The starvation of the long distance runner: A meta-analysis of disordered eating, relative energy deficiency, and the elusive path to recovery in ultramarathon performance

The culture of ultra-endurance running has long been celebrated as a testament to the indomitable human spirit, or perhaps more accurately, as a testament to what happens when the human spirit decides to ignore every biological safety protocol ever evolved. While the community prides itself on the ability to endure grueling terrain, extreme weather, and sleep deprivation, there is a quieter, more insidious endurance taking place: the persistence of disordered eating and clinical eating disorders. The data suggests that for a significant portion of this population, the finish line is not just a physical destination but a metabolic cliff. The prevalence of mental health issues among ultra-endurance runners is startlingly high, with eating disorders ranging between 32.0% and 62.5% across various cohorts.1 This meta-analysis seeks to peel back the technical layers of this phenomenon, examining why individuals who run for twenty hours straight often believe that an extra slice of toast is the primary obstacle to a podium finish. It appears that the intersection of high training volumes, sociocultural pressures for leanness, and a heavy dose of perfectionism has created a biological equivalent of a dumpster fire that many athletes are currently trying to use for warmth.