and many other runners do experience, especially at peak training uh periods. You you get sick often. Um so the solution is what? Um would it still be nutrition, rest?

SPEAKER_01 15:50

Yes. Back to basics, make sure that you're fueling enough and fueling with healthy, natural, complex um nutrients, macro and micronutrients, and rest. So with all the stress that you're putting on your body, um your body tries to adapt, right? But if you're constantly putting on more stress, then it breaks and that's when you start getting sick.

SPEAKER_02 16:25

Okay, okay. Tell me now what to boost my immune system, yes, food you mentioned is is key, and resting is also key. Would I be right to consider supplements? I heard somebody saying if you're a runner you will need supplements because you're doing something that the body's not used to, so food may not be enough. What what's your take on that?

SPEAKER_01 16:50

That's a very contentious issue. Um however, because most of us are not eating the best way we should, I think that's where there's the role for supplements. And as the name suggests, they are supplementing, they are not your food. So you still need to strive to eat food, real food, and then supplements. Um, with your minerals, your multivitamins, good quality um supplements, yes.

SPEAKER_02 17:23

Okay, no, that's fine. I know it's an issue that you know many people are debating, the issue of supplements. But yeah, with good advice, doctors like you, we we we can come right with that. Tell me now the the the psychological and life stresses that interaction uh with the physical training stress. How can it how can it push a runner towards illness?

SPEAKER_01 17:54

So this is one of the interesting things about the human in its entirety, um, we are indeed fearfully and wonderfully made. So the body doesn't really distinguish between training stress and life stress. So stress is stress to your body. So for example, if you training for a big race, and then on top of that, you have a demanding period at work or at home, you effectively doubling the load versus when you were just doing your training. So to your body, it sounds, it looks like you've doubled your your load, whether it doesn't differentiate that okay, part this part is physical, this part is psychological. Stress becomes stress. Um and the hormonal and physiological reactions in your body are the same. And for example, one of the key pathways is the increase in cortisol um when you are undergoing stress. And and chronic elevated cortisol then causes you problems um in on your physical body now, whereas it may have started um as a psychological stressor, which is why then it's important to be mindful that even if you keep your training low to the same, if you suddenly have a psychological stressor, that is going to impact how your body responds.

SPEAKER_02 19:32

Yeah, yeah. That's very interesting. Um, you mentioned something I never thought of that uh the body doesn't separate work stress from training stress or any other psychological issue with training stress. Sure, sure, sure. Is that why uh stress can impact your performance as well?

SPEAKER_01 19:57

Absolutely, why? Um because let's say you've been training for this big event and then you lose a close family member a week before, it will affect you. Because now you've added an extra load on your body that is not physical, but it's a load nonetheless.

SPEAKER_02 20:18

Sure, sure. That's very interesting. Thank you for those insights. I've got a I've got a friend who's a runner who always gets um you know gastrointestinal distress. But this only happens when he runs, uh especially long distance marathon or anything beyond a marathon comrade. What is causing that? Um how can this person be assisted?

SPEAKER_01 20:46

So runners tummy. A lot of runners suffer with that. Um some people find it too embarrassing to talk about. Um so you may not you may think it's only happening to you. Trust me, a lot of endurance athletes experience it, especially running. Um, especially once you get to marathon and beyond, you get problems with your gut. And here's uh part of the explanation. So during moderate to high intensity running, the blood flow to your stomach goes down because the body is prioritizing your muscles and temperature regulation, some of the key things that you need because you're running. Add to the deprioritization of digestion, the jerking and the bouncing that you're doing. Because now you're running, your stomach is literally being shaken. And then, on top of all that, shaking and reduced blood flow, you're adding food that the body needs, the stomach needs to digest. Now, because of the shaking and the fact that there's poor perfusion, that is poor blood supply to the stomach. The stomach doesn't do so well in digesting the food, then you get nauseous, you're getting cramps, you're getting diarrhea. So the key thing to manage it is to train your gut. Also, nothing new on race day. One of the other things that actually upsets uh people's stomachs is high concentration um gels. So if you using a c a gel that has a high sugar concentration, that's gonna upset your stomach. But even more so if you're using something you've never used before, it's a recipe for disaster. So the best thing you can do is to train your gut during training and see what works for you. Um also something else that um makes the situation even worse is if it's hot. So if you're running in very hot conditions, humid conditions, now your body is prioritizing temperature regulation even more and your stomach suffers. Umfortunately, you spoke, you said your friend is training for comrades, um, which is in winter, but it's in Durban, so it's warm and it's a whole day event. So one of the things that comrades' runners actually need to take into consideration is trying to simulate comrades' conditions when they're training. Meaning, for example, a lot of us train early hours of the morning. I mean, I know people who run from 4 a.m. or 5 a.m. Most of us need to run before we go to work. At that time, the sun is not up yet. And that is not in keeping with what you're going to experience at Comrades. So you need to also try running in the middle of the day because that is what you'll be doing at Comrades. So if, for example, you have flexibility at work, then consider on some days, um, short runs, you're doing them during your lunch hour. In the weekends, instead of running at 5 in the morning, run at 11. But of course, make sure that you you're protecting your skin. But you need to simulate those conditions because you might um be training with a specific gel at 6 a.m., but it's cool. And then when you take it at 2 p.m. at Comrades, it's hot, you're tired, it treats your body differently.

