As a teenager, I always identified as one of the ‘bigger' runners. It was just an observation and never a concern of mine. After a childhood spent chasing around three older, stronger siblings, filling out my scrawny little frame was something I embraced. Race commentators would call me ‘strong’ and I took it as a compliment. Strength kept me going in training and helped me stay consistently injury free. Strength pulled me past the skinny runners in races and onto the podium. Strength brought enjoyment and opened up opportunities for scholarships, sponsorships and success.
As I progressed to a higher level, I started to lose sight of my strength advantage. I’d come to learn about the concept of ‘power to weight ratios’ and saw it demonstrated by those ahead of me in races I wanted to be winning. As I watched the long, lean legs of athletes 5 years my senior stride past me to the podium, I could only focus on one thing: the need to look like them.
I viewed moving abroad to pursue a scholarship opportunity in America as my chance to go ‘all in’ with the running: to make the most of every experience, to do a little extra and work a little harder than before. I was a determined athlete making progress in my sport and eager to reach my potential. But I wasn’t stupid. I understood the importance of rest, the basics of nutrition and the concept of periodisation. I knew about those girls who became so thin they got slower; so malnourished their bones fractured; so over-trained they wound up with chronic fatigue. I knew about those girls who cared so much about their appearance they allowed themselves to develop eating disorders. I knew that it cost them their sport, their health and sometimes, their lives. Yet, I also knew I wasn't one of those girls. I was simply someone who hadn’t yet tapped into the performance advantage of being light and lean. Someone who could do with making a few improvements to their diet and getting more serious about training. Now seemed like the time to do so.
At first, I not only achieved the desired results of refining my diet but exceeded them. Combined with a shiny new training programme and significantly more mileage than before, adopting a ‘clean’ approach to eating did me wonders. Fitting into smaller shorts correlated with faster times and compliments about my sleek, new physique. Studying the behaviours and habits of ‘successful’ runners I was surrounded by taught me I didn’t need desert after dinner. I didn’t need to drive when I could cycle to training and I didn’t need a rest day if I didn’t feel tired. I felt empowered by the control I had over my choices and my ability to manipulate my body composition in the same way as others I looked up to. In a terrifyingly short space of time, I redefined my previous notions of health and success. Blinded by improving times, a sense of fitting in, I had obliviously morphed into one of those girls.
It took some time before the consequences of my new behaviours started to emerge. They were psychological at first, so I dismissed them quite easily. I wasn’t bothered about my growing preoccupation with food; my disproportionate emphasis on achieving a certain mileage each week; or my uncharacteristically low moods – just so long as I was running well.
I allowed myself to believe that professional athletes thought about food all day too; that they didn’t indulge in pasta and white carbs either; that they definitely didn’t allow themselves treats until the end of season; and that ‘clean eating’ was just what it took to be the best they could be. I was so dismissive of my potential to develop an eating disorder that I never for a second viewed my control as anything other than commitment. I never tracked calories, made myself throw up, or skipped meal times, so I was able to convince myself I was doing the right thing – that this was just what it took to succeed.
The first time the extent of this control crept into my consciousness was around five months later, when I flew home for the Christmas holidays. I had always been so relaxed in my approach to training and eating at home that returning to that environment highlighted quite how rigid I’d become. Despite being thrilled to be back, I noticed that I’d returned with an anxiousness around food that was never there before. Yet my new behaviours had quickly become so entwined with my sense of success and self-worth that I was far too terrified to relax them.
The festive fortnight I’d previously adored now felt like a barrier along my path to progress. Instead of enjoying my favourite foods and joining old friends for runs, I stuck with the super-foods and solo sessions, depriving myself of any real pleasure at all. My new satisfaction came from maintaining strict control and sticking to my path like glue. Resisting pudding was rewarded with a pride over my will-power and tacking a few miles to my morning runs allowed me the odd indulgence. My new body composition brought compliments from family and friends, reinforcing the sense of achievement that my new lifestyle brought me. For as long as I was flying in training and looking the part, I was able to ignore the voice in my head who whispered it wasn’t sustainable.
