From the Archives: 2014
This is a blog post that I wrote and published on my athlete blog page in September 2014, as a result of being diagnosed with Relative Energy Deficiency in Sports (RED-S). As the blog page is no longer available, I pulled this post out of my personal archives to share. The following post is unedited, raw and real. How I like to keep it. At the time, writing this was extremely cathartic and I hoped it would provide information and insight to others.
Letting the cat out of the bag….
A touchy subject which does affect males just as much as females. The message of this blog? To shed light and educate others on what I believe to be an under-reported syndrome in sport, which I have been dealing with myself. This is raw, this is me. So enjoy the words and the pictures.
The Female Athlete Triad
You may have heard of the Female Athlete Triad, which is characteristic of a female athlete with disordered eating, changes in body composition, and secondary amenorrhea. Initially in 2005, the Female Athlete Triad was based on the combination of disordered eating and irregular menstrual cycles. This lead to a decrease in hormone levels resulting in poor bone health.
In 2007, the American College of Sports Medicine (ACSM) redefined this term as the relationship between energy availability, menstrual function, and bone health. These three components each related to each other. Additionally, the Triad was described as a continuum with different severities of ‘health’; athletes move on a continuous spectrum, ranging from a healthy athlete to the opposite end of the spectrum: amenorrhoea, low energy availability, and osteoporosis.
“The Triad was described as a continuum with different severities of ‘health’; athletes move on a continuous spectrum, ranging from a healthy athlete to the opposite end of the spectrum: amenorrhoea, low energy availability, and osteoporosis.”
After multiple studies and clinical experiments, energy deficiency was the main factor that underpinned the Triad. That is, the good ol’ see-saw of: the energy deficiency relative to the energy intake and energy expenditure.
“That is, the good ol’ see-saw of: the energy deficiency relative to the energy intake and energy expenditure.”
This lead to further conclusions that the Triad is not caused by the low energy availability, menstrual function, and bone health, but a ‘syndrome’ that is caused by relative energy deficiency that affects many physiological and psychological functions. To accurately describe all of these additional findings, a new term was developed to encompass all aspects of this syndrome, called Relative Energy Deficiency in Sport (RED-S).
Throughout my reading, the main problem of RED-S is under-fuelling the body for it to support main functions for optimal health and performance. Health and performance can be affected dramatically with RED-S. Long-term effects include anaemia, chronic fatigue, and risk of infection and injury. Additionally, cardiovascular, gastrointestinal, metabolic, endocrine (and many more) medical complications can occur. We also can not eliminate the psychological stress that can also have an effect on low energy availability. On the flip side, low energy availability can affect psychological function.
“The main problem of RED-S is under-fuelling the body for it to support main functions for optimal health and performance. Health and performance can be affected dramatically with RED-S.”
As touched on, energy deficiency can also affect hormone production and function. Abnormal levels of hormones, especially sex-hormones, can result in an altered menstrual cycle. The term ‘Functional Hypothalamic Amenorrhea’ refers to the low energy availability that affects hormones released in the hypothalamus (an almond sized section in the brain), therefore alters hormone function resulting in loss of menses.
Within sport, low energy availability can lead to a lack of performance and response to a training stimulus.
“Within sport, low energy availability can lead to a lack of performance and response to a training stimulus.”
So why am I ranting on about The Female Athlete Triad, now coined Relative Energy Deficiency in Sport? Well, this is me in a nutshell. I feel it is important to share this syndrome as I believe it is under-reported and the severity is among athletes (both male and female) is not recognized or realized.
For me, this was exactly it. I was unaware of the state my body was in and it was crying out for attention. I had every excuse in the book not to notice it: I was training hard so I am supposed to feel tired; I will bounce back out of it – I don’t need to cut back the training, I am eating plenty to refuel. I had every test done with ‘normal’ results. Well, multiple tests actually came back ‘abnormal’, but the big players were fine. There were constant questions running through my mind: my training should be going better as I am putting in the effort – why is this not reflected in my performance? And the biggest question - how lean can I get to go faster?
How do you know you have something wrong when you have been in that state for such a long time? It wasn’t till unexpected changes in my life occurred that I realized I had to face these hard facts and so-called ‘issues’ and get to the bottom of it (quite literally!). These issues consisted of irregular bowel discomfort (and lots of it), fatigue, irritability, fatigue, illnesses and injuries, fatigue, loss of menses, did I mention fatigue?
Once I came to terms with these labels I had to deal with another battle – putting on weight I was not willing to do so, or not thinking that I needed to. Why did it affect my head so much?
I will say I am not at the scary end of RED-S spectrum, however, I have had significant health issues because of it. We fixate on how we look over how we feel. Hold on, let me rephrase this instead of collating everyone into a group to make this issue less daunting. I was fixated on how I looked over how I was feeling. It should be the other way around right? Constant feedback of “you look tired” should’ve sent off alarm bells. I was tired, I was exhausted, but heck my skinfolds were mint so in my mind I was winning. Eating disorders and body image be a difficult and strange concept to grasp and for those that are not a similar situation may never understand.
Katie, how did you get this way?
Yes, I am educated – a degree in Nutrition – which was almost my worst enemy. Yes, I didn’t come to terms with after a LONG time, and I only did because I had, and still have, medical complications because of it. No, no-one said anything early on and my symptoms were an issue but not life-threatening. So I put it down to ‘it is a phase I am going through, it will pass’. When people did ask if I was refuelling appropriately, my ignorant reaction was ‘of course, because I know about food.’ We all want to put our best foot (face/figure/image) forward, and for me, that was looking the part. I can’t stress enough, this was all MY doing. My competitive nature to be the best. I was fixated and far too serious and I lost sight of why I love the sport so much. In the end, it back-fired and took me down.
But as I am writing I know I have turned a corner. I am much heavier with ‘more’ padding, which, I still struggle with day-to-day. This is the new me, don’t judge me. Some days you don’t wake up “Flawless” like Beyoncé and feel ‘podgy’ and those days you just have to deal with it. We all have those days, right?
“But as I am writing I know I have turned a corner. I am much heavier with ‘more’ padding, which, I still struggle with day-to-day. “
But, I will say, and somewhat reluctantly (as I never thought in a million years I would be in this position, or believe I had this syndrome), I am seeing the benefits of the extra energy I am giving my body. I am able to get through a whole day with training, if not twice, and not be zonked for the rest of the day. Small steps to reach my goals. And if this blog will at least get one person thinking, questioning, reflecting, or understanding about this syndrome that is a bonus.
The diagnoses I have been given:
Relative Energy Deficiency Syndrome, with chronic mild energy deficiency, hypothalamic amenorrhea, Irritable bowel syndrome and Iron deficiency without anaemia. But these do not define me.
“if this blog will at least get one person thinking, questioning, reflecting, or understanding about this syndrome that is a bonus.”
Bye for now,
Kt