SPEAKER_02 24:40

You talked about training the gut. Uh, something that many people are not aware of, and they never think it's important that you must train your stomach to prepare for the for the event, not just the muscles.

SPEAKER_01 24:53

Absolutely. We so focused on training our legs that we forget about the stomach.

SPEAKER_02 25:00

I think that might be a solution for him because he he doesn't take nutrition at all when he trains. And also it races the marathons, he hardly takes anything. Maybe that's why he gets sick uh when he's doing ultra marathons. Uh, you mentioned earlier about nutrition and other things, those are underrated things but very effective prevention and way of sorting out issues. Are there any other underrated but effective prevention strategies to keep uh runners healthy and performing consistently?

SPEAKER_01 25:38

So the most underrated strategy is still the basics. Fueling. So we've talked about nutrition, what you eat, how you eat it, when you eat it. For example, I mean, I did spend a bit of time on the fact that people are intentionally reducing their caloric uh input. I mean, in clear terms, how much they are eating. That is not okay if you're training a lot. So you should be eating anything from three to five meals a day, um, especially on days where you are training hard, whether it's distance or intensity. But also we need to avoid fast dance training because you're asking your body to perform when you haven't put anything in. Um second thing that is also very important is sleep, because when you are sleeping, your body gets to do some very important functions that it cannot do when you are up awake, or at least it deprioritizes when you are awake. Number three, recovery. Recovery is not wasted time. Recovery is part of training. We can never overemphasize the importance of recovery. That is where your body adapts. Um, your your the impact of your training is not seen during the training. Yes, the training, the workout itself is important, but when you are recovering, that is when your body is adapting, and then you will see the gains. So if you're never recovering and you're constantly loading, you're not giving your body the opportunity to adapt and recover, and therefore give you better output for all the work that you're putting in. So, in a world where we're looking at our stats and we're buying all these expensive devices, we often overlook the most um important things and the things that um consistent athletes are managing to do and that they recover deliberately as part of their training. They eat well, they prioritize sleep, mind your psychological state.

SPEAKER_02 28:01

Another issue that runners experience is heat-related illnesses. I believe these are major risks as well in running. Especially in warm climates like South Africa or during long events. Um so I believe these can range from mild conditions to life-threatening emergencies. I've seen many runners experiencing heat exhaustion, heat cramps, fainting, etc. What are the other heat-related illnesses that runners may experience?

SPEAKER_01 28:37

Sure. So others may be over hydration, interestingly enough, um, which can lead to hyponatremia when you've um the amount of sodium in your body is low, um, so you've overdiluted um your blood. So when it's hot, the the temptation is to drink, drink, drink. Yes, it's good to drink, but pure water is not enough. Because when you're sweating, you're not losing water only. You're also losing salt. So you need to replenish the salt that you're losing. I mean, you see other athletes, um, and I'm one of those people, when it's very hot and I sweat a lot, I can feel the salt on my face. So when I uh rehydrate during my runs, especially on hot days, I need to take um electrolytes because I'm losing electrolytes. I can't just take water because the more water I take, the more I'm diluting, and then I can have hypo hypernatremia, which is too um a loss of sodium.

SPEAKER_02 29:50

What is heat stroke?

SPEAKER_01 29:52

So when your body is not regulating itself enough, so the temperature regulation is not um optimal in very hot conditions, then that's when you get heat stroke.

SPEAKER_02 30:08

Oh, okay. Does it include you collapsing or what?

SPEAKER_01 30:14

Oh yes. So some people actually do collapse or you feel faint. Um, so basically it comes from when your actual core body temperature, so there's the outside temperature, right? And then there's the core body temperature. So this is not just about the outside temperature going up. This is now your core body temperature going up, and that's potentially causing damage to your bodily organs. Um, and that can result in, I mean, yes, you can collapse, but the things that usually happen first is you literally feel like you're baking, you get a headache, you get nausea, you're breathing too fast, or you're you feel like your heart is gonna jump out of your throat, and then that's when you now you get confusion, or you some people may even collapse.

SPEAKER_02 31:09

I've seen a few runners collapsing. How do you usually deal with somebody with a stroke?

SPEAKER_01 31:15

Oh, they need to go to the ER. Well, before, I mean, call an ambulance, they need to be taken to hospital. Before the ambulance or you are able to get them to hospital, make sure that you put them in a cool area. You can uh put them in cold water if you're at home, remove excess clothing and all those things. Just try to cool them as quickly as you can whilst you move to an area where they can get them medical help.

SPEAKER_02 31:44

Now thank you so much, Dr. Kamata, for these informative um insights. Tell me, um now, are there are there illnesses that I can run while I have them? Or all sickness you have to just stop running or recover first before you continue.

