Monday, December 25, 2017

Guest Post: Stewart Dutfield's 2017 Journal

And now for something a bit different...

Local ultrarunner Stewart Dutfield was kind enough to share the diary he's been keeping for 2017 and I thought it would be fun to include it here. His journal is based on the diary of fellow Brit Alan Bennett and is a cool glimpse into the thoughts of a dedicated runner who enjoys experiencing the world around him. Hopefully Stewart will keep us updated with some semi-regular posts in 2018.


Trail markers at the terminus of the Long Path imply that it continues northward...
13 January. Old Stage Road, above Altamont in Albany County, is currently the northern terminus of New York's Long Path; Ken Posner's recent book describes his 350-mile journey that ended here with a wry twist. On a clear, cold Friday evening 18 of us arrived at the trailhead for a the first full moon adventure of the year. People had traveled for hours, from Connecticut and Westchester, to walk five miles in the dark and watch moonrise over the Hudson Valley. After Dick had fallen hard on ice fifty yards in, we encountered good footing except on the dirt roads (back country ice skating, anyone?). The trail climbed hardly at all, but the view from High Point took in all of Albany and beyond. The informal trail along the cliff edge led, at one point with the rising moon directly ahead, to another high overlook at Hang Glider Point. As we took snapshots of people doing headstands, a bright light emerged from the woods: a fat-tire cyclist, no doubt as surprised to see us as we were to see her. 

Wednesday, December 6, 2017

Blogger of the Year, Take Two!

I'm very happy to announce that for the second straight year I've been shortlisted by the fine folks at RunUltra for the Ultra Blogger of the Year award.  RunUltra is a UK-based website that is an amazing repository of all things ultrarunning.  Their content runs the gamut: training advice, gear reviews, reporting on elite results from all over the globe, articles on physiology, motivation, race preparation, and basically anything else you might want to know in the ultra world.  Those guys (and gals!) know their to be named once again to their shortlist of candidates is truly an honor.
Last year's vote came down to the wire, though a closer examination of the balloting apparently revealed some...irregularities.  I can neither confirm nor deny reports of Russian hacking.  Anyway, the great Sarah Lavendar Smith, author of the superb blog "The Runner's Trip" (as well as The Trail Runner's Companion, an excellent book) was ultimately named a most deserving winner.  Sarah's up for the award again this year, so let's see if we can give her a (legitimate) run for her money.

This was kind of a big year for us here at "A Muddy Par of Heels."  I tried to branch out a little with the Running and Your Heart series of posts, adding a bit of an informative/academic bent that I hope people found useful, in addition to the usual race reports and other nonsense you've come to know and love.  Also this year I launched my podcast, "The Pain Cave," a series of conversations about running in general and ultrarunning in particular that takes a closer look at some of the science behind the sport, and other relevant issues of the day.  I view the blog and the podcast as kind of a companion set; hopefully each has helped enhance your enjoyment of the other.  (You can find The Pain Cave on my new website,, which is still a work in progress but ultimately should bring all my various running-related interests under the same tent.)  Unfortunately Lexi didn't quite hold up her end of the bargain this year--she's busy co-writing a novel about dragons with a friend of hers--so if I don't win I suppose I can blame it on her.

If you enjoy the blog, please take a moment to vote for me on the RunUltra website.  (You can use that link there, but I also figured out how to link the voting page with the image at the top of this post--if you just click on the badge at the top of the page, it takes you right to the voting!  If that's not enough of a reason to vote for me, I don't know what is.)  Scroll down to my name--I'm the eighth name on the left side, just above some punter named Jeff Browning--and click "Vote" under my name.  Wait, you're not done!  Now scroll all the way down to the bottom of the page, fill in your name and email address, and press "Enter."  You should get a new screen that confirms you've voted.  Thanks!  One vote per email address please; we don't want any monkey business this year.  Voting runs until January 14.  Just do it now before you forget.  As a cool bonus, everyone who votes is automatically entered in a drawing for a super cool Suunto Trainer watch.

In all seriousness, thank you for all your support of this blog.  It's a silly pursuit, I know, but it really means a lot when I get positive feedback from people who read the posts and let me know they've gotten something positive out of it.  I'll keep bugging y'all to vote, and I hope I win, but just having that kind of support is what keeps me plugging away at this thing.  But, seriously, go vote now.

