On Why We Exercise

When you’re an intern, you table your feelings, so to speak. By 9 am July 1, you become so laser focused on becoming a master of efficiency, on checking off check box after check box that you’ll look up and realize its April and start to feel just a tiny bit of emotion, which then starts to get overwhelming, and you quickly return to your checkboxes.

Answer the page, check the box.

Answer the page, check the box.

I feel similarly about exercise these days. Its become a checkbox in a sense. I can still wax philosophic on why I run (or go to spin or pilates) and I genuinely think I do things for the right reason. However, as an intern, exercise has become a bit of a compulsion for me, an emotional crutch that I lean on heavily to provide a sense of normalcy in a fairly hectic life. Its something I’ve always done (dance, gymnastics, tennis, swimming, softball, soccer, so on and so forth) and I genuinely like it.

#tbt 1996

#tbt 1996

However, since I’ve started intern year, I’ve been a goal-less exerciser, for the first time in my entire life. I’m  not trying to become a stronger gymnast, a better tennis player, or a faster runner. I’m….doing something I love to do.

And, this got me thinking…because the prerogative of millennials is to overanalyze our happiness instead of just being happy. Right?

Fundamentally, I think I like to work out a lot because its fun, it makes me feel better, and, most importantly, I am deathly afraid of the following: hypertension, hyperlipidemia, diabetes, coronary artery disease, strokes, heart failure, not feeling my feet from diabetes, kidney failure from high blood pressure, and so on an so forth.

And, because I've met my best friends through sports...

And, because I’ve met my best friends through sports…

And, to be honest, “exercise gives you endorphins, endorphins make you happy, and happy people just don’t shoot their husbands” – truer words have never been spoken. I’m pretty sure Malcolm Gladwell could find an association between exercise and crime rates.

At the end of my analysis, I determined that if we get to the root of the issue – besides the “I like it” part and the “I’m terrified of coronary artery disease” part – there are really two reasons I exercise: body function and body image.

Which one is more important to me? I can’t figure that one out.

Let’s back up a little bit.

First, meet Chainsaw and Jaws (yes, those are their names – sort of):

 

Aka "Chainsaw" Photo Credit: Flex Studios

Aka “Chainsaw” Photo Credit: Flex Studios

 

[Sorry you guys, I took these pics off the internet. Don’t hate me.]

I think I’ve spent what equates to a small wedding fund going to both of their classes this year (pilates for Liz, spin for Jaws) mostly because I like their classes and partly in an attempt to look like them. [And partly because this winter was terrible and I was not into running in the polar vortex with ice on the ground if I could help it.]

This weather is more up my running alley.

This weather is more up my running alley.

Unfortunately, thus far, osmosis hasn’t worked. Science is really letting me down.

By the principle of osmosis, shouldn't the higher concentration of abs spontaneously migrate to the lower concentration of abs? Yes?

By the principle of osmosis, shouldn’t the higher concentration of abs spontaneously migrate to the lower concentration of abs to create an equilibrium? Yes?

I also take their classes (and others…and run) because I want my body to be able to do the things I want it to do. I want to be able to run marathons if I want to…or to work 80 hours a week on a labor floor without collapsing.

As I said in my last post, I’ve done some  double/triple spins and run/pilates or run/spin or pilates/spin combos. So, if my body can conceivably do what I want it to do, why do I care exactly what it looks like? If can run a marathon, why am I mad at science for 6-pack osmosis not being a “thing?” If I can work 80 hours a week, run, still fit into my clothes, and not collapse, why do I keep interrogating Lauren on “how she does it.”

Seriously, Lauren. What do I have to do? Birth a child 10 months ago?

Seriously, Lauren. What do I have to do? Birth a child 10 months ago?

I don’t know either. The answer escapes me, like the concept of the iCloud.

[Seriously, you all, what is and where is the iCloud.]

Just some food for thought.

I probably won’t figure out the answer (like I’ll never understand the concept of the iCloud), but I’ll keep working out because I like it and the way it makes me feel. Do my part in decreasing the crime rate. Because, in the end, we really do this because endorphins make us happy, right?

TELL ME: BODY IMAGE VS BODY FUNCTION – YOUR THOUGHTS – GO!

Until next time…

 

 

 

 

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Humbled: Pilates

I like to think that I’m in good shape.

