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  • Writer's pictureAnnie Bothma

The following post is a detailed description of my comeback to the road racing scene to win the Durban International City Marathon that took place on the 12th of March 2023 in a new course record of over 7-minutes, while simultaneously claiming the South African Marathon Title.




I made my marathon debut at the Sanlam Cape Town Marathon in 2019. I went into this race extremely under-trained and ill-prepared for the rigorous demands of the marathon. Racing the marathon requires an athlete to train at a much higher volume to be able to tolerate the pounding that comes over the 42.2 km (or 26.2 mile) distance. At the time I was only racing primarily 10km road races, as well as the odd 15km or 21km every once in a while. I had just returned from the USA, the previous year in the middle of 2018, where I only races 5/6km cross country races or 5 000m or 10 000m on the track. I never need to take in nutrition during the race.

When you race a marathon, fueling adequately before and during the race is a big part of what will allow you to achieve your best performance. In the months preceding the race, you have to train your gut to tolerate fuel during training, just like you train your muscles to tolerate the pounding from the road. Before my debut marathon I didn't understand the importance of fuelling and it lead to a terrible encounter with the dreaded marathon wall!

I planned to take in three gels during the marathon (which is not enough!!!) but I only got in one! The first gel, someone else took before I got to the elite table and the second one I opened up too quickly and it shot all over my body, except in my mouth! Eventually I got my first gel in at the 30km mark, but it was way too late, the damage had been done! I went from running a 2:35 marathon pace to finishing in a 2:41. This was the catalyst that drove me to start studying sport nutrition, so I could truly understand the metabolic demands that comes with racing the marathon.

However, I did manage to finish 10th overall and was the first South African to cross the finish-line that day. In 2019, the Cape Town Marathon also doubled as the South African National Marathon Championships, but due to the fact, that I was not selected to represent Western Province, I could not be awarded the national title. I had approached WPA before the race to run in their colors, but they rejected me. I understand, it was my debut and they did not believe I could finish a marathon.


I went to Kenya at the end of 2019, to train for the Vienna City Marathon in May 2020, however, when the whole world shut down in March of 2020, I quickly had to return to South Africa to go into lock-down.

During the pandemic, I completed 7 marathon build-ups without racing the marathon at the end, due to all the race cancellations and postponements that was going on at the time. It was truly a sad time for the running community and I know I am not the only athlete who didn't have any opportunities to compete.

However, I kept training and kept hope that my opportunity would come to race again. It never did. But through the pandemic I ran solo-time trials instead of races to challenge myself and improved my personal best times from the 5km up to the marathon.

One of these were an actual event that took place in October 2020 instead of the mass-participation Sanlam Cape Town Marathon. The race organized an Elite Marathon on a looped course in Cape Town. It was a very lonely and mentally challenging race. I ran solo without a pacer or bike to help me for the entire duration of the race in 4-5km loops, with the majority of it being cobble stones. I wasn't properly tapered for the race either, since I was busy preparing for a marathon at the end of that year (that ended up getting cancelled as well!)

However, it was still an opportunity that I was grateful for, since I got to run at an event with official timing and that would be more than just another Garmin file on my watch. I managed to win and still run a time of 2:33:35 on the day.


In September 2021, I was diagnosed with Central Diabetes Insipidus (CDI). This condition occurs when the body can't regulate how it handles fluids. The condition is caused by a hormonal abnormality, in my case, it is directly linked to my hypopituitarism and my body’s insufficient production of antidiuretic hormone (ADH). CDI is not related to type 1 or type 2 diabetes (also known as diabetes mellitus), but it does share some of the same signs and symptoms. The two main symptoms of CDI are extreme thirst (polydipsia) and frequent urination.

Before I got diagnosed and received treatment, I was chronically dehydrated and, as a result, my athletic performance suffered. The main reasons why dehydration has adverse effects on exercise performance are: reduction in blood volume, decreased skin blood flow, decreased sweat rate, decreased heat dissipation, increased core temperature, and an increased rate of muscle glycogen use. My blood pressure would drop and I would end up being dizzy and disorientated. I battled with the cold and often lost feeling in my hands and feet. I frequently fainted, during both training and races.

To manage my condition, I was prescribed a synthetic hormone called desmopressin acetate (DDAVP). This medication replaces the missing ADH, which is supposed to be secreted by my pituitary gland. Gradually my medication was increased with the goal to counteract the amount of fluids I was losing through urine, but it was now more concentrated than before. I was losing a lot of electrolytes, especially sodium.

