“Is this healthy?” This question came up for me this morning. I had awakened to a 5AM alarm, left the house a little after 6AM only to drive 2 hours to the mountains to run and hike a 15-mile trail. I ate breakfast in the car while driving and ate gels and some food while walking. I’m attempting to maintain a certain amount of miles per week in order to ramp up training again in the near future.


But is this healthy?


A little background about me. I turned 38 years old this year and completed my first 50K (31.5 mile) trail race this Fall. Soon after, I ran another 30-mile mountain pass. Although it may sound like I am at my fitness prime, I have Crohn’s disease (an autoimmune disease), and am considered immune-suppressed with its medication. My family history is filled with its own health concerns. My extended family seems to think the way I exercise is dangerous. The fear is not necessarily grounded in anything substantive per se, more of a fear of being overextended. I am a pretty slow runner and I struggle with managing electrolytes and generally not barfing. During my race I paused at mile 22. Another runner passed me and checked in. I share that I am trying not to vomit and he quickly replied, “Sometimes you just have to be like Elsa and let it go.”  Perfection.


So all this being said, can exercise be unhealthy? The short, frustrating answer is: it depends. We have all learned through the COVID-19 pandemic that there are quite a few limitations to available research. This also extends to exercise science.  


Rhabdomyolysis (extreme muscle breakdown) can occur with varying intensity of exercise. Endurance athletes have higher coronary calcium scores than the average population. That is, calcification in the coronary arteries in the heart that can cause a blockage and lead to a heart attack, although it is undetermined if this increases the risk of heart attack for these individuals. So is the level of activity that creates fitness all that healthy?


Despite these rare risks, there is a lot of evidence of the benefits of physical activity, including increased cardiovascular efficiency, mitochondrial density, and increased capillary bed density to name a few. There is also evidence that running may protect against osteoarthritis of the knees, and 7000-8000 steps per day can add a significant increase to life expectancy. Additionally, the endorphins the body produces with exercise can also improve mental health. 


So where do we draw the line? 


First, let’s look at the definitions between “healthy” and “fitness.”


Health definition: The state of being free from illness or injury.


Fitness definition: The condition of being physically fit or healthy.


These definitions are somewhat helpful in illuminating my point. The paradox of fitness is that it often requires small and sometimes large body stressors to induce physiologic change in the body for a desired outcome. Building up to fitness requires proper training. 


Take training for a half marathon, for example. A runner must start with regular runs that progressively increase in mileage. They progress by cyclically increasing miles every week, and usually decreasing miles every fourth week leading up to the race. These stressors placed on the body cause metabolic changes in the muscles of the legs, heart and circulation. They also serve to strengthen the ligaments and tendons gradually over time in the ankles, knees and hips. In short, training puts stress on the system that increases metabolic waste, and damages the tissue for the short term to increase the resiliency and compensation over time. This training effect can diminish health for the short term by causing increased fatigue, possible insomnia, muscle soreness, and other changes. This leads to an increase in the body’s ability to tolerate more and more training. Ultimately the damage and repair cycle repeats itself.


Training to reach fitness peak also involves many variables. No two people obtain the same results with identical training loads. Working with a trainer or coach who can formulate a personalized training regimen would be essential for those wishing to train for these extreme activities.  


So I’ll share my takeaways from my personal experience, and what I have been able to glean from the research. 


Firstly, health can be compromised in the pursuit of fitness, but generally if one is gradually increasing fitness and being mindful of overuse injuries, working with a physical therapist or trainer, and gradually applying exercise load, the body has a way of adapting to the stress over time. We know that exercising for prolonged periods can have a short-lived immune suppressive effect, so this is something to be mindful of when doing long, sustained efforts.


Secondly, due to these effects, it is very important to get enough calories to allow your body to repair. When training, eating more is necessary to maintain health and fuel this higher demand of activity.  


I will not be discussing supplements or “diets”here, but there are two markers worth checking, to maintain health and performance when increasing training load: vitamin D and ferritin (the storage form of iron). Talk to your doctor about getting these simple blood tests run and what their target range for you might be (my preference is 50-70 ng/mL for vitamin D and 70-100 ng/mLfor ferritin). These markers are important for all people in training, regardless of gender. Personally, I discovered both my levels were extremely low, and I was able to address the problem. These are two simple items that could have a net gain on training effect and prevent deteriorations of health while increasing training volume.


Thirdly, something I find useful to consider, is what else fitness is doing for you? There are many intangible benefits of exercise, including increases in mood, a sense of accomplishment, and even a sense of community. These things are very important features of health as well. I find my workouts are meditative, and they allow me to manage my day to day stress a little better. Honestly, I feel alive in the mountains in a way I typically don’t on the day to day.


Lastly, I think, if possible, it is important to have some sort of coach on board if you are embarking on a particularly bold fitness venture. We all have blind spots and having someone to help see yours during training can be the difference between injury and success. The accountability they provide is also generally helpful.


To come back to the question, is this healthy for me? I guess I still don’t know how to answer that. I’ll stack the odds towards health and we’ll see how it goes.

Dr. Ian McLogan is a naturopathic physician who specializes in men’s health, gastrointestinal disorders, and physical medicine.