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Running Medical Issues: Must Read!

Runners are a special group of people.  They're focused, motivated and put together a little differently from other people.  They don't mind hard work and working toward goals that are well into the future.  It's our job to be sure that we're supporting their healthy sport.  There are a couple of medical concerns we need to consider.  I'll give the summary of action items first.

Action Items:
1.  Insure that your runner is getting 600 units of Vitamin D and 1300mg of Calcium daily in his(her) diet and/or supplements.  Achieving these targets will probably require supplements.
2.  If your runner has any of the risks for iron deficiency (see below) or has started their menstrual cycle, start a once daily (women's) vitamin with iron.  Get their ferritin checked annually.
3.  Check their height and weight at home at least every other month.  Discuss any rapid growth or weight loss with their coach.  Weight loss in youth runners is always a concern that needs to be addressed.

Bone Health:
Medical evidence has become more and more clear that most runners do not get enough Vitamin D and Calcium in their diets for maximal bone health.  In youth this leads to less bone deposition and a higher risk of injury especially stress fractures.  These effects have significant carry over into adulthood--especially for peri-pubescent girls.  Let me say it clearly:  Your runner's future bone health and lifelong risk of osteoporosis, hip and spine fractures is determined by the bone they are building today.  

The recommended "dose" of Vitamin D is 600 units daily.  The recommended "dose" of Calcium in 1300mg daily.  A glass of milk fortified with Vitamin D has 100 units of Vitamin D.  It has 300mg of calcium.  Thus it would take 6 glasses of milk to get your recommended dose of Vitamin D and 4 to meet your daily requirement for calcium.  (Note:  While other dairy products have calcium most are not fortified with Vitamin D.)  And unfortunately sun exposure does not make up for dietary inadequacy--especially in the fall, winter and spring.

Please review your runner's diet and consider using a Vitamin D and Calcium supplement to achieve a daily intake of 600 units of Vitamin D and 1300mg of calcium.  It's going to be tough to reach these levels through diet alone.

Additionally starting menstruation late and/or any missed menstrual cycles are big risks for current stress fractures and osteoporosis in the future and need to be taken seriously and discussed with their doctor and/or coach.  Careful attention to adequate nutrition (weight loss is always a concern in youth runners) and adequate recovery (sleep, stress reduction, nutrition again) need to be given to these.

Iron Deficiency:
A second big risk to runners is iron deficiency.  Iron is involved in nearly all of the oxygen transporting and utilization reactions from the lungs to the muscles and mitochondria.  Without adequate iron stores we can't utilize oxygen fully, our adaptation to hard training is incomplete or absent.  Without enough iron we're not getting the benefits of training.  Iron stores should be checked annually in most runners and twice per year in anyone with risks for low iron.  Doctors need to check a ferritin level which reflects total body iron stores.  A normal hemoglobin and hematocrit is not enough to insure proper iron stores for a runner.  (And many doctors don't know this.)

Runners lose iron through sweat and possibly through transient poor blood flow to the GI tract causing ischemia and blood loss.  Low iron is especially more likely in:
--vegetarians or those who eat little red meat
--during times of rapid growth where our intake can't match the body's demand for more
--after menstruation starts when there are significant additional losses.

Here is a link to a letter you can take to your doctor that will help you get the right test done:
https://docs.google.com/document/d/1kGO-rXT_G0kcVwnT9TY1_9kDlUUACHdBDUd7mto2ARY/edit?usp=sharing

Weight Loss:
Unless a youth runner is significantly overweight when they begin a running program any weight loss raises big concerns for:

Inadequate nutrition--their bodies may not be able to recover from the stress of running and adapt to training.  They may not have the energy they need to train. 
Eating disorders--unfortunately common in both female and male runners, eating disorders are a serious medical problem with long term life consequences.  They need to be addressed by medical professionals specializing in their treatment.  They can be life threatening.

Please spend a few minutes to think these three big issues through and take action for your child's benefit and safety.  Based on the best medical evidence most of our runners should be on Vitamin D, Calcium and Iron supplements.  We should monitor their weight and growth regularly at home.

Thanks!