It has not even been four weeks since I stood on the course of World’s Toughest Mudder overnight in Fairburn, Georgia.  The overnight low was estimated at about 32 degrees F. Add to that a high humidity and intermittent wind and the “feels like” temp was in the high 20’s.  To someone who is wet, exhausted and hungry the temperature probably felt much colder. Prolonged exposure to extreme cold creates hypothermia which is an actual, measurable decrease in core body temperature.  According to the Wilderness Medical Society Expert Panel on Accidental Hypothermia “As your brain cools down your personality and communication can quickly change. You may be irritable, confused, apathetic, lethargic, have poor decision making and appear obtunded.”

Immediately before the start line and about 100 yards from the medical tent (about 99 yards too many) Tough Mudder’s contractor for medical services, New York based Med Prep Group, conducted “neuro checks” on athletes wishing to go out for another lap.  I worked with Med Prep conducting those checks all night long. To me the neuro check is as much about how you appear to me at that moment as it is convincing me that you have the capacity to return to the pit safely some 5-7 miles from now. Those two extra miles exist only for the athlete that fails every obstacle with a penalty and penalty mileage does not count toward official mileage.  We are checking for your current status as it applies to the definition above, and at the same time, gauging your probability of success. I asked as many “what is 5 minus 2” questions as I did “what did you just eat?” and “where is your neoprene hood?”

Molly Kenneth Iceland and Hypothermia
WTM 2018.  Fairburn, Georgia.  Sunrise on the frozen tundra.  Photo credit: Brad Kerr
Molly Kenneth Iceland and Hypothermia
Kait Bykowicz keeps gutting it out. Photo credit:  OCR Nation.
Molly Kenneth Iceland and Hypothermia
Andrew Cook. Frozen pathway.

My first WTM was 2016 and in Las Vegas the warm med tent spilled out onto the course where we popped in and out alternating between assessing, treating, reassessing and returning you to the wild.  Built on a model of “catch and release” medicine, Med Prep Group is the only company able and willing to provide such a high level of medical service with the ultimate goal of seeing the athlete continue.  Athletes can receive up to 30 minutes of care on the course and 30 minutes of care in the med tent provided that they do not require a vehicle to get there. At Tough Mudder no athlete, not even the elites, are disqualified for needing medical care.  In this way, athletes may warm to the idea that medical staff are a resource rather than a threat and medical issues are addressed when they are an annoyance and long before they become an emergency. In Atlanta, the med tent was in a poor location, off of the course, far down the road, as the last white tent on the left in a string of white tents.  The Pit, on the other hand, was an absolute work of art and offered good pit spots even to late comers with many arteries that dumped easily back onto the course. So this year, instead of sharing that job with a team and having a warm tent nearby I was the frozen sentry.

I watched you walk for your cadence, your limp, your ability to navigate the hard left turn past the Race Center that brought you to me.  It was my own special field sobriety test. As you drew closer I gave you a direction: “stop”, “wait”, “one line”, “come to me” and watched if your brain could appropriately process the instructions.  The truth is, by the time we stood eye to eye, before I ever offered you a hug or piece of chocolate, before I said “how’s it going?” or “how are you?” your neuro check was mostly over.

Molly Kenneth Iceland and Hypothermia
Kevin Calder “In the drink”  Photo credit: World’s Toughest Mudder

I know people and how they think, how they move.  I know what the human body does when well, when sick, when stressed, when exhausted.  I could see it in your eyes, as I touched your forehead and turned on your headlamp for you because your hands were frozen solid. I could see exactly who you were, how prepared you were and more than likely, how that next lap was going to go for you. If you gave me cause to doubt you, I would bug you with a few more questions. Around 3:00 am everyone started getting more questions. The quick assessment had become more challenging and the consequences of being wrong had grown more brutal. If I stopped you to recommend you warm up and have a few hours of sleep you absolutely could continue later.  However, if you got out there on course and somewhere in the back forty you needed the cart to come in, if you pushed until the wheels fell off in that unforgiving climate, that cart ride would cost you your timing chip. How many times did I remind you of that? How many of you opted for the sure thing? How many pressed on? Elite athletes, I was trusting your professional status to mean you were better prepared, trained and supported when I waved you through. Only once did that come back to bite me.

Molly Kenneth Iceland and Hypothermia
Reese Thompson and company demonstrate that some WTM obstacles are designed to require help.
Molly Kenneth Iceland and Hypothermia
Daniel Cramer definitively proved that water moccasins are nocturnal. Photo credit: World’s Toughest Podcast’s Jeff Goras

So much goes into that moment.  It was the culmination of a hundred thousand small decisions. When you stood for the requisite check… how long had you been training?  A year? Five? I didn’t need to ask the details of your life that had driven you to this point, the way that activity is a basic human need to you just like air or water, because I already understood. I could see the quality of your gear, sometimes I pinched your sleeve to measure the millimeters of your wetsuit. I sent you back to your pit for your flasher, your wind layer. I looked to see if you appeared to be able to handle what stood before you.  With hands unwilling to emerge from the cocoons of their Bleggmitts I opened the chocolate for you and popped it in your mouth. You just passed the neuro check.

Now what?  “Up the hill”. Yes. Up and away, into what? A frozen landscape of just you and your thoughts. Your consequences played out in the darkness. Is this what you wanted?

