The Chicago Sun Times



How marathons can kill you


                    October 6, 2002


                    BY JIM RITTER


                    Health Reporter


                    In the last four Chicago marathons, three runners have died.


                    Last year, a 22-year-old man died of apparent heat stroke. In 2000, a

                    45-year-old man had a heart attack. And in 1998, a 43-year-old woman died

                    because she apparently drank too much water.


                    As in past years, organizers will provide plenty of medical backup, including 17

                    first aid stations with doctors, nurses and defibrillators and a 120-cot medical

                    tent. But with 37,500 runners, including first-timers who might not recognize

                    danger signs, no one can guarantee there won't be another death in the 25th

                    LaSalle Bank Chicago marathon next Sunday.


                    That phenomenon is relatively new here. There were no deaths before 1998,

                    noted marathon executive director Carey Pinkowski. "We look at it as three

                    deaths in 25 years," he said.


                    And there's no one reason for the tragic string.


                    It used to be that only the top runners attempted marathons. Now casual

                    runners compete, and some don't train properly. The only qualification for the

                    Chicago marathon is to sign up before the registration cap is reached.


                    Once runners get in, they can underestimate their ability. The human body was

                    not designed to run 26.2 miles, and marathoners have always faced a small risk

                    of dying. Indeed, the first person to run a marathon died.


                    Legend has it that in 490 B.C., a Greek soldier dropped dead after running 25

                    miles to Athens to announce a battle victory. And in the 1912 Olympics, a

                    Portuguese marathoner died from heat stroke.


                    While no one keeps exact count, the USA Track and Field Road Running

                    Information Center estimates there are four to six marathon deaths a year.

                    Nationwide, about 425,000 people ran in 300 marathons last year.


                    A 1996 study estimated there is roughly one death for every 50,000 runners, a

                    risk researchers called "exceedingly small." This risk is twice as high as that of

                    exercising at health clubs, another study found.


                    Running strengthens the heart and lungs, controls weight, lowers cholesterol

                    and blood pressure, improves sleep, strengthens bones and relieves stress,

                    depression and anxiety.


                    But marathoners overdo it. It takes only 12 to 15 miles of walking or running per

                    week to be fit, said Swedish Covenant Hospital cardiologist Dr. Noel Nequin.


                    Marathon runners can injure muscles, tendons, ligaments, bones and cartilage

                    and suffer blisters, chafing, heat stroke, exhaustion and dehydration.


                    In the Chicago marathon, 1 percent to 2 percent of runners need medical

                    treatment. However, running injuries rarely are permanent.


                    "Most of them are not elite or even good runners," said Dr. John Cianca,

                    medical director of the HP Houston Marathon. "Should an entry-level runner run

                    a marathon right off the bat? Probably not."


                    Here are three ways a marathon can turn tragic.


                    Heart attack


                    Overweight and approaching his 40th birthday, Dan Towns began running to get

                    into shape. Five years later, he was fit enough, or so it seemed, to run the 2000

                    Chicago marathon.


                    But a few miles from the finish, Towns collapsed and died. An autopsy revealed

                    atherosclerosis, hardening of the arteries.


                    While exercise generally is good for the heart, it can trigger a heart attack in

                    people who have heart disease but may not know it. Consider Jim Fixx,

                    best-selling author of The Complete Book of Running. After Fixx died while

                    jogging, an autopsy revealed he had clogged arteries and an enlarged heart.


                    Running a marathon injures muscle tissue, triggering an inflammatory response

                    that makes the blood more prone to form clots that can cause heart attacks,

                    said Dr. Arthur Siegel of McLean Hospital in Massachusetts.


                    Siegel took blood samples from 80 Boston Marathon runners before and after

                    the race. The morning after, he found elevated levels of inflammatory and

                    clotting factors in the runners' blood.


                    Based on this finding, Siegel recommends all marathoners take one

                    blood-thinning aspirin the day before the race to reduce the risk of clots.


                    Heat stroke


                    During last year's Chicago marathon, Luke Roach drank water every two miles

                    and dressed lightly in the 50-degree weather. Nevertheless, heat stroke killed

                    him near the finish line. His body temperature was 107 degrees.


                    Early on, the Chicago marathon was held in August, but organizers switched to

                    October and set the start time at 7:30 a.m. But even in cool weather, some

                    runners suffer heat stroke.


                    Dehydration is the main cause. A runner who does not produce enough sweat

                    to keep cool can suffer headache, dizziness, disorientation and fatigue. The

                    best way to prevent that is to drink plenty of water.


                    Water intoxication


                    But drinking too much also can be dangerous.


                    In the 1998 marathon, Kelly Barrett became disoriented around the 24th mile

                    and went into cardiac arrest, apparently from drinking too much. She died three

                    days later.


                    Excessive water dilutes the blood. The concentration of sodium in the blood

                    drops, leading to swelling of the brain, which can be fatal.


                    Two others have died from drinking too much water, in the Boston and Big Sur

                    marathons. Non-fatal cases are more common. Normally, a person gets rid of

                    excess water by urinating. But during a marathon, Siegel said, the inflammatory

                    response can alter hormone levels, which in turn can reduce the body's ability

                    to produce urine.


                    The standard advice is to drink three to six ounces for every 20 minutes of

                    vigorous exercise. But depending on the weather and how much a runner

                    sweats, this could be too little or too much.


                    There is perhaps a better way to determine your water needs. During training,

                    weigh yourself before and after a long run. If you gain weight, you're drinking too

                    much, and vice versa.


                    Taking this a step further, Siegel suggests marathon organizers provide scales

                    at aid stations so runners can weigh themselves along the route.