We had trouble figuring out the correct medication dose for my body to manage this condition and as a result a whole host of medical complications occurred that side-lined me from competition form the end of 2021 until December 2022 when I raced at the ASA Cross Country Trials in Potchefstroom.



I only started running at the beginning of November 2022, after taking 5-month complete break from running and doing very little running in the months preceding during the first half of 2022. Therefore, when I initially started running I didn't think I would be able to run a marathon in 2023. I wanted to try to make the team for world cross country and represent my country in Australia.

I went into the trials very under-trained. My body felt so sore afterwards, that I could only do easy shorter runs for a whole week. To be honest, my body actually feels better now, after running a marathon than what it did after that 10km at the ASA cross country trials back in December! It was to be excepted that I would struggle, since I was only able to cover the 10km distance for the first time 2-weeks before the trials. I also only managed to do one 30-minute fartlek workout before the race, which was definitely not enough to compete against the strong field that lined-up on the day.

However, after placing 4th at the trials on 3 December 2022, I finally felt like I got a bit of trust and confidence back in my body and started believing again that just maybe I would be able to run a marathon the next year. I knew I was basically starting from scratch. I had to build a base again, before I could consider doing any hard workouts or attempt marathon distance long runs.

On Monday the 12th of December, I started following a structured running program again. For the first time in a very long time, I was no longer just doing easy runs, but structured workouts and a long run weekly. In December 2022 and January 2023, all my training was geared towards handling the challenges of a cross country course. I did A LOT of hill repetitions and fartlek workouts on the grass or in the mountains. The only exception was the long run, which I gradually increased as my body got use to the pounding of the road again.

Representing South Africa at the IAAF World Cross Country in Poland as a Junior in 2013 and in China as a senior in 2015, was one of my career highlights. Therefore, I was fully focused on getting fit as possible to be ready to represent my country on the 18th of February in Australia to the best of my ability.

However, when the final team was announced on 3 February 2023, my name was not on the list. The criteria that was sent out before the trials stated, that the top 5 across the line at trials would go to Worlds and that there would be one discretionary spot. Why, was I not selected you may ask...I can't give you a clear answer, because I don't know either.

I followed the path I thought you were suppose to follow if you wanted to make the team. I took a big risk not being fully ready to race. I made a big financial investment paying my own way to go run at the trials. But, I knew that team was final. The only thing I could do was accept it an shift my focus towards a new goal...

The ASA Marathon Championships


On the 4th of February, I ran and finished my first road race since the end of 2019. I raced the hilly Firgrove 15km challenge where I managed to be the first female athlete across the finish-line. The following day, I went out on tired legs and ran a 30km long run. I was all in now on racing the Durban International Marathon in six weeks time on the 12th of March 2023.

Throughout the rest of February, my workouts changed from hill repetitions, fartleks and short 400m repetitions on the grass to long speed-endurance marathon style workouts. One of my favorite workouts that I did two times during that month was: 4km (1km float) x 4 for a total of 20km. The second time, I managed to improve my times, which showed me there was progress in my fitness.

I did another race as part of training. On the 19th of February, I raced the Cape Peninsula Half Marathon on a particularly windy day. I battled running 21km straight into a very strong headwind on this point-to-point course. I was very lucky to still win, but felt pretty defeated running a slow time, even slower than my training times or target marathon pace. But, in hindsight looking back at it now, I think it helped prepare me mentally for the windy weather conditions that I had to face on race day at the Durban Marathon.

Three days after I ran the half marathon, I did a 35km as my last long run, before the marathon. The goal was to run progressive and try to finish strong. I felt strong and the pace felt comfortable from the start, which allowed me to run faster than my target. This gave me hope that I was finally getting closer to the fitness level I was able to achieve back at the start of 2021, before I took a break from running. I also used this opportunity to practice my fuelling and grabbing bottles from a table for one more time.

Very important to note, I did NO double runs on the road during the three months before I ran the marathon. If I did a second session it was always cross training on the ElliptiGo. I also continued to do some sort of strength or core work in the gym every single day to strengthen my body and help prevent injuries.

I also didn't run close to the mileage I use to in the past, when I was preparing for marathons during the pandemic, simply because my number one goal was to make it to the start line healthy and injury free. I knew, I needed to be very careful and conservative coming back from such a long break from running. However, this does kinda makes me excited, because I know there is more room for growth and improvement in the future.