SPEAKER_01 32:06

Look, illness means your body is not in its optimal state, right? But having said that, there's acute illnesses and there's chronic illnesses. So if it's an acute acute means it's a short-term new thing, chronic is something you're living with. So we can't say that if you have an illness, you can't train, because then it means everyone who has a chronic illness can train, can participate in sport, which is not true. Because those people actually need to be active. That's part of the management of a lot of uh chronic illnesses. It actually improves their condition and the management of their condition. But if it's a new thing that has come up in the last few days or weeks, you need to get that checked out first before you continue with your training.

SPEAKER_02 33:04

Okay, okay. Uh colds and flu.

SPEAKER_01 33:09

Colds and flu is um look, rule of thumb, this is not a the that says the word. Um if your symptoms are only around the nose or above the neck, it's usually safe to continue training, but I would say continue cautiously. If your temperature is elevated, your body temperature that you take with the thermometer, not just feeling with the palm of your hand. So if you if because look, your body tells you when things are not going right. And we need to learn to listen to our bodies. So if you feel something is off, then get it checked out properly, either by yourself first, if you're not sure, go to a professional. So if you check your body temperature, for example, and it's 39 degrees, then that means your symptoms are not above the neck. Because remember, the temperature is a whole body thing, right? Uh, even if you you're only sneezing, but your body temperature is high, then that's a cause for concern. But if your symptoms start going below the neck, then definitely you should not train, you should wait for it to pass, give it a few days, or go see um a professional. Usually a cold lasts up to a week, and then you're fine to continue training.

SPEAKER_02 34:38

Okay, okay, okay. That's very helpful. Yeah, thank you so much for that. If if you are on medication, let's say you've gone to been to a doctor and it's giving you maybe antibiotics, you're going through something, but you are feeling better, but you have to complete your your medication. I'm feeling alright, but I'm still on antibiotics. Uh, can I continue training while I'm taking medication?

SPEAKER_01 35:07

I'll limit my response to antibiotics. If you're taking antibiotics, it means there's an infection, a bacterial infection in your body, and you should respect that and let your body recover. If you have a viral illness, you're not usually given antibiotics, um, though some patients demand antibiotics even if they have a viral flu. Um, and some doctors like dishing them out. Um, so even if so, for antibiotics, please wait for yourself to recover, your body to recover, and then you you continue with training gradually, you're not gonna pick up where you left off because you've taken a break. If you have a viral illness, wait for it to pass because you don't want to be pushing the virus all over your body.

SPEAKER_02 36:00

If you had to give uh a runner uh self-check questions to monitor their health, what will those be?

SPEAKER_01 36:08

Okay, so first things first, listen to your body.

unknown 36:12

Okay.

SPEAKER_01 36:13

Is what I would say. And then ask yourself the question Am I coping or am I just pushing through? Because a lot of runners, they just want to keep going, keep going. But having said that, I also, I mean, I'm I'm not naive to the fact that we by virtue of being an endurance athlete, you are required to push through fatigue sometimes. Um but there's a there's a point where you need to ask yourself, is this just fatigue or have I reached a point where I'm unwell? So if you listen to your body every morning, just do a check top to toe. Um how am I feeling mentally? In what space am I in? Um respiratory. So am I breathing fine? Um I'm struggling, and then you listen to your heart, you listen to your stomach. Um, and by listen, I'm not talking about stethoscopes or anything. This is you just lying on your bed and just doing a mental check of what's happening in your body. Do I feel normal? Do I feel fine? Is there some cause for concern? Um, and if you have things that you're concerned about, then you should, if for example, you've been feeling tired and you've been resting, but it's not making a difference, then there could be something brewing, you might be starting to get sick, or you may be overtraining, or it may be red. So just a regular check-in with your body every day or every other day, um, just to make sure that you're still in the right path. Uh, you're not over-exerting yourself as you build up on your mileage as you go towards race day.

SPEAKER_02 38:12

Okay, I'll definitely take that, uh, those advice. Um any last thoughts that to somebody who is who is a runner who is preparing for an event? What would you say to those? Especially at this point, we are training for comrades, last weight.

SPEAKER_01 38:32

Sure. So my last words would be runners generally don't get sick because they are training too much. They get sick when their total load consistently exceeds their ability to recover. So we need to think of our bodies, of stress, of our bodies as like having a stress bucket, right? So you're putting in something in your stress bucket every day. It's your training, it's uh poor sleep, it's pressure from work, it's the fight that you had with your best friend, uh, you're not eating enough, you're underfueling, that stress bucket is getting fuller and fuller. And if you keep adding more things into the stress bucket without emptying it through recovery, through taking care of yourself, through proper nutrition, the body gradually loses its ability to absorb the training. And that's where you you either not going to progress or you're going to plateau and you you don't see the value of all the work that you're putting in.

SPEAKER_02 39:48

As we conclude today's episode, I want to leave you with this thought. As an enjoyment runner, we we pride ourselves on pushing truth is okay. But not everything is meant to be pushed through.