When my college peers were plunging into bowls of unlimited soft-serve and debriefing nights out over pepperoni pizza, I was running miles around an indoor track, going to bed just early enough to avoid the inevitable hunger pangs that would otherwise keep me awake.
I remember once watching another young woman order a thick-breaded sandwich with turkey, cheese, and avocado from a cafe and thinking, quite matter-of-factly, that I would never be able to do that. That I simply wasn't one of those people who could, well, eat.
I always let the bowl of bite-sized chocolates pass by me in French class, and gave my once-hip-hugging jeans to my roommate. I lost the weight people typically gain freshman year and then some, despite being a perfectly healthy weight for my frame beforehand.
Still, I was convinced I was in the best shape of my life. After all, when you barely have body fat, you can see all your abs and isn't that the picture of health and fitness? Never mind that I also didn't have a period, or sanity.
What I did have was relative energy deficiency in sport RED-S for short a condition that's now attracting attention thanks to elite runner Mary Cain's recent New York Times video. She says her experience with RED-S was brought on by what she saw as an abusive coaching system at the now-shuttered Nike Oregon Project, leading to injuries, a derailed career, and even self-harm and suicidal thoughts.
(Nike has said it is looking into "the deeply troubling allegations" and the coach at the center of the accusations, Alberto Salazar, has said while he may have made "callous" or "insensitive" comments, he disputes notions of abuse.)
Statistics and other elite athletes' testimonies suggest the dangerous condition is disturbingly pervasive in top-tier athletics. But my experience as a recreational athlete one who never advanced out of junior varsity swimming in high school demonstrates that the condition can also affect people who are simply active. It's not only caused by sports programs that emphasize results above all else, but by unrealistic societal ideals of what healthy looks like.
No period means low estrogen, which can lead to permanently weakened bones that are prone to injury. Brian Snyder/Reuters
"Relative energy deficiency in sports syndrome" is a fancy way of explaining what happens when you don't eat enough to fuel your activity level. (Back when I was diagnosed, it was known as female athlete triad, which more specifically involved women and girls, and disordered eating. But most professionals now call it RED-S, in part to include male athletes, and recognize that undereating isn't always related to an eating disorder.)
People with the condition can experience fatigue, a lack of progression in their training, stress fractures, and, eventually, a disruption in their menstrual cycles because their bodies aren't equipped to handle a theoretical pregnancy.
Without a menstrual cycle, their bodies "aren't going to be able to get the necessary levels of estrogen to maintain strong bone health," Cain explained in the New York Times video.
For Cain, that meant five broken bones, poor performance in career-defining events, suicidal thoughts, and, eventually, a need to drop out of the elite training program that had once been a dream come true. For me, it meant developing osteopenia, a precursor to osteoporosis. I was 18 going on 80, according to a startling scan of my bones.
The consequences of RED-S for elite and recreational athletes alike can continue for years. Research suggests it raises the risk for heart disease, and a disrupted menstrual cycle can lead to fertility issues and an increased risk of certain cancers, Insider previously reported, as well as permanent bone damage.
"It's not just that bone density is lower, it's that the bones have changed, and that's really hard to fix," Mary Jane De Souza, a professor of kinesiology and physiology at Penn State who specializes in the syndrome, previously told Insider.
Estimates of the ubiquity of RED-S vary widely, but studies suggest it's especially common in sports that emphasize aesthetics or leanness, like running and gymnastics, with as many as 69% of female athletes in those types of sports missing their periods.
High-level athletes' anecdotal reports reflect these findings.
Four-time obstacle course racing world champion Amelia Boone, for example, recently spoke out about her 20-year-long struggle with anorexia, leading to stress fractures that eventually woke up her up to the need for treatment.