I went into this race with a very positive mindset and had all intent to go out hard and fast! I wanted to see what my body can do after such a long time not running the marathon. A big goal was also to really RACE the marathon for the first time. This first time around it was just so daunting finishing the 42.2km, and the second one it was more a race against the clock! This time, I wanted to race to win!


However, warming up in the rain with the wind raging around me, I must admit I was pretty worried. Due to my medical condition, my body does not tolerate cold temperatures very well and I have had many failed workouts, long runs and even races as a result of my blood pressure and core temperature dropping too low. Luckily, due to the fact that the humidity was so high, at around 85%, it wasn't that cold and I managed to get through the race without experiencing any of these symptoms. I only lost feeling in my hands.

The biggest factor ended up being the wind. It was extremely gusty out there, I don’t think the broadcast showed just how bad the wind really was out there. Due to the fact that it rained before and during a big portion of the race made the footing pretty bad. There was a lot of big water puddles on the roads that we had to dodge and the promenade was very slippery, making it hard to run fast.

I knew, we all had to face those conditions, so I tried my best to focus on my form and stay positive. However, it definitely impacted my ability to run fast and achieve my goal time.


The most frustrating thing on the day was the shortage of refreshments along the route. After my nutrition failure during my first marathon, I didn't want to make the same mistake twice. I also have the knowledge now, after completing my masters in sport nutrition, to fully understand what difference it can make in your performance to fuel and hydrate adequately during a marathon.

I planned to get a bottle every five kilometers, but they told us at the pre-race technical meeting that there would be no bottles at 5km and 15 km. The refreshment tables were also not where they were supposed to be. My first bottle was not even at the 10K station, I only got the first at 12 km mark and although I was still on pace at the time, I could feel that the damage had already been done. The most important fuelling stations are during the first half of the marathon, since as the duration and intensity increases as time passes, it becomes harder and harder for the body to absorb and digest nutrients and use it for energy. This is because blood-flow gets shunted aways from the gut to the working muscles who needs it more at that stage.

I think that’s definitely something this race can improve upon. I don’t understand why it’s so hard to put a table every five kilometers for elite runners. You’re already focusing so hard for two-and-a-half hours on that pace and you don’t really want to think about bottles that much. You just want to grab and go. Having low muscle glycogen impeded my ability to finish strong in those last 12km, like I did in my long runs and workouts. I was also very dehydrated afterwards when I was doing drug testing.


  • Remember, this was my individualized plan, I am not suggesting you copy this plan, I am purely sharing what I did.


  • 2.5 hours before the 6am race start


  • 1 bottle ISO ACTIVE Powerbar Drink


  • 75g of carbs/hour

  • 600 ml/hour

  • 7 x bottles of Powerbar - Alternating between Powerbar ISO-ACTIVE & ISO-MAX

Just an important note here: The reason I only use drinks, instead of gels and water is because one of my biggest risk factors during exercise is dehydration with my Diabetes Insipidus. I am always a bit dehydrated just simply because of the amount of fluid I lose through my urine daily. I also wake up multiple times during the night to go to the toilet, and as a result, I already start my day in a deficit. Therefore, I need to make sure I prioritize my hydration during the marathon, especially if it is hot or humid. You may find using a combination of gels and drinks/water work better for you.

This is also why Powerbar has been an absolute game-changer in my performance and health! Water just runs straight through me, while Powerbar ISO-ACTIVE & ISO-MAX drinks and their electrolyte tablets contains added sodium that helps retain fluid better. It also contains calcium, magnesium, chloride, and potassium that is lost in small amounts through our sweat.

I had zero gastrointestinal (GI) upset while using Powerbar products on Sunday. In fact, I have never had any GI upset using their products, which is huge for someone suffering from Celiac Disease! At least, I know I have a good product that works well for me in Powerbar and I do hope that in the next opportunity I get to race the marathon I will be able to execute my race day nutrition plan better!


At the 39 km, when the former winner of the Two Oceans Marathon and Soweto Maraton, Chaltu Bedo Negashu from Ethiopia, tried to pass me, I told myself:


I had worked too hard and come too far to let her pass! I dug really deep, and immediately accelerated, opening a 10m gap. I kept pushing for the next 3.2km until the finish-line. The victory of finally breaking that tape was truly a combination of so many months and years of struggle and suffering that finally paid off!

I managed to break the course record by last year's winner, Shelmith Nyawira Muriuki from Kenya (who was third in the race this year), by more than seven minutes. I also improved my personal best time of 2:33:35, that I ran in the Elite Sanlam Cape Town Marathon in 2020, to 2:30:31. The defending ASA Marathon champion, Jenet Mbhele, was 4th overall and the second South African home, also in a new personal best time of 2:37:08.


