All Runners: No Immunity from Heart Disease

The circumstances surrounding Micah True’s untimely death while he was out on a routine 12-mile trail run in the Gila wilderness area of New Mexico have caused many runners to look inward…to their own hearts. According to the Associated Press, “While medical examiners couldn’t point to the cause of the heart disease, they said True’s left ventricle, the chamber of the heart that pumps oxygenated blood to the rest of the body, had become thick and was dilated. That can result in an irregular heartbeat during exertion.” Despite all the training and miles logged, runners everywhere are nervously asking themselves: Is my own ticker also faulty?  Do I need a check-up? Should I even give up running? While the official autopsy report for True called his death “natural”, that word is loaded with multiple meanings and interpretations. In the following article, Dr. Phil Maffetone examines more closely the subject of heart disease, chronic inflammation and what it means for the endurance athlete. –NRC


Endurance Athletes: No Immunity from Heart Disease

by Dr. Phil Maffetone

Heart disease is preventable. It even occurs in runners. In the 2008 U.S. Olympic marathon trials, Ryan Shay collapsed and died about five miles into the race. There have been many others—some survived, like Alberto Salazar, and some didn’t, like James Fixx.

Inflammation is a major problem in the hearts of some athletes competing in long events. It’s another factor that raises the risk of bodily damage or even death. Recently, Laval University’s Dr. Eric Larose presented his frightful research findings at the Canadian Cardiovascular Congress 2010 in Montreal. He followed a group of 20 marathoners, 14 men and 6 women, ages 21-55, before and after their race. He showed that racing was associated with an inflammatory condition that raised the risk of death seven times that of normal. Most of these runners had significant inflammation that reduced heart function, with dehydration contributing to the problem. While these runners all recovered by their three-month follow up evaluation, this appears to be an indication that many runners have serious inflammatory problems under the stress of competition.

Chronic inflammation is a problem I’ve seen too often in endurance athletes when I was coaching. In addition to avoiding the stress of overtraining, balancing the intake of different types of fats can prevent abnormal inflammation.

Sometimes the chronic inflammation is subtle, and other times more obvious. In addition to being associated with physical imbalances and injuries, it can affect the rest of the body too, including the heart. Not all endurance athletes have this risk. In Larose’s study, only one runner did not have the inflammatory problem. This appears to be the same ratio in athletes I initially examined—the vast majority had some level of abnormal inflammation.

Chronic inflammation is commonly caused by dietary imbalance, which comes from two areas.

– Consuming an imbalance of dietary fat: too much omega-6 (especially vegetable oils) and too little omega-3 fats can cause chronic inflammation.

– Consuming refined carbohydrates, including sucrose, maltose and most other sugars, which are high glycemic, increase insulin. Elevated insulin levels cause many omega-6 fats to convert to chemicals that produce inflammation. (This does not include carbohydrates consumed during races as this does not produce high levels of insulin.)

All these issues are discussed in The Big Book of Endurance Training and Racing.

Larose’s study did not factor in how aspirin and other NSAIDs affected the heart and inflammation. Unfortunately, many endurance athletes consume these drugs, especially before and after a race, despite the damage they do and the lack of clinical effectiveness.

An important indication that your fats may be out of balance and your risk of inflammation is high has to do with how aspirin or other NSAIDS affect you. These drugs often provide many people with symptomatic relief of pain—but not everyone. If you do get relief from these drugs, it may indicate your fats are not balanced and chronic inflammation exists. That’s because the primary action of these drugs is to artificially balance fats for you.

While the media usually won’t publish stories about balancing dietary fats, they often write about studies that show certain anti-inflammatory drugs can reduce the risk of heart disease, and other conditions including cancer. But drugs such as aspirin can be a double-edged sword—helping a part of you while hurting another. Consider these examples:

– Patients with heart disease are often prescribed daily aspirin after a heart attack. The reason for this is that aspirin “thins” the blood; it reduces the aggregation of platelets contained in blood vessels. Studies show this can lower the risk of a heart attack or stroke by 22 percent compared to those not taking aspirin. However, studies also clearly show that many patients taking aspirin can have a four-fold increased risk of having a second heart attack.

– In the case of asthma, a condition associated with chronically inflamed airways, taking aspirin (and other NSAIDS) may not help. In fact, studies show that up to 70 percent of these patients may not tolerate aspirin. Moreover, aspirin can actually cause asthma in some people. Studies show that aspirin-induced asthma is due to an alteration in the balance of fats.

– The use of aspirin in preventing colorectal cancer has been highlighted by the media for years. But a recent study by Alaa Rostom, M.D., and colleagues from the University of Ottawa in Canada showed that, while some studies demonstrate reduced risk of cancer, others do not. So the results are not conclusive.

– An overlooked factor in aspirin use in relation to preventing disease is cost effectiveness. This has to do with the drug’s side effects. Studies show that the use of aspirin in colon cancer, for example, is not cost-effective. This is due to the high expense from complications of the drug’s side effects. These side effects include internal bleeding and ulcers.

