Men?s Health contributing editor Jim Thornton was concerned when his friend, an elite triathlete, repeatedly coughed up blood during a race and ended up in the hospital. So Thornton decided to research just exactly what landed his friend in the E.R.?and came back with a surprising answer. Read Thornton?s investigation and discover the hidden danger that athletes may face when they pop a common pill.
Three miles into the run, Jeremy Cornman, 33, felt some congestion in his lungs and wondered briefly if he?d caught a cold.? It seemed unlikely. He was, after all, in paradise?Kona, Hawaii, to be specific?and until now, his 4th Ironman World Championships had been going largely according to plan.
Jeremy started coughing up blood around mile 14 at Kona.
A little over 5 hours earlier, he?d finished the 2.4-mile swim leg of the triathlon in decent time (1:01.28),?and quickly transitioned to the bike.? For the next 112 miles, Jeremy, a former beach lifeguard and current masters swim teammate of mine from suburban Pittsburgh,?averaged 22.3 mph, completing the bike leg in 5:02.18.? He was now in 26th place in the highly competitive 30-34 age group?with his best leg, the marathon, left to go.? ?Last year,? he says, ?the run had been my ace in the hole, and I knew if I could run the same way again, I?d dramatically improve my placement.?Back in Pennsylvania, I was just one of Jeremy?s many friends and well-wishers tracking his race progress live on the Internet.?When his marathon began with 6-minute miles, most of us figured he was on course to set a PR.? What none of us could know was that his ?chest cold,? which had emerged out of nowhere, was getting worse fast.
As Jeremy later explained in person, he started coughing on the run, hoping to clear out the gunk accumulating in his lungs. Not until mile 14, his pace now closer to 10-minute miles, was he forced to stop altogether.? He bent over at the waist and coughed violently for several minutes.? The sputum this dislodged was foamy and tinged in red.? Other triathletes who?ve suffered similar symptoms sometimes convince themselves the ?red? is merely coloring from a sports drink.?But Jeremy didn?t delude himself.? He knew right away he was coughing up blood. (Are you running yourself to death? Learn The Severe Risks of Marathon Running.)
Despite this, once his lungs were clear, he felt much better and decided to soldier on.? Improved breathing was short-lived.? At miles 17, 20, and 23, he was forced to stop and repeat the process.? Each time, more blood appeared in the sputum.
When Jeremy finally crossed the finish in 9:45.45 for a 50th place in his age group, disappointment in his performance quickly took a back seat to worries about his health.? At the medical tent, he overheard the doctors talking about ?wet, very wet lung sounds? and ?pulmonary edema.? They arranged for an ambulance to take him to the Kona Community Hospital, where he would spend the next two days.
Pulmonary Edema: Who?s at Risk?
Jeremy is by far the fittest guy I know, and when I learned about his diagnosis, I could scarcely believe it.? Pulmonary edema, an abnormal back-up of fluids in the air sacs of the lungs, is common in older people with congestive heart failure.? Accidents and other severe health problems can cause it, too, but the only time I?d heard of a hyper-fit, elite athlete suffering from it is during an episode of HAPE, or high altitude pulmonary edema, an occasional bane of recreational skiers and would-be Everest summiteers alike.? But a new category of at-risk athlete has recently been reported.
In a 2010 study published in The American Journal of Emergency Medicine,?researchers found that ?pulmonary edema is an unusual but not rare event, which occurs in approximately 1.4 percent of community triathletes.?
?While cross-training in the pool during a high-mileage phase of marathon training, I had an episode of SIPE, or swimming-induced pulmonary edema, myself,? says the study?s lead author, Charles C. Miller III, Ph.D., Professor and Chair of the Department of Biomedical Sciences at Texas Tech University Health Sciences Center. Like Jeremy, he ended up hospitalized temporarily before being released with no good explanation for what had caused it.? After combing the research literature himself, Miller discovered case reports of pulmonary edema in military swimmers and free divers.? He also found threads discussing the condition on Internet triathlon forums. (Have a burning question about your first big race? Check out the Men?s Health Triathlon Training Guide for your answer.)
With the help of USAT, the national governing body for the sport of triathlon, Miller and his colleagues surveyed 1,400 adult triathletes about ?breathing problems? during the swim, eventually focusing in on 20 who reported coughing up ?pink frothy or blood-tinged secretions??a signature of pulmonary edema.