I am not 100% sure yet, since one opportunity opens up another door for you and I would like to be in the position where I can say yes to good opportunities that may come across my path. I have missed out on so many great opportunities due to my health struggles and all of the setbacks I have faced in my life, that right now, I am at a stage in my life where I am living day by day. I really appreciate every day I am healthy enough to put on my shoes and go for a run. I can and will never take it for granted: I run with an attitude of pure gratitude!

However, because I did not achieve the time goal I set for myself going into the Durban international Marathon, I have decided to give myself another shot to try run the World Championship Qualifying Standard of Sub-2:28:00, before the qualifying window closes on 31 May 2023.

It will be a short turn-around and is certainly not ideal, but I believe that if I can perhaps eliminate some of the external factors that went wrong in Durban, I may just be able to still make my dream a reality!

Stay tuned, more detail coming soon!

Thank you for reading and following along with my journey. I appreciate your support and hope that my story can inspire you to also chase your dreams, regardless the obstacles that may come across your path. #runtoovercome

~ Annie

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  • Writer's pictureAnnie Bothma
- Annie Bothma, January 2023

This post is not a recap of my 2022 or a prediction of what is to come in 2023. As much as I wish I could turn back the clock and prevent some of the heartache of 2022, or as badly as I want to plan out my whole 2023, I know I simply can't! The past is the past and the future will always be unknown...and maybe that's part of what makes it exciting!

Instead in this post, I share a few of "WHAT" thoughts:

  • What I learned in 2022.

  • What were some of my global running highlights of 2022.

  • What is next for me..


A word that really resonate with me going into this new year is GRATITUDE.

Last year, my word of choice was Courage or Bon Courage! You can read more about why I chose this word for 2022 and what it means here: BON COURAGE. But it turned out to be a perfect choice! I ended up needing a lot of courage for what I had to endure in 2022...

I already wrote a long reflective blog post on what happened to me in 2022, so I am not going to bore you by writing about it again in this post. You can go read more about that here: THE MISSING PUZZLE PIECE. But, all I can say is: Last year was hell for me! So, there is literally no better word than GRATITUDE to describe my feelings going into 2023, healthy enough to run and without any injuries!


You can't change what you are not aware of, so without a bit of reflecting we can't learn, grow or get better. Reflection does not only have to happen on a yearly basis, it is a constant process. I like to reflect daily on where I could improve, but also what I did well that will allow me to move forward.

Here are a few key learnings I took away from 2022 that I believe will benefit me in 2023 and beyond...


In 2022, my chronic medication for my Central Diabetes Insipidus was putting me in a state of hyponatremia. As a result of my inappropriate ADH dosage my body was losing all the important minerals needed to maintain and build strong bones. Being chronically hyponatremic was detrimental to my bone health and as a result I suffered a series of bone stress injuries. Aside from the harmful effects it had on my bone metabolism, it was also life-threatening and greatly impacted my life-quality. I felt like I was living in a fog; I was always feeling tired and battled with chronic headaches every day.

Due to the fact that I was unable to run for the most of the year, I mainly did non-impact or low-impact cross training activities, like aqua jogging, indoor cycling, and ElliptiGo. In the past, unless I was injured or struggled with a niggle, I didn't do any cross training. When I was training in Kenya, the option to cross train wasn't there, but I didn't have any injuries for three years straight, so I didn't need to seek out other cross training methods. Why would I cross train, if I can run, right? However, last year I had no choice but to turn to cross-training.

There were many days when I was unable to cross-train or simply going through the motions because of how bad I felt, but I can say with certainty that the cross training that I was able to do has made me a stronger athlete! In fact, at the moment, I have replaced all my double runs with cross-training sessions because I feel it is a way I can reduce the impact while still reaping all the benefits of developing my cardiovascular system and simultaneously working muscles that may be neglected when I run. If you are someone who doesn't utilize cross-training as part of your running program, I would urge you to give it a try. I have found that it has drastically improved my ability to run up hills!

I also did a lot of strength training and rehab in the gym. I was already doing resistance training, but it was more functional training and core workouts. In 2022, I started lifting heavy and really shifted my focus to getting stronger and more powerful as an athlete. I did heavy compound lifts like squats and deadlifts and slowly worked my way up to being able to lift almost twice my body-weight for 4 sets of 4-8 reps. I also improved my upper-body strength and was even able to work up doing a total of 60 pull-ups consisting of 4 sets of 15 reps with minimal rest between. My biggest motivation to do strength training is not just to improve my performance, but rather build and maintain my bone density and reduce my risk of injuries in the future. I believe strength training should be a key component of any athlete's training program.


