It’s been just over a month that Micah True’s body was found in the rugged wilderness area of southwestern New Mexico. The legendary ultrarunner and memorable “Caballo Blanco” centerpiece of Born to Run had gone missing after a rather routine 12-mile trail run. An autopsy report released Tuesday by the Office of the Medical Investigator in New Mexico showed that the 58-year-old runner had cardiomyopathy, a disease that results in the heart becoming enlarged.

According to the Associated Press, “While medical examiners couldn’t point to the cause of the heart disease, they said True’s left ventricle, the chamber of the heart that pumps oxygenated blood to the rest of the body, had become thick and was dilated. That can result in an irregular heartbeat during exertion.”

Ultra runners are still puzzled by True’s sudden death. They all thought he was exceptionally fit and healthy. The Associated Press quoted two of Caballo’s friends, both of whom participated in the search in the Gila wilderness.

Scott Jurek: “It doesn’t fit with him going on a two-hour run. It wasn’t exceptionally hot. By a lot of ultra-marathoners’ standards, it was pretty simple. I doubt he was running that hard. I think it was just a matter of timing.”

Chris McDougall: “This is a guy who could set out with a little bag of ground corn, a bottle of water in his hand and be gone all day. The day before he died, he did a six-hour run.”

The autopsy report concluded that “the manner of death is natural.” But that statement, by itself, is less conclusive than it seems. Could True’s death have been prevented? Why then, and why during a relatively easy run? The NRC asked one of our health advisors and frequent contributors, Dr. Steve Gangemi, aka the Sock Doc, to look over the autopsy report and offer his opinion. — Bill Katovsky

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Nothing “Natural” About Dying from an Enlarged Heart

by Dr. Steve Gangemi, aka the Sock Doc

It’s interesting to read a report, in this case an autopsy report, which reads that the individual died of a disease that was “natural”when that person was only 58 years old and supposedly in excellent health. The medical examiner performing the autopsy has deemed True’s death a result of unclassified cardiomyopathy which resulted in a cardiac dysrhythmia during exertion.

Basically this means that he died because his heart muscle was deteriorating slowly over time and eventually this created the electrical activity of his heart to beat abnormally most likely leading to inefficient pumping of the heart and finally cardiac arrest. Normal? Definitely not. Common? Perhaps very much so.

The examiner further states, “The manner of death is natural.” Natural? I’d like to think not–a heart doesn’t “naturally” fail in such a manner, especially at 58 years of age. Though the most common reason for cardiomyopathies is ischemia (lack of oxygen supply to the heart), the medical examiner notes that there was no evidence of ischemia or inflammation of the heart. It’s all a bit strange.

So since there was apparently no ischemia or other cause for True’s heart disease, this could very well leave one to speculate that his condition, and death, was one which resulted from hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy (HCM) is a thickening of the heart muscle and the most common leading cause of sudden cardiac arrest in athletes. Those with HCM often have a severe thickening of the left ventricle of the heart, and True’s autopsy does clearly state this. This condition, known as left ventricular hypertrophy (LVH) can eventually result in cardiomegaly –an enlarged, inefficient heart.

The medical examiner does note in his review of the cardiovascular system that True’s “heart is enlarged” and further notes “mild to moderate arteriosclerosis”, though he makes no relationship of either condition to his LVH and further back to his HCM — his “cause of death.”

Ultimately True died in the same matter many fit but unhealthy athletes have died in the past, and unfortunately many more will succumb to the same fate in the future. In 2007, during the Olympic marathon trials, 28-year old long distance athlete Ryan Shay collapsed and died from a heart attack. He, like True, also had cardiac hypertrophy, and subsequently cardiomegaly. And like Caballo Blanco, his final autopsy notes that he too died of

“natural causes.

I can assure you one thing – dying from a heart attack due to prolonged, chronic structural changes in your heart is far from natural. A thickening and scarring of cardiac tissue is the result of the body’s inability to keep up with prolonged and excessive stress demands – essentially it’s in constant repair mode, and losing. Shay had this process occurring in his heart (fibrosis) and True in his arteries (arteriosclerosis). These “osis” conditions are due to free radical damage, inflammation (even temporary, but frequent), and hormonal and metabolic problems that occur from training too hard, lack of rest, improper diet, and other lifestyle factors.

In the upcoming Part V of the Sock Doc Training Principles, I will go into further detail how and why highly conditioned athletes are dying from chronic endurance training and steps you should be actively taking now so you too don’t all of a sudden die from a “natural cause” such as a heart attack, cardiac arrest, or any other disease or disorder in which your body can no longer keep up with the demands you place on it.

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FROM THE ACTUAL AUTOPSY REPORT: