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  Latest update:4/15/2023

Miscellaneous Medical Questions.


Q.I recently rode Paris Brest Paris, perhaps you know about this ultimate 1200k endurance cycling event. I did not make it to the finish but did make it 1100k, in about 82 hours (which meant I had 8 hours to do 100k...) I was not dehydrated nor was my blood sugar low. I rode 26 hours before sleeping for 5 hours (good sleep) and then 22 more before 3.5 hours of sleep. The third day I felt good, riding at dusk I became very fatigued, disoriented, even hallucinated. I made it to a control, got 4 hours of sleep, thought all would be well. Started riding at 6 am, could not stay awake, tried napping by the side of the road, and I guess did not look like I was doing so well as someone called an ambulance. My blood pressure was OK, pulse was 45, slightly low for me. As I plan to do this and make it in 2007, any advice for legally dealing with this sort of fatigue? I tried caffeine, amazing how little caffeine does once one reaches this level. Does what happened to me indicate any condition or syndrome or lack of some nutrient? Is there a quick fix when one gets this (I know sleep... other than that) low?

A. The short answer is "no". I doubt there are any supplements that would prevent this from happening. Even when you eat just right, there is a limit related to your own physiology that reflects metabolism at the cell level. On another day, it might be a breeze and yet you would have done nothing differently as far as training. Good luck in 2007.

Avoiding the Flu

Q. I bike about 100 miles a week. With the upcoming flu/cold season, will altering my diet in any way prevent or reduce my chances of catching a cold/flu? If I get a cold/flu, will altering my diet in any way reduce the length of time I have a cold or flu? Will regular moderate exercise during the time I have a cold/flu reduce the the length of time I have a cold or flu, make it worse, or do nothing at all?

A. There is no evidence that diet supplements will reduce your chances of getting a viral URI or upper respiratory infection ("the flu"), although a regular, moderate exercise program does appear to provide some protection. If you do get a viral URI, zinc lozenges will cut down the duration of symptoms. During the early phase - when you are having aches, chills, and perhaps a fever - it is best to back off on your training or riding program. There has been suggestive evidence that continuing to push during this time can lead to additional problems.

B12 Injections

Q.I am a competitive rider 46 Years old. Can you give any clarification on using large doses (3cc) at a time of B12. Are there proven benefits to this?

A.I believe any benefit would only be a placebo response. There is no physiology that would support this (unless you have pernicious anemia) not any scientific evidence.


Q.I have been told to exercise to avoid osteoporosis (which runs in my family). Will cycling do the trick?

A.We're discovering that cycling may contribute to bone loss in both men and women because it's not a weight-bearing activity. So cyclists should cross-train for bone health. Weight training and jumping (like rope skipping) are helpful.

Saddle Sores

Q.I have been having problems with saddle sores, especially after long, and multiple day rides. Any ideas.?

A.Saddle sores are due to a combination of tissue injury from long saddle times which in turn decreases tissue resistance to infection. Skin bacteria present in the area (the skin surface on the buttocks) can then take advantage of this decrease in the barrier to infection.

Approaches to minimize risk of saddle sores focus on decreasing the skin injury and minimizing the concentration of bacteria on the skin. Both decrease the odds of an infection taking hold in the "fertile soil" of the injured tissue.

Take simple steps first:

And consider topical agents. Having tried almost every possible combination of butt butters and cremes, I've had the most success applying a base layer of neosporin to the sit bone (ischial tuberosity) area followed by Bag Balm or Chamois Butter to provide a barrier. Even riding 4 or 5 times a week, that has kept me saddle sore free for several years.

More details on the physiology along with tips to avoid saddle sores at How to Solve Saddle Sores.


Q. I'm preparing for a mountain bike competition (2 days with 100 Km/day). I began a training program in February with gym exercises and spinning sessions (3-to-4 times each week). Since early June I replaced spinning sessions with outdoor bicycle rides (both road and mountain rides).During spinning sessions I train in the zone (152-165 bpm) for 45 minutes/hour. My MHR is 185 bpm. I use a HRM to monitor my progress.

During the 5 months or so since I began to train (an average of 8 to 10 hours/week) I noticed a resting heart rate passing from 59 bpm (February) to 50 bpm (end of June). At the end of June, during a outdoor road ride I experienced two episodes of palpitations with my HRM reading 200 bpm, no symptoms, everything normal. I stopped and after 2 minutes my heart rate abruptly dropped to 110 bpm. My RHR has not changed. I am a male, 43 years old in good health, my effort ECG is perfectly normal so is the cardiac echography. San these short episodes of tachyarrythmia be caused by overtraining?