I never ran through pain last year. That is part of what made my injuries so fucking frustrating. There were never any warning signs. The one day I was still able to run and walk without pain, and the next, I would be stopped dead in my tracks with a sharp unbearable pain.

I would go see my Physio and Chiropractor and they never suspected it to be a fracture. I even passed all the clinical tests, but when I went for a scan it showed up as a bone-stress injury. I don't blame them for not thinking something was wrong, they don't have x-ray vision. I have also been told this is not typically how stress fractures present, however, due to the fact that my fractures were not related to my training-load or a biomechanics issue, but rather due to an inappropriate medication dose, it didn't show-up like one would expect.

I would urge all athletes to listen to their body without judgement. Don't simply push through pain. Don't simply accept a diagnosis either if you feel something is wrong. Investigate it and make sure you get the proper testing done to get an accurate diagnosis.


I am more than just a runner. I am a daughter, sister and friend. I am also a running coach and sports nutritionist. In May 2022, I also became a student again. I decided to continue my education and enrolled in a post-graduate program in sports nutrition through the Instituted Of Performance Nutrition (IOPN).

My goal is to equip myself with the tools and knowledge to best help the athletes I work with. I decided to use the time I was unable to train like usual and compete, to read a lot of books on sport nutrition, coaching, running, sport science and psychology. I watched lectures and listened to some of the top researchers explaining complex topics on muscle physiology and fuel utilization. I listened to podcasts with some of the leading experts in the field; all in an attempt to learn as much as I can about running and sport nutrition.

I rebranded and reopened my coaching business. I closed my Fired Fitness personal training business at the end of 2019, and temporarily stopped my running coaching, when I chose to chase my own running dreams. I packed my bags and went to train at 3000m altitude in a training camp in the mountains, located in a small township in Kenya, called Kipsiat. I didn't have any access to wi-fi, and was thus no longer able to continue coaching my athletes online.

However, I always knew I would return to coaching, since it’s such a big passion of mine, and I see it as my way to give back to the sport which has given me so much. I am back in South Africa for the foreseeable future and I was able to restart my business. Over the past two years, during the global pandemic when racing opportunities were scarce and races were being cancelled, a lot of runners also didn't feel the need to seek out coaching services, since they didn’t have any specific races to prepare for. However, the race calendar is finally filled-up with races again, and the running world is back to normal after the negative effects of the pandemic. To learn more, read my post: MERGING MY PASSIONS: ANNIE'S ATHLETES

Fired Fitness is back, but under a new name, a new look, with more services and with a new mission! ANNIE'S ATHLETES now offer personalized coaching services for runners, and sport nutrition services for everyone, including elite athletes, weekend warriors, recreational exercisers, or anyone who wants to improve their health and life quality through fitness and nutrition.

Coaching helped me stay connected to the sport in 2022, when I was unable to line-up and compete myself, I was able to get excited and celebrate the performances of my athletes. It gave me purpose and bought me so much joy to see them achieve their goals and improve their personal best times. I am very proud of every athlete on my program and look forward to continue seeing their progress in 2023!



I am not just a runner, I am a big fan of the sport! I breathe and live it! It is part of me and I can't and don't want to imagine my life without it. So, when it was threatened to be taken away from me in 2022, I grabbed onto what I could and became an even bigger fan! I completely immersed myself into every opportunity I got to be closer to the sport!

I watched every single diamond league meet; every single day of the World Championships, Commonwealth Games, and most of the European Championships. I watched every single major marathon from gun to tape! I streamed races on youtube and watched post-race interviews of athletes. I listened to running podcasts and got to know the stories behind the athletes.

I now know with certainty, if for some reason, I am not able to run one day, I will always be a fan of the sport. Nobody can ever take that away from me!


Watching my Kenyan teammate, Judith Korir, earn a silver in the marathon at the World championship in Eugene was so special. Judith was one of the athletes who worked the hardest in the camp. She was extremely committed and dedicated. I observed how some athletes often lost focus and just skip training sessions or move in and out of the camp. Not Judith. She was one of the most consistent athletes in our group. I feel privileged to call this amazing athlete my friend and it was so exciting seeing her deliver this breakthrough performance at Worlds!

