Are You Under-Fueling Your Workouts? Part 2
Sports nutrition is a confusing world to navigate. What does mean for you?
Last week, we looked at the new International Olympic Committee Consensus Statement on Relative Energy Deficiency in Sport (REDs).
While I believe it’s important to know about these new developments and what researchers have come to agree upon, it’s a lot of dense information to sort through. And for the average person and athlete, it can leave you scratching your head and wondering: What does this mean for me? Or in the case of coaches and parents: What does this mean for my athletes or my child?
Sports nutrition is a confusing world to navigate—what to eat, when to eat, how much to eat, in what proportions to eat—not to mention the endless array of supplements, pre-workout/post-workout mixtures, and miraculous performance-boosting concoctions on the market.
I get it. People are physically active. People are playing sports and competing in races. People want to improve their performance and move well. And nutrition is an important piece of the puzzle.
But it feels like along the way, we’ve lost sight of the forest for the trees and have become hyperfocused on complicated and advanced nutrition strategies without first making sure that we’re nailing the basics of nutrition and energy requirements.
Meeting your body’s energy needs is paramount.
Without sufficient energy to support the body’s essential functions, you’re building your fitness and athletic training on top of a deck of cards and it can easily topple over.
This issue could go in a million different directions but I wanted to highlight some areas to pay attention to. I hope it’s helpful.
Big disclaimer: This is by no means meant to be prescriptive recommendations. I am not a sports dietitian or medical professional. If you have questions or need more guidance, consult a registered dietitian or sports dietitian.
1. REDs Can Affect Anyone
You don’t have to be an elite or professional athlete. It can affect anyone, no matter what level of sport or age. It’s an equal opportunity condition.
If you need a refresher on REDs, take a look at last week’s newsletter.
2. Meet your energy needs first
This should be your first priority. Health should be your first priority. Full stop.
That’s because your body likes to be in a state of balance. You want to avoid periods where your energy supply dips into the red, both over the longer term and during any one day. Yes, that includes things like skipping breakfast or lunch or any other big gap between eating. That also includes things like not eating something pre-workout or afterwards.
And guess what? When your body feels like it’s in balance and well-fed, it can perform better.
Even if you think you’re fueling well, we all have blindspots that can crop up when we want to eat healthy or “clean.” It’s easy to start cutting calories here and there or cutting out certain food groups. For example, I know that I need to eat well in order to recover well from knee surgery but that hasn’t stopped stubborn thoughts from infiltrating my brain, telling me that I don’t need to eat that much or that I can skip lunch/dinner because I’m not exercising right now.
3. Don’t skimp on carbs
The research shows that low carbohydrate intake is associated with low energy availability and can contribute to REDs. This is especially true for women because women may need more carbohydrates to keep their hormones happy and healthy.
4. The Canary in the Coal Mine
While there’s no one test that can tell you whether or not you have REDs, female bodies have a pretty good early warning system—the menstrual cycle.
The menstrual cycle is an indicator of overall hormonal health and an important vital sign. Just like your pulse, blood pressure, body temperature, and respiratory rate, your cycle—whether it’s absent, whether it’s regular or irregular—can offer a snapshot of what’s going on inside your body.
If you’re experiencing frequent irregular periods, cycles longer than 35 days, or no period for three or more consecutive months, it can be a sign that you’re not be eating enough. It’s worth checking in with your healthcare provider.
And no matter what anyone may say or what you’ve heard through the grapevine, losing your period is not normal.
The tricky thing is that many people take hormonal contraceptives, which overrides the menstrual cycle in order to prevent pregnancy. But because the menstrual cycle is suppressed, hormonal contraceptives can mask signs menstrual irregulars, underfueling, and REDs. The bleeding that does occur during the placebo phase (when you aren’t taking “active” pills with hormones) isn’t the equivalent of a period and not necessarily a sign of good hormonal health. This is a complicated topic but you can read more about hormonal contraceptives and athletic performance here.
5. Is it REDs? It is Overtraining Syndrome?
The symptoms of REDs and overtraining syndrome (OTS) can look pretty similar. Both are conditions that involve multiple factors and causes and involve multiple different body systems. They both affect the hypothalamic-pituitary–adrenal axis, the main system that controls the body’s stress response. Both REDs and OTS are diagnoses of exclusion, meaning that you have to rule out all other possible causes first. There are definitely connections between the two but researchers don’t understand the full scope and nature of those connections. (This paper that looks at the connections between the two.)
As researchers have started to understand energy availability and REDs more, some believe that a good portion of athletes diagnosed with OTS may actually be dealing with an underlying fueling problem instead. In other words, athletes may not be recovering well not because they have overreached in their training efforts and are not recovering but because they haven’t adequately fueled their body. They may have a case of REDs instead of OTS.
REDs and OTS are not the same. It’s important that know the root cause behind the issues you may be experiencing so that you can get the appropriate care.
The misdiagnosis of OTS isn’t due to bad faith but because we didn’t know a lot about energy availability and REDs until recently. It’s an example of how new research insights can help led to better diagnoses and treatment.
6. Adolescents and Parents
Adolescence is when you set the foundation for your adult body. Think of it like blowing glass. During adolescence, you’re in the molten phase when you shape what will crystallize as your adult form. But any dent or knick during this more pliable phase can leaving a lasting mark. And most often, those dents manifest as low bone density and a higher risk of bone stress injuries and early onset osteoporosis.
Your body needs energy to support the tremendous growth and change that occurs during adolescence and to ensure you enter into adulthood with a durable and healthy form. That means active and athletic kids need to eat, probably a lot more than we think they need, and they need to eat frequently throughout the day. Parents need to talk to the girls in their lives about the menstrual cycle, aside from just fertility, and watch for signs for delayed onset of menstruation (if they’re 15 and haven’t had their period yet, you should talk to your child’s doctor) and menstrual irregularity. Losing your period is not OK.
This is also why body composition is NOT recommended for people under the age of 18 because it can cause you to hyperfocus on what a body looks like and lead to behaviors such as disordered eating and eating disorders. And eating disorders tend to take root during adolescence.
This YouTube video from long distance runner Allie Ostrander is a really powerful and personal look at the tremendous damage caused by underfueling during the developmental years. It is worth watching all the way through.
7. REDs and Athletes Who Breastfeed
It’s exciting to see more women staying active across the lifespan and in particular, more women returning to physical activity and sport after having a baby.
But postpartum women who are athletes or physically active and who are breastfeeding face unique challenges that could put them at risk for developing REDs for a couple of reasons. (This is the topic of one of the editorials in the British Journal of Sports Medicine issue on REDs.)
During the postpartum period, the body’s hormonal environment can be described as “pseudo-menopausal”—the menstrual cycle hasn’t resumed and estrogen levels are low—and can resemble the hormonal changes that accompany REDs. People who are breastfeeding also have a higher risk for bone stress injuries because of lower estrogen levels, regardless of activity level.
It’s also hard to keep up with daily eating needs during the postpartum period, especially if you’re breastfeeding when your calorie needs are even higher.
For many people, there’s a desire—and rush— to return to one’s pre-pregnancy weight, which can lead to diet, excess exercise, and other behaviors that can create an even bigger energy deficit.
However the exact mechanisms and relationships between all of these factors are still unclear and researchers are hoping to untangle the different factors at play. But until then, postpartum athletes who are breastfeeding need to pay attention to their energy needs.
8. Perimenopause and Menopause
During the menopausal transition, there are change to the body’s hormonal environment that mirror the changes that we think of when we think of low energy availability in women athletes—no or irregular menstrual cycles, lower levels of hormones like estrogen. Does the decline in estrogen influence the risk for REDs? Does hormone therapy mitigate those hormonal changes?
I wish I had more information to share but I do know that there is a lot more research underway on perimenopause and menopause in active and athletic women. It’s just going to take some time until we start to understand what it means.
In the meantime, it is important to recognize that this is tumultuous stage of life for some. The physical changes you may experience—weight gain and body composition changes—can lead to body and weight dissatisfaction and that dissatisfaction leaves people in middle age at risk for developing eating disorders.
What I’m Reading
I was so happy to watch Molly Seidel cross the finish line of the Chicago Marathon in 8th place and with a new personal best, especially after reading this profile by Rachel Levine. It’s rare that you hear an athlete being so open and honest in an interview.
This piece almost made me want to go skydiving. Almost. It’s a beautiful tribute to writer and ultrarunner Emily Halnon’s mom.
I think I have productivity dysmorphia?
Maybe this book will change my relationship to pain too?
And please, can we finally stop judging pregnant women and mothers and telling them what to do?
If you found this helpful, please hit the like button below or share it with others!
Thanks for being here. More soon.
Christine
EYES WIDE OPEN!! thank you!