By Frank Horwill
How to spot the warning signs of "Mysterious Mono", and what to do about it
Seven out of the western world's top 10 runners every decade will contract it. The disease will strike them when they are at the peak of fitness, and it often lingers on for months or even years, disappearing and reappearing like a weed. It is glandular fever (infectious mononucleosis). What is it? It is, in fact, possibly a group of diseases, of which the cause is still unknown but is presumed to be a virus. As its common name implies, it is a fever which particularly affects the glands (lymph nodes) - they swell under the armpits and in the groin, as well as the throat. Accompanying this is considerable exhaustion.
Why are runners particularly prone to this infection? To answer this we must refer to Hans Selye's stress theory. We possess a finite amount of anti-stress factors. We use about a third of them to deal with our work, another third goes in accommodating our training, and possibly 10 per cent in dealing with the other vicissitudes of life. This leaves us with a reserve of anti-stress factors to deal with unwelcome pressures. We can hold on for a while even when all the anti-stress factors are being utilised, such as with an increase in the training load; the anti-stress brigade toughens up its stance by getting used to the heavier load, but as this happens anti-stress factors to ward off infection become weakened and that is when the fever strikes.
What signs to watch for
Many sports doctors refer to the disease as 'Mysterious Mono' because it attacks the young and healthy in particular. Here, acute observation of how individual athletes respond to training may prevent the curtain coming down. Here is a list of actual 'smoke signals' given off by athletes that their anti- stress factors are about to be invaded by mono.
- Athlete A had a big toe that became sore.
- Athlete B complained that his sleep was disturbed.
- Athlete C got recurrent sore throats.
- Athlete D became very spotty in the face.
- Athlete E became very testy.
- Athlete F developed a sore in the comer of his mouth.
- Athlete G had a higher resting pulse rate.
- Athlete H developed one-day sneezing bouts.
It could be argued that when any one of these symptoms occurs it is too late to do anything about it, but this is not necessarily so. Often altering the rest day from the traditional Friday before the race on Saturday to a Wednesday breaks up the strain of five consecutive days of training. Changing the training routine from track to fartlek on grass or a weekend by the sea brings about a stabilising effect.
What about diet?
Much has been written about manipulating the diet to improve performance. More important is how to load the diet against infection and deal with the stress of training. The term, 'a good balanced diet', is a little too glib for serious runners.
The anti-infection vitamins are B6, B5, C, E, A, and folic acid - added to this are fatty acids. The anti-infection minerals are iron, zinc, and trace minerals. These form an integral part of the DAILY diet, not the odd vitamin or mineral snack each week topped up with junk food. The recommended daily allowance (RDA) for each should be known by athlete and coach. Once known, that figure can safely be doubled (Prokop of Germany believes that in most cases the RDA should be trebled by serious athletes).
Here is a list of foods that provide the highest source of the anti-infection nutrients:
B6 - Most meats, fish, egg yolk, wholegrain cereals, bananas, avocados and nuts
B5 - Eggs, wholegrain cereals and meat.
C - Pure orange juice, most fruit, green vegetables, liver, kidney and potatoes.
E - Vegetable oils, nuts, seeds, soya and lettuce. Eggs and dairy produce provide small amounts.
A - Animal and fish livers, kidney, eggs, milk and butter, green, yellow or orange-pigmented produce. Folic acid - Liver, green vegetables, kidney, eggs and wholegrain cereals.
Iron - Liver, kidney, heart, egg yolk, legumes, cocoa, cane molasses, shellfish and parsley. Zinc - Oysters, ginger-root, muscle meats, and all types of nuts. Small amounts are found in carrots, peas and potatoes.
Fatty acids - Evening primrose oil and fish oil. Note: anyone with any form of epilepsy should not take primrose oil without medical supervision. Those with blood disorders or bleeding problems should only take purified fish oil under medical supervision.
It is pertinent to mention that two studies of athletes in training revealed lower levels of serum zinc compared with those of controls. This may be due to increased sweating, increased blood volume and higher-than-normal protein intake. When in doubt about nutritional status, a good multi-vitamin and mineral capsule should be taken.
Sudden jumps in training load
Strangely, it is not sudden increases in training loads for short periods (not more than seven days) that lower resistance to glandular fever, it is an increase of more than 25 per cent in one go for several weeks that does the harm. A typical dangerous practice would be to upgrade the training load from 50 miles a week to 100 miles a week without gradual progression, and to maintain it for several weeks. The body can just about cope with a week of it, as in crash training, but no longer.
The question of rehabilitation after a bout of glandular fever is a personal one. Steve Ovett, for instance, was able to resume normal training within three months. Another athlete known to the writer had to cease training every six weeks for about two years before he was able to knit together several months of meaningful work. Jim Ryun (former mile and half- mile world record holder), when given the all-clear by his doctor, trained every other day for three months, then two days consecutively with the third off for two months, and thereafter twice a day.
There are three criteria to be met before an athlete returns to training: (1) The fever must have abated; (2) The Iymph nodes must be normal; (3) The laboratory tests must be negative and the spleen palpable. This is then followed by every-other-day training of not more than 15 minutes' duration consisting of steady running. This can be increased by five minutes a day per week until the magical one hour is reached. Then three consecutive days with the fourth day off of normal training. Suffice it to say that the vitamins and minerals listed should be kept at an exceptionally high level.
Some doctors believe that magnesium plays a vital role in rehabilitation. This is easily supplied by taking a handful of any of the nut family and daily helpings of green, leafy vegetables. One of the symptoms of deficiency is white spots on the finger nails, which also occurs with zinc deficiency.
Glandular fever, also known as Epstein-Barr virus, has created havoc in the running world. Many athletes on the verge of Olympic honours have been denied. Some are so disheartened by its recurrence that they give up the sport. It can be prevented and it can be conquered with knowledge and resolution.