Elite Runner Needs Help With Random Fatigue

3/10

Have you tried a paleolithic diet?

Some kids peak athletically at 12-13 years old. Your kid is likely one of them.

Is it possible your son has developed summer allergies? I have known of one high school runner who could compete on a national level through cross-country and the indoor season but was unable to achieve a similar level/result in racing from late April til the end of September.

it is more a dietary thing. Paleo works wonders, I have read on the net.

for now keep up the good nutrition and monitor ferritin, vitamin D and thyroid and be patient

is he a healthy weight? eating enough food?

This is Chronic Fatigue Syndrome. I wish it wasn't, but if you treat it like it is, he will be better off in the long haul.

I hope that in two years you post that he is all better and that he has now broken 4:10/9:00 ... but you have to take this seriously.

It is too much to type to tell you what to do and you are likely not going to find a doctor who specializes in it, but the up and down nature of it is the telltale sign.

When it happened to me I was not as talented as your son, but about a 15:40-15:50 XC runner as a junior. I started having that running in sand feeling and was finishing about 30-50 seconds slower than I should have in races. The whole race felt like the last 400m as far as pain and effort, it was terrible.

Took a month off and started back up for track and did fairly OK. 4:35/9:55 indoors. Felt really tired whenever I went hard, but like your son, the doctors told me I was fine.

Beginning of outdoor the wheels fell off. Had a workout where I ran 2:07, 63, 63, 63, 61 and felt like I was "on my way" and then I just fell apart and, like your son, I could barely run. I ran a few 1600s in 4:55-5:05 but was struggling to even make it to school.

They will tell you that it is depression or burnout or not meeting his expectations (which would be very high for a kid that good), but it happens suddenly and is not any of those things.

I have had it for 28 years.

I wish him luck, and wish this was not it, but it likely is.

It could be, as this is almost exactly as I experienced it. But I also had low ferritin and relapsing/remitting mono prior to my downfall. I would recommend that he stops running, gets more than adequate sleep and nutrition, and sees somebody that can at least run the "basics" like a Sed, rate, early and late antibody titers for EBV, CMG, and HHV6, maybe a tilt table test to see if he has orthostatic hypotension or neurally mediated hypotension, etc, and see if his cardiac output and cardiac index are normal, both in a supine and tilted position. He would also likely have methylation block, but I'm not sure how you test for that specifically. Is his sleep disturbed?

This may be something that just a little time off can take care of, but I just wouldn't risk his entire future. Some people who have simply eaten a great diet (like paleo with heavy emphasis on the vegetables, no gluten, no dairy, no sugar), gotten adequate sleep, even if they need meds to help, and normalized blood volume with salt tablets have been able to fully recover, but they were only a few years in. The other question - do you have mold in your house or frequent water intrusions, because mycotoxins can be very problematic as a co-factor?

newname, I believe you are the same poster on the "Diagnose my girlfriend's mystery illness?" I need to contact you.

m.youtube.com/watch?v=1Q6b7ieL1SM

This is a link to his 13 year old 4:32. As you can see he was not overly mature or anything. He eats a balanced diet and days he sleeps well. Only running 40-45 miles a week compared to 60+ others in our area run.

nah wrote:

3/10

Don't be an ass. Do you really think someone would or even could come up with a trolling post including that degree of detail? It took me about 15 minutes to figure out who this kid is, and he's for real.

To the OP -- serum ferritin is a tricky thing, because the range of values considered normal is very wide and varies from lab to lab. Also, there's not a linear relationship between declining levels and declining performance, i.e., if you are running 16:30 with a normal blood profile, it doesn't necessarily follow that a ferritin level of 35 correlates with a top end of 16:45, 30 with a top end of 17:00, etc. Hematology in the context of distance running is complex.