I was forced to pay attention when some physical consequences started to emerge. I’d been feeling exhausted in training for seemingly no reason, dropping out of sessions for the first time ever and struggling to keep up on runs. Blood tests revealed my ferritin iron levels had taken another nose dive, so I was sent off for a set of transfusions in a chemotherapy ward and a diagnosis that served the perfect scapegoat for further RED-S warning signs.
In the absence of any other abnormal test results, anemia seemed enough to justify my persisting fatigue, poor appetite, further weight loss and thinning hair, but as the months wore on and my iron levels were intravenously increased, the symptoms only intensified. Now compounded by constant colds and an even stronger form of exhaustion that I couldn’t seem to shake, I knew something else was the matter. Still, I pushed on, desperately hoping it would pass.
On occasions where I was too tired to train, I grew increasingly conscious of how much I relied on it for my happiness and sense of purpose. Without much else in my life besides studying, I’d grown so homesick that running had started to play an even more outsized role in my life. Without it, it just seemed to be a matter of passing the days, going through the motions until I could go again. When I could, I felt so flat and feeble that I pushed harder, fuelled by a mounting pressure to perform and the absurd notion that this could all be driven by a lack of fitness.
Now wasn't the time or place to show weakness. I knew I couldn’t possibly have lost fitness in the space of a few days, but I felt dissatisfied and pathetic and hurting myself more seemed to help. So, for as long as my body allowed me to, I pressed on until the fatigue grew so strong it became impossible. Whilst warming up around a track in the 30 degree heat without even breaking into a sweat, my body started slowly shutting down, one muscle group at a time until it brought me to my knees. The game was up, but by then, running had become such a mental and physical battle that among the feelings of despair and frustration, I felt a strange sense of relief. Eventually, 12 months after the first big red warning sign, my body forced itself into the rest it had been begging for.
If at this point, I’d been diagnosed with RED-S, perhaps the next part of the story could’ve been avoided. But at the time, no other athlete, friend, coach, physio or doctor involved in my set up had even heard of it. So, after making the heartbreaking decision to call it a day and wait out an agonising few months before my flight home, I returned to the UK still utterly oblivious to the underlying issue and too exhausted to explore it.
After a few months of being home, the frustration over why I suddenly now felt out of control around food and exercise grew strong enough to motivate me into action. The unwavering support of my boyfriend helped me kick-started an attempt to repair the mental and physical damage I had done—at last recognising it was time to confront the disordered eating habits and gain back some sense of perspective over the role running played in my life. As painful and distressing as it was, I was forced by my own body to stop and reset.
Intense work with a behavioural therapist helped me understand just how restrictive my eating had become and a nutritionist helped educate me in how much more food I needed to fuel my body. With some intense (at times overpowering) reluctance, I allowed myself to gain the weight required to bring myself out of the energy deficit I had accumulated. I learned how to sit with the discomfort of looking and feeling far from the way I’d associated with my self-worth; how to reverse the destructive path I was blazing and how to embrace food as fuel again. I've underplayed the enormity of the challenge that this time in my life presented. I could write a whole book on this chapter in my story but for now, I'll just say that it was a process that changed my perspective on life in a way that only happens when it takes you to dark places; shattering the false foundations I had built my identity upon and raising me up again with a new sense of clarity.
After a few months of intense physical rest and psychological growth, I had the green light to ease gradually back into training. I was ready to put the past behind me and take on the challenge of proving to myself that with a stronger frame, my body could be more successful than ever. Again, if I’d been equipped with the knowledge and support I needed surrounding RED-S at this point, my journey over the next few years would’ve been entirely different. Instead, I’d been given an unsatisfactory diagnosis of chronic fatigue and left without answers to the myriad of other issues that this prognosis hadn’t accounted for.
