© Leyla Helvaci
June 16, 2026
Christine Bürg and Sophie Rodewyk
Why are women often more successful than men in ultramarathons? Orthopedic surgeon Dr. Yvonne Ebel discusses physiology, mental strength, nutrition, and the risks of extreme endurance stress.
An interview with
Dr. med. Yvonne Ebel
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The recent buzz around ultra-marathons — fueled by performances like Rachel Entrekin becoming the first woman to win the legendary Cocodona 250 race in the USA with a new course record, and Arda Saatçi, who gains massive social media attention for his extreme endurance challenges — is bringing endurance sports back into the spotlight for a wider audience.
Impressive feats of endurance, media attention, and new role models for ambitious runners—but behind these spectacular records lies a clear warning: such extreme performances are more than mere motivational trophies.
They require highly specific physiological adaptations, carefully planned training programs, medical nutritional management, and thoughtful attention to recovery, fluid and electrolyte balance, and sleep.
In an interview with orthopedist Dr. Yvonne Ebel, we discussed the physiological reasons why women have surprising advantages over very long distances, what physical and mental requirements ultra-endurance events demand, and what training mistakes can pose health risks.
In extreme ultramarathons, the performance gap between men and women narrows dramatically. At distances exceeding 300 kilometers, women often run even faster than men. This is due to specific physiological advantages in extreme endurance events. What exactly are they?
Men typically have higher maximum oxygen uptake values, larger cardiac output volumes, and greater muscle mass. However, in extreme ultradistances, these physiological advantages become less decisive for performance.
Women, by contrast, draw on fat reserves more efficiently during extreme endurance exertion and show greater resistance to muscular fatigue, an advantage partly attributable to estrogen. Women also tend to maintain a steadier pace and have lower body weight, which can be particularly beneficial in night runs and high-altitude mountain terrain.
Another explanation for slower muscular fatigue in women is that they utilize Type-1 muscle fibers—commonly called slow-twitch fibers—more effectively. These fibers contract slowly, work efficiently, and resist fatigue. Due to hormonal differences, women can recruit these muscle fibers more effectively than men.
What specific physical and mental prerequisites are necessary to endure an ultramarathon?
Completing an ultramarathon requires many qualities to come together. Proper endurance and strength training is essential beforehand, but metabolic adaptation, nutrition, and mental resilience also play major roles. As the distance increases, the mental component becomes increasingly critical.
How does the body manage to run 400 kilometers over 56 hours on just 19 minutes of sleep? What exactly happens?
but is physiologically in an absolute state of exception. The body must provide enormous amounts of energy, compensate for muscle damage, maintain fluid balance, and counteract sleep deprivation.
Toward the end of the race, not only the heart, lungs, and muscles are pushed to their limits, but the central nervous system in particular must contend with pain and sleep deprivation.
Let's be honest: is that really healthy anymore?
This question doesn't have a simple yes-or-no answer. With proper preparation, running a single ultramarathon is certainly not harmful to your health. The competition is more of a boundary experience and extreme athletic exertion, but it's also wonderful motivation once you've made it through.
What advice do you have for people interested in running long distances, such as ultramarathons? How should they train and prepare, and for how long? What nutrition and supplements do you recommend? What other factors are important to consider? Are there any practices to avoid?
The best preparation for a marathon involves consistent training that balances hard effort with adequate recovery. Strength and flexibility training are also essential.
Nutritionally, adequate protein intake is crucial. Proper hydration is individual and should be optimized repeatedly during training.
Supplements should be individually dosed under medical supervision with laboratory monitoring. I find it difficult to make general recommendations here. Electrolytes such as sodium, potassium, and magnesium play an important role.
For me, a major red flag would be ignoring pain (for example in joints) for extended periods to push through training programs as hard as possible.
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