The researchers then found 11 more SIPE victims on the popular triathlon site slowtwitch.com,?bringing the total case number to 31.? They then surveyed these folks about potential risk factors, from health conditions to supplement use, hoping to tease out important contributors.
Four of these immediately jumped out. High blood pressure emerged as the number one risk for SIPE, perhaps because it can impair blood circulation from the lungs.? For Jeremy, this seemed an unlikely prospect given his own blood pressure is 105/70, and there?s no history of hypertension in his family.? The second leading risk factor?gender?is equally unlikely.? Women, for unknown reasons, are significantly more likely than men to develop SIPE.? The third risk, however, does apply.? Researchers found that the longer the swim course, the greater the risk for SIPE, and a full Ironman has double or more swimming than the half-Ironman, Olympic distance, and sprint triathlon events.? Still, the vast majority of men in the full event never get SIPE.? I was beginning to wonder if Jeremy?s case was just an unlucky fluke. (Get breaking news and must-have health tips delivered straight to your inbox when you sign up for the FREE Daily Dose newsletter.)
The Secretly Dangerous Supplement
Which brings us to the fourth risk: fish oil supplements.? ?We cast a wide net on supplement use to see if we could identify important patterns,? says Miller. ?We were indeed surprised to find not only that fish oil use was statistically associated with SIPE, but that the association persisted even after multivariable adjustment, which means it wasn?t just following along with something else we?d measured.?
How fish oil might contribute to pulmonary edema is uncertain, but it?s a natural blood-thinner known to inhibit blood clotting.? Taking high doses has been linked to nose bleeds, blood in the urine, bleeding gums after tooth brushing, internal bleeding, and even hemorrhagic strokes.? Most doctors recommend no more than 3 grams per day. (Which pills should you pop every morning? Gulp down?The Top 10 Supplements for Men.)
Triathletes, to be sure, don?t always get their supplement advice from GPs.? Starting 7 weeks out from this year?s race, Jeremy told me he ramped up to his heaviest training volume of the year, a regimen he maintained over the next 5 weeks before gradually tapering.? ?I?d heard that fish oil was beneficial during heavy endurance training due to its anti-inflammatory and immunity-boosting properties,? Jeremy tells me. ?So during this period, I increased my fish oil to 9 x 1200 mg capsules per day.?
At nearly four times the recommended maximum daily amount, Miller believes it?s possible fish oil fanaticism may have played a role in his pulmonary edema.? Even so, he doubts this is the entire story.? ?Humans, and especially athletes, are extraordinarily resilient creatures,? he explains.? ?I feel very strongly there is a ?perfect storm? effect here, where many things must be present to cause the weak link in the chain to break.? The four risk factors we found may not be all that important individually, but when you add one or more of them to all the other stresses of a triathlon start?immersion in cold water, intense sudden onset-exercise, and so forth?sometimes the cardiopulmonary system just can?t compensate. ?
A Blood-Free Future
Happily for athletes like Jeremy, other researchers have found no measurable lingering effects on heart or lung function a month or more after a SIPE episode, Miller says. On the other hand, he adds, if you?ve suffered one episode, you?re at higher risk for suffering another.
?But the good news here is that athletes might not have to do much to reduce the odds of recurrence,? he says.? A simple thing like controlling blood pressure?or not overdosing on fish oil?might be all that?s necessary.? One of Miller?s friends, for example, had suffered SIPE on many occasions before discovering two keys to preventing it: avoid overhydrating and make sure to warm up in the water before the race starts.? The result? No SIPE problems for the past two years.
?The one thing I can?t in good conscience recommend,? Miller says, ?is anyone continuing a race with SIPE. Come back to fight another day. We train meticulously for races and in the moment often can?t see beyond the horror of a DNF.? But mourning loved ones don?t appreciate race-day heroics.?
Jeremy, who?s off fish oil for now, says he plans to be much more moderate in his dosing if and when he resumes taking the supplement.? He says he also hopes to have the fortitude to drop out if a race if SIPE strikes him again.? ?It still might depend on the size and the scope of the event,? he acknowledges.? ?But it was such a frightening and sobering experience, I?d like to think I?d be much more likely to play it safe next time.? (Need more nutrition advice from leading experts? Sign up for?our FREE Belly Off! newsletter.)
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Source: http://news.menshealth.com/fish-oil-supplements/2012/11/06/
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