Balancing dietary fats not only can reduce chronic inflammation, but reduce the risk of disease, and control pain. In addition, it can help with recovery from training and racing, prevent and correct many injuries, and improve athletic potential.


This article originally appeared on Dr. Phil Maffetone’s website.

7 Responses to “All Runners: No Immunity from Heart Disease”

  1. Aside from dietary factors, inflammation is more often as a result of glutathione being depleted. Glutathione, among many things, is the body’s major anti inflammatory agent. Yet few people recognize this fact as they keep trying to invent new medications like Ebriel, promote various herbs and so on to diminish inflammation. More information at

  2. Jim says:

    So… looks like the take home point from this article is to cut back on processed foods and eat foods rich in omega-3s? Feel like I already do that. Was there anything else I missed?

  3. Matt says:

    A very interesting piece. Yet I’m trying to get a sense of how this can help to explain the death of Micah True, who lived off of beans and stone-ground corn.

    Also, I’d love to read Dr. Mark’s take on the recent study written about in the NY Times indicating that running is very beneficial up to a point, but becomes toxic after a certain threshold. The study found that running 20 miles or less was correlated with lower rates of heart disease. Those who ran more than 20 miles per week had higher rates of heart disease than those who did no running at all. This was particularly worrisome to me as an avid runner whose weekly mileage is considerably higher than that.

  4. Trey says:

    Heart disease cannot be prevented by running. No amount of physical activity can overcome poor dietary choices. But what is the best way to eat?

    In Christopher McDougall’s recent book, Born to Run, we were told that running will lead us to the ‘right’ diet. “Eat as though you were a poor person,” he wrote, quoting Joe Vigil. This seems to echo the sentiments in the popular vegan manifesto, _The_China_Study_, by Dr. T. Colin Campbell and his son. Never mind that neither the Tarahumara or the Chinese are vegetarians, we are led to believe that a primarily starchy and low fat diet is heart healthy.

    The conventional wisdom goes that heart disease is caused by high blood cholesterol, especially the ‘bad’ LDL type, and that saturated animal fats raise cholesterol. Thus we have the proliferation of cholesterol lowering drugs and the constant admonition to reduce dietary fat intake. So, it probably does baffle adherents to this conventional wisdom when someone who seemingly does the right things still dies from a heart attack. The conventional wisdom on heart disease is based upon epidemiological studies that look for associations that might suggest cause and effect. As any scientist will tell you, correlation does not prove causation. Thus, the conventional wisdom is unproven. Gary Taubes described the convoluted history of the lipid hypothesis of heart disease in his book _Good_Calories,_Bad_Calories_.

    Nevertheless, more recent clinical research by scientists like Dr. Thomas Dayspring has narrowed the focus on the causative factors in heart disease. The data suggests that it is not the cholesterol, but the lipoprotein itself that is to blame. A high number of LDL (low density lipoprotein) particles (not to be confused with the volume of lipids, including cholesterol and fatty acids, that they can carry) strongly correlates with inflammation in the arteries. What causes this abnormally high number of lipoprotein particles? Well, it’s probably not the meat you eat.

    Remember “The China Study”? Not the popular book but the actual epidemiological study it was purportedly based upon. Well, the strongest dietary correlation with heart disease in China was wheat consumption, a significant point not even mentioned in the popular book. Methinks Dr. Campbell and Son are suffering from a bit of cognitive dissonance.

    And speaking of cognitive dissonance, what about Christopher McDougall’s Born to Run? Don’t get me wrong; I enjoyed the story immensely. However, while all but endorsing veganism with examples of vegan runners, he gave us the strongest reason of all to eat a diet containing meat: persistence hunting. The evolutionary adaptations that made us who we are today correlate strongly with the consumption of high quality animal protein and fat. So why would animal protein and fat now suddenly cause the chronic diseases of civilization? Well, civilization didn’t start with the consumption of meat, but any student of history can tell you that whole ecosystems have been wiped off the map in mankind’s relatively recent pursuit of grains as a dietary staple. To add insult to injury, industrialization set about to further comodify grains by separating them into refined component parts. Our modern diets of processed grains, industrial seed oils, and sugars have more in common with drugs than the whole foods we evolved to eat. Like any drug, processed ‘food’ can have side effects like heart disease, diabetes, obesity, cancer, etc. They can make us sick, and then we are told to take more drugs (like Lipitor and aspirin) to treat our symptoms.

    The big question though is, if we evolved to be distance runners, is it really the running itself that causes inflammation leading to heart disease? Or is running merely associated with heart disease simply because of the substandard foods common to our culture?

    • MarkC says:


      thank you for this informative post. i’m big proponent of what Taubs writes and hopefully one day my profession will get it and start communicating the right message to patients. Get rid of the simple carbs and corn syrup. yes eat good quality red meat, eggs, and other healthy fats.


  5. Mae T. Young says:

    I love running to keep fit; but I need to admit that running makes my legs look even bigger. Is this true or just my imagination??? Let me know plz because I’m really confused now.
    Mae from breast cancer gear.

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