A. Palpitations can be caused from many things - including genetic predisposition. A recent article suggested that runners had more atrial fibrillation as they aged than non runners - even though running is felt to be a "healthy" activity. Electrolyte imbalance is another cause - be sure you are replacing potassium and magnesium (supplements are not harmful and any excess is lost through the urine). And caffeine and lack of sleep can aggravate a tendency toward palpitations as well. Since you have had an echo, I presume you have talked to a physician - an arrhythmia can be the first sign of ischemia or coronary artery disease. With that said, the answer is possibly due to overtraining, although unlikely with your RHR going down. I notice that your trainer had you at about 80-85% max ht rate when spinning. A big mistake is training too hard every day - you really only need to ride at this level for 3 days a week. then add in a day or two of intervals and work on getting one or two slow spinning days per week.

Blood pressure during exercise

The physiologist in me had always wondered about blood pressure changes with exercise. This is a nice review on a pretty esoteric topic.


Eye glasses and using your cycle computer

Q.I wear reading glasses and find that I have trouble reading my cycle computer with my sunglasses. Thoughts?

A.I have the same problem and finally broke down and got a pair of subscription sunglasses. You can get bifocals or varilux (variable refracted) lenses (which I find the easiest for myself),

Here is another idea I found on - "There is a low-cost alternative for seeing up close -- stick-on bifocal lenses. These are simply thin pieces of vinyl that you attach inside the lenses of your normal glasses or sunglasses. They come in six different prescription strengths from 1.25 to 3.00 and are extremely easy to install and use. Buying sunglasses is expensive enough without adding on a bifocal prescription. For about $20 I was able to apply these lenses to a cheap pair of sunglasses that I already owned to see if they worked. They did, much better than ever expected. They aren't a solution if you need distance correction, but if you normally require help to read up close (i.e., you wear reading glasses or bifocals), stick-ons are worth a try. There are several online sources, including www.stickon and

Varicose veins

Does cycling increase your risk of developing varicose veins? The answer depends to a degree depends on how many hours you spend on the bike each week. This link highlights an extreme - the prominent veins seen in Tour riders. Why the prominent veins in this select group? Most likely a result of the extremely large blood flow in the working leg muscles - the blood needs to get back to heart and the surface veins are a significant return route. And since these veins are not surrounded (and constrained from dilation) by muscle or connective tissue, they expand much more easily to meet the increased flow load. A second reasons is the lack of subcutaneous fat (a reflection of their general low % body fat) which accentuates the venous prominence. How about the rest of us? This link explains the physiology.

For the average rider, the development of varicose veins is no more of a personal risk than for their non riding peers. But if you do spend long hours in the saddle for training and endurance rides, your risk will go up a bit.

Statins and physical performance

Q. My physician suggested I take a statin for my elevated cholesterol. I know statins can cause muscle aches. Is it possible they could impact my on-the-bike performance?

A Statins are one of the more commonly prescribed medications and have there own set of side effects - mainly muscle aches in 1 out of 5 users, occasionally severe enough to stop the medication.

I always wondered if there were performance changes in those who were taking statins but did NOT have myalgias (muscle aches). The answer is now in. Statin users in primary prevention experiencing myalgia do not have impaired aerobic exercise performance or muscle strength compared to

A recent study investigated the question as to whether intense physical exercise (which can cause micro-tears and muscle pain) would increase the muscle discomfort side effect of statins. The findings? Statin therapy didn't aggravate normal muscle fatigue (which can be associated with sustained exercise, or adversely affect blood levels of enzymes or other biomarkers associated with muscle injury. To quote directly from the paper "Muscle pain and fatigue scores increased similarly in all groups with exercise and were not worsened by statins. This study demonstrated that habitually active statin users can engage in prolonged moderate intensity exercise without exacerbating skeletal muscle injury and reinforces the recommendation to combine statin therapy with a physically active lifestyle." However, it is often a challenge to sort out symptoms of myositis (actual muscle inflammation) from statins as blood tests are not as good a differentiator of myositis as one might like to think.

So if your physician has recommended a statin, don't let worries about it impacting your exercise program by increasing the odds of post exercise muscle pain, aggravating muscle injury, or otherwise decreasing performance hold you back. Give the drug a try, and if you are one of those who do develop muscle discomfort, let your personal level of distress (is it severe enough to interfere with riding or your daily life?) dictate whether it is time to talk to your physician about alternatives (such as benpedoic acid which is one of an entirely different class of medications). If the discofort is more an annoyance than limiting, another alternative is to stop it for a month and then restart "just to be sure" it is the culprit.

All questions and suggestions are appreciated and will be answered.

Cycling Performance Tips
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