When Healthy Isn’t Healthy: Discovering REDs as a Recreational Runner
by Lucy Jenkins
Where It Began
As someone who loves sport, but considers myself far from an ‘athlete’, I feel a pull to talk about my experience of REDs within recreational running. When I was diagnosed with osteoporosis at age 25 following a series of bone stress injuries while training for my first marathon, it was a huge shock. It challenged everything I thought I knew about being ‘fit and healthy’, and, hearing that this likely related to a history of REDs was both a lightbulb moment and major reason to ask the question: how on earth had I not heard of this before?
While I now consider myself to genuinely love the sport, my journey into running wasn't a particularly smooth one. Having been a fairly un-sporty child, I can pinpoint the first time I made a conscious effort to ‘exercise’ upon reading my first women’s fitness magazine, bought with my pocket money. As a very self-conscious 11-year-old, seeing the super-toned fitness models and being told that following that months’ trending diet and exercise plans could make me look like them, I was quickly hooked.
I started to weigh myself daily, record every calorie I ate, and internalise every snippet of diet and lifestyle advice I came across, meaning that many foods were quickly demonised and eliminated from my diet. Moving as much as possible and eating as little as possible became my new obsession. I started to restrict food and developed mental quotas for how much exercise I felt I should do each day, which I’d feel incredibly agitated for not reaching on occasions. I received praise for my seemingly ‘healthy’ new habits and I felt a huge sense of productivity as I pushed myself in ways that I thought would make me a fitter, healthier and generally better version of myself. Looking back, I can see how disordered my approach was at this time and how it negatively impacted my life and relationships. But because my weight never dropped low enough to ring alarm bells, and with my habits seeming fairly healthy on the surface, I carried on this way for many years.
Ironically, this also led to some positive developments as my keenness to be active led me to join my first netball club and take up running. Netball did wonders for my confidence and helped me to realise that I enjoyed sport for more than just the aesthetic benefits. I also attended my first Parkrun around this time (the beginning of a love affair) and with some perseverance, I discovered a true enjoyment of running far beyond how it made me look. I’ve found that my relationship with food and exercise has shape-shifted over time, and it certainly hasn’t always been straightforward, but I think I’ve experienced an overall trajectory to a healthier approach in both areas.
Missed Signs and Misdiagnosis
During this time however, I unfortunately lost my period. As I was still young and my periods had never been very regular, several GPs advised me to simply 'give it time'. With no return in my periods after a number of years, I underwent a series of scans, tests and investigations that eventually led to a diagnosis of Polycystic Ovary Syndrome (PCOS) at age 20. This is a diagnosis typically made by exclusion of other possibilities, and I was advised to take the combined contraceptive pill going forward to regulate my periods. Although I never quite felt that this diagnosis fitted, I was willing to put a stop to the uncertainty of inconclusive tests and move forward with this explanation.
Thinking back to these investigations, I’m fairly sure that no one actually asked about my diet or activity levels, likely due to my seemingly healthy BMI. In hindsight, I think this likely reinforced my belief that despite my preoccupation with food and exercise, what I was doing was largely good for my health, and certainly wasn’t causing me any harm".
Years later, after moving cities and joining my first club, I started running far more - for the mental benefits more than anything; I loved the headspace, social connection and sense of achievement. I’d already run regularly for years but this period saw a sharp increase in my mileage and I finally felt brave enough to sign up for my first marathon. Unfortunately however, while less intentional at this time, some of the habits I had developed around food had lingered. While I made some changes to my nutrition with my increased training load e.g. adequate fueling before a long run, there were many changes I didn’t make, e.g. adjusting calories intake throughout the week, learning to fuel during long runs and considering recovery.
In particular, carbohydrates were a food group that I had continued to restrict, partly still thinking this was a helpful thing to do. I also held a belief that proper fueling and recovery advice was less important for me as a ‘casual’ runner, who participated for enjoyment rather than time goals".
Although my overall relationship with food and exercise had improved, those old habits and my view of myself as ‘not a serious runner' were quite significant blocks to taking on board advice about nutrition, rest and recovery. This went hand in hand with my tendency to think that pushing myself harder and harder was the way to better results. Soon enough, the injuries started. Stress reactions in my foot, sharp back pain, and constant frustration. I still managed to complete my marathon, feeling okay at the time, but the pain flared up again soon after. Tired of playing injury whack-a-mole, I asked my GP for a bone density scan, thanks to a fellow runner’s suggestion. The next day, I got a text diagnosing me with osteoporosis in my spine and osteopenia in my hips and femur. The high of finishing a marathon quickly gave way to fear and confusion. I didn’t know much about osteoporosis, and it felt terrifying. I was only 25 and being active was a huge part of my life. I didn’t know anyone else my age with this diagnosis, and I found this news hugely isolating.
Discovering REDs
Waiting for follow-up appointments felt slow and endless. Following my diagnosis however, REDs was mentioned. As I’d never heard of it before, I turned to google to learn more. This is when I came across the Project RED-S website. The info, links, and athlete stories were a lifeline. Learning about REDs felt like a lightbulb moment, helping me to see how some of the behaviours I had considered ‘healthy’ over the years, particularly around this idea of ‘moving more’ and ‘eating less’, had likely impacted me in the long term. Even though I’d never looked underweight, I’d been in an energy deficit for a long time, and my body was struggling as a result. I wasn’t an elite athlete, but the symptoms fitted. Realising this brought some relief but also a lot of emotion. I saw how much strain I’d put on my body in the name of being healthy, which had ironically come to have the opposite effect.
Since then, I‘ve been lucky to access various NHS appointments to help manage my health. My issues with my periods have now been linked to REDs rather than PCOS, and my back-pain diagnosed as small stress fractures. Accessing appointments was not an entirely speedy process, but I do now feel I have more information and tools to progress in the right direction, though I recognise that this will take time. I’ve made a lot of progress in healing my relationship with food, movement, and body image, but I know these things can still resurface, especially when I’m trying to recover and engage in sport. I feel fortunate that I was in a place where I could accept the need to be in an energy surplus, even if that meant gaining some weight. In all honesty, I still find it uncomfortable at times, but asked to do this a few years earlier, I don’t think I could’ve done it. It’s not always part of the picture, but when it is, I think that considering and supporting the psychological factors at play in REDs can be a critical part of recovery. I really hope this side of care continues to grow.
I also think that my story, like many others, highlights ongoing issues in the understanding and treatment of women’s health, and I do feel that my misdiagnosis of PCOS meant that I didn’t access support for REDs and disordered eating when I needed it most.
A Hope for Change
While receiving the osteoporosis diagnosis felt shattering initially, I do feel it has been a turning point in encouraging me to finally treat my body with some compassion i.e. to fuel it, rest it, and slow down when needed. While running remains difficult for me currently, I hope that with patience and perseverance this is something I can return to in a balanced way over time. I do however recognise that processing and managing my health will be an ongoing and non-linear process, and in all honesty can be really tough at times. Not being able to run (for now) can feel so incredibly hard sometimes, especially with uncertainty around how my bone health will progress, but I hope that my efforts will eventually help me return in a balanced way to a hobby I love.
In the meantime, I hope that I can play a small part in bigger efforts to raise awareness of REDs, particularly how this can present at a recreational level. Although it’s hard to say how open to it I would have been at a younger age, I’m amazed that it took me so long to hear about REDs, despite having existed in multiple sporty circles, having had a series of medical appointments about related issues and exhibiting some tell-tale signs of REDs for many years.
I know how incredibly beneficial sport can be at all levels, but I also recognise how factors can tip an approach to sport into slightly less healthy territory fairly easily. Whether it’s diet culture, chasing performance, or just not knowing enough about fuelling and rest, there are so many ways people can slide into low energy availability without realising. I also wonder how many people, like myself, may come into sport as part of efforts to lose weight and/or struggles with body image, which may therefore influence how we approach training and fueling. I also think that recreational settings, where we may consider ourselves ‘casual runners’ rather than ‘athletes’, could be an important place to emphasise that messaging about a holistic and balanced approach to sport also applies to us. This seems particularly important given that we are often balancing our sport alongside busy work/family lives, and therefore the scope to spend time prioritising recovery, nutrition and balance may be more limited. I really do think that raising the profile of REDs and even just encouraging more conversations about rest, nutrition and recovery at all levels of sport, could be subtly powerful in shifting the culture and helping to ensure that our sports stay healthy, sustainable and fun, as they should be.