I’ve run some marathons. Qualified for Boston. I can do 3 spin classes in a day (although not a regular thing). Maybe throw in a barre class here and there.

Yeah! Running! I can do that!

Yeah! Running! I can do that!

And, then I took pilates with Elizabeth (aka Chainsaw? Just go with it) at Flex today.

It was humbling, slightly embarrassing, and I’d probably now just consider myself in “good cardiovascular shape.”

I pride myself on being really tough and able to handle really hard classes because, you know, I’ve run marathons! I’m a resident! What’s harder than a marathon?! Or harder than a day on the labor floor?! Nothing! I should be able to handle anything, right?

Pilates. Pilates can be harder than a marathon.

You know a class is hard when you’re going to the 5K pain place, sweating to death, and actively thinking of ways to possibly cheat (yep, I went there). In fact, at one point I tried to some something on my knees rather than in plank position and Elizabeth every so sweetly came over and said, “honey that’s not going to do anything for you.” No slacking allowed. I was getting my money’s worth. [PS: Thanks, Elizabeth!]

As a bonus, the whole reformer thing makes it not so easy to take breaks. One wrong move and I was afraid I might plummet 3 feet straight down into the well of the reformer into Pilates hades.

I was shaking. I was sweating. Like all those laboring patients I see, except I wasn’t birthing a child.

And, for some reason, I loved it.

It was extremely humbling. I knew I lacked core strength but this class really drove the point home.

I only wish I had known about this class when I was training for marathons and trying to do anything (acupuncture!) and everything (chiropractor!) not to get injured.

Elizabeth was super sweet, gave great technical corrections (the former gymnast in me always loves this), and doesn’t allow you to give up (even if you try, like me).

So, moral of the story — Go! Take her class! Bring your A game! Moreover, bring your abs.

TELL ME: YOUR FAVE NYC FITNESS CLASSES AND/OR INSTRUCTORS.

Currently, I’m loving Jaws and Akin at SoulCycle and just took a class at Chaise 23 with Rachel and loved her, too.

Until next time….

Living On The Wild Side

Almost – 28 years and I’ve finally found that wild streak that I was supposed to have in my teens…

[Of note, I’ve always been a general homebody and fear a “bad reputation” or “getting in trouble” like the plague or Ebola virus. My parents never set a curfew for me in high school because they knew I’d be home by a decent hour because I like to sleep. Always a schedule to maintain! Because being 17 was really tough with that “homework” done while watching TV….]

I’m taking a test next week that I haven’t studied for.

Step 1 studying…the good ol' days...

Step 1 studying…the good ol’ days…

I’m running a half marathon in two weeks and haven’t run over 7 miles at one time since…the marathon!

IMG_0877

[I am, however, experimenting with what I’m calling the SoulCycle training plan. I’ll report back about how well that worked. ]

Next, I plan on doing something really crazy – like trying unpasteurized cheese.

For a brief overview of the SoulCycle “training plan,” suffice it to say I’ve done a lot of classes and done a good bit of “doubles” to count as “long runs.” It remains to be seen if this helps maintain running fitness. I really just trying to make it through this half marathon (Miami! With Gia! And KScott!) rather than race it so I think my “training” should work for that purpose.  I do think SoulCycle helps maintain aerobic fitness, stimulates the neuromuscular system because the pace is usually quick, and is a good core workout because you have to support yourself out of the saddle so much.

I'm pretty sure the grapefruit candle  has some sort addictive scent that keeps you coming back...

I’m pretty sure the grapefruit candle has some sort addictive scent that keeps you coming back…

If you’re curious, my fave instructors as of late (there are many I like) are Jaws, Sydney, and Bethany.

Jaws’ class is full of really good technical corrections so you get the most out of it and has a good baseline level of resistance so you always feel like you’re working. She usually has one song that you jog the whole time and its feels like 1k repeats to me. She also rides the whole class (which is super tough) so I’m always very inspired to keep working really hard since she’s doing the same thing AND talking.

Sydney’s class usually has something new and different (big hill with a sprint in it and then using the weights on the hill) and her energy is fantastic. She’s having so much fun that you’re having fun. She’ll push you really hard but you’ll be smiling the entire time. It’s awesome.