Shortly after her breakthrough performance at Worlds, Judith also went onto place 4th at the London Marathon. She would have been a pacemaker for Brigid, but when Brigid sadly withdrew with injury, Judith was instructed to finish the race! She accepted the challenge and still managed to improve her personal best time on the day and nearly finished on the podium!


Watching Eilish McColgan winning gold in the women's 10,000m title at the Commonwealth Games - 36 years after her mother. She ran this race with so much grit and determination. The way she finished that race showed she wanted it more than anyone else on the day! Well deserved after all the hard work she has put in over the years and the adversity she had to overcome in her career.

I have always resonated with Eilish. She is an athlete who has been very vocal about body shaming due to her long slender build. She would often get trolled online and receive inappropriate comments after races about the way she looks.


Eilish McColgan made the comment on Twitter recently:

“Nothing pisses me off more than someone making a comment that I’m ‘too skinny’. I’m naturally small – always have been. Some people are just slim! I doubt they would comment on someone slightly larger than ‘average’. I’m a healthy athlete and human. Go body shame elsewhere!”

All my life I have been judged and criticized for the way I look. I do not have an eating disorder! I don't judge others who struggle with this, since I acknowledge that it is a serious mental illness that is unfortunately very prevalent in our sport. But, it is simply not part of my story. I have always been skinny due to my medical condition. I have Hypopituitarism, Celiac disease. and Diabetes Insipidus. My body does not produce the hormones of a normal individual and does not function the way a normal individual's body would. I have never liked being skinny or small, and often wish I looked different, but I had to learn to accept my body for what it is and appreciate it for what it can do, instead of focus on what it is not.

Over the years I have received so many hurtful and negative comments both online and in-person, so it is nice when athletes like Eilish stand-up and speak-up about body-shaming! Don't just judge or criticize people based on how they look, there is more beneath the skin than just the way someone looks!

3. BERLIN 2022

Eliud Kipchoge did it again! The GOAT made history once again in the 2022 Berlin Marathon when he ran 02:01:09 to smash his own marathon world record by 30 seconds!

I was glued to the screen for the entire duration of the marathon! I couldn't believe it when he went through the half-way mark under 60:00 minutes and had a projected finishing time of under 2-hours. Are we about to see the first sub-hour marathon in real race conditions?! Unfortunately, he did end up slowing in the second half, but was still managed to break his own world-record by a substantial margin!

Kipchoge is just amazing to watch! He moves with so much ease and fluidity, making running a marathon look comfortable! The way he carries himself with so much confidence, yet so much humility! He is truly an inspiration figure to all runners and someone who has had a very positive impact on the sport. I can't wait to see him take on the Boston Marathon in 2023!


I am hoping to open up my 2023 season in February with some shorter road races. One of my biggest goals this year is to improve my times over the shorter distances. I have smashed every single personal best time from 3K up 30K during tempo runs and time trials during the Covid-pandemic. Now, that the races are back and my body is finally healthy enough to compete, it is definitely time to erase those old outdated personal-best times. I am extremely excited and grateful to be able to race again after everything that has happened over the past three years.

I will also be going back to my roots and replacing the roads with grass and dirt from time to time to take part in cross country races. Cross-country was my first introduction to the sport and I will grab the opportunity to compete in a cross country race whenever it presents itself.

However, my main focus moving into 2023 will be the marathon. The marathon has won my heart and I feel I have a lot of untapped potential left over the 42.2km to discover! You can definitely expect to see me on the start-list of a marathon in the near future!

Watch this space!

Thank you for following along on my journey, I appreciate your support.

May 2023 be a great year for you!

- Annie

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  • Writer's pictureAnnie Bothma

This is probably the most vulnerable and personal blog post I have ever written and shared with the world. It is easy for an outsider to judge or criticize me for what happened to me in 2022. However, without all the inside knowledge, you cannot make assumptions or accusations. For the majority of 2021 and 2022, I didn't know or understand what was happening in my body; in fact, I felt like I lost control.

How could I trust my body when it failed me at times when I needed to perform? It didn't make sense to me that I could no longer carry myself the distance, nor do the smallest tasks. In 2022, I had lost all trust in my body, and in this post I will share how after a year and a half of suffering I was finally able to restore that trust!


In September 2021, I was diagnosed with Central Diabetes Insipidus (CDI). This condition occurs when the body can't regulate how it handles fluids. The condition is caused by a hormonal abnormality, in my case, it is directly linked to my hypopituitarism and my body’s insufficient production of antidiuretic hormone (ADH). CDI is not related to type 1 or type 2 diabetes (also known as diabetes mellitus), but it does share some of the same signs and symptoms. The two main symptoms of CDI are extreme thirst (polydipsia) and frequent urination.