So, despite gradually easing back into things and maintaining a far healthier relationship with nutrition than before, I soon started to notice a familiar fatigue creeping back in. This time, it seemed to come from nowhere and brought with it some strange, albeit novel, accompanying symptoms. My legs felt bloated and inflamed after running and my whole body seemed to ache all of the time. Despite having restored my weight during my rest period to my healthy 'pre-anorexic' level, I had inexplicably started to gain additional weight around my stomach and thighs in line with increased exercise. By then I knew better than to reduce my caloric intake, but I felt tight and uncomfortable in my own skin and it made no sense. Wasn't exercise supposed to achieve the opposite effect?!
The only thing that weighed on my mind was the fact my periods hadn't returned since coming off the Contraceptive Pill many months before. But, every doctor I saw reassured me this was normal for an athlete in training. I told myself to stop worrying and get on with it but months went by and things had far from improved. I was able to train and race relatively well, but I was still struggling with poor gut health, frequent illness and wasn’t recovering well between runs. My weight still hadn’t balanced out, my moods were all over the place, my libido was non-existent and I was still without a period. Yet, every doctor who looked at my body weight and food consumption reassured me: no period - no problem.
On the edge of exasperation and dealing with identity crisis part-two, I decided to do my own research. Considering the vagaries of my situation I wasn’t optimistic about finding anything of use, but I was soon overwhelmed by what I found. At the time, accessible information about my issues were relatively scarce, but what I eventually stumbled upon was the most precious knowledge of all: a whole series of blogs, articles and podcasts describing MY problem in every ugly, frightening and intimate detail!
So, what was my problem? Hypothalamic Amenorrhea (HA) and Relative Energy Deficiency in Sport (RED-S).
Head here for a more detailed description but in an ultra-simplified nutshell, RED-S refers to a whole host of physiological and psychological consequences resulting from low energy availability. The consequences include significant hormone disruption which can have serious knock on effects on almost every bodily system. One such effect is a loss of menstrual function, otherwise known as HA – one huge red flag for RED-S among athletes who aren’t using hormonal methods of contraception.
At first, I couldn’t believe that the simplicity of the RED-S description could possibly explain the complicated nature of my problem. Since I wasn’t underweight and was eating significantly more than I ever had done, I couldn’t entertain the idea that I could still be in an energy deficit. How could something so obvious account for my digestive issues, irritability and inability to recover well from training? And as for HA, how could just hormones explain the severity of my fatigue, provide the answers to my weight gain, or justify the emotional turmoil I was going through for seemingly no reason at all?
As I dived deeper into the research, it became apparent that I had quite simply spent years in an energy deficit that was far from replenished during the ‘reset’ I thought was behind me. In some ways, I had made progress: tackling the intentional calorie restriction via the eating disorder therapy and going part-way towards giving my body the rest it had needed. In others, I’d achieved nothing much at all, remaining in the dark about the extent of the damage I'd done and denying myself a true recovery process in my rush back to training. So, despite now enjoying far more freedom around food, I was somehow still under-fueling for the amount of exercise I was doing. And, despite running far less miles than before, it was enough to maintain my missing periods.
I’d love to say that the end of my quest for answers gave rise to a seamless transition into a true and complete recovery process. In theory, once I understood where I was going wrong and gained all the knowledge I could possibly need about periods and their importance, I could set about regaining them. In reality, it turned out that knowing what to do was one thing and actually doing it was another. The next few months brought a series of half-hearted efforts and frustrating partial comebacks, as I attempted another round of confronting my warped perceptions of what was adequate nutrition and a reasonable amount of exercise whilst continuing to perform at a high level. I seemed to be stuck in an agonising middle ground; motivated enough to start the process but continually falling short, time and time again.
Eventually, receiving guidance from specialists in the area started a journey that culminated with regaining my period, happiness, and a healthy return to sport. It also inspired another rewarding but equally challenging project: to share my experience with others via this resource. If you’re still with me, then chances are something you’ve read has resonated with you. You might be at the point where good intentions have led to initial rewards, but now cracks are beginning to show. Or you may have reached your roadblock, perhaps in the form of a stress-fracture, a mental meltdown or a fatigue like mine. Whichever way your problem has presented itself and whichever stage you might be at, my aim is now to provide the athlete-to-athlete support and experience you may be seeking. So, if you wan't to talk, head here.