My own experience -- I ran under 16:00 in a road race the spring of my senior year of high school, and in cross-country, after a summer of 60-ish mile weeks, started my college "career" by running 8Ks in the high-26 range, commensurate with a 9:41 two-miler. But my diet sucked, unlike my alcohol intake, and I was having a hard time breaking 28:00 by season's end. I rallied some in the indoor season, but by spring I was cooked, and I went from bad to dismal, ending my short spring season with a 5K in the 16:50s, with a last mile of about 6:00, sucking mad wind.

I got a blood test and my ferritin level was 22. The doc at the student health center recommended ferrous sulfate in pill form (this was before Feosol and other liquid iron was available), 65 mg elemental iron in a 325-mg pill, twice a day for two weeks and once a day after that until I could be tested again. He said it might upset my stomach, constipate me, and lead to black, tarry stools. It did, but this subsided within a week.

After about two months of this, on a regimen of 75 to 80 miles a week, I was able to run a 10K road race just before cross-country season started in close to 33-flat, and went on to be much improved in XC.

The subjective signs your son described sound very much like iron deficiency. However, this is complicated by the fact that his ferritin appears to have been corrected, albeit incompletely, and I can't disagree with the fella with has been thru CFS and thinks that may be the culprit.

He *could* be hypothyroid without gaining weight, and even if he's gaining some, he's presumably still growing and some gain is natural, in fact desirable. It would be useful to know a thyroxine level to go with that TSH, to see just how much thyroid hormone a normal level of TSH is engendering.

It would also be handy to see a complete anemia panel including Hb/'Crit, MCV, MCH/MCHV, RDW.

Anyway, you do have a talent on your hands and I'm sure this will be worked out in due time. Best wishes.

Some good points. He was taking 5ml of ferisol with oj in the morning and before bed. We dropped it back to just once a day because I didn't want him to go to high. In the heart of the season maybe he needs that second dose.

Sagarin wrote:

newname, I believe you are the same poster on the "Diagnose my girlfriend's mystery illness?" I need to contact you.

Yes, that's me. My email is moodybiker1 AT cs.com. Thank you Jeff, good memory. I would welcome an email and I will respond.

I was hesitant to post my email on here and then I thought about it for a while and subsequently forgot.

They call him a troll because he says his son is an elite while that is laughable.

Where are you located - it sounds like the Midwest somewhere? I am in the NC area now and willing to try to help runners dealing with these strange types of things. It can be very frustrating. My colleagues and I are working with one right now who has bounced from doctor to doctor, with anything from useless advice to dangerous advice - many doctors just don't understand enough about running to really "get it." For instance, only checking hemoglobin is rather pointless.

For the Chronic Fatigue Syndrome like effects, there is a theory I have started following regarding an immune mediated sympathetic nervous system dysfunction which is helped by the ADHD drug Adderall. There was one individual I know who had symptoms of fatigue and gained 40 pounds within her abdomen (had a pregnancy belly) over the course of about 1.5 years and did fine on every exam with every specialist, including blood work, endoscopies, radiographs, etc. The individual who told her about the sympathatic nervous system dysfunction said it manifests itself in many different ways, and he is still working on defining it better, but that Adderall works. Sure enough, it did in a major way - all of the excess weight came off (it was all fluid) and her myriad of symptoms went away.

I am starting to believe this sympathetic dysfunction can be behind many of these cases of unexplained fatigue, however would need a more thorough evaluation. It would be interesting to look at physiological response to exercise on a "good day" and on a "bad day" and have some heart rate variability data also.

Does he have any signs of fibromyalgia (painful spots on the skin) on the bad days? Once we start talking about CFS or Fibromyalgia, some people will just role their eyes and say it is a "made up" disease, but I do believe there is something to it, including that sympathetic nervous component.

If he is racing at a heart rate of 190 on a good day, and 190 on a bad day, that is useful information for those who say lack of effort is an issue.

Adderall is a stimulant, related to methamphetamine. It may work but possibly doesn't address the cause of the problem.