Before I got diagnosed and received treatment, I was chronically dehydrated and, as a result, my athletic performance suffered. The main reasons why dehydration has adverse effects on exercise performance are: reduction in blood volume, decreased skin blood flow, decreased sweat rate, decreased heat dissipation, increased core temperature, and an increased rate of muscle glycogen use. My blood pressure would drop and I would end up being dizzy and disorientated. I battled with the cold and often lost feeling in my hands and feet. I frequently fainted, during both training and races.

To manage my condition, I was prescribed a synthetic hormone called desmopressin acetate (DDAVP). This medication replaces the missing ADH, which is supposed to be secreted by my pituitary gland. Gradually my medication was increased with the goal to counteract the amount of fluids I was losing through urine, but it was now more concentrated than before. I was losing a lot of electrolytes, especially sodium.

To top it all off, after 10 years in athletics, I had never had a bone stress injury or a fracture. In fact, I was consistently doing marathon training for three years without getting an injury or niggle that took more than a day to recover.

This year, I suffered through four back-to-back bone stress injuries!


How did I go from never having a bone stress injury before and not being injured for three years running the highest mileage I have ever done, doing the longest long runs of my running career, and completing the most intense sessions I could have ever imagined, to a series of bone stress injuries?

Let's backtrack to when the first cracks started to show...

In January 2022, I had a stress fracture in my left calcaneus. I spent 9 weeks doing non-impact or low-impact cross training activities, like aqua jogging, indoor cycling, and ElliptiGo. I also did a lot of strength training and rehab in the gym. I was able to start running pain-free and gradually increased my running distance. I was only able to sustain a quarter of the weekly mileage I used to breeze through.

During a run in April, I felt a sharp, debilitating pain in my back. I cut the run short and rested the next day. When the pain didn’t subside, I went for an MRI scan. Another stress fracture showed-up – this time in my sacrum!

I returned to non-impact and low-impact cross training activities, with minimal strength work this time. After six weeks I was able to very slowly return to running. But, my return was short-lived. After only 8 weeks of low-volume and minimal intensity running, I had a stress response in my right calcaneus.

Something didn’t make sense.

I was already being meticulous with my nutrition, to support my health and optimize athletic performance. I focused on getting sufficient calories and carbohydrates to stay in an energy balance and support my training. I have never done fasted training sessions or deliberately restricted my dietary intake. I increased my protein intake and was taking collagen daily to help facilitate a proper recovery and repair.

I abstained from running for another 6 weeks, and then started on an underwater-treadmill at 70% of my body weight. After only 5 sessions, each less than 30 minutes, I sustained yet another stress fracture, this time in my 4th metatarsal on the left foot.

Something really didn’t make sense!

I was suffering from hyponatremia.


Every single blood test I did from December 2021 up until October 2022, pinned me as hyponatremic. My blood sodium levels were consistently around 120-30 mmol/L. Normal blood sodium is typically around 140-145 mmol/L. Symptomatic Hyponatremia can occur when the plasma sodium concentration rapidly drops to 130 mmol/L or less. Sustained low levels increases the risk of developing swelling of the brain (delusional encephalopathy) and accumulating extracellular fluid in the lungs (pulmonary edema). When plasma sodium falls below 120 mmol/L, the risk of a brain seizure, coma, and even death, increases.

I understood that hyponatremia was serious. I was adding salt to all my meals, drinking 1500-2000 mg of sodium through electrolyte tablets in my water, and later, even started taking a salt tablet with my meals, each containing 200 mg of sodium. Nothing was able to raise my levels back to normal. I suffered through the side effects of hyponatremia. I felt foggy and struggled to concentrate for long periods. I was always tired and I always had a headache. I was no longer able to keep up my cross-training intensity. Concentrating on my studies and work became increasingly difficult. I feared breaking more bones and felt extremely depressed, unable to participate in the sport I love so much.

One evening in October, it overwhelmed my body. My head was pounding and my world grew darker. I felt like everything was spinning. Like I was floating and then it just went black. I woke up in the middle of the night, my face covered in my own spit. My head and face felt swollen and my body too heavy to move. I fought against the feeling of fatigue, but ultimately I gave in and just closed my eyes again.

I suffered a seizure...


