My story of training with RED-S

I ran cross country and track at the Division 1 collegiate level and it is fair to say I was obsessed with running. I meticulously logged my miles, iced my legs, stretched my muscles, and overanalyzed every workout. I wanted to do everything perfectly in the name of being the best. I now know I was doing everything wrong.

I wanted to be the best runner I could be and I saw a clear path there: just do more than everyone else. I’d run the extra mile, forgo the rest days, trade sleep with early morning training. I would just outwork everyone. On my team. In the Big Ten. In the NCAA. So simple. 

This plan was as naive, flawed, and short-sighted as my 18-year-old self. Before and during college, I established unhealthy habits in the name of running performance that still haunt me to this day. Overtraining, under-recovering, under-fueling, mentally burning out but pushing forward despite my slowing times. I hadn’t had a period in years by the time I started college. 

At the time I believed it was my character that was slowing and out of sync. There must be a special “it” quality that NCAA champions possess and, since I obviously didn’t naturally have it, I would work for it. My well-educated, grown up, adult self now rolls my eyes and says, “What was I thinking? How could I have been so stupid?” It’s so easy to see my mistakes looking back, but I know too well that while in the midst of disordered living, the right path is anything but clear. 

Fast forward to my 35 year old self, and my story has a happy ending. I got healthy, became a Doctor of Physical Therapy, and started helping other runners stay healthy and avoid these dangerous mistakes. I’ve left my old ways in the past. “Maybe it was just my problem anyway,” I used to think. “Maybe I was just over-zealous and under-informed and I should have known better. Surely (I used to reassure myself) these ideas haven’t trickled down to the next generation.”

So imagine my shock listening to young female runners in the clinic recite the same thought viruses with which I was once infected: run as hard as you can everyday, train like the boys, no rest days, out-work everyone, lighter is faster, it’s OK to lose your period. My experience tells me this will end badly. My education informs me that this is dangerous. My intuition advises me that this is pervasive and getting worse. 

What all of these disordered thoughts and actions amount to is a serious condition called Relative Energy Deficiency in Sports (RED-s). 

RED-s is impaired functioning of all the body systems that make up a healthy person and a strong athlete. As training increases and eating does not, an energy deficit develops and grows larger. Your body can’t support both training and living. Many important aspects of health and performance get worse, like muscular strength, concentration, coordination, and bone health.

I’m a true believer that words matter. If we have words to attach to a concept, it becomes real. So here are the words I needed as a young woman and what young women today need to take seriously: RED-s is dangerous. It’s not a badge of honor to risk your health for sport. It’s short-sighted and unsafe. It will make you slower, injured, and in need of help.

What else would I tell my younger self? This: Running doesn’t have to be so hard. It should be fun the majority of the time. You don’t have to live hour-to-hour with your energy. Losing your period does not mean you’re fit. Rather, it means you’re on a path of destruction. Nothing (repeat NOTHING) is more important than your health. 

During college, I had one person call me out on my behavior. This isn’t a criticism to those who didn’t say anything. It’s a testament to the power one person speaking the truth can have. My good friend and roommate decided to confront me about my destructive behaviors, even though she knew I would get defensive. Which I did. At the time, nothing really came of the conversation. We argued, got over it, and I continued to get injured. It wasn’t until I left college and started to process my experiences that I came back to my friend’s voice of reason.

It may not have helped at the time, but she planted a seed for my future self to cultivate. I appreciate now that she cared more about my long-term health and risked having an uncomfortable conversation. I think of her when trying to help young women navigate the complex issues of training and health. The power of one voice is significant. Now, I’m happy to be that voice, especially when discussing difficult topics, like over-training, menstruation, perfectionism, and eating disorders. 

Despite getting off track with my health, I value many of my collegiate running experiences. Being part of something bigger than myself was a positive experience that cannot be replicated. I learned that I am tough beyond measure and that I will achieve anything I set my mind to, self-destructive or self-empowering, and it is my responsibility to myself to be self-empowering. I learned I also have a responsibility to others to be a voice for change.

Dr. Maya Angelou said to “do the best you can do until you know better. Then when you know better, do better.” I now know better and I will help others do better. If you’re having a hard time with running, let’s talk. I’ll listen, educate, collaborate, and learn from your story. There may be a lot to sort out, but sharing your struggles and asking your questions is a great place to start. 

Here’s the last thing I would tell my younger self: Be nice to yourself, young woman. The future of our sport belongs to you.

Katie Noble is a Doctor of Physical Therapy, a journalist, and a runner. She enjoys empowering and supporting female runners with evidenced-based education.