Bethany’s classes are always emotionally on point. One time she played Kris Allen’s “Live Like You’re Dying” and I’ve never felt more inspired to like…live life…and stuff. Maybe I was just really tired and hit me. Regardless, Bethany’s classes are hard, the cues are on point, and one time I wanted to scream “I LOVE EXERCISE” after her class I was on such an endorphin high. I refrained.

[On another note, being on nights for a month will make you super emotional and want to scream things like “I LOVE EXERCISE” in a room full of strangers.]

[For the public record, I’ve taken one of Akin’s classes and it was the hardest arm series ever. I’m also a big Danny, Ben T, and Madison but haven’t taken them in a while.]

Plus, during a polar vortex, SoulCycle is warm!

Anyways, that’s all for now.

TELL ME: HOMEBODY? WILD CHILD? FAVE SPIN CLASS AND INSTRUCTOR

Until next time..

 

 

Contemplating a Coach? Here’s Why I’ve Had One

In my [copious amount of] free time, I’ve noticed a lot of talk on Twitter, running blogs, and such about running coaches. Why would anyone get one? Is it worth it?

Steph took me on as her charge in November 2010 and I’ve kept her as the head of my running brain trust since. That poor girl has put up with far too many neurotic emails for what I’ve paid her.

Steph, this is what you're working with. Good luck! :)

Steph, this is what you’re working with. Good luck! 🙂

I originally approached Steph with a very specific, calculated plan in classic Meggie Smith fashion (ie very specific and detailed). I wanted to qualify for Boston in the spring of my 3rd year of medical school (New Jersey Marathon 2011) in hopes of running Boston 2012 right before I graduated medical school. Check it off the life checklist [because life always follows a neat and linear checklist-like plan, right?]. To be honest, I initially thought I’d have a coach through NJM 2011 and then I’d go on my merry way.

My guiding principle in life. The almighty checklist.

My guiding principle in life. The almighty checklist.

Turns out I didn’t qualify for Boston in 2011 (or 2012), I really liked having Steph has my coach, I took a year to do research in infertility, I decided I hated the marathon, then decided I liked it again, and finally, by some stroke of luck, actually qualified for Boston right before I graduated medical school.

Boom! 2.5 years and I finally got it.

Boom! 2.5 years and I finally got it.

[Wow, Steph, you’ve been through a lot with me!]

Steph, what's harder: coaching me or this workout?

Steph, what’s harder: coaching me or this workout?

The cash flow as a med student is slim to none (or rather retrograde seeing as you are paying tuition) so there were plenty of times where I financially questioned keeping her on. Luckily, I was able to pick up enough babysitting and tutoring jobs to make it work, but below outlines many of the reasons I came up with to keep a running coach.

Steph and her groupies

Steph and her groupies

In the end, the decision was always fairly simple. Running made me happy and training to become a “better” runner made me even happier. And, we should invest in our happiness, right?

[Unless it’s cocaine or cigarettes that is making you happy. Then, please, don’t invest in that.]

WHY I’VE HAD AND KEPT A RUNNING COACH:

1.  EXPERIENCE + 2. OUTSOURCING OF THINKING + 3. TRUST/DOUBT ISSUES

My first three reasons for having a coach somewhat go hand in hand so its hard to talk about each separately.

Let’s get real. I’m not training to run a world record or become the next Mary Cain. I could, indeed, read a book or follow an online training plan.

What does reading a book require? Time! And time is money in my world.

You know what else I don’t have a lot of? Running experience. I’ve played thousands of tennis matches since I first started competitive tennis at 14 years old. There are certain elements of the game that you only learn through experience; those unteachable tricks, tips, and expertise that you take for granted once you know them. I imagine running is the same. Steph is the experience I lack and the expertise that I need.

Last, as a member of over-thinkers anonymous, sure I’d read the book, but then I’d spend a month thinking “should I do this workout or that workout” or, we’re getting even deeper here now, “what physiologic system is this working and am I working the right one?” I’m sure I’d wonder if I was pushing myself too hard or not enough. I’d probably doubt what I was doing constantly and change my plan more than Taylor Swift changes boyfriends.

Knowing me, I’d make the process of coming up with a training plan way too complicated and time consuming. Solution? Have an expert do it for you.

Boom! Plan handed to you. Time and mental energy reserved for other things. Plus, if you trust your coach (which I do), its fool proof! Follow the plan and you can’t fail (or, at least, my chances were minimized versus making my own plan).

With two of my running faves, Steph and Gia. And, looks like someone forgot their sunnies!

