The Ibuprofen Question

Something that I have often wondered and questioned. Got this from IrunFar this morning. Ibuprofen and Its Effects During Ultramarathons Posted: 28 Jul 2010 03:00 AM PDT Many runners use anti-inflammatory medications (ibuprofen or Motrin, also known as NSAIDs) before, during, and after running to stave off pain. I personally have had mixed results using these medications while running, and do remember quite vividly having intense back pain after Squaw Peak 50 mile race in June of 2001 where I used ibuprofen throughout the race. I didn’t use ibuprofen much during runs after that, and after seeing what happened to Erik Skaggs at Where’s Waldo 100k last year[1], I decided to dig a little deeper into the subject and do some research. It’s a tough subject to gather information on because not a lot of medical research has been focused in this area. Most medical research focuses on “already sick” people and not healthy athletes. There is one specific event, however, where quite a lot of research material was put together from information gathered at Western States 100 in 2005. Three journal articles were written using the data gathered at Western States 100 mile endurance run. In the studies analyzed, both male and female athletes were selected (54 total athletes): 29 were placed in the ibuprofen group, while 25 were placed in the control (non-ibuprofen) group. Blood and urine samples were collected from participants in both groups before and after the race. In the ibuprofen group, participants ingested 600mg day before race, and 1200mg (divided into doses of 200mg every 4 hours) on race day. McAunulty Study In a study by Steven McAunulty, et al.[2], the authors looked at how oxidative stress on the body was influenced by ibuprofen use. Oxidative stress, for clarification, is the inability to detoxify and repair damage to body systems done by the production of free radicals and peroxides. Free radicals and peroxides can cause direct damage to cells and can disrupt normal energy production within cells. When overly abundant, they can cause cell death. McAnulty looked at certain measurable inflammatory markers (F2-isoprostanes) in the blood and urine and when comparing pre-race to post-race samples, found significantly differing levels of inflammatory makers in both blood and urine in the post-race ibuprofen-use samples. His conclusion was, “Ibuprofen use compared with nonuse by athletes competing in a 160-km race was associated with significantly increased oxidative stress.” How does this happen and what does it mean? Kidney cells may be damaged and altered during and ultramarathon as a result of ibuprofen use. There has been previous research that has shown that ibuprofen increases blood flow to the stomach and small intestine and thereby increases leakage of toxins into the bloodstream, increasing oxidative stress. Ultrarunning magnifies this effect. Post-race blood levels of measured inflammatory markers (F2-isoprostanes) were elevated by 37% above normal in the ibuprofen group, compared to 20% elevation in the non-ibuprofen group. These same markers, when measured in post-race urine, were increased by 138% in the ibuprofen users, and unchanged in non-users. This is statistically significant data that shows ibuprofen was increasing stress on body. The authors concluded that based on their findings, “we recommend caution in using ibuprofen and other NSAIDs during ultra-distance exercise events.” Nieman Study David Nieman, et al.[3] used the same study subjects and samples to analyze a different set of inflammatory markers. I think the most interesting thing that he did was to also set up a subjective pain-rating score for the athletes to use. The 10-point Likert scale for measuring delayed onset muscle soreness (DOMS) was used for the seven days following race completion. Statistically significant was the following study conclusion, “Ibuprofen use compared to non-use by athletes competing in a 160-km race did not alter muscle damage or soreness, and was related to elevated indicators of endotoxemia and inflammation.” The measured damage was seen in decreased capability of the kidneys to filter toxins properly (by measuring decreased urine creatinine, a typical test used to measure kidney function), and higher levels of blood inflammatory markers (interleukins, cytokines, and c-reactive protein: all indicators of inflammation and pain). Dumke Study Charles L. Dumke, et al.[4] likewise analyzed information gathered from Western States 2005. Previous data collected in other studies measured significant electrolyte disturbances while running and using ibuprofen. Dumke dispelled this information. Ibuprofen use did not, in and of itself, alter blood concentrations of key electrolytes such as sodium, potassium, chloride, or calcium, nor did it affect blood proteins. An interesting trend was discovered, however: longer running times, lower training volumes, and older runner age all correlated with lower sodium concentrations (hyponatremia) at the finish line, suggesting that the longer you are out there and the older you are, the more important it is to pay attention to electrolyte replacement. Take Home Information: The studies results in a lot of daunting scientific speak. I did my best to pare it down to an understandable discussion. I think there is some really valuable information to be gained from these articles, and I look forward to more studies being conducted in the future. Probably the most important point that is not discussed in these journal articles is the fact of listening to our bodies, and doing what we feel is right for them. As tough as we may be as ultrarunners, it is always good to hold a healthy dose of respect for the fragility of the human body. What has worked for us in the past may not work for us in the future, and something that we have never used before may just be the magic ticket to get us through our next race. Missy Berkel is a Nurse Practitioner from Salt Lake City, Utah and has been running ultras since 1998. She is running the Wasatch 100 in September. [1] http://runtrails.blogspot.com/2009/08/erik-skaggs-hospitalized-for-renal.html [2] McAnulty, et al. (2007). Ibuprofen use during extreme exercise: effects on oxidative stress and PGE2. Medicine and Science in Sports and Exercise (39)7. [3] Nieman, et al. (2006). Ibuprofen use, endotoxemia, inflammation, and plasma cytokines during ultramarathon competition. Brain, Behavior, and Immunity 20. [4] Dumke, et al. (2007). Ibuprofen does not affect serum electrolyte concentrations after an ultradistance run. British Journal of Sports Medicine 41.