When I ran Toughest Mudder East in Boston this year I was astonished to find as I emerged from the water at Rope-a-dope that some alien force drained all of my energy in an instant.  I’ll never forget the feeling of the world tipping sideways and my sudden and unexpected inability to remain upright. Fortunately a friend saw me listing off the path and corralled me.  He tried to feed me but I buried the food in the hay bale I had crashed behind. I could not stop crying. Physiologically, I had “hit the wall” or “bonked” when I crossed the tipping point and exhausted all of the energy stores of glycogen in my muscles and liver.  There was no warning and no apologies. The body goes from a compensatory state to a noncompensatory state like flipping a switch. The cold only increases the likelihood that you will crash and the water seals your fate with its unique energy draining and core body temperature lowering abilities.

Molly Kenneth Iceland and Hypothermia
Brandon Beneke “All alone”.  Photo credit: Linda Beneke
Molly Kenneth Iceland and Hypothermia
Dan Stowe’s bib left unsupervised froze solid.  WTM 2018.
Molly Kenneth Iceland and Hypothermia
Charles Haupert enjoys a snack to keep up energy and warmth.

The human body has enough energy stored as glycogen in the liver to perform basic functions for about fourteen hours without food before needing to go to alternative sources. Being alive burns calories, as does being outside in the cold. And what about your activity level? How do you account for that? How could you ever possibly eat enough to sustain your energy and not bonk?  Very deliberately. In the required medical safety briefing the night before The Leadville 100 Medical Director Dr. Charles Hill says “You may think of this as a running event with some eating when in fact this an eating event with some running.” Today I listened to the interviews of WTM 2018 winners Rea Kolbl and Kris Mendoza – interviews that were conducted prior to their wins – and what was the common theme? Food. Eat. A lot. Bring choices. Bring food with you on the course. Just keep eating.  When you don’t want to eat your pit crew should force you. If you bonk, your race is over. Everything is about staying warm and not hitting the wall. Eat.

There are only three macronutrients that all your foods can be classified under: carbohydrates, protein and fat.  Many, possibly even most, of us have tinkered with our diets and ratios of these macros in an effort to maximize performance.  However, an endurance event in winter conditions requires a fairly deliberate eating approach that differs greatly from anything you may have ever done. Consider how each of the three macronutrients affects your blood sugar levels and then make a plan of combining foods to maximize performance in extreme conditions.

Molly Kenneth Iceland and Hypothermia1. CARBOHYDRATES: Your body loves sugar, at least at first. Simple sugar is “fast acting” and easily converted to energy.  But because you can enjoy that fast acting energy spike know that your energy level can crash down just as quickly.  If your endurance event diet is going to rest heavily on carbs know that you will need to eat every 20-30 minutes to prevent an unsightly crash.  Common carbs you’ll see on course are gu’s, gels, blocks, performance drinks, cookies, and fruit.

2. PROTEIN: A Clif bar has about 8 grams of protein. There are about 3-5 grams in a Stinger waffle, These item do not have large quantities of protein. There is a WTM theme of the turkey sandwich enjoyed in the pit, or on a penalty lap. Protein spikes lower and later than their carbohydrate counterparts allowing you more staying power. While you won’t enjoy an energy surge you are also less likely to suffer the energy crash when protein is part of your intake.

3. FATS:  The secret weapon of performance in a cold climate.  The power move in winter snow camping is peanut butter at bedtime. Over several hours as the night grows colder the energy from the peanuts is just ramping up. There is no spike in calories derived from fat sources and the energy provided will be much longer lasting. Examples include any nut butter, available in 2 tablespoon pouches from Justin’s and many other brands, fats as they appear in chips or a donut, fats in your pepperoni or cheese pizza. Stinger waffles derive 50% of their calories from fat and slide nicely against your pecs and inside your wetsuit. A package of Justin’s holds two tablespoons (about 200 calories) of nut butter inside the wrist of your wetsuit without getting in the way.  By wearing “gorilla gloves” (available from Home Depot) under your Bleggmitts you will have the dexterity to open a pouch of food on the go all without ever exposing your bare hands to the wretchedly cold conditions.

WTM 2018 was all about calories and gear.  If you’re headed to Iceland know that the weather there today is 40/34 F which is almost exactly what we had at WTM. The people who did well at WTM wore only synthetic clothes in many layers. Whether it was fancy compression gear or thrift store polypropelene the key is that you read labels and avoid cotton. People that were effective brought several wetsuits and possibly a neoprene shortie, vest or jacket to put on over their wetsuit but underneath their full wind layer. Neoprene covered their head and hands and a synthetic buff provided the flexibility to protect their neck, face or a second layer under their dive hood. They wore shoes a half size larger than normal to accommodate all those synthetic or neoprene socks. They ate frequently and ate a variety of macronutrients both on and off the course. They kept moving. They committed fully in their gear, their nutrition, in their minds and hearts. And so can you.

Molly Kenneth Iceland and Hypothermia
Ashley Russell.  Too cold outside… not much warmer “inside”…once the body is cold it is very difficult, but not impossible, to recover.
Molly Kenneth Iceland and Hypothermia
Martin Gemmell and Andy West  tell the truth about WTM 2018.


Please enter your comment!
Please enter your name here