With two of my running faves, Steph and Gia. And, looks like someone forgot their sunnies!

4. ACCOUNTABILITY

This is one I don’t struggle with that much. If you give me a plan or list, I’m fairly good at following it [translation: slightly neurotic about following it]. However, on days where my motivation waned, having someone to report back to (albeit virtually) usually gave me whatever kick I needed to get out the door. Plus, let’s get real – if I’m paying someone to give me these workouts, I’m going to do them. Not doing so would be like having a gym membership and not using it (ie throwing money down the drain).

5. TO SEE IF I COULD BE BETTER THAN I EVER DREAMED

I think this is probably the real, subliminal reason I’ve had and kept a running coach. When I first started running, I always thought of myself as “destined to be a slow runner” (sometimes still do). I figured the best I could get was hobby jogging. My reasoning? If I didn’t like running for the first 23 years of my life, I probably wasn’t very good at it, which is why I never picked it up as a kid. And, I was very happy with that [hobby-jogging] for a while.

Hobby jogger no more...

Hobby jogger no more…

Somewhere along the way, I remembered that at some point, I was a pretty good athlete. I had fleeting thoughts that maybe, if I put some work in, I could translate that athleticism to moderately good running. Keep up with my friends. See how fast I could get.

Turns out, with a little work, I became faster than I ever really thought when I first got Steph as a coach. It’s been fun to sort of discover myself as a runner with her by my side.

So, thanks, RC!

So, thanks, RC!

While I may have reasoned keeping a coach in a very linear fashion (I pay a you, a professional, to render me a service), I like to think that the coach-athlete relationship I have with Steph is a bit more complex than that. I like to think (I can’t speak for her, obviously!) that Steph is somewhat invested in my success and accomplishments; that we’re more of a team than a purely business relationship.

Steph’s belief in me has often been more than I’ve had in myself. A lot of times, that’s my mental “wild card” in races — if Steph believes I can do something, I should, too.

PrePostRCNew

BOTTOM LINE: Having a coach has saved me time, mental energy, and has made my running and racing experience that much richer. 

TELL ME: HAVE YOU HAD A COACH? WHY OR WHY NOT? WERE YOUR REASONS SIMILAR TO MINE?

Until next time…

Marathon Game Changers

The Eugene Marathon 2013 wasn’t my first time in track town. I went last year…twice actually. Once for the whole Eugene Marathon weekend (I ran the 5K) and then for #totallytrials with Oiselle. I distinctly remember watching SarahOUAL, Sweaty Emily, Faster Bunny, Skinny Runner and company all tear it up in Eugene, yet all I was thinking was “thank God that isn’t me.” I swore of marathons and found a new friend in 5Ks and 10Ks.

"5ks are rad. The marathon is stupid."

“5ks are rad. The marathon is stupid.”

Now, a year later, I’m all “the marathon is magical and you’ll find unicorns on the course and forest fairies and it will be amazing so just keep running forever and ever and ever.” In fact, if running and I were in a relationship, we’d be on our honeymoon in Fiji, where it’s beautiful even when its monsooning.

"Unicorns do exist!"

“Unicorns do exist!”

What changed? Probably just finding running friends who helped me like running for intrinsic reasons versus extrinsic gain. But, I’ve been thinking about a list of “game changers” in the past year that helped me go from marathon hater to BQ’er.

I owe my marathon love to these girls.

I owe my marathon love to these girls.

CAVEAT: I’m not going to impart any words of wisdom that aren’t already out there in the universe. I’m not going to tell you any brand new information. These are just the few things that worked for me and, hopefully, can help you, too.

1. LEARNING TO TEMPO

Tempos aren’t might strong suit. Or, at least, in the past they weren’t. I used to freak out over hitting paces EXACTLY (I’m very literal and specific with most things) and a deviation in a few seconds would derail me (it sounds silly now). I used to stop very frequently during tempos, which I’m fairly sure is against the whole point of the run. Taking breaks during a harder effort isn’t exactly confidence boosting for a race either. There are time outs in a race.

I used to think that each workout need to be great – spectacular even – to produce a good result in a race. About a year ago I changed my whole attitude. I told myself that I didn’t need to be great, I just needed to be consistently good. And a lot of good workouts would lead to a great race.