Revising Training + Remaining Optimistic

I suppose this is sort of part II to my last blog. Given the nature of my achilles tendon and the almost stress fracture, I've been forced to change my entire 2010 calendar. Having come to terms with that now and accepted that I won't be at the Canadian Death Race this weekend (but sending loads of goodlucks to everyone that is) I've had to think about how/what will be the best way that I can prepare and be ready for this September when I head to Italy for the Tour des Geants - a 300km, non-stop, solo race on full on single track that will take me around the base of the highest four thousanders in the Alps! AWESOME!!

So with my new goal for this fall, I've been thinking about how I can best train given the nature and caution of my injuries that I must proceed forward with. I've been biking 12-16hrs weekly over the past 5-6 weeks so my MTB is strong. I've been on the SUP lots too, so upper body endurance is increasing once again. Last week I was able to test out running and it went pretty good. I did a 20min and a 30min with no pain during or the day after. This week I've done a 1hr, a 45min and another 30min, happy to report zero pain. My confidence is returning slowly but surely. Each run I've focused entirely on quick cadence with a midfoot strike.

Gutted that I had to pull out all my A ultra's this summer, I'm trying to determine what will be best for Italy. I was so looking forward to the CDR and even though I don't think that I have lost any fitness, I know that there was no way that I could go and run 130km without having run in 6 weeks. That would probably just lead to re-injury. So, because I have been multi-sporting, I've maintained fitness and endurance and probably above all else, stayed mentally sane. Team Technu recently asked me if I would come join them in Lake Tahoe for a 24hr adventure race. With not being at the CDR and my weekend suddenly free, I thought why not. This would still give me a solid 24hrs of training but would not be entirely on foot. The run/trek sections will be dispersed throughout the race and it will be a good test to see where I am at. In addition, it will give me some sleep deprivation training, something that I haven't had to utilize since last October at World AR champs in Portugal. So, here I am now in Tahoe. After a 2 day drive down, I'm now prepping my gear and enjoying some California time. The race gets underway tomorrow at 8am. Check out Big Blue Adventure Race.

Unfortunately, I will be racing against my team, DART-nuun Sport-Multi. Having thought that I would be at the CDR, the team had to find another female. However, I will return back to California in 2 weeks time to race with them at Gold Rush.

All in all, I am feeling positive about the progression of my injuries and the rest of 2010 for racing and adventuring. I've decided to not stress over missing the CDR now as there are so many other races to go and tackle out there. I can't wait for Italy and my return to ultra running. I've had so much support from people in regards to this difficult time that I can't say thanks enough. I've recently become an Aunty too, and so despite having a very challenging entrance into this world, little Ela is my newest inspiration. She has put life back into perspective for me so I thank her for that.

I've been ticking some items off of my Bucket List too so I will share that shortly. Some good things do come injury I suppose :)

I hope everyone is enjoying their summer, adventure onwards.....

Not EXACTLY as planned....but it's all HOW you view it!

It’s not with great excitement or awesome news that I get to write this blog entry. The last 4 weeks have been extremely challenging, forcing me to learn patience, set new goals and remember that life does not always unfold as one wants.

I set my calendar for this year with the hopes of checking off some incredible races on my bucket list. I was so keen to turn my attention to some of the great races here in Canada and I gotta say, we have a few. Originally, I thought that the first part of 2010 would be ultra running focused and then I would transition into some multi-sport by the end of summer in order to prepare for world champs and some other team races. Training was going great. After coming home from Salomon Advanced Week in France this spring, I was motivated and just couldn’t get enough of blasting around the Squamish trails. I was thankful to be home after a winter up north. However, my achilles injury from last year decided to return as I slowly pulled out all the cross training (ie – bike workouts) from my training plan with the hopes of being more sport specific. On the plus, training was going great. I was starting to climb with power once again and had really improved my cadence and leg turn over on the flats, something that has always been a weakness for me. Eventually though, I realized that this damn achilles issue has become a life long chronic problem and I could only push through it for so long. I had been in full “management” mode for about 16 months, getting regular weekly treatment and starting off every run in pain. But, when you are doing something you love, it’s hard to quit. I had big plans for this year and there was no way that this stupid injury was going to ruin things for me. And probably, had I not gotten the start of the stress fracture to my other foot, I would have just kept on going at this pace. Healthy to do that? No, not at all. Would I tell a client to stop? YES, for sure. I think my issue is that my pain box always seems to have room for a little more so I had willed myself to keep on going.