The hardest things to talk about are also the most important to share. . After my last stress fracture in March, I finally admitted that it was time to make changes. Im not dense: Ive known for a long time that the reason I keep breaking bones is because of my 20-year history with anorexia. . So Ive spent the last three months at an eating disorder treatment facility, working to restore the health of both my body and my mind. . Theres a crippling shame that comes with knowing the reason you keep breaking your body but feeling incapable of changing that on your own. Theres an embarrassment that, at 35, Im still battling this. Theres a paralysis that comes with the cognitive dissonance of knowing what you need to do, but continually falling short of that. . But theres also a great freedom that comes in complete surrender. A quiet confidence that starts to build when you reach out for help. A calm when you realize theres nothing to be ashamed of. And a peace that overcomes as you realize that, finally, you are learning to live again. . This is, hands down, the most important journey in my life, and one Im ready to share. Link to full blog in my bio (one blog post cant do it justice, so this will be an ongoing process). . To those who have been with me every step of the way, thank you. My journey is only just beginning, but Ive never been more excited for what the future has to hold. : @codypickens . #edrecovery #hope
A post shared by Amelia Boone (@arboone11) on Jul 8, 2019 at 4:08pm PDTJul 8, 2019 at 4:08pm PDT
Olympic figure skater Gracie Gold "got caught in a system" that compelled her to become thinner and thinner, the New York Times reported, and eventually had such severe disordered eating she, like Cain, imagined taking her life.
Now, Cain's video has inspired more elite athletes to join the chorus. Olympic swimmer Caroline Burckle wrote on Instagram that "not having a monthly cycle was a badge of honor," and that she missed hers for 10 years, while also suffering from depression and broken bones.
Hi. I have something to say and admittedly have no clue how to speak about this important and timely topic. Rather than craft the perfect message or post in a way that doesnt feel authentic to me, Ill just speak from my heart. This photo was taken at the Olympic Games in 2008, one of the highlights of my many years of swimming. I am proud of it! Additionally, I struggled with a large amount of body image issues that were largely driven by the culture of endurance sports, specifically surrounding opinions of what a womans body should look like... smaller, skinnier, lighter, cuter, leaner. Not having a monthly cycle was a badge of honor, and I didnt have one for a decade (my retirement years included). Before I knew it, I had dipped scarily low in body weight, was in treatment for depression and body dysmorphia, and later broke a few bones because of my lack of nourishment and self-love. Ill be honest, I am shaking writing this because I dont know everything and everyone has something going on, and YEAH, they do. However I literally lead a business based around mental health for teenage athletes and Olympic athletes so why the hell wouldnt I speak of this importance? I am learning that I dont need to apologize for my experience or downplay it but rather support the positive movement around change. So... it is in NO way okay to negatively push young athletes to become physically unhealthy in their sport in order to perform. While I understand there are varying standards in several realms, the overall mindset that one is not good enough if they arent skinny enough has got to stop. Becoming a better athlete is working with the tools and body that you were given and learning how to fuel it properly, stay hormonally healthy, and create a mindset of a abundance surrounding what it is CAPABLE of doing. From my personal experience, many women in varying body sizes can perform at the same level, proving it is about becoming aware and tending to what works for you, with support systems and environments for positive accountability rather than fostering shame. It comes from WITHIN, so lets cultivate spaces that encourage that. (Continued below)
A post shared by Caroline Burckle (@caroburckle) on Nov 8, 2019 at 1:25pm PSTNov 8, 2019 at 1:25pm PST
Cate Barrett, a former Division 1 track athlete, posted that "college programs today are still preaching thinner is fast, and telling women to lose weight, or that low weight and lost periods aren't a problem."