FinishLineMedal:Smile

So, before tempos, I’d tell myself to “just be good” and to “not stop.” A good many were slower than I would’ve liked, but I didn’t stop. And then not stopping became routine, rather than the reverse, and I found myself running a 6.5 mile tempo nonstop by September.

The whole “learning to tempo” bit not only helped improved the physical systems that it works (I don’t know what these are, this is why I have the RC), but it also helped my mental focus. Focus upped my marathon game for sure.

2. LEARNING TO USE THE GARMIN AS A TOOL AND NOT A SLAVEDRIVER

When I first got a Garmin, I’d try to run to make the Garmin say something. For instance, I’d want to make it say 8:10/mile during a tempo. If it was too slow, I’d try to make it say 8:10/mile even if that meant stopping because it was too hard for me at the time.

I’m not sure which the mental switch occurred, but sometime last fall or this spring I got good at using the Garmin as a tool. I’d run the pace at which the effort felt appropriate for the what the workout called for. And the Garmin would tell me what that was. It’s a really subtle difference that is somewhat hard to articulate, but, basically I dictated a run, not a Garmin.

"Yes Garmin! I'm in charge! I didn't care that you told me I ran a 6:50 mile for the first mile!" That one didn't turn out so hot. Maybe I should pay a tiny bit more attention to it...

“Yes Garmin! I’m in charge! I didn’t care that you told me I ran a 6:50 mile for the first mile!” That one didn’t turn out so hot. Maybe I should pay a tiny bit more attention to it…

I’ll even wear a Garmin in a race now as I know I won’t have any mental breakdowns over it. I can see a pace during a race, but won’t mount an emotional response to it until after.

I’m not even sure if the above makes sense. Just go with it.

3. NUUN

I drank a lot of nuun before and after both long runs and the marathon itself. The discovery of banana nuun while in Eugene was clutch. Although I’m drinking more banana nuun now than I care to admit.

I don’t drink nuun while I run mostly because I don’t carry my own water (in case you were wondering).

I, too, was a banana skeptic. I am now a convert.

I, too, was a banana skeptic. I am now a convert.

Read this study on how under-hydrating affects your run the next day.

4. INTRINSIC MOTIVATION

I started running in 2009 and started taking the “getting faster” thing more seriously in 2010. I have no idea why, but for a long time I felt like I need to prove myself as a “good” runner, mostly to myself. I think I doubted my abilities for a long time and wanted race times to show me that I was a runner (vs runner-poser?) and, maybe, an “average” or “above average” one at that. [What the definition of “average” and “above average” runner is, surely, subjective.]

More1

For a while, I think I wanted a BQ to prove something to myself, to show myself that I was “good” or “above average.” Sometime this spring, my attitude changed. I wanted a BQ because I knew I was those things – “good” (to me) and “above average” (again, to me). I started thing about myself differently as a runner, as someone who was capable and strong. This sounds terribly conceited, but, in other words, I wanted a BQ because I knew I could do it not because I wanted to prove to myself that I could do it.

[If that makes any sense whatsoever.]

5. JOY AND FRIENDSHIP

I wouldn’t have even signed up for two marathons in the past year if it weren’t for Gia and Jocelyn. Both run marathons because they love to run and it brings them a lot of happiness. And they showed me that I could learn to love the distance and have more fun than I could have imagined training for it.

So thankful for my #sisterinsport Gia - friends make a workout fly by! After 6 x 1 mile on a cold day in February!

So thankful for my #sisterinsport Gia – friends make a workout fly by! After 6 x 1 mile on a cold day in February!

We're running 20 miles! Who's excited?! Who's scared?!

We’re running 20 miles! Who’s excited?! Who’s scared?!

Now, let’s get real. The stars aligned for me in Eugene and, of course, it’s very easy to say “of course I could do it” after the fact. I was definitely a tiny bit doubtful leading up to the race. It’s a marathon after all. It’s a long time to run. A lot can happen in 3 hours (I mean, in Titanic, Rose and Jack fall in love and Jack dies all in that span of time). Could I have run 3:38 or 3:45 that day? Absolutely. But, I knew deep down before this race that I was trained to run 3:33-3:34 because of the above mentioned aspects IF everything went right on the day. I’m lucky it did.

TELL ME: GAME CHANGERS FOR YOU AND YOUR RUNNING?