So this near stress fracture thing. Ya, what a pain. I won’t go into detail in this blog as to why that happened but to say in brief, my body started compensating as I ramped up my mileage and prepared for the Blackfoot Ultra, my first 100km of the year. Rrrrrrrrr…..I couldn’t believe that this was happening. I had already signed up for Sinister 7 and for the Canadian Death Race as well!! Trust me, this took a severe reality check to accept the fact that no, I wouldn’t be at ANY of these events this year.

Needless to say, I’ve been in a pretty big rut for the past months. Mentally I am struggling big time. When you can’t do something that you love, it’s devastating. I suppose we take our bodies for granted way too often, expecting them to always be 100% and ready to just go. I am healing though and fast at that, might I add. I haven’t run now in almost 4 weeks but I am cross training like a mad woman, biking 24/7, hitting the SUP and can you believe this, LEARNING TO SWIM!!!! Oh yes, that’s right. I’m swimming 4x’s a week now and loving it! Why have I avoided this for so many years? Not sure but I know that it will open up some future doors for me so that I can enter new types of racing!

So I guess that what I can tell you this: I’m trying to find the positives now in this injury. All good things can come from the bad right? I’ve got amazing sponsors who understand. I’ve got an incredible network of coaches, friends and loved ones who are supporting me. I’m staying focused on the road ahead! Things could be a heck of a lot worse, that’s for sure. Just to share some of the positives that move me forward each day:

1) I get to focus even more on all my awesome clients who are racing and adventuring – I get to live through them

2I get to watch lots of friends go out and tackle their own goals – I get to send support to them and reciprocate what so many people do for me

3) I’m learning to SWIM!!! And loving it

4) I’m learning to accept the notion of “change of plans”

5) I’m understanding more of the training systems that my body needs – I can’t just run but rather I must bike and cross train as well. With that said, I’m a multi-sport athlete at heart, I like doing it all!

6) I’m finding all kinds of cool races/events to focus on for the Fall + Winter

7) I’m spending more time on my businesses and the big adventure ahead

8) I’m doing all kinds of bike and SUP training sessions in awesome places, hence, checking even more things off of my bucket list

9) I’m growing as an athlete each and every day

To aid in this recovery process, I’ve started a VERY aggressive IMS treatment plan. It is working extremely fast. I continue to see Laura for massage and soft tissue release. I’ve increased my daily dosage of Udo’s Oil as well as well as Wheat Grass, MSM Joint Formula and am using Traumeel like there is no tomorrow. I am allowing myself more sleep. I’m done with dealing with pressing through injury. While my pain box has allowed me to do so much, I suppose it has been a detriment as well. Team mates know that once I start a race, I won’t quit. However, I want to be an example to all of you out there who are afraid to back off when something hurts. It’s ok to stop and address it. You will be happier in the long run.

So there you have it! That is where I am at in a nut shell. Each day I am one step closer to being back on my feet. I’ve still got lots of great things planned for the summer, not all involve racing but rather lots of great adventures. Come September, I will hit the road for Italy, Nevada and Spain for some epic races. October is filled with speaking engagements. November just might be the scariest challenge that I have ever undertaken.

I must always remind myself that those races will always be there for me to tackle, they aren’t going anywhere. I still got a lifetime to get everything in because what I do is a lifestyle, something that I have entered into by choice because of the happiness that it gives me. Training is not seen as “training” in my world, but rather as a chance to explore, challenge, experience!

Thank you to everyone for all your support, the road ahead looks AWESOME.

Tofino Running Camp Video

Thanks to Jacuqeline Windh who had her camera rolling during the 1st annual Challenge by Choice running camp that I put on in June. Here, she gives everyone a great look at beach running at it's finest and how incredible it was that our camp dates fit perfectly with the Summer Solstice. On the last morning of camp, a few of us set out for one last beach run while others participated in the Edge2Edge marathon.

The Morning Commute - Squamish Style

STANDUP4COFFEE

Summer Smoothie - Banana H20melon

I've been drinking the ultimate recovery/re-hydration smoothie these days. I make it in a 6 cup blender and then just drink it over a period of 4 to 5hrs. Seeing as I usually have at least 2 workouts in a day, I drink 1 cup before I head out for my first training session and then I drink the remainder before my second workout. I feel like this smoothy restores my energy levels and flushes out my body. Here is my recipe, cheers to good health!

3c WaterMelon

1 Handful spinach

1 Banana

2 TBSP Udo's Oil

1 TSP Wheat Grass

3 Dashes of Cinnamon

1 Scoop Vega Protein Powder

2 Sticks Celery

1 TBSP Hemp Hearts + Flax Seed (ground)

Fill the rest of the blender up with water