For so long, I thought I was the problem. To me, the silence of others meant that pushing my body past its healthy limits was the only way. But I know we were all scared, and fear keeps us silent. @runmarycain Mary Cain's expos of abuse she suffered while training as a young pro runner is shocking and upsetting. A decorated coach at Nike, Alberto Salazar, pressured her to lose weight to run faster. This is an inexcusable abuse of power. Salazar had nearly every resource available to boost Marys performance, yet chose to emphasize a strategy that risked her health. And it didn't even fucking work. It drove her to slow races, self-harm and quitting the sport. Marys story resonates with the amateur and collegiate running community all too well. We've experienced the same thing. Being shamed for our size. Told that our poor performances were because of weight. And that we were lucky to be here, so we shouldnt complain. That this is part of the sport. I competed for a D1 NCAA track team for all four years of college. While this was a great experience, it did leave me with a disordered view of my body and food. 11 years after I entered the NCCA, I still feel the strain that Im not small enough. I know this is not factual and rational, but my mindset is a work in progress. I do not know any teammates who emerged from the NCAA system unaffected by the pressure to be thinner. It may seem like the entire running community is already woke to this issue, but please listen: IT IS WILD how deep this goes. It is still happening. Girls still need help. College programs today are still preaching thinner is faster, and telling women to lose weight, or that low weight and lost periods arent a problem. College sports are not the only offenders here, but they have to do better. They, along with the whole running world, have the opportunity and obligation to make a positive impact in young peoples lives. I am thankful that Mary Cain and many others have faced their fear and brought their stories to light. This is how we change.
A post shared by Cate Barrett (@beingcate) on Nov 8, 2019 at 12:39pm PSTNov 8, 2019 at 12:39pm PST
My run-in with RED-S demonstrates the issue can affect anyone who doesn't eat enough to support their activity level.
"We need to be studying the prevalence of RED-S in a variety of populations," including in non-athletes, Dr. Kathryn E. Ackerman, a sports medicine physician who directs the female athlete program at Boston's Children's Hospital, told Insider.
One of her recent studies included 1,000 teens and women between ages 15- to 30-year-old who exercised at least four hours a week, whether on their own or in an organized environment. She and colleagues found that 47% had disordered eating patterns and experienced more negative health and performance consequences as a result.
Most of the attention and outrage in reaction to Cain's video is related to what she described as abuse by Nike-affiliated coaches and a male-dominated system that doesn't understand or respect the female athlete's body.
The push for which I cheer loudly is for the running world to take a different approach to training young girls. This should include putting more women in coaching and leadership positions, and ensuring psychologists and nutritionists are integral parts of the teams as well.
"Too many teams are led by older men, who seem unable to have an appropriate, supportive conversation about weight and periods with young girls. As a result, we need to educate people on how to have these conversations," Cain previously old Insider.
But it's not just the running community, or even the athletic community in general. I didn't have a coach weighing me and shaming me, Olympic trials to qualify for, sponsorships to keep, or a career and reputation at stake. I had a pair of running shoes, time and new freedom, and a culture reinforcing my addiction to both exercise and its "results."
"There is a myth that all ultra-lean athletes are the epitome of health," Ackerman told me. "This is not always the case."
"There's a lot of ignorance as to how this works; that endurance sports and running is not necessarily weight loss," runner Latoya Shauntay Snell previously told Insider. Snell, who has become a role model for runners of all sizes, has done 15 marathons, five ultramarathons, and is training for a 100-mile race.
"You have to eat to go out there over and over and do those grueling miles," she said.
That's me earlier this year, about to participate in my first half-Ironman triathlon. Ryan Lynch
Thanks to my parents' insistence I talk to a therapist after seeing my bony body when I returned home for the holidays, I was referred to a physician who worked with athletes. She ordered the bone scan revealing osteopenia, and diagnosed me with female athlete triad, which I doubt many doctors had even heard of back then.
Many still don't, Ackerman told Insider. One 2018 study reported that less than half of clinicians, physiotherapists, and coaches could correctly define the disorder.
I was steered back on track, physically and mentally, within a year, and quickly made up for my semester sans ice cream and late-night pizza. Today, about 14 years later, I look back on my college years with pride bordering on obsession.
I've maintained a love of fitness, and even completed my first half-Ironman triathlon this summer, which I chased with a thick-breaded turkey and cheese sandwich. (I'd have gladly added avocado if it was available.)Still, I don't know how my bones look today or if my fertility was compromised.
Other girls and women, both serious and recreational athletes, are surely struggling, even if only their bones know it. So as the running community addresses this critical and uncomfortable issue, let's remember that this isn't just their issue to solve.
See the article here:
I had the condition that broke down Nike runner Mary Cain's body, and I wasn't even an elite athlete - INSIDER
