I was overwhelmed by the messages I received after an Instagram story about my stress response injury. It turns out a lot of you want to know more about RED-S.
Of course, I’m not an expert, in fact until I was diagnosed, I’d never heard of it. It feels appropriate during mental health awareness week that I share my story and links to where you can find out more information if you have concerns of your own.
Writing this has been incredibly difficult, in fact I started it in January! I had to stop because it surfaced some personal demons and being injured, I couldn’t use exercise as my normal way of dealing with these.
It’s easy for me to write about RED-S factually but it doesn’t seem fair to do this without giving you a little background to what’s got me to this point.
Exercise has and probably always will be my way of ‘coping’ with life. It helps me to feel good about myself and feel more comfortable in my own skin. Racing has taught me to respect my body for what is can do and to nurture it and look after it so that it can perform. But, this hasn’t always been the case.
Growing up I suffered with mental health issues and had a dysfunctional relationship with food, manifesting itself in an eating disorder which was serious enough to see me hospitalised in my 20’s. I might have eluded to it in other posts/blogs but I don’t really talk about it in detail because I’ve blocked a significant period of my life out.
LET’S TALK PERIODS
My whole life I’ve had regular periods. Even during an incredibly stressful time personally in 2015 when my weight dropped to 52 kgs, I was still regular. Ironically, I was running really well at this time. Arggghhh that’s why it’s so hard not to make the comparison between weight and performance sometimes.
All that changed a few months ago. I’m not sure how many periods I missed because I’d never needed to keep track before, but I assumed being 46 this was the start of a pre-menopausal stage for me. I had no idea this was a warning sign for what was about to come.
TRAINING & FUELLING
Last season I tracked my food on MyFitnessPal to make sure I was getting enough, specifically protein, but it also reminded me to increase my calories according to the training load for that day. I honestly don’t think I was obsessed but I was pretty lean at 55-56kg. I felt really good in myself and strong plus I had my best year ever on a bike so I had no cause for concern! Let’s not forget that I wasn’t running most of this time.
In September I started running again and by January this year, I felt really strong and I was building nicely for Powerman Portugal. I’d hit sessions hard over Christmas and New Year because I had more time to train! I also indulged in a bit more wine and meals out than normal. So, with a skin-tight Trisuit looming maybe I was subconsciously trying to keep other areas of my calorie intake in check.
Under fuelling certainly wasn’t a conscious thing but looking back maybe I hadn’t been eating enough of the good stuff.
INJURY & DIAGNOSIS
One evening in January as I got out of the bath, I found myself limping slightly. Closer examination of my leg and there was a really painful area above my ankle bone (fibula) but it also looked a bit swollen and lightly bruised, so I iced it and assumed I’d banged it. When I got up the next day it was fine and when I ran, I couldn’t feel a thing, so I carried on as normal. A week later I went for a sports massage and the same thing happened. This time excruciating, vomit inducing pain when the spot was touched. Only then did I consider this might be something a bit more serious than a bang.
I got booked in to see Becki at Physiokinetic as soon as I could. After answering lots of questions I was relieved to hear that my build and training load was fine but shocked and upset to hear that I might not have been eating enough calories to aid proper recovery!
Becky referred me to Dr Kim Gregory Consultant Physician Sport & Exercise Medicine BSc(Hons), MBChB, MRCP(UK), MSc(SEM), DipSEM(UK&I), FFSEM(UK) who delved much deeper into my history and confirmed a diagnosis of RED-S. She felt that I could have been in an energy deficit a long time. As cycling isn’t a weight baring activity it would be less likely to show by means of injury.
WHAT IS RED-S?
REDS. Defined by the International Olympic Committee, REDS (‘relative energy deficiency in sport’) is a complex syndrome entailing ‘impaired physiological function including metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health caused by relative energy deficiency’.
Renee McGregor BSc (hons) PGDIP (DIET) PGCERT (sportsnutr) RD BASES is a leading Sports and Eating disorder specialist dietitian.
Renee tells Metro.co.uk: ‘When we exercise, we use energy in order to fuel and power the activities we are performing. It is essential that sufficient energy is put into our bodies to meet the demands we place upon it, otherwise there will be an energy deficit. ‘Low energy availability arises if nutritional intake isn’t sufficient to cover the energy demands of both training and resting metabolic processes. Where there is a prolonged period of low energy availability, this is known as RED-S.’
WHAT ARE THE SYMPTOMS?
- Over-training or difficulties taking rest days
- Recurrent injuries, including stress fractures
- Feeling cold on warm days
- Disrupted sleep patterns
- Constipation and bloating
- Fear of food and weight restoration
- Anxiety around meals and irrational behaviour
- Poor performance and difficulty adapting to increased training
- Increased fatigue
- Very low or high resting heart rate
- Missed or irregular periods
- Morning erectile dysfunction (in men)
ROAD TO RECOVERY
Since diagnosis in January I fell apart a little which is why I took some time away from social media. In that time, I’ve under eaten, I’ve over eaten and I’ve gained 3kg which I absolutely loathe. None of my clothes fit me comfortably so I feel uncomfortable in myself and this triggers the destructive cycle of do I really need to eat, do I deserve to eat.
And then lockdown happened. At first I was elated to be able to train but with no routine and having Lillie at home with me I’ve struggled to find the structure I crave. I’ve had days where I’ve not seen the point in getting up, so I’ve stayed in bed late then forgotten to eat at all.
It was hard for me to accept that I might have contributed to this injury (and possibly others) but I’ve had to admit that some areas of my eating habits still need to change (frequency, amount, exclusion). I have been referred to a dietitian so am looking forward to getting much more advice around this.
I’ve also recently opened up to a couple of people close to me and they have been great which has really helped me.
As frustrating and upsetting as this process has been, I can only learn from it and come back a stronger and better athlete, and I will.
WANT TO KNOW MORE?
Please feel free to share with anyone who might benefit from knowing about something I was completely oblivious to and please don’t forget, this effects men too!