I started doing research on bone health. I listened to the IOPN’s Podcast WE DO SCIENCE, with Prof Craig Sale on Athlete Bone Health. I listened carefully to Dr. Laurent Bannock and Prof. Craig Sale discussing the important factors when it comes to preventing bone stress injuries and/or the development of osteopenia or osteoporosis. The next day, I downloaded the research paper that was referenced in the podcast – Nutrition and Athlete Bone Health, by Craig Sale, Kirsty Jayne Elliott-Sale (2019) – and eagerly started reading.

I read it over and over; finally, I found the missing puzzle piece!

I finally understood what was actually happening in my body! It finally made sense why I was getting repeated bone-stress injuries.

As I was reading, my eyes grew wider…

“ In line with this, there is also the possibility that the challenge to fluid and sodium homeostasis that would occur under these circumstances might influence bone metabolism and health. This, to our knowledge, has not been directly or well studied in relation to the athlete, but there is some suggestion from the osteoporosis focussed literature suggesting that bone might be negatively affected by hyponatremia. Verbalis et al. [83] examined the effects of using a syndrome of inappropriate antidiuretic hormone secretion rodent model to show that 3 months of hyponatremia (~ 30% compared with normonatremia significantly reduced the BMD of excised femurs and reduced both trabecular and cortical bone, purportedly via an increase in bone resorption and a decrease in bone formation. The same paper also reported on a cross sectional analysis of human adults from the Third National Health and Nutrition Examination Survey, showing that mild hyponatremia was associated with significantly increased odds of osteoporosis, in line with the rodent data presented. This might be explained by novel sodium signaling mechanisms in osteoclasts resulting in the release of sodium from bone stores during prolonged hyponatremia [84].” (Sale, 2019)

Suddenly, I realized my CDI medication was putting me in a state of hyponatremia! As a result of my inappropriate ADH dosage my body was losing all the important minerals needed to maintain and build strong bones. I knew I needed to be on medication to manage my condition, thus not being chronically dehydrated, but I also knew that I needed to get my sodium levels back to normal as soon as possible.

I felt overwhelmed, realizing the damage that the medication has done to my body and that my suffering could have been prevented. Yet, I felt excited. Could this be the answer to turning my situation around? After several months of pain, I finally saw a way out of this dark hole.

I immediately booked an appointment with my endocrinologist. He was alarmed after hearing the news, seeing the latest blood results and just how low my blood sodium levels had dropped. He advised that the dose was too high. Being chronically hyponatremic was not only detrimental to my bone health, but it was also life-threatening!

“Annie, if we don’t adjust the dose right now, you are not only going to continue breaking bones, but you are going to die!”

He adjusted my dosage and for the following few weeks I had to go for weekly blood tests to monitor my sodium and hydration levels. At the beginning of November, I was finally able to start running again without pain. I had only been doing short easy runs for 4 weeks when I received the opportunity to go run at the South African Cross Country Trials where the world cross country team were to be selected to represent the country in 2023 at the IAAF World Cross Country in Australia.

I decided to risk it and booked my ticket to go run at the trials. I knew I wasn’t ready to compete at my best, but I still wanted to give myself the opportunity to race again. With limited fitness, I managed to squeeze my way onto the team coming 4th. I felt intense gratitude for making my third World Cross Country Team after everything I had to overcome this year.

I throw my arms up in the air like I won the race. I feel like crying. I can’t believe it. I made the team. I am going to the world cross championships in Australia! After all those months of living in a fog, feeling confused and not understanding what was happening in my body. I had lost all trust in my athletic ability and thought I would never be able to compete at the same level as before. There were even times when I thought I would never be able to run again, let alone compete at a national or world championship. Overwhelmed by gratitude I walk off the course. I FINALLY HAVE MY BODY BACK!


This incident taught me an extremely valuable lesson as a professional athlete, but also as a practitioner. Knowledge is power. If you can understand what is going on you can help and equip yourself to make better choices in the future. In my case, discovering what was going on in my body saved my life! Furthermore, it made me realize you should be a student of your body and a student of life. You should always ask questions, and never stop learning or growing! You should take responsibility for your body and situation. Others aren’t always going to be there to help figure things out; sometimes you need to be able to help yourself and in the process you will be able to help others in the future!

This incident has forced me to delve deeper into the research of bone metabolism and how to prevent bone stress injuries in athletes. It taught me about the delicate fluid

and sodium balance that exists in the body and how hyponatremia can be just as dangerous as dehydration. Most importantly, it taught me to not simply accept

things the way they are. I will strive to always ask questions, research, learn, and grow. I will now try to encourage every athlete I coach or help with their nutrition to be curious about their situation and to take responsibility for their body and life.

- Annie

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