One of the most interesting parts of this conversation with Dr. Teddy Bross was hearing him explain how strange it can be for endurance athletes to navigate modern healthcare.

Most runners spend the majority of their time in this middle ground where they’re healthy enough to not really fit into the medical system, but still pushing their bodies hard enough that things constantly need attention. They’re not “sick,” but they’re also dealing with recurring fatigue, weird bloodwork, GI issues, chronic injuries, hormone problems, poor recovery, and a thousand little warning signs that something is off.

And a lot of the time, nobody is really connecting the dots.

Teddy is a family medicine physician based in Colorado who works primarily with athletes and active adults through his practice, High Point Direct Care. He’s also an ultrarunner himself, which matters more than people probably realize. A huge part of this conversation revolves around the difference between being treated by someone who understands endurance sports from the inside versus someone trying to interpret athletes through a standard medical framework.

Because athletes don’t fit neatly into that framework at all.

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One of the more interesting parts of the conversation was Teddy explaining how often athletes avoid medical care entirely until something has already gone very wrong.

Part of that is personality. Runners are good at tolerating discomfort and convincing themselves things are “probably fine.” But part of it is also structural. Traditional healthcare systems aren’t really designed for people who are mostly healthy but occasionally need immediate, nuanced help.

You tweak your knee. You’re exhausted all the time. Your stomach is wrecked halfway through every long run. Your training suddenly feels flat for no obvious reason.

None of those things feel dramatic enough for urgent care, but they also don’t fit neatly into the normal pace of primary care. By the time many athletes finally get answers, they’ve already spent months trying to troubleshoot it themselves.

Teddy talked a lot about trying to close that gap. Not just reacting to injuries, but helping athletes identify patterns before things completely spiral.

That statistic stopped both Jon and probably most listeners in their tracks.

Teddy explained that current research suggests nearly half of runners are experiencing low energy availability at any given time. Not just elite athletes either. Recreational runners. Competitive runners. Men and women.

And the tricky part is that it rarely shows up as one obvious symptom.

It can look like fatigue. Recurring injuries. GI issues. Poor recovery. Brain fog. Hormonal changes. Declining performance. Sleep problems. Mood swings. Constant soreness.

Because every system in the body depends on energy.

One of the most interesting explanations Teddy gave was around GI distress in endurance athletes. The digestive system has an incredibly high cellular turnover rate, and when the body doesn’t have enough energy available, it starts prioritizing survival elsewhere. Blood flow shifts toward working muscles and away from digestion, absorption slows down, inflammation builds, and eventually runners end up dealing with chronic stomach issues that they often assume are “just part of running.”

A lot of the time, they’re not.

The conversation around ferritin and iron deficiency was one of the most practical sections of the episode.

Teddy explained why iron deficiency is so common in endurance athletes and why many runners misunderstand the testing process entirely. He also broke down why ferritin matters more than simply checking serum iron and how inflammation can distort results if you don’t know what you’re looking at.

More importantly, he talked about context.

A runner’s bloodwork doesn’t always look like a non-runner’s bloodwork. Elevated creatinine might not mean kidney failure. Higher liver enzymes might simply reflect training load and muscle damage. Numbers without interpretation can create unnecessary panic very quickly.

That’s where experience matters.

Not just reading labs, but understanding the person sitting in front of you and the demands they’re placing on their body.

There’s also a really beautiful thread running through this episode about consistency.

Teddy shares stories from pacing David Roche at Leadville and being there for some of the most emotional moments in ultrarunning over the last few years, including Western States and Canyons.

But the takeaway wasn’t really about records.

It was about diligence.

At one point, Teddy references something he heard about Grant Fisher: the reason he’s so good is because his coach always knows exactly what he’s doing. The routines are consistent. The habits are predictable. The small things get done over and over again.

Teddy puts it simply:

“Excellence in the end just becomes really boring.”

That line captures a lot of what this conversation is really about. Whether it’s training, recovery, fueling, medicine, or long-term health, the people who stay healthy and perform well over time usually aren’t chasing shortcuts. They’re paying attention to the basics consistently.

One of the reasons this conversation works so well is because Teddy approaches both medicine and running with a deep sense of curiosity.

The episode opens with him talking about books, animal behavior, sensory perception, and the kinds of rabbit holes he naturally disappears down when something catches his interest. That same mindset shows up later when discussing athlete care. Curiosity allows him to ask better questions instead of just checking boxes.

Why is this athlete fatigued?

What patterns are getting missed?

What does this bloodwork actually mean in the context of their life and training?

The best moments in the conversation happen when medicine stops feeling transactional and starts feeling collaborative instead.

The longer this conversation goes, the clearer it becomes that many endurance athletes are trying to operate at a high level without enough support around them.

Not enough recovery. Not enough fuel. Not enough access to people who actually understand the sport.

And for a lot of runners, the assumption has simply become that feeling terrible is normal.

Teddy challenges that idea throughout the entire episode.

Not by promising quick fixes or optimization hacks, but by arguing that athletes deserve healthcare systems that actually make sense for the way they live and train.

🎧 Listen to the full episode with Dr. Teddy Bross on For The Long Run wherever you get your podcasts.

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Jon is a runner, cyclist, and podcast host from Boston, MA, who now lives in Boulder, CO. For The Long Run is aimed at exploring the why behind what keeps runners running long, strong, and motivated.

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