Until next time…

 

The Lucky Ones

Was this the title of a movie lately? Maybe a Nicholas Sparks book? Well, anyways…

I’m still riding the marathon high and post-marathon depression hasn’t hit, yet. This is fantastic because the Dance Moms season finale was last night and the two compounded together could have easily sent me into despair.

Let me tell you marathon + friend endorphins are crazy. I slept maybe 4 hours Sunday night and only drank maybe 3 oz of coffee on Monday and I made it through the whole day. Can someone bottle this stuff for residency?

I think I need a temporary tattoo intervention...

I think I need a temporary tattoo intervention…

I can’t remember if I blogged a whole lot about training for the Eugene Marathon, but there were two overarching themes to the whole “season,” if you will…

First, it was always fairly easy as I felt like “one of the lucky ones.” And, second, I finally felt like a long distance runner and not just someone who likes to exercise and sort of likes to run long but not really that long because it gets old after a while.

In training for past marathons, I’ve definitely had a good many runs where I was complaining, scared of the workout, didn’t want to run 20 miles, and so on and so forth. That didn’t happen this time. This came from two changes in my outlook: 1) I realized this was sort of the last hurrah for hard training for a while and 2) I realized how lucky I was to be doing this.

Two of my friends, Jocelyn and Ali, got fairly (or very) sick this spring. Both haven’t been able to run as much as they would have liked (or, sometimes, at all).

Ali running last fall. Ali, I had to steal this pic of the internet of you. Hope that's ok...

Ali running last fall. Ali, I had to steal this pic of the internet of you. Hope that’s ok…

Jocelyn. A doubt you've seen her on this blog before.

Jocelyn. A doubt you’ve seen her on this blog before.

Seeing them being “taken out of the game” under circumstances fairly out of their control made me realize how lucky I was to have three things align: my health, my motivation to train, and the time to train. It’s not often that those three stars align and I realized that I was pretty much one of the luckiest people in Manhattan to be able to say I had each of those three things.

There was a distinct moment in a workout where this felt all too true. I was doing 3 x 2 miles on the track, which is a pretty hard workout, I think. I was in the midst of my 2nd one and Jocelyn, who was on her first runs after having to take about a month off, came up to the track. I thought how much Jocelyn would probably want to be in my position (well, maybe, can you vouch for that, Joc?) and that I got to be the lucky one to be doing that track workout.

And then I also got my own paparazzi for that workout...

And then I also got my own paparazzi for that workout…

On top of the “lucky” feeling, I also had this sort of “I feel like a marathoner” moment after one of my long runs. In the past, I’ve never been one to really love the long run. Its long (duh), can get a bit monotonous and boring, and it takes a chunk out of your weekend. This time around I was lucky enough (yet again) to have buddies for most long runs, making them more effortless than usual. In particular, on my 18 mile run two weeks before the Eugene Marathon, I ran two loops of Central Park during the middle of that run. The hills on the first loop felt a bit laborious; those on the 2nd loop felt like a breeze. It felt like the run got better as it went along, like mile 15 was more effortless than mile 5. It was the first time I got what so many of you like about the long run and made me think that this marathon might actually go pretty well.

During that long run...

During that long run, loop 1. Thanks, Lora, for the photo!

Same Run, loop 2

Same Run, loop 2. Thanks, Lora, for the photo!

Those two things made this marathon distinctly different than the others.

I promise I’ll stop being so nauseating soon. I’m probably peaking in life right now – no real responsibilities, healthy, and people are basically congratulating me on existing. Fourth year of med school is the bomb. Talk to me in August and the unicorn won’t be so glittery anymore. It’ll be probably more like an angry mare.

TELL ME: BEST TIME YOU’VE EVER HAD TRAINING FOR A RACE? UNRELATED – HAVE YOU EVER PAINTED AN ENTIRE APARTMENT AND SHOULD I ATTEMPT THIS MYSELF?

Until next time…

On Synthroid and Elite Athletes

Recently, an article was published in the Wall Street journal that has really got me thinking.

The article profiles “US Track’s Unconventional Physician,” an endocrinologist by trade who has treated several high profile athletes for “subclinical hypothyroidism.” To summarize the article, typical TSH (thyroid stimulating hormone) cut-offs are around 5, depending on your laboratory, and, I presume, depending on the signs and symptoms of the patient. Dr. Brown, the physician profiled, considers his threshold to be 2, meaning that, to him, a TSH of 2 combined with symptoms means an underactive thyroid. He has been prescribing synthroid (thyroid hormone replacement) for some athletes he has diagnosed with hypothyroidism…with good results…15 Olympic gold medals and counting.

