[…] thought that ultrarunners probably might not consider a 50K to be a true “ultra.” I posted this question to the online list and received unanimous and overwhelming support from the ultrarunning community that 50K is, indeed, considered an ultra distance by those who actually run ultras, everything from 50Ks to 100 miles and beyond.

Mr. LeMay makes the statement that “SOK is only 5 miles longer than aregular marathon, so that distance is not putting your body through much more suffering than a regular marathon.” I would invite Mr. LeMay to run the Glacial Trail SOK in Wiscon

Send your letters to

[…] sin early next October and see if he might not revise his opinion after that experience! Mr. LeMay needs to remember—or perhaps learn—that while marathons are typically run on roads, many ultras are run on trails, often quite difficult and challenging trails. Glacial Trail, for example, is run on single-track trails in Northern Kettle Moraine. The footing can be quite tricky, as you dodge and scramble over endless rocks and roots and tackle numerous hills. I found it put my own body through quite sufficient “suffering,” thank you! Mary Fredricks via e-mail

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DOES RUNNING LOWER

hormone levels so much that one could miscarry? I got pregnant at a time when I wasrunning 50 miles a week. Iran 30 miles a week in the middle, and cut it to 15 to 20 at the end. At 37 weeks, a healthy Grace was born naturally after 5 hours of labor. Since then I have had two miscarriages while running fewer miles than when I got pregnant with Grace. My midwife is concerned that my hormone levels are not right because of running and periods of amenorrhea while a teenager. I would love more information on this subject. Beth R via e-mail

EXERCISE DURING pregnancy is generally safe for most women, and the American College of Obstetricians and Gynecologists and other scientific groups have developed exercise guidelines for women who are pregnant. Exercise certainly may influence reproductive hormonal activity, as has been documented in research focusing on the female athlete triad (disordered eating, amenorrhea, and osteoporosis). These hormonal changes are thought to influence bone health and may also affect fetal health. Exercise may also interact with insulin resistance during late gestation

and affect blood glucose levels, possibly leading to hypoglycemia and altered fetal development. Additionally, exercise may increase sympathetic neural activity and epinephrine secretion, which may decrease uterine blood flow, leading to transient fetal hypoxia and altered fetal development. However, for most women, exercising within appropriate guidelines, these are not major concerns. Nevertheless, I think that after two miscarriages you should consult with a sports-oriented gynecologist to evaluate your exercise program and reproductive system. There are certain conditions wherein absolute contraindications exist for exercise during pregnancy and others where relative contraindications exist. An excellent resource is ““Par-Med-X for Pregnancy,” which includes a prescreening questionnaire to identify contraindications to exercise during pregnancy, safety considerations, and exercise guidelines. You can get this guide from the Canadian Society for Exercise Physiologists, Suite 202, 185 Somerset Street West, Ottawa, Ontario, Canada K2P 0J2. Mel Williams

established the Human Performance Lab at Old Dominion University

in Norfolk, Virginia, and is an M&B Science Advisory

Board member; he won the

60-69 age group category at

the 1998 Boston Marathon.

ON THE MARK @ 161

IDO not think any data supports the idea that exercise changes hormone levels, but I usually recommend that women who have had problems cut back until the pregnancy is well established. Folate supplementation may be helpful, and some women benefit from one baby aspirin daily until the end of the first trimester. I also asked Liz Joy, MD, of the University of Utah to offer her comments; her response follows:

“T am unaware of any research that suggests that exercise increases one’s chance of first trimester miscarriage, especially if the exercise being done is not greater than what was being done prepregnancy. However, on a case-by-case basis, exercise theoretically might impact negatively on pregnancy. It is possible that exercise could induce luteal phase insufficiency, resulting in very early losses. Probably more likely is simply an age-related change in your cycle that is causing these losses. I would recommend that you get the book Taking Charge of Your Fertility and start charting your cycles. This will give you and your midwife more information to work with.”

William Roberts, MD,

is in private practice with MinnHealth Family Physicians and MinnHealth SportsCare Consultants in White Bear, Minnesota. He is medical director of the Twin Cities Marathon and a member of this magazine’s Science Advisory Board.

I HOPE this answer helps you some. Dealing with miscarriage and trying to find answers is traumatic. Running

162 M@ MARATHON & BEYOND

can affect reproductive hormone levels, thereby altering menstrual cycles and possibly reducing chances of falling pregnant. However, I know of little to no evidence that moderate levels of running can affect hormone levels once pregnant to the extent that miscarriage occurs.

Furthermore, the causes of miscarriage are many, with “hormone deficiencies” being about the bottom of the list. About one percent of women have repeated miscarriages (two or more), and for most of them no cause is ever identified, and most of them go on to have a healthy and successful subsequent pregnancy.

An inadequate level of progesterone is regarded as the main hormonal cause of miscarriage, but little scientific evidence supports this notion. Pregnancies progress under widely varying progesterone levels, and supplementing with progesterone has no effect on the course of a fragile pregnancy.

Other reasons I don’t think hormone levels explain your miscarriages:

° You have carried a child at much higher mileage with no problem, so on less mileage it is unlikely that you would develop hormonal imbalances—unless those imbalances were caused by some other factor, such as age and stress. That is, running is not to blame.

° There is no evidence that amenorrhea in adolescence has any effect on later adult fertility, provided menstrual cycles become regular.