Sunday, December 3, 2017

Running and Your Heart, Part V: Coronary Calcifications

So I thought I was done with the Running and Your Heart series, but some questions came up that made me realize I needed to clarify a couple of points.  And I don't know, maybe we're not done with the series; I could see doing some more in-depth posts in the future about some specific issues.  A detailed post on atrial fibrillation might be in order.  For now, though, we're going to delve a bit deeper into coronary calcifications, their significance, and what the research means for us as distance runners.
image: the Heart Research Institute

As such, think of this post less as the fifth installment in the series and more as part IIIb, as we'll be addressing basically what we talked about in part III (and touched on briefly in part IV).  Let's recap some of the main points from that post.  The coronary arteries are blood vessels that carry blood to the heart muscle, supplying that muscle with the oxygen needed to carry out its function--namely, pumping blood throughout the body.  Blood flow through these blood vessels can be compromised by a disease process called arteriosclerosis--literally, a hardening of the arteries.  Generally, arteriosclerosis is caused by the accumulation of plaques within the walls of the arteries, resulting in a narrowing/hardening of the arteries (stenosis) that can impede the flow of blood to the heart muscle.  In times of increased stress on the heart (i.e., exercise), the demands of the heart muscle for oxygen are increased; if not enough blood is able to flow through these narrow, stenotic arteries to meet this demand, the heart muscle suffers from ischemia (lack of oxygen).  Prolonged ischemia, or complete occlusion of the artery, can lead to infarction, or death of a part of the heart muscle--which, if significant enough, can be debilitating or fatal.

Remember that in part III, we discussed the use of CT scans in detecting underlying coronary artery disease--namely, looking for calcium deposition in the coronary arteries.  Calcium is a component of many arterial plaques and is easily visible on high-resolution CT scans.  This test is especially useful in folks who don't have any symptoms of coronary disease but may have risk factors.  A growing body of research indicates that long-term endurance athletes--those who have been training at high levels or volumes for a decade or more--paradoxically have higher rates of coronary calcification than those of their age-matched peers in the general population, despite having much lower rates of many risk factors, like diabetes, hypertension, or obesity.  Remember that these studies have demonstrated correlation, not causation--we can't say that sustained exercise is the cause of this finding, only note that the relationship exists.  And recall also that we've yet to demonstrate what the real-world implications of these findings are--which is the point of this more involved discussion. To wit, the question: does having more coronary calcification lead to a higher risk of having a cardiac event?  The short answer is, yes--but for marathon runners, maybe not.

Numerous studies of the general population (that is to say, not specifically among marathon/ultramarathon runners) have correlated coronary artery calcification (CAC) scores to a higher risk of suffering a cardiac event, such as heart attack, death, or the need for revascularization (a re-opening of a blocked artery).  The exact degree of risk varies by study, but ranges from a four-fold risk increase to a twenty-fold increase have been reported in studies of varying size and quality.  Higher CAC scores are associated with a higher degree of risk, with significant risk increases generally seen with scores above 100 or 300 (zero is "normal").

OK, so that's bad.  Higher scores are associated with higher risk, and we've demonstrated that "obsessive" runners have higher scores, on average, than the general population.  That means our risk of suffering a significant cardiac event must be much higher, right?  Well, not necessarily.  First off, as I mentioned in the earlier post, there is research suggesting that long-term aerobic exercise leads to coronary arteries that have larger diameter, and have a greater ability to dilate.  (The autopsy of seven-time Boston Marathon champion Clarence DeMar famously revealed that his coronary arteries were two to three times wider than average.)  Secondly, to better understand our level of risk, we need to understand the nature of arterial plaque and the reasons one might suffer from a cardiac event.

Generally, narrowing of the coronary arteries, in and of itself, is unlikely to cause a cardiac event.  The precipitating factor in a cardiac event is often the rupture of an arterial plaque.  A piece of the plaque can break off and get carried "downstream" to a narrower part of the artery.  If it gets lodged there, it can cause a complete occlusion of blood flow to an area of the heart muscle, resulting in a heart attack.  So if we can identify which plaques are more susceptible to rupture, this will allow for a better stratification of risk.

Simply put, not all plaque is created equal.  Arterial plaque is generally composed of various substances: fat, cholesterol, calcium, and fibrin, to name a few.  One way of thinking of plaques is to classify them as either "hard" or "soft".  Hard plaque, made up of predominantly calcium, is generally considered more stable and less prone to rupture than softer (mostly cholesterol) or "mixed" plaque.  The good news is that while high-volume exercisers have higher CAC scores, they are much more likely to have hard, calcific plaques (read: stable) and much less likely to have mixed plaques than subjects who exercised the least.

So while we know that elevated CAC scores in the general population put people at risk for cardiac events, the risk for runners who have elevated CAC scores may not be the same, because of the composition of their plaques, and possibly the dilation of their coronary arteries.  Perhaps this is why, despite the fact that runners appear to have paradoxically higher-than-expected rates of calcification, cardiac events among habitual marathoners seem to remain relatively infrequent occurrences.