By sub-clinical, the medical establishment means that the patient’s free T4 (thyroid hormone itself) is normal, while the TSH is elevated or slightly elevated.   To my best understanding, this is a somewhat newer disease entity that has not been as well characterized or protocolized in treatment schemes. In addition, one could argue that a sub-clinical case is actually a future overt hypothyroid patient waiting to be found and supplementation should be started to prevent any adverse effects of the disease. However, as a caveat, I am just a medical student and not a board certified endocrinologist or even a doctor (yet), so, I would take what I write here with a grain of salt (and I’m also writing this a fairly quickly, no time for editing!).

Now, to be clear, I am not an endocrinologist nor am I a professional athlete, so I really have no dog in this fight. But, I did read the article with a keen interest as “curious observer.”

Here are the questions that popped into my head as I read:

1. What is the mechanism of this disease? 

The most common cause of hypothyroidism in the US is Hashimoto’s thyroiditis, an autoimmune disease in which you have autoantibodies against certain proteins in the thyroid gland (for example, thyroid peroxidase). However, seeing as autoimmunity was not mentioned in the article, my best guess would be that hard training suppresses the hypothalamus, which is upstream in the chain of events in stimulating the thyroid gland (hypothalmus secretes TRH–> pituitary  secretes TSH –> thyroid secretes thyroid hormone), somewhat like how anorexia can cause you to stop having a period (hypothalmic suppression then suppresses the menstrual cycle).

2. Is this effect reversible when the person stops training if he is claiming that it is the hard training that is suppressing the thyroid?

Or, stated another way, is this a temporary under-active thyroid? Or have they permanently lost thyroid function?

IF my proposed mechanism is what Dr. Brown or others was thinking, then is this effect reversible when not in a hard training mode and did has anyone retest TSH at that time to see? [If anyone has any papers on this, please send along! Not enough time for a thorough literature search tonight…]

3. Do the athletes stay on synthroid (thyroid hormone replacement) after they are done competing?

Excess thyroid hormone isn’t without consequence! Unless you like heart arrhythmias (atrial fibrillation in this case) and accelerated bone loss…

4. Has anyone suggested that this is due to some sort of immunosuppressive process and, if so, is it somehow linked to the seemingly increased rates of gluten intolerance in elite runners?

I actually have no data to back up that gluten intolerance claim it just seems that nearly every elite runner that I’ve met (which is like, what, 5?! really making a claim on nothing here) is intolerant to gluten.

Just an interesting thought to me…is there something about hard training that abnormally affects physiology to make these people susceptible to depressed thyroid function and gluten intolerance? However, these might be “true, true, unrelated” – both entities found in elite athletes, but in no way related in how they come about.

5. Does this constitute a new performance enhancing drug?

And, here’s an ethical issue I’m not sure I want to add my opinion to, seeing as I’m not a professional endocrinologist nor athlete and really have no place giving an opinion.

Surely, if you need replacement therapy (if you have Hashimoto’s, if you had your thyroid gland surgically removed) it isn’t “performance enhancing” as you do need thyroid hormone to live.

However, is adding replacement to someone who may not necessarily be hypothyroid, but is tired and has a borderline TSH constitute using a performance enhancing drug? I’m not really willing to say without knowing more information. Also, who isn’t tired? Were these athletes having more symptoms other than fatigue?

It’s just an interesting idea to ponder.

6. If Dr. Brown is right, are we missing an entire population who needs hormone replacement? Should you replace hormone in, say, a 35 year old male with a TSH of 3.5 who is a little tired, but isn’t an elite athlete?

Anyways, speaking of tired, I need to settle down the brain, read some on gynecology, and go to bed.

TELL ME: THOUGHTS ON THYROID HORMONE REPLACEMENT IN ELITE ATHLETS? PERFORMANCE ENHANCING OR NOT? MEDICALLY NECESSARY? IS THE MEDICAL ESTABLISHMENT MISSING A WHOLE GROUP OF PEOPLE WHO ACTUALLY NEED THYROID REPLACEMENT BUT CURRENTLY AREN’T GETTING IT?

Until next time…