Dr. S., if you understand CFS/ME, yes, there is most definitely a sympathetic and parasympathetic nervous system problem involved, though compensatory, but it's not nearly that simple (the HPA axis gets reversed, likely mediated by an infection of some sort and an inappropriate response to allopathic stress load). There is severe immune dysfunction, as in a depressed innate immune system, but also an upregulated component that won't turn off. It is biased towards down regulating Th1, favoring Th2 and is a likely survival strategy of successful viruses that makes them particularly virulent, or there could be a virulence gene put there by God knows what.

As new name said, it would take way too much time to get into all of the nuances of the disease. There is a lab in Stockton, CA called the Pacific Fatigue Lab, and they run bicycle ergometry tests on subsequent days looking at aerobic threshold, among many other parameters. In controls, most of the parameters stay the same between the tests, but in CFS, they drop significantly on day 2. It's tricky in runners and cyclists, because they are so fit to begin with, but the Pacific Fatigue Lab data has been relied upon to procure disability (though I never went and am not on disability).

http://www.pacific.edu/Academics/Schools-and-Colleges/College-of-the-Pacific/Academics/Departments-and-Programs/Health-Exercise-and-Sport-Sciences/About/Pacific-Fatigue-Lab/About.html

We are getting ahead of ourselves. He may not have CFS (myalgic encephalomyelitis) at all. However, this kid may have something akin to the beginning of this, but the bottom line is, that, no matter what is going on with him, he SHOULD take time off and not increase his allostatic stress load further, lest he fall into the abyss. Pushing on is a huge risk. I wish it was as simple as Adderall.

I wish this kid and his parents the best. newname, I know what you mean about the email and wanting to keep a certain degree of anonymity. I will backchannel you.

There's been some recent studies suggesting up to a little less than 1/2 of all chronic fatigue cases are caused by bacterial or parasitic infections in the digestive tract. Not saying these studies are right or wrong, or if this is what your son has. However, if you've tried everything else, I'd keep this in the back of your mind (as probably should your doctors). From a scientific perspective, this could help explain periodic exacerbations of chronic fatigue. I'd roll with what some of the other posters mentioned above, and keep this in the back of mind.

And so it goes wrote:

They call him a troll because he says his son is an elite while that is laughable.

I'd say that 4:30 as an eight-grader and 16:17 as a frosh on an XC course is close enough. And if you think the main thrust of the post was "my son is elite" and not "my son needs help," then you are useless anyway and should just shut your goddamned mouth and possibly immerse yourself in many gallons of hydrofluoric acid.

Another possibility wrote:

There's been some recent studies suggesting up to a little less than 1/2 of all chronic fatigue cases are caused by bacterial or parasitic infections in the digestive tract. Not saying these studies are right or wrong, or if this is what your son has. However, if you've tried everything else, I'd keep this in the back of your mind (as probably should your doctors). From a scientific perspective, this could help explain periodic exacerbations of chronic fatigue. I'd roll with what some of the other posters mentioned above, and keep this in the back of mind.

The gut microbiome is certainly in play as our bodies are composed of 80%+ microbial DNA, and gut tests and tests for certain inflammatory markers are positive in CFS as in many illnesses. Plus, 70% of the immune system resides in/near the gut. I took a therapy specifically aimed at addressing the gut/immune system, and while it helped, it didn't totally normalize representative bacteria, though it did normalize function. It is highly likely that the body, for whatever reason, doesn't want oxygen in (hemoglobin has an extremely high affinity for it and we don't desaturate properly after a long breath hold), which would favor facultative anaerobes. Probably true of the brain as well.

You are correct that subtle imbalances in the microbial colonies in the gut can have major ramifications. Just read about the gut microbiome in a major gastroenterology journal. Personally, I think about 75% of chronic illness could be treated or prevented by keeping the proper balance. Look at the Terry Wahls' diet. She put her MS into remission by eating immaculately. People are finally waking up to just how much it's true that, "You are what you eat."

Uncivil Engineer, I'm sorry for your son, and I truly hope this